Research and literature reviews on determination, distribution, risk factors and impact of Lyme disease.

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Determination means (who and where)

-in the US
-Globally
-Prevalent in the north and south (are there more cases in d South or North?)

Distribution
-Season (when is it common)
-Are men and women affected equally?
-what is d gender distribution
-age distribution
-Racial distribution
-Social distribution

Factors that determine exposure (Risk factors)
-Genetic factors
-environmental factor
-socio-economic factor

Impacts on public (effects)
-Social effect
-the psychological effect
-Family effect
-Community effect
-Economic effect

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Lyme borreLiosis in europe This information leaflet contains five sections and is intended for a generic and public health audience: © ECDC/G. Hendrickx 1.Lb is found in certain areas of europe. What are the risks in European countries? 2. Ticks can be the carriers of disease. How is the disease transmitted? What are the risk factors? 3. Disease characteristics of Lb. What are the symptoms and how can it be treated? 4. Tick-borne diseases are preventable. What measures can be taken to protect yourself? 5. more information is available. Where can you find more information and guidance on effective prevention and control activities? Key messages • Lyme disease, or Lyme borreliosis (LB), is a bacterial disease transmitted to humans through the bite of infected ticks. It is a common disease in Europe. • The number of cases in Europe has increased steadily, more than 360 000 cases having been reported over the last two decades. • Central Europe is the region with the highest incidence of LB, as reported by the Czech Republic, Estonia, Lithuania and Slovenia. • The risk of LB is reduced by avoiding tick bites. • The most effective ways of avoiding tick bites include wearing long trousers and long-sleeved shirts, and using repellents on the skin and clothing. The skin should be checked periodically for attached ticks, which should be removed as soon as possible. • Typical symptoms include a characteristic skin rash, called erythema migrans, often accompanied by fever, headache and fatigue. Without antibiotic treatment, the infection can spread to the joints, the heart and the nervous system. • Most cases can be treated successfully with antibiotics taken over several weeks. 1. Lb is found in certain areas of europe box 1. What is a vector-borne disease? LB is the most common tick-borne disease in Europe (Fig. 1). Between 1990 and 2010, the highest average incidence rates among the reporting countries were found in Belarus, Belgium, Croatia, Norway, the Russian Federation and Serbia (< 5/100 000), Bulgaria, Finland, Hungary, Poland and © ECDC/G. Hendrickx • Vector-borne diseases are illnesses caused by pathogens in human populations. • These diseases are spread by vectors: living organisms that can transmit pathogens between humans or from animals to humans. • Many vectors are bloodsucking insects, which ingest pathogens during a blood meal from infected hosts (humans or animals) and transfer them to new hosts during subsequent blood meals. • Mosquitoes are the best known disease vectors. Others include certain species of ticks, flies, sandflies, and fleas. Slovakia (< 16/100 000), the Czech Republic, Estonia, and Lithuania (< 36/100 000) and Slovenia (< 130/100 000). It is important to be aware of LB risk areas and, if exposure is likely, to take precautions to reduce the risk of infection. Fig. 1. Number of Lyme disease cases in europe as reported to WHo Centralized information system for infectious Diseases (CisiD). 2. Ticks can be the carriers of disease LB is caused by the bacterium, Borrelia burgdorferi, and is transmitted to humans by the bite of infected ticks, mainly Ixodes ricinus. Ticks become infected when they feed on small mammals (such as rodents) and certain birds that carry the bacterium in their blood. In risk areas, as much as 5-40% of ticks may be infected. The risk of contracting a tick-borne infection is determined by the overall number of ticks in the area, the proportion of those carrying disease, and human behaviour. In risk areas, people involved in outdoor recreational or occupational activities (e.g. hunting, fishing, camping, collecting mushrooms and berries, forestry, farming, military training) are at an increased risk of being bitten by ticks. Changes in the geographic and temporal distribution of the ticks and the disease have been observed in recent decades. Ticks are spreading to higher altitudes and more northern latitudes and disease incidence is shifting towards spring and autumn. Many factors are involved, including climate change, changes in land cover and land use, changes in the distribution of tick hosts, and human-induced changes in the environment. 3. Disease characteristics of Lb LB is a multisystem disorder, which can affect several tissues. The symptoms can be divided according to the two stages of the disease (early and late) but progress from the early to the late stage does not always occur. When a person is bitten by an infected tick, the only symptom in the first stage consists of a red skin rash or lesion (called erythema migrans) that spreads in ring form from the site of the bite. This occurs in about 60–90% of cases within 2–30 days of the tick bite. If left untreated, a disseminated infection affecting the nervous system (10% of cases), the joints, the skin and/or the heart (rare) may follow within days or weeks. Fig. 2. An example of erythema migrans caused by Lb infection. No laboratory tests are required to diagnose erythema migrans (the rash characteristic of LB); a clinical evaluation and an assessment of the risk of tick exposure suffice. Laboratory tests are necessary to confirm a diagnosis of latestage infection. B. burgdorferi antibodies are usually detectable within 4–8 weeks of infection: patients with latestage infection usually test very strongly positive for these antibodies. However, the occurrence of false-positive tests in patients with other infections or conditions, such as autoimmune diseases, can lead to misdiagnosis and inappropriate treatment. © CDC/James Gathany All LB patients should be treated for several weeks with appropriate antibiotics (amoxicillin, cephalosporin, and macrolides for disseminated infections). Early treatment can prevent the risk of developing late-stage complications. Patients with late-stage LB can also benefit from antibiotics but if severe tissue damage occurs prior to treatment, complete recovery may not be possible. 4. Tick-borne diseases are preventable No licensed vaccine is currently available for LB. LB infection is best prevented by avoiding tick bites and promptly removing ticks attached to the skin. An integrated approach to voiding tick bites and preventing infection is necessary. This includes wearing protective clothing, using tick repellents, checking the entire body daily for ticks, and removing attached ticks before transmission of infection can occur. © WHO Ixodes ticks live on the ground and climb 20-70 cm onto grasses and bushes where they wait for hosts. The tick bite is painless and it is often impossible to sense a tick moving on the skin. An attached tick should be removed using tweezers or fine-pointed forceps, grasping it as closely as possible to where it is attached to the skin and pulling it gently upwards, trying not to break off the mouth parts. The risk of LB infection is not increased if the mouth parts are left behind. A skin disinfectant should be applied after removal of the tick to prevent infection. When checking the skin for ticks, particular attention should be paid to skin folds as ticks seek the more humid parts of the body, such as the groins, the armpits, the waistband area, under the breasts and behind the knees. In young children, the head (including the scalp) and the neck area should also be checked carefully as tick bites are relatively more common at these sites in this age group. Before entering homes, clothing, bags and other belongings should be examined thoroughly for ticks. The best ways to avoid tick bites are to: • avoid tick risk areas; • be informed about how to remove ticks and recognize early symptoms; • use insect repellent on skin and clothing when in risk areas; • wear protective clothing with long sleeves, and long trousers tucked into socks or boots. 5. more information is available WHo documents Lindgren E, Jaenson TGT. Lyme borreliosis in Europe: influences of climate and climate change, epidemiology, ecology and adaptation measures. Copenhagen: World Health Organization; 2006 (http://www.euro.who.int/__data/assets/pdf_file/0006/96819/E89522.pdf). Lyme Borreliosis (Lyme disease). In: International travel and health [website]. Geneva: World Health Organization; 2014 (http://www.who.int/ith/diseases/lyme/en/). eCDC resources ECDC communication toolkit on tick-borne diseases. Stockholm: European Centre for Disease Prevention and Control; (http://www.ecdc.europa.eu/en/healthtopics/emerging_and_vector-borne_diseases/tick_borne_diseases/public_ health_measures/pages/communication_toolkit.aspx). Factsheet for health professionals – Lyme borreliosis [website]. Stockholm: European Centre for Disease Prevention and Control; 2010 (http://www.ecdc.europa.eu/en/healthtopics/emerging_and_vector-borne_diseases/tick_borne_diseases/lyme_ disease/factsheet-health-professionals/Pages/factsheet_health_professionals.aspx). Ixodes ricinus [website]. Stockholm: European Centre for Disease Prevention and Control; 2014 (http://www.ecdc.europa.eu/en/healthtopics/vectors/ticks/Pages/ixodes-ricinus.aspx). Tick species – distribution maps. In: Tick maps [website]. Stockholm: European Centre for Disease Prevention and Control; 2010 (http://www.ecdc.europa.eu/en/healthtopics/vectors/vector-maps/Pages/VBORNET-maps-tick-species.aspx). other resources Medlock JM et al. Driving forces for changes in geographical distribution of Ixodes ricinus ticks in Europe. Parasites & Vectors. 2013;6:1 (http://www.parasitesandvectors.com/content/6/1/1). Randolph SE. Tick ecology: processes and patterns behind the epidemiological risk posed by ixodid ticks as vectors. Parasitology. 2004;129(S):37-65. Rizzoli A et al. Lyme borreliosis in Europe. Eurosurveillance. 2011;16(27) (http://www.eurosurveillance.org/images/dynamic/EE/V16N27/art19906.pdf). Study Group for Lyme Borreliosis – ESGBOR [website]. Basel: European Society of Clinical Microbiology and Infectious Diseases; 2013 (https://www.escmid.org/research_projects/study_groups/esgbor/ or http://www.eucalb.com/). Vázquez M et al. Effectiveness of personal protective measures to prevent Lyme borreliosis. Emerging Infectious Diseases. 2008;14:210-216. Lyme borreLiosis in europe WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark http://www.euro.who.int European Centre for Disease Prevention and Control (ECDC) Postal address: ECDC, 171 83 Stockholm, Sweden Visiting address: Tomtebodavägen 11a, Solna, Sweden http://www.ecdc.europa.eu Emerging Infectious Disease journal ISSN: 1080-6059 Volume 21, Number 8—August 2015 Dispatch Geographic Distribution and Expansion of Human Lyme Disease, United States On This Page The Study Conclusions Cite This Article Figures Figure (/eid/article/21/8/14-1878-f1) Tables Table (/eid/article/21/8/14-1878-t1) Downloads PDF RIS [507 KB - 3 pgs] (/eid/article/21/8/pdfs/14-1878.pdf) [TXT - 2 KB] (/eid/article/21/8/14-1878.ris) Altmetric (https://www.altmetric.com/details.php?domain=wwwnc.cdc.gov&citation_id=4660127) Kiersten J. Kugeler (/eid/article/21/8/14-1878_article#comment) , Grace M. Farley, Joseph D. Forrester, and Paul S. Mead Author affiliations: Centers for Disease Control and Prevention, Fort Collins, Colorado, USA Cite This Article (javascript:void(0);) Close (javascript:void(0);) Highlight and copy the desired format. Kugeler KJ, Farley GM, Forrester JD, Mead PS. Geographic Distribution and Expansion of EID Human Lyme Disease, United States. Emerg Infect Dis. 2015;21(8):1455-1457. https://dx.doi.org/10.3201/eid2108.141878 Kugeler KJ, Farley GM, Forrester JD, et al. Geographic Distribution and Expansion of Human AMA Lyme Disease, United States. Emerging Infectious Diseases. 2015;21(8):1455-1457. doi:10.3201/eid2108.141878. Kugeler, K. J., Farley, G. M., Forrester, J. D., & Mead, P. S. (2015). Geographic Distribution and APA Expansion of Human Lyme Disease, United States. Emerging Infectious Diseases, 21(8), 14551457. https://dx.doi.org/10.3201/eid2108.141878. Abstract Lyme disease occurs in specific geographic regions of the United States. We present a method for defining high-risk counties based on observed versus expected number of reported human Lyme disease cases. Applying this method to successive periods shows substantial geographic expansion of counties at high risk for Lyme disease. Lyme disease is a multisystem tickborne zoonosis caused by infection with the spirochete Borrelia burgdorferi (1 ,2 ). Since 1991, state and territorial health departments have reported human Lyme disease cases to the Centers for Disease Control and Prevention through the National Notifiable Diseases Surveillance System. Most cases are reported from the northeastern, mid-Atlantic, and north-central states, although the number of jurisdictions that report a high number of cases has increased over time (3 ). To better quantify and track the geographic distribution of human Lyme disease, we developed a simple but robust method for defining counties where residents have a high risk of acquiring this disease. The Study Counties with a high incidence of Lyme disease were identified by using SaTScan version 9.1.1(4 ). Numbers of confirmed Lyme disease cases reported at the county level during 1993–2012 were aggregated into 5-year intervals (1993–1997, 1998–2002, 2003–2007, 2008–2012) to minimize the influence of travel-associated cases and short-term changes in surveillance practices. Incidence was calculated by using each county’s average population at risk, which was estimated from US Census data for the midpoint of each period (i.e., 1995, 2000, 2005, and 2010). Identification of high-risk clusters was based on county incidence rates, with a maximum possible cluster size equal to 25% of the US population (minimum size was 1 county). County centroids were used as geographic reference for analyses. During the study period, 3 different surveillance case definitions were used (i.e., those established in 1991, 1996, and 2008) (5 ). Relative risk (RR) was defined as the observed number of cases divided by the expected number of cases for a specific period and population size, and adjusted for differences in the population at risk across space (4 ). Calculations were based on a discrete Poisson probability distribution. RR was calculated for potential clusters and for individual counties within detected clusters. Statistical significance of possible clusters was determined by using likelihood ratio tests and standard Monte Carlo hypothesis testing (n = 999 replications) (4 ). Because of the circular shape used in spatial scanning, not all counties within an identified high-risk cluster were necessarily characterized by high Lyme disease incidence. Some may have been included because they share a border with a county having high incidence. Ultimately, counties designated as high incidence were those within a defined, statistically significant high-risk spatial cluster (α = 0.05) and with a countyspecific RR >2.0. Figure Figure (/eid/article/21/8/14-1878-f1). United States counties with high incidence of Lyme disease by the period when they first met the designated high-incidence criteria, 1993–2012. Highincidence counties were defined as those within a spatial cluster... In each period, 2 major foci of largely contiguous counties met the high-incidence county designation: 1 in the northeastern United States and 1 in the north-central United States (Figure). During the first 5-year period (1993–1997), 69 counties were characterized as having high incidence of Lyme disease, including 4 isolated counties in the southeastern United States (Table (/eid/article/21/8/14-1878-t1); Figure). During the next period (1998–2002), 130 counties were characterized as having high incidence, and the 4 counties in the southeastern United States ceased to meet the criteria for this designation. During the third and fourth periods (2003–2007 and 2008–2012), 197 and 260 counties, respectively, were characterized as having high incidence (Table (/eid/article/21/8/14-1878-t1); Figure). Over time, the number of counties in the northeastern states identified as having high incidence of Lyme disease increased >320%: from 43 (1993–1997) to 90 (1998–2002) to 130 (2003–2007) to 182 (2008– 2012). In the north-central states for the same periods, the number of counties having high incidence increased ≈250%, from 22 to 40 to 67 to 78. In each of the latter periods, a small number of counties previously identified as having high incidence ceased to meet the criteria; however, most remained above the threshold during all periods assessed (Table (/eid/article/21/8/14-1878-t1)). The county geographic center of each major focus was calculated according to Euclidean distances between county centroids by using ArcGIS 9.3 (Environmental Systems Research Institute, Redlands, CA, USA). The center of the high-incidence focus in the northeastern United States generally moved westward and northward, away from the coast of northern New Jersey and into east-central Pennsylvania. In the north-central high-incidence focus, the geographic center remained relatively stable in northwestern Wisconsin, moving northward and southward between adjacent counties over time. ∠ Top (javascript:void(0)) ∠ Top (javascript:void(0)) Conclusions We describe a simple measure for objectively defining counties having high incidence of Lyme disease. Systematic application of this method to 4 consecutive periods showed geographic expansion of high-risk areas. Despite the substantial increase in the number of counties with high incidence, the limited movement of the geographic centers suggests relatively constant rates of geographic expansion in all accessible directions. Although risk maps for Lyme disease have been developed on the basis of entomologic measures such as density of and infection prevalence in nymphal Ixodes scapularis vector ticks, these measures do not uniformly predict risk of human Lyme disease (6 ,7 ). Prior analyses of temporal trends in human Lyme disease surveillance have not been explicitly spatial or have been conducted by using data from a single state (8 –13 ). Surveillance data are subject to several limitations, including changing surveillance case definitions, availability of public health resources for surveillance, variations in surveillance practices, and reporting based on county of residence instead of county of exposure. Nevertheless, in accordance with the purpose of public health surveillance, these data provide valuable information about the magnitude and geographic distribution of areas in the United States where residents are at high risk of acquiring Lyme disease (5 ,14 ). Four counties in the southeastern United States had high incidence of human Lyme disease during the early years of national surveillance but subsequently had low incidence. This circumstance may reflect improved standardization of diagnostic procedures and a recognition that another condition, southern tick-associated rash illness (also known as STARI), occurs in the region. Patients with this illness have rash similar to that of Lyme disease, but the condition is not caused by B. burgdorferi bacteria ( 15 ). The ability to identify these isolated counties shows that our method is not biased toward detecting only counties near other areas with high incidence of Lyme disease. A true reduction in human risk for Lyme disease or changes in surveillance practices may have influenced the small number of counties meeting high-risk criteria during 1 period but not in subsequent periods. The RR cutoff of 2.0 was arbitrarily chosen to capture counties with not just elevated risk but a substantially higher risk for disease than other counties. The overall pattern of expansion in each period was similar when RR cutoffs of 1.5 and 3.0 were used (data not shown). However, using different RR thresholds to define high incidence changes the number of counties that meet the high-incidence criteria. This variation underscores that risk can be elevated in areas that fail to meet our high-incidence threshold. Risk for encounters with infected ticks, even within high-incidence counties, is influenced by human behavior and varying landscape characteristics that impact tick abundance and small mammal species composition. Geographic expansion of high-risk areas may occur because of changes in conditions that favor tick survival or because of geographic dispersal of infected ticks by birds and deer to areas where other necessary components already exist to support ongoing transmission. Our results show that geographic expansion of high-risk areas is ongoing, emphasizing the need to identify broadly implementable and effective public health interventions to prevent human Lyme disease. ∠ Top (javascript:void(0)) ∠ Top (javascript:void(0)) Dr. Kugeler is an epidemiologist with the Division of Vector-Borne Diseases, Bacterial Diseases Branch, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA. Her main research interests are the epidemiology and prevention of bacterial vector-borne infections. ∠ Top (javascript:void(0)) Acknowledgment We acknowledge the contribution of public health personnel in state and local health departments who have devoted extensive resources to Lyme disease surveillance in the United States. ∠ Top (javascript:void(0)) References 1. Stanek G, Wormser GP, Gray J, Strle F. Lyme borreliosis. Lancet. 2012;379:461–73. DOI (http://dx.doi.org/10.1016/S0140-6736(11)60103-7) PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez? cmd=Retrieve&db=PubMed&list_uids=21903253&dopt=Abstract) 2. Steere AC, Coburn J, Glickstein L. The emergence of Lyme disease. J Clin Invest. 2004;113:1093–101. DOI (http://dx.doi.org/10.1172/JCI21681) PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez? cmd=Retrieve&db=PubMed&list_uids=15085185&dopt=Abstract) 3. Adams DA, Jajosky RA, Ajani U, Kriseman J, Sharp P, Onwen DH, et al. Summary of notifiable diseases— United States, 2012. MMWR Morb Mortal Wkly Rep. 2014;61:1–121.PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez? cmd=Retrieve&db=PubMed&list_uids=25233134&dopt=Abstract) 4. National Notifiable Diseases Surveillance System (NNDSS). Lyme disease (Borrelia burgdorferi ). Case definitions [cited 2014 Oct 20]. http://wwwn.cdc.gov/nndss/script/conditionsummary.aspx? CondID=100 (http://wwwn.cdc.gov/nndss/script/conditionsummary.aspx?CondID=100) 5. Kulldorff M. SaTScan: software for the spatial, temporal, and space-time scan statistics. 2011 [cited 2013 Mar15]. http://www.satscan.org 6. Connally NP, Ginsberg HS, Mather TN. Assessing peridomestic entomological factors as predictors for Lyme disease. J Vector Ecol. 2006;31:364–70. DOI (http://dx.doi.org/10.3376/10811710(2006)31[364:APEFAP]2.0.CO;2) PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez? cmd=Retrieve&db=PubMed&list_uids=17249354&dopt=Abstract) 7. Pepin KM, Eisen RJ, Mead PS, Piesman J, Fish D, Hoen AG, Geographic variation in the relationship between human Lyme disease incidence and density of infected host-seeking Ixodes scapularis nymphs in the eastern United States. Am J Trop Med Hyg. 2012;86:1062–71. DOI (http://dx.doi.org/10.4269/ajtmh.2012.11-0630) PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez? cmd=Retrieve&db=PubMed&list_uids=22665620&dopt=Abstract) 8. Chen H, White DJ, Caraco TB, Stratton HH. Epidemic and spatial dynamics of Lyme disease in New York State, 1990–2000. J Med Entomol. 2005;42:899–908.PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez? cmd=Retrieve&db=PubMed&list_uids=16363174&dopt=Abstract) 9. Frank C, Fix AD, Pena CA, Strickland GT. Mapping Lyme disease incidence for diagnostic and preventive decisions, Maryland. Emerg Infect Dis. 2002;8:427–9. DOI (http://dx.doi.org/10.3201/eid0804.000413) PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez? cmd=Retrieve&db=PubMed&list_uids=11971779&dopt=Abstract) 10. Bacon RM, Kugeler KJ, Mead PS. Surveillance for Lyme disease—United States, 1992–2006. MMWR Surveill Summ. 2008;57:1–9.PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez? cmd=Retrieve&db=PubMed&list_uids=18830214&dopt=Abstract) 11. Waller LA, Goodwin BJ, Wilson ML, Ostfeld RS, Marshall SL, Hayes EB. Spatio-temporal patterns in county-level incidence and reporting of Lyme disease in the northeastern United States, 1990–2000. Environ Ecol Stat. 2007;14:83–100. DOI (http://dx.doi.org/10.1007/s10651-006-0002-z) 12. Kitron U, Kazmierczak J. Spatial analysis of the distribution of Lyme disease in Wisconsin. Am J Epidemiol. 1997;145:558–66. DOI (http://dx.doi.org/10.1093/oxfordjournals.aje.a009145) PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez? cmd=Retrieve&db=PubMed&list_uids=9063347&dopt=Abstract) 13. Eisen RJ, Lane RS, Fritz CL, Eisen L. Spatial patterns of Lyme disease risk in California based on disease incidence data and modeling of vector-tick exposure. Am J Trop Med Hyg. 2006;75:669–76.PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez? cmd=Retrieve&db=PubMed&list_uids=17038692&dopt=Abstract) 14. Teutsch SM, Churchill RE, editors. Principles and practices of public health surveillance. 2nd ed. New York: Oxford; 2000. 15. Wormser GP, Masters E, Nowakowski J, McKenna D, Holmgren D, Ma K, Prospective clinical evaluation of patients from Missouri and New York with erythema migrans-like skin lesions. Clin Infect Dis. 2005;41:958–65. DOI (http://dx.doi.org/10.1086/432935) PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez? cmd=Retrieve&db=PubMed&list_uids=16142659&dopt=Abstract) ∠ Top (javascript:void(0)) Figure Figure Figure. United States counties with high incidence of Lyme disease by the period when they first met the designated high-incidence criteria, 1993–2012. High-incidence counties were defined as those within a spatial... (/eid/article/21/8/14-1878-f1) Table Table Table. Data for United States counties with high incidence of human Lyme disease during four 5-year periods, 1993–2012 (/eid/article/21/8/14-1878-t1) ∠ Top (javascript:void(0)) Cite This Article (javascript:void(0);) DOI: 10.3201/eid2108.141878 Table of Contents – Volume 21, Number 8—August 2015 (/eid/articles/issue/21/8/table-of-contents) Comments Please use the form below to submit correspondence to the authors or contact them at the following address: Kiersten J. Kugeler, Centers for Disease Control and Prevention, 3156 Rampart Rd, Mailstop PO2, Fort Collins, CO 80521-3003, USA Return Address Send To Authors Editors Comments 10000 character(s) remaining. Send ∠ Top (javascript:void(0)) The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above. File Formats Help: How do I view different file formats (PDF, DOC, PPT, MPEG) on this site? (http://www.cdc.gov/Other/plugins/) (http://www.cdc.gov/Other/plugins/#pdf) Page created: May 11, 2016 Page last updated: May 11, 2016 Page last reviewed: May 11, 2016 Centers for Disease Control and Prevention (https://www.cdc.gov/), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) (https://www.cdc.gov/ncezid/) Office of the Director (OD) (https://www.cdc.gov/ncezid/) LYME DISEASE FACTS AND STATISTICS Below you’ll find the facts about Lyme disease and information you need to know. 329,000 new cases each year in the US Lyme disease is one of the fastest growing infectious diseases in the US and Western Europe. In September 2015, the Centers for Disease Control and Prevention (CDC) revised their estimates (http://wwwnc.cdc.gov/eid/article/21/9/15-0417_article), indicating that more than 329,000 new cases were contracted each year in the US — an increase of up to 10 times what was previously believed. Public funding far below that of less common illnesses Lyme disease receives less than 2% of public funding for West Nile and 0.2% of funding for HIV/AIDS, despite the fact that the annual case count for Lyme dwarfs either disease. Half a million patients struggling with long-term late-stage Lyme Reported in all 50 US states and more than 65 countries worldwide The disease which was first discovered in New England (Lyme, CT) has been expanding its footprint across the country with hot spots in the northern midwest and on the coast in California. Reported Cases of Lyme Disease In California, infected ticks found in 42 of 58 counties On the West Coast, the primary carrier is the Western blacklegged tick (http://www.bayarealyme.org/about-lyme/what-causes-lyme-disease/blacklegged-tick/), or Ixodes pacificus, and its principal host the grey squirrel. (This differs from the East Coast where the Eastern Blacklegged tick, Ixodes scapularis, is the principal carrier and the white-footed mouse its primary host.). The Western blacklegged tick has been found in all but two California counties (56 in total) and infected ticks have been discovered in 42 counties. Current diagnostics miss up to 60% of acute cases The current “gold standard” diagnostic for Lyme disease is a two-tiered ELISA/Western Blot blood test (http://www.bayarealyme.org/get-help/lyme-testing/) measuring human antibodies against Borrelia burgdorferi (http://www.bayarealyme.org/about-lyme/what-causes-lyme-disease/borrelia-burgdorferi/). This diagnostic is an indirect measure of infection, detecting the body’s immunologic response to infection rather than detecting the Lyme bacteria itself. It misses up to 60% of cases of early-stage Lyme disease, as it can take weeks for the body to develop measurable antibodies against the infection. Early treatment typically successful but many patients go undiagnosed for years Most never recall being bitten Less than half ever show the telltale bullseye rash As many as 20% continue to experience symptoms even after treatment Donate Our mission is to make Lyme disease easy to diagnose and simple to cure. Join us and help find a solution. Donate Now (https://www.bayarealyme.org/get-involved/donate/) Lyme Disease (https://www.bayarealyme.org/about-lyme/) Prevention (https://www.bayarealyme.org/lyme-disease-prevention/) Get Help (https://www.bayarealyme.org/get-help/) Events (https://www.bayarealyme.org/events/) Our Research (https://www.bayarealyme.org/our-research/) Blog (https://www.bayarealyme.org/blog/) About Us (https://www.bayarealyme.org/about/) Get Involved (https://www.bayarealyme.org/get-involved/) Media (https://www.bayarealyme.org/about/media/) Educators (https://www.bayarealyme.org/educators/) Get in Touch Bay Area Lyme Foundation 884 Portola Road, Suite A7 Portola Valley, CA 94028 Tel: 650.530.2439 (tel:6505302439) Fax: 855.229.5963 (tel:8552295963) info@bayarealyme.org (mailto:info@bayarealyme.org) Twitter Facebook Sign Up for Our Newsletter Keep up-to-date on developments in Lyme research, prevention tips, and Lyme news with our quarterly newsletter. Email: Sign Up Privacy Policy (https://www.bayarealyme.org/privacy-policy/) Terms of Use (https://www.bayarealyme.org/terms-of-use/) Bay Area Lyme Foundation is a registered 501(c)(3) nonprofit. © 2018
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Running Head: LYME DISEASE

Lyme Disease
Name
Institutional Affiliation
Date

Author´s Notes

LYME DISEASE

2

Lyme Disease
Lyme
disease is one of
the most spread
bacterial disease
in the United
States, with over
than 300,000
new infections
every year. The
infection spreads
by the bite of the
infected blacklegged tick both in the northeastern, mid-Atlantic, north-central United States,
and the Pacific Coast. (“WHO | Lyme Borreliosis (Lyme disease),” n.d.)
The infection does not result transmitted in the instant of the bite, the tick needs to be
attached to the human body during 36-48hs before the bacteria in the infected tick attacks the
human body. Generally, the tick attaches itself to the groin, a...


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