In the News
UNC Institute for Global Health and Infectious Diseases

Researchers evaluate diagnostic testing landscape for tick-borne disease in the Southeast

Tick-borne diseases including Spotted Fever Group Rickettsiosis (SFGR), ehrlichiosis, and increasingly Lyme disease, represent a substantial public health concern throughout much of the Southeastern United States. North Carolina experiences some of the highest rates of SFGR and ehrlichiosis in the United States, often accounting for more than of 10% and 5% of cases reported to the CDC, respectively. Yet timely and accurate surveillance is limited by both the nature of reporting and the limitations of existing diagnostic methods.
Johns Hopkins Magazine

A tracker for tickborne illness

Inspired by the popularity of the JHU COVID-19 dashboard, scientists from the Bloomberg School and the JHU School of Medicine teamed up to design a Lyme disease dashboard, hoping to draw public attention to this pervasive and often debilitating illness and to encourage additional research. ‘It’s a great example of how we can collaborate across the university,’ says John Aucott, an associate professor of medicine and director of the Johns Hopkins Lyme Disease Research Center, who is part of the project.
The Washington Post

The tick that makes people allergic to red meat is in D.C.

Our recent warm weather has reawakened ticks, and one type in particular is becoming more common in the D.C. area: the lone star tick. One bite from this tick can cause a life-long adverse reaction to eating red meat.
Research
JAMA Network Open

Patterns Testing for Tick-Borne Diseases and Implications for Surveillance in the Southeastern US

Tick-borne diseases (TBD), including spotted fever group rickettsiosis (SFGR), ehrlichiosis, and, increasingly, Lyme disease, represent a substantial public health concern throughout much of the southeastern United States. Yet, there is uncertainty about the epidemiology of these diseases because of pitfalls in existing diagnostic test methods. This cross-sectional study included diagnostic test results for TBD at UNC Health, a large academic health care system with inpatient and outpatient facilities, from January 1, 2017, to November 30, 2020. During the 4-year study period, 11 367 individuals (6633 [58.4%] female; 10 793 [95%] non-Hispanic individuals and 8850 [77.9%] White individuals; median [IQR] age, 53 [37-66] years) were tested for TBD. Among the 20 528 diagnostic tests performed, 47 laboratory-confirmed, incident cases of SFGR, 27 cases of ehrlichiosis, and 76 cases of Lyme were confirmed, representing incidence rates of 4.7%, 7.1%, and 0.7%, respectively. However, 3984 of SFGR tests (79.3%) and 3606 of Ehrlichia tests (74.3%) lacked a paired convalescent sample. Of 20 528 tests, there were 11 977 tests (58.3%) for Lyme disease from 10 208 individuals, 5448 tests (26.5%) for SFGR from 4520 individuals, and 3103 tests (15.1%) for ehrlichiosis from 2507 individuals. Most striking, testing for ehrlichiosis was performed in only 55% of patients in whom SFGR was ordered, suggesting that ehrlichiosis remains underrecognized. An estimated 187 incident cases of SFGR and 309 of ehrlichiosis were potentially unidentified because of incomplete testing.
Canada Communicable Disease Report

Surveillance of ticks and their pathogens, Canada, 2019

The objective of this article is to characterize passive and active surveillance of the main Lyme disease tick vectors in Canada in 2019 and the tick-borne pathogens they carry. Passive surveillance data were compiled from the National Microbiology Laboratory Branch and provincial public health data sources. Active surveillance was conducted in selected sentinel sites in all provinces. In passive surveillance, specimens of I. scapularis (n=9,858) were submitted from all provinces except British Columbia and I. pacificus (n=691) were submitted in British Columbia and Alberta. No ticks were submitted from the territories. The seasonal distribution pattern was bimodal for I. scapularis adults, but unimodal for I. pacificus adults. Borrelia burgdorferi was the most prevalent pathogen in I. scapularis (18.8%) and I. pacificus (0.3%). In active surveillance, B. burgdorferi was identified in 26.2% of I. scapularis; Anaplasma phagocytophilum in 3.4% of I. scapularis, and Borrelia miyamotoi and Powassan virus in 0.5% or fewer of I. scapularis.
Pathogens

Sentinel Surveillance Contributes to Tracking Lyme Disease Spatiotemporal Risk Trends in Southern Quebec, Canada

Lyme disease (LD) is a tick-borne disease which has been emerging in temperate areas in North America, Europe, and Asia. In Quebec, Canada, the number of human LD cases is increasing rapidly and thus surveillance of LD risk is a public health priority. In this study, we aimed to evaluate the ability of active sentinel surveillance to track spatiotemporal trends in LD risk. Using drag flannel data from 2015–2019, we calculated density of nymphal ticks (DON), an index of enzootic hazard, across the study region (southern Quebec). A Poisson regression model was used to explore the association between the enzootic hazard and LD risk (annual number of human cases) at the municipal level. Predictions from models were able to track both spatial and interannual variation in risk. Furthermore, a risk map produced by using model predictions closely matched the official risk map published by provincial public health authorities, which requires the use of complex criteria-based risk assessment. Our study shows that active sentinel surveillance in Quebec provides a sustainable system to follow spatiotemporal trends in LD risk. Such a network can support public health authorities in informing the public about LD risk within their region or municipality and this method could be extended to support Lyme disease risk assessment at the national level in Canada.
Emerging Infectious Diseases

Effects of Tick-Control Interventions on Tick Abundance, Human Encounters with Ticks, and Incidence of Tickborne Diseases in Residential Neighborhoods, New York, USA

Tickborne diseases (TBDs) such as Lyme disease result in ≈500,000 diagnoses annually in the United States. Various methods can reduce the abundance of ticks at small spatial scales, but whether these methods lower incidence of TBDs is poorly understood. We conducted a randomized, replicated, fully crossed, placebo-controlled, masked experiment to test whether 2 environmentally safe interventions, the Tick Control System (TCS) and Met52 fungal spray, used separately or together, affected risk for and incidence of TBDs in humans and pets in 24 residential neighborhoods. All participating properties in a neighborhood received the same treatment. TCS was associated with fewer questing ticks and fewer ticks feeding on rodents. The interventions did not result in a significant difference in incidence of human TBDs but did significantly reduce incidence in pets. Our study is consistent with previous evidence suggesting that reducing tick abundance in residential areas might not reduce incidence of TBDs in humans.
BMC Public Health

Spatiotemporal trends and socioecological factors associated with Lyme disease in eastern Ontario, Canada from 2010–2017

Currently, there is limited knowledge about socioeconomic, neighbourhood, and local ecological factors that contribute to the growing Lyme disease incidence in the province of Ontario, Canada. In this study, we sought to identify these factors that play an important role at the local scale, where people are encountering ticks in their communities. We used reported human Lyme disease case data and tick surveillance data submitted by the public from 2010–2017 to analyze trends in tick exposure, spatiotemporal clusters of infection using the spatial scan statistic and Local Moran’s I statistic, and socioecological risk factors for Lyme disease using a multivariable negative binomial regression model. When adjusting for population counts, Lyme disease case counts increased with larger numbers of Borrelia burgdorferi-infected ticks submitted by the public, higher proportion of treed landcover, lower neighbourhood walkability due to fewer intersections, dwellings, and points of interest, as well as with regions of higher residential instability and lower ethnic concentration (Relative Risk [RR] = 1.25, 1.02, 0.67–0.04, 1.34, and 0.57, respectively, p < .0001). Our study shows that there are regional differences in tick exposure patterns in eastern Ontario and that multiple socioecological factors contribute to Lyme disease risk in this region.
Relevant Resources
Prevention and Symptoms
US Resources

Companion Animal Parasite Council

Parasite Prevalence Maps

California Department of Public Health

Lyme Disease in California ArcGIS StoryMap

Upstate Medical University

New York Tick Surveillance Dashboard

University of Rhode Island

TickEncounter

Cary Institute of Ecosystem Studies

Lyme & Tick-borne Disease

Columbia University

New York City Ticks

Bay Area Lyme Foundation

Citizen Science Tick Maps
Canadian Resources

Bishop’s University

eTick Public Tick Map

Companion Animal Parasite Council

Parasite Prevalence Maps

Canadian Lyme Disease Research Network

Research Projects
Resources
European Resources

European Centre for Disease Prevention and Control

Surveillance Atlas of Infectious Diseases
Tick Maps