What You Should Know About Lyme Disease and Other

Tick-Borne Diseases

Minnesota Department of HealthDisease Prevention & Control

625 Robert St NPO Box 64975

Saint Paul, MN 55164(651) 201-5414

Revised October 2009

Goal

“Minnesota residents and visitors will take action to prevent exposure to ticks which may carry Borrelia burgdorferi; will know the signs and symptoms of Lyme disease and other tick-borne diseases; and if present, will seek early diagnosis and treatment.”

1995 Minnesota Lyme Disease Public Education Plan

Goals of presentation

• Be aware of Lyme disease and other tick-borne diseases

• Recognize basic signs and symptoms • Seek early diagnosis and treatment• Know whether you live, work or play in

endemic areas• Practice prevention activities• Know whom to contact for more

information

LYME DISEASE

Borrelia burgdorferi, the bacteria that cause Lyme disease

History

1975 Juvenile cases of arthritis found in Connecticut

Disease named Lyme disease

1985 Lyme disease became reportable in Minnesota

Lyme DiseaseSigns & Symptoms

3 to 30 days after deer tick bite• Rash (often “bulls-eye”)• Fever• Chills• Headache• Muscle and joint pain• Fatigue

Erythema migrans (EM) rash characteristic of Lyme disease

Lyme disease rashwithout central clearing

Lyme DiseaseSigns & Symptoms

Days to weeks after illness onset• Multiple rashes• Facial paralysis on one side• Fever, stiff neck, headache• Weakness, numbness, arm/leg pain• Irregular heart beat• Persistent weakness and fatigue

Multiple Rashes

• Reaction as bacteria move through body

• Not caused by multiple tick bites

Multiple Rashes

• This is another example of a multiple rash.

Lyme DiseaseSigns & Symptoms

Weeks to months after illness onset• Fatigue• Chronic arthritis• Nervous system problems

Joint swelling and pain may occur weeks to months after onset of illness if left untreated.

Joint Swelling

Diagnosis of Lyme Disease

• Physical examination• History of possible exposure to

deer ticks• Blood tests may be performed

– A screening test is done first, followed by a confirmatory test for antibodies to Lyme disease bacteria

Remember

Early recognition of signs and symptoms of Lyme disease is very important for prompt diagnosis and treatment.

Treatment

• Lyme disease can be treated• Antibiotics are used to treat

Lyme disease• Talk to your doctor about

specific treatment

Questions aboutDiagnosis or Treatment

of Lyme Disease?

Call your doctor

or

Minnesota Department of Health at 651-201-5414

TICKSBlacklegged Tick

(deer tick)(spreads Lyme disease)

American dog tick(wood tick)

(does not spread Lyme disease)

adult male adult female

Blacklegged ticks have three life stages

Blacklegged Ticks (Deer Ticks)

Nymph

Adult(female)

Larva

Blacklegged Tick Larvae

• Size of period at end of sentence

• Initially does not have Lyme disease bacteria, so does not transmit the bacteria to a host

• May get the bacteria from a host who has the bacteria

Lyme disease researchers often live-trap small mammals to collect blacklegged ticks.

Collecting ImmatureBlacklegged Ticks

Immature blacklegged ticks can be infected by feeding on mice that are carrying Lyme disease bacteria.

Transmission can also occur from the ticks to mice.

Natural Host forImmature Blacklegged Ticks

Blacklegged Tick Nymph

Blacklegged Tick Nymph

• Size of a poppy seed

• Transmits most cases of disease because they are so difficult to detect

• Seeks a blood meal from mid-May to mid-July

Adult female

Blacklegged Tick Adults

Adultmale

Blacklegged Tick Engorgement

Male and Female Adult Blacklegged Tick

• Feed and mate on large animals in the fall or early spring

• After feeding, females lay eggs, then die• Ticks that did not feed or mate go

dormant

EGGS

Eggs laid,adults die

MEAL 1• Mouse• Bird

SPRING

WINTER

SUMMER

FALL

Larvae molt into nymph

stage

Nymphs molt into

adults

MEAL 3• Person• Deer• Dog

ADULTS

MEAL 3* For adults

that did not feed in fall• Person• Deer• Dog

Nymphs dormant

LARVAE

MEAL 2(peak feeding

time May-mid July)• Person• Mouse• Dog

NYMPHS

Two-Year Life Cycle of Blacklegged Tick

Blacklegged Tick Habitat

Trails and Edge Habitat

• Blacklegged ticks live in woody, brushy areas that provide food and cover for hosts such as mice and deer

• Exposure to these ticks can be greatest along trails and edges of woods

Blacklegged ticks search for a host from the tips of low-growing vegetation, generally climbing onto a person or animal near ground level.

Blacklegged Tick Questing

Blacklegged Tick Feeding

To Get Lyme Disease

• Blacklegged tick must be infected with Lyme disease bacteria

• Only the nymphs and adult females can transmit the Lyme disease bacteria

• Tick must be attached 24 - 48 hours before it passes bacteria to host

Lyme Disease Cases by State, 2002 (n = 23,763)2002 Lyme Disease Cases by State as Reported to CDC

n=23,763

3989

37219

26118075535852

46312349

194

D.C.25

259

137

82

2

79

26

26

21

25

28

1112

5

3

41

47

1090

867

42

1

2

6

7

0

139

1

1

4

0

11

4

5

4

4

12

97

0 3

26

738

2002 Lyme Disease Cases by State as Reported to CDCn=23,763

3989

37219

26118075535852

46312349

194

D.C.25

259

137

82

2

79

26

26

21

25

28

1112

5

3

41

47

1090

867

42

1

2

6

7

0

139

1

1

4

0

11

4

5

4

4

12

97

0 3

26

738

Minnesota Department of HealthMay 2008

Wadena

Hennepin

Murray

Pine

Aitkin

CassHubbard

Wilkin

Itasca

St. Louis

Cook

Wash-ing-ton

Lake

Le Sueur

Rice Goodhue

NoblesRock Jackson Martin Faribault FreebornMower

Fillmore Houston

WinonaOlmsted

DodgeSteeleWasecaBlue EarthWatonwanCottonwoodPipestone

Nicollet

Wabasha

DakotaScott

Chisago

Isanti

Brown

Sibley

Carver

WrightMeeker

Kandiyohi

Renville

Redwood

Sherburne

LyonLincoln

Yellow Medicine

Lac Qui Parle

Swift

Big Stone

PopeStevensTraverse

Chippewa

Stearns

Benton

Carlton

Kanabec

MilleLacs

Crow Wing

Morrison

Todd

DouglasGrant

Ottertail

BeckerClay

ClearWater

MahnomenNorman

Red Lake

PenningtonPolk

Beltrami

Marshall

Koochiching

Lakeof theWoods

RoseauKittson

McLeod

Ram- sey

Anoka

Lyme Disease Areas of Highest Riskin Minnesota

Tick-borne disease risk in Minnesota is highest in forested areas within the shaded zones.

Blacklegged ticks may also be found at lower levels in some forested areas outside this zone.

Reported Cases of Lyme Disease in Minnesota, 1986-2008 (n = 9,726)

94 83 83107

67 80

196147

202 204252 256 261

283

465 463

866

475

1,023

917 913

1,239

1,050

0

100

200

300

400

500

600

700

800

900

1,000

1,100

1,200

1,300

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

Year

Nu

mb

er o

f C

ase

s

0

200

400

600

800

1000

1200

1400

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

Year

Nu

mb

er o

f C

ases

Metro AreaGreater Minnesota

Reported Cases of Lyme Disease in Minnesota by Location of Residence,

1998-2007 (n=6,905)

AnokaWashingtonRamseyDakotaHennepinScottCarverTotal

County

187183

383218

65

469

No. of Cases

Reported Cases of Lyme Disease byCounty of Exposure, Twin Cities

Metropolitan Area, 1998-2007

1. Crow Wing2. Cass3. Pine4. Aitkin5. Anoka6. Washington7. Houston8. Morrison9. Hubbard10. Itasca

WisconsinOther

County 966 (20%) 370 (8%) 302 (6%) 207 (4%) 187 (4%) 183 (4%) 125 (3%) 124 (3%) 103 (2%) 103 (2%)

940 (20%) 1,120 (24%)

4,730

No. (%) of Cases

Total Cases with Known Exposure

Top Ten Counties of Exposure for Reported Cases of Lyme Disease,

1998-2007

0% 0% 0% 0%

4%

22%

41%

19%

9%

4%

1% 0%0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

Month

Per

cen

t o

f C

ases

Reported Cases of Lyme Diseaseby Month of Onset, Minnesota,

1999-2008 (n = 6,277*)

* Excluding 1,415 cases without erythema migrans or with unknown onset dates

24%

11%

8%

9%

16% 16%

10%

6%

0%

5%

10%

15%

20%

25%

0-12 13-19 20-29 30-39 40-49 50-59 60-69 70+

Age at Time of Onset

Per

cen

tReported Cases of Lyme Disease

by Age at Onset, Minnesota,1999-2008 (n=7,610*)

* Excluding cases with unknown age at time of onset

Reported Cases of Lyme Disease in Minnesota by Sex, 1999-2008

2,960 (38%)

Female

4,732 (62%)

Male

7,692

Total

Human AnaplasmosisSigns and Symptoms

• Fever (over 102 degrees)

• Chills and shaking

• Severe headache

• Muscle aches

618 14

3036

79

93

149

76

139

186176

322

278

0

50

100

150

200

250

300

350

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Year

Nu

mb

er o

f C

ase

s

Reported Cases of Human Anaplasmosisin Minnesota by Year, 1995-2008

(n = 1,602)

5%

2%3%

7%

16%

22%

20%

25%

0%

5%

10%

15%

20%

25%

30%

0-12 13-19 20-29 30-39 40-49 50-59 60-69 70+

Age at Time of Onset

Per

cen

tReported Cases of Human Anaplasmosisby Age at Onset, Minnesota, 1999-2008

(n = 1,530)

* Excluding cases with unknown age

Human AnaplasmosisSex Distribution, 1999-2008

Male Female Total

980 (64%) 554 (36%) 1,534

0% 0% 0%2%

10%

30%

27%

10%

6%8%

5%

1%0%

5%

10%

15%

20%

25%

30%

35%

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

Month

Per

cen

t o

f C

ases

Reported Cases of Human Anaplasmosis by Month of Onset, Minnesota,

1999-2008 (n = 1,519*)

* Excluding 15 cases with unknown onset

Hennepin

Murray

Pine

Aitkin

CassHubbard

Wilkin

Itasca

St. Louis

Cook

Wash-ing-ton

Lake

Le Sueur

Rice Goodhue

NoblesRock Jackson Martin Faribault FreebornMower

Fillmore Houston

WinonaOlmsted

DodgeSteeleWasecaBlue EarthWatonwanCottonwoodPipestone

Nicollet

Wabasha

DakotaScott

Chisago

Isanti

Brown

Sibley

Carver

WrightMeeker

Kandiyohi

Renville

Redwood

Sherburne

LyonLincoln

Yellow Medicine

Lac Qui Parle

Swift

Big Stone

PopeStevensTraverse

Chippewa

Stearns

Benton

Carlton

Kanabec

MilleLacs

Crow Wing

Morrison

Wadena

Todd

DouglasGrant

Ottertail

BeckerClay

ClearWater

MahnomenNorman

Red Lake

PenningtonPolk

Beltrami

Marshall

Koochiching

Lakeof theWoods

RoseauKittson

McLeod

Ram- sey

Anoka

Cases with unknown exposure = 266

Cases with known exposure = 1,057

Minnesota = 722 Wisconsin = 99Other State = 7

7

41 155

229

15

6

99

14

5

123965

368

2

10

100

7

1

3

5

1

* Includes confirmed and probable cases

7

4

1

2

31

112

1

2

1

1

1

Reported Cases of Human Anaplasmosisin Minnesota by County of Exposure,

1995-2007(n = 1,323)

1

2

4

1

1

1

Babesiosis Signs & Symptoms

• High fever• Chills• Headache• Muscle aches• Fatigue• Loss of appetite

Summary of Tick-Borne Diseases,Minnesota, 1999-2008

(n = 9,333)

7,692 (82%)

1534 (16%)

107(1%)0

2000

4000

6000

8000

Lyme disease Humananaplasmosis

Babesiosis

Nu

mb

er

of

Ca

ses

Prevention Actions• Campers, hikers, hunters, people in outdoor

occupations, and people who live near the woods may be at risk in the counties known to have blacklegged ticks.

• Know whether you live, work or play in an area that has blacklegged ticks

• Take precautions when in blacklegged tick habitat, especially from May through July

• Remember, preventing exposure to blacklegged ticks requires diligence

Lyme Disease Vaccine

• Discontinued in 2002

Use repellents (DEET or permethrin), according to label directions.

Tucking pants into socks creates a barrier to ticks.

Wearing light-colored clothing helps to more easily spot ticks.

Prevention

It is a good idea to check yourself and your children for ticks after spending time in a wooded or brushy area.

Checking for Ticks

Check your dog or cat for ticks before bringing them inside.

There is a Lyme disease vaccine for dogs, but it does not prevent them from bringing ticks into the home.

Pets

Avoid Deer Tick Bites

• Be aware of high-risk times and places

• Walk in the center of trails to avoid picking up ticks from brush

• Wear long pants, light-colored clothing, and repellent

If you live in area with ticks, they are usually located around the fringe of your yard and a wooded area.

Avoiding Blacklegged Ticks at Home

Ticks have barbed mouth parts. This means that ticks attached to the skin should be pulled out slowly and steadily.

Removing Attached Ticks

To Remove a Deer Tick

• Use tick forceps or tweezers• Grasp the tick close to the skin• Pull outward S-L-O-W-L-Y, gently,

and steadily• Do not squeeze the tick• Use an antiseptic on the bite

Important Messages

• Know whether you live, work or play in an area that has deer ticks

• Take preventive actions

• Seek early diagnosis and treatment

Whom to Contact

Minnesota Department of Health

651-201-5414

Metropolitan Mosquito Control District

651-645-9149

Minnesota Department of Health’sLyme Disease Web Site

www.health.state.mn.us

Scroll down to “Diseases and Conditions” and click on “Diseases A to Z”

Click on “Lyme Disease”