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Lyme Disease

Lyme Disease. What You Should Know to Protect the Children of Bucks County. Learning Goals. What is Lyme Disease? How can you identify it? How is it treated? Why is it significant to Bucks County? Where does Lyme disease exist? How can it be prevented?. What is Lyme Disease?.

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Lyme Disease

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  1. Lyme Disease What You Should Know to Protect the Children of Bucks County

  2. Learning Goals • What is Lyme Disease? • How can you identify it? • How is it treated? • Why is it significant to Bucks County? • Where does Lyme disease exist? • How can it be prevented?

  3. What is Lyme Disease? • A tick-borne illness • Transmitted through the blacklegged or “Deer” tick • 20% of deer ticks carry Lyme Disease bacteria • Over 27,000 new cases each year • Most common vector-borne disease Aucott, J., Morrison, C., Munoz, B., Rowe, P.C., Schwarzwalder, A., West, S.K. (2009). Diagnostic challenges of early Lyme disease: Lessons from a community case series. BMC Infections Diseases, 9(79), doi:10.1186/1471-2334-9-79/ Centers for Disease Control and Prevention. (2007). Prevention: Lyme disease transmission. Retrieved October 17, 2009 from http://www.cdc.gov/ncidod/dvbid/lyme/ld_transmission.htm

  4. What is Lyme Disease Centers for Disease Control and Prevention. (2008). Surveillance for Lyme disease --- United States, 1992--2006. Morbidity and Mortality Weekly Report (MMWR). 57(SS-10), 1-9.Retrieved October 17, 2009 from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5710a1.htm

  5. What are the symptoms? Early Localized Phase • 3-30 days • Localized skin infection • 5-6.8 cm “Bulls-eye” Rash • Flue-like symptoms Centers for Disease Control and Prevention. (2007). Prevention: Lyme disease transmission. Retrieved October 17, 2009 from http://www.cdc.gov/ncidod/dvbid/lyme/ld_transmission.htm Gathany, J. (2007). Erythema Migrans. [Photograph]. Retrieved October 17, 2009 from http://phil.cdc.gov/phil/details.asp?pid=9875 Eppes, S. (2003). Diagnosis, treatment, and prevention of Lyme disease in children. Pediatric Drugs, 5(6), 363-372. Weber K, Wilske B. (2006). Mini erythema migrans--a sign of early Lyme borreliosis. Dermatology, 212(2), 113-116.

  6. What are the symptoms? Early Disseminated Phase • 3-12 weeks • Multiple 5-6.8 cm “Bulls-eye” Rash • Neck pain • Meningitis • Carditis • Facial paralysis • Eye inflammation Eppes, S. (2003). Diagnosis, treatment, and prevention of Lyme disease in children. Pediatric Drugs, 5(6), 363-372.

  7. What are the symptoms? Late Disease Phase • Beyond 2 months • Severe arthritis • Serious neurologic damage Eppes, S. (2003). Diagnosis, treatment, and prevention of Lyme disease in children. Pediatric Drugs, 5(6), 363-372.

  8. Treatment • Is not contagious • Follow pediatricians recommendations • Rarely fatal Centers for Disease Control and Prevention. (2007). Lyme Disease --- United States, 2003--2005. Morbidity and Mortality Weekly Report (MMWR). 56(23), 573-576.Retrieved October 17, 2009 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5623a1.htm Centers for Disease Control and Prevention. (2007). Prevention: Lyme disease transmission. Retrieved October 17, 2009 from http://www.cdc.gov/ncidod/dvbid/lyme/ld_transmission.htm

  9. Who is at risk? • Children aged 4-14 • Boys more than girls Centers for Disease Control and Prevention. (2008). Surveillance for Lyme disease --- United States, 1992--2006. Morbidity and Mortality Weekly Report (MMWR). 57(SS-10), 1-9.Retrieved October 17, 2009 from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5710a1.htm

  10. Who is at risk? • More cases reported in summer Centers for Disease Control and Prevention. (2008). Surveillance for Lyme disease --- United States, 1992--2006. Morbidity and Mortality Weekly Report (MMWR). 57(SS-10), 1-9.Retrieved October 17, 2009 from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5710a1.htm

  11. Why at risk? • Bucks County’s deer population • Deer cannot have Lyme disease • Deer transport Lyme disease via ticks • Ticks prefer to feed on large animals Centers for Disease Control and Prevention. (2009). Prevention: Manage deer populations and movement. Retrieved October 17, 2009 from http://www.cdc.gov/ncidod/dvbid/lyme/Prevention/ld_Prevention_Control_Deer.htm [Deer Tick]. (n.d). [Photograph]. Retrieved October 17, 2009 from http://www.cdc.gov/ncidod/dvbid/lyme/ld_transmission.htm Pennsylvania Game Commission. (n.d). Lyme Disease. Retrieved October 21, 2009 from http://www.pgc.state.pa.us/pgc/cwp/view.asp?a=465&q=151357

  12. Statistics Centers for Disease Control and Prevention. (2008). Surveillance for Lyme disease --- United States, 1992--2006. Morbidity and Mortality Weekly Report (MMWR). 57(SS-10), 1-9.Retrieved October 17, 2009 from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5710a1.htm

  13. Statistics  Pennsylvania Department of Health Bureau of Health Statistics and Research (2009). Lyme disease [Interactive database]. Epidemiologic Query and Mapping System (EpiQMS). Available from the Pennsylvania Department of Health Web site: http://app2.health.state.pa.us/epiqms/default.asp

  14. Statistics Bucks County • Average rate for Pennsylvania(all ages) = 32.1 /100,000 • Bucks County(all ages) = 89.5 / 100,000 • Average rate for Pennsylvania (< 15 y/o) = 38.9 / 100,000 • Bucks County (< 15 y/o) = 87.0 / 100,000 Pennsylvania Department of Health Bureau of Health Statistics and Research (2009). Lyme disease [Interactive database]. Epidemiologic Query and Mapping System (EpiQMS). Available from the Pennsylvania Department of Health Web site: http://app2.health.state.pa.us/epiqms/default.asp

  15. How is it prevented? • Know what a deer tick looks like • Avoid tick invested habitats • Insect spray • Personal protective measures Centers for Disease Control and Prevention. (2008). Prevention: Protect yourself from tick bites. Retrieved October 17 from http://www.cdc.gov/ncidod/dvbid/lyme/Prevention/ld_Prevention_Avoid.htm Vazguez, M., Muehlenbein, C., Cartter, M., Hayes, E.B., Starr, E., Shapiro, E.D. (2008). Effectiveness of personal protective measures to prevent Lyme disease. Emerging Infectious Disease, 14(2),210-216.

  16. Prevention Juvenile or “nymph” deer tick • Start growth in spring • Size of a poppy seed • Black Pennsylvania Game Commission. (n.d). Lyme Disease. Retrieved October 21, 2009 from http://www.pgc.state.pa.us/pgc/cwp/view.asp?a=465&q=151357 [Ticks]. (n.d.). [Electronic illustration]. Retrieved October 17, 2009 from http://www.cdc.gov/ncidod/dvbid/lyme/images/TickMaster4_12.jpg

  17. Prevention Adult deer tick • Mature in early spring • Size of sesame seed • Female more common • Black with red coloring near rear • 2.5 mm Pennsylvania State University. (2008). Lyme Disease [Brochure]. Retrieved from http://pubs.cas.psu.edu/freepubs/pdfs/uf006.pdf [Ticks]. (n.d.). [Electronic illustration]. Retrieved October 17, 2009 from http://www.cdc.gov/ncidod/dvbid/lyme/images/TickMaster4_12.jpg

  18. Prevention Avoid tick habitats • Most common in: • May • June • July • Walk in center of trails • Avoid contact with: • Overgrown grass • Brush • Leaf litter Centers for Disease Control and Prevention. (2008). Prevention: Protect yourself from tick bites. Retrieved October 17 from http://www.cdc.gov/ncidod/dvbid/lyme/Prevention/ld_Prevention_Avoid.htm

  19. Prevention Personal Protective Measures • Light colored clothing • Long sleeves • Long pants • Hats • Insect sprays Eppes, S. (2003). Diagnosis, treatment, and prevention of Lyme disease in children. Pediatric Drugs, 5(6), 363-372.

  20. Prevention Questions to ask • Does your child live in close proximity to grassy fields or heavily wooded areas? • Does your child (of working age) have an occupational exposure that puts you at risk for tick bites (such as working in landscaping, forestry farming, or wild-life parks management)? • Does your child engage in outdoor activities that put you at higher risk for tick bites? • Does your child wear clothing to protect against ticks while outdoors, e.g., long pants, long-sleeved shirts, or light-colored clothing? • Do you and your child routinely use tick repellents on the skin and/or clothing while outdoors? • Do you routinely spray tick pesticides against ticks on your property? • Do you and your child routinely check for ticks on the body after being outdoors? • Do you have any pets at home? Vazguez, M., Muehlenbein, C., Cartter, M., Hayes, E.B., Starr, E., Shapiro, E.D. (2008). Effectiveness of personal protective measures to prevent Lyme disease. Emerging Infectious Disease, 14(2),210-216.

  21. Prevention After being outdoors……… • Inspect • Armpit • Scalp • Groin Centers for Disease Control and Prevention. (2008). Prevention: Protect yourself from tick bites. Retrieved October 17 from http://www.cdc.gov/ncidod/dvbid/lyme/Prevention/ld_Prevention_Avoid.htm

  22. Prevention If tick found……… • Remove with tweezers (pull out directly near ticks mouth) • Wash hands and tweezers when done Centers for Disease Control and Prevention. (2008). Prevention: Protect yourself from tick bites. Retrieved October 17 from http://www.cdc.gov/ncidod/dvbid/lyme/Prevention/ld_Prevention_Avoid.htm Eppes, S. (2003). Diagnosis, treatment, and prevention of Lyme disease in children. Pediatric Drugs, 5(6), 363-372.

  23. Prevention Vaccine Centers for Disease Control and Prevention. (2007). Lyme Disease --- United States, 2003--2005. Morbidity and Mortality Weekly Report (MMWR). 56(23), 573-576.Retrieved October 17, 2009 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5623a1.htm Eppes, S. (2003). Diagnosis, treatment, and prevention of Lyme disease in children. Pediatric Drugs, 5(6), 363-372.

  24. Further Information Centers for Disease Control and Prevention http://www.cdc.gov/ncidod/dvbid/lyme/ Bucks County Department of Health http://www.buckscounty.org/government/departments/HumanServices/HealthDepartment/index.aspx Lyme Disease Foundation http://www.lyme.org Lyme Disease Network http://www.lymenet.org/ Lyme Disease in Pennsylvania http://www.lymediseasepa.com/ Pennsylvania Department of Health http://www.dsf.health.state.pa.us/health/site/default.asp Pennsylvania Game Commission http://www.pgc.state.pa.us/pgc/cwp/browse.asp?a=460&bc=0&c=69880&pgcNav=|

  25. Conclusion • Prevention is key • Know how to detect

  26. References Aucott, J., Morrison, C., Munoz, B., Rowe, P.C., Schwarzwalder, A., West, S.K. (2009). Diagnostic challenges of early Lyme disease: Lessons from a community case series. BMC Infections Diseases, 9(79), doi:10.1186/1471-2334-9-79 Eppes, S. (2003). Diagnosis, treatment, and prevention of Lyme disease in children. Pediatric Drugs, 5(6), 363-372.  Antibiotics. (2008). Merck Manual [Online]. Retrieved October 21, 2009 from http://www.merck.com/mmhe/sec17/ch192/ch192a.html Centers for Disease Control and Prevention. (2007). Lyme Disease --- United States, 2003--2005. Morbidity and Mortality Weekly Report (MMWR). 56(23), 573-576.Retrieved October 17, 2009 from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5623a1.htm Centers for Disease Control and Prevention. (2007). Prevention: Lyme disease transmission. Retrieved October 17, 2009 from http://www.cdc.gov/ncidod/dvbid/lyme/ld_transmission.htm

  27. References continued… Centers for Disease Control and Prevention. (2008). Prevention: Protect yourself from tick bites. Retrieved October 17 from http://www.cdc.gov/ncidod/dvbid/lyme/Prevention/ld_Prevention_Avoid.htm Centers for Disease Control and Prevention. (2008). Surveillance for Lyme disease --- United States, 1992--2006. Morbidity and Mortality Weekly Report (MMWR). 57(SS-10), 1-9.Retrieved October 17, 2009 from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5710a1.htm Centers for Disease Control and Prevention. (2009). Prevention: Manage deer populations and movement. Retrieved October 17, 2009 from http://www.cdc.gov/ncidod/dvbid/lyme/Prevention/ld_Prevention_Control_Deer.htm [Deer Tick]. (n.d). [Photograph]. Retrieved October 17, 2009 from http://www.cdc.gov/ncidod/dvbid/lyme/ld_transmission.htm

  28. References continued… Gathany, J. (2007). Erythema Migrans. [Photograph]. Retrieved October 17, 2009 from http://phil.cdc.gov/phil/details.asp?pid=9875 Pennsylvania Game Commission. (n.d). Lyme Disease. Retrieved October 21, 2009 from http://www.pgc.state.pa.us/pgc/cwp/view.asp?a=465&q=151357 Pennsylvania State University. (2008). Lyme Disease [Brochure]. Retrieved from http://pubs.cas.psu.edu/freepubs/pdfs/uf006.pdf Pennsylvania Department of Health Bureau of Health Statistics and Research (2009). Lyme disease [Interactive database]. Epidemiologic Query and Mapping System (EpiQMS). Available from the Pennsylvania Department of Health Web site: http://app2.health.state.pa.us/epiqms/default.asp Pennsylvania Game Commission. (2003). Population Management Plan for White-Tailed Deer in Pennsylvania 2003-2007. Retrieved October 20, 2009 from http://www.pgc.state.pa.us/pgc/lib/pgc/deer/pdf/Management__Plan6-03.pdf

  29. References continued… [Ticks]. (n.d.). [Electronic illustration]. Retrieved October 17, 2009 from http://www.cdc.gov/ncidod/dvbid/lyme/images/TickMaster4_12.jpg Vazguez, M., Muehlenbein, C., Cartter, M., Hayes, E.B., Starr, E., Shapiro, E.D. (2008). Effectiveness of personal protective measures to prevent Lyme disease. Emerging Infectious Disease, 14(2),210-216. Weber K, Wilske B. (2006). Mini erythema migrans--a sign of early Lyme borreliosis. Dermatology, 212(2), 113-116. *Note: Unless otherwise referenced, all images are taken from Microsoft Office 2007 Clip Art

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