LYME & TICK Update 12/18/13
From: Maine Health Alert Network 12/18/2013
Re: Update on Tick Borne Diseases in Maine Message: Although the weather outside may be frightful, temperature alone is not enough to kill the ticks. The deer tick can remain active in its adult stage from fall to spring as long as the temperature is above freezing. The tick will remain alive, but inactive when temperatures are below 40 degrees Fahrenheit.
Maine CDC continues to see increased numbers of tick borne disease reports in 2013, including multiple cases with onset of symptoms as late as December. Maine CDC is investigating a probable case of Powassan encephalitis, which if confirmed will be the first documented case in the state since 2004. Providers should continue to consider tick borne illnesses, even during the winter months.
Tick ME Off – Ticks are back in Maine
Lyme disease is the most common vector-borne disease in Maine and the second most common of the reportable infectious diseases in Maine. It is time to start tick checks. Ticks may be active any time the temperature is above freezing, and we expect the number of tick bites and therefore cases of Lyme to increase as the weather continues to get warmer. May is Lyme Disease Awareness Month in Maine so remember to educate your patients about ticks and how to avoid exposure.
The most common tick in Maine is Ixodes scapularis (the deer tick). This tick can carry not only Lyme disease, but also Babesia and Anaplasma phagocytophilia, two emerging tick borne infections in Maine. Cases of all three diseases are on the rise in Maine. Rocky Mountain Spotted Fever (RMSF), Ehrlichiosis, and Tularemia are also tick borne infections carried by ticks other than the deer tick. Although these diseases are not currently endemic in Maine, they are becoming more common either through travel or local acquisition. Most infections of tick borne diseases occur during the summer months. If you see a patient with “summer flu” especially if their WBC is low—think Anaplasma and Babesia and send a PCR.
Testing is available for all tick borne diseases. Two tier antibody testing including western blot for both IgG and IgM is recommended for Lyme disease testing. Polymerase Chain Reaction (PCR) is the preferred method when testing for Anaplasma, Ehrlichia and Babesia. PCR is available for RMSF, but is generally unreliable for blood samples. RMSF and Tularemia can be tested by serology, but should always include both acute and convalescent testing.
All tick borne diseases are reportable in the state of Maine. For accurate surveillance we need all cases of tick borne disease reported. We request that all diagnosed erythema migrans (early Lyme disease) rashes be reported to Maine CDC as well as all positive lab diagnoses for any tick borne disease. Cases can be reported by fax at 1-800-293-7534 or by phone at 1-800-821-5821
IDSA treatment guidelines available here
Lyme disease case report form available here