Maine Medicine Weekly Update - 05/06/2019  (Plain Text Version)

Lyme disease remains the most common tickborne disease in Maine.  Providers reported over 1,400 cases in 2018 (preliminary data as of 3/25/19). While ticks can be active at any temperature above freezing, they are most active in warmer months. May is Lyme Disease Awareness Month in Maine, and the Maine Center for Disease Control and Prevention (Maine CDC) is asking health care providers to help stress the importance of tick education. Specifically, please encourage patients to be “Tick Aware and Tick Alert” when spending time outdoors.  This includes:

1. Using caution in areas where ticks may be found;
2. Wearing light-colored clothing that covers arms and legs;
3. Using EPA approved repellents; and
4. Performing daily tick checks after being outdoors on themselves and any pets.  Taking a shower after exposure to a tick habitat is an effective way to wash off any unattached ticks and provides a good opportunity to do a tick check.

Important to Remember

• Lyme disease is preventable by avoiding contact with infected ticks and tick infested areas.
• Lyme disease is caused by the bacteria Borrelia burgdorferi, which is transmitted through the bite of an infected deer tick (Ixodes scapularis). The tick must be attached to an individual for 24-48 hours before the bacteria that causes Lyme disease can be transmitted.
• The most common early symptom of Lyme disease is an erythema migrans (EM), a “bull’s eye” rash that appears 3-30 days after transmission (seen in about 60 to 80 percent of cases nationwide). Other early symptoms include: fatigue, fever, headaches, arthralgia, and myalgia.
• Disseminated symptoms include: arthritis including joint swelling, Bell’s palsy and other cranial neuritis, encephalitis, lymphocytic meningitis, radiculoneuropathy, and second- or third-degree atrioventricular block.
• Antibiotic therapy is effective for the treatment of Lyme disease.  Clinical treatment guidelines are available at the Infectious Diseases Society of America (IDSA)’s website.

Lyme disease is not the only disease that can result from a bite by Ixodes scapularis. Anaplasmosis, babesiosis, Borrelia miyamotoi, and Powassan are other tickborne infections found in Maine. In 2018, the number of human anaplasmosis cases decreased to 477, the number of human babesiosis cases decreased to 101, the number of human cases of Borrelia miyamotoi increased to 8, and there were zero identified cases of Powassan (preliminary data as of 3/25/19).   The decrease in cases is likely the result of the hot and dry summer Maine experienced and should not be taken as an indication that the threat of tickborne diseases is diminishing.  The majority of tickborne illnesses occur during the summer months when ticks and humans are active outdoors. 

Thank you for your invaluable help in the prevention and early identification of tickborne diseases here in Maine.

Resources:

•  IDSA treatment guidelines available at http://cid.oxfordjournals.org/content/43/9/1089.full
• Lyme disease case report form available on the web at http://www.maine.gov/lyme under Resources for Physicians
• University of Maine Cooperative Extension Tick ID Lab submission instructions found at http://extension.umaine.edu/ipm/tickid/
• To continue getting updates throughout May please like our Facebook page at https://www.facebook.com/MaineCDC
• For additional questions, please call Maine CDC at 1-800-821-5821 or email disease.reporting@maine.gov
• Tickborne videos can be found on our website https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/videos.shtml
• Human Lyme disease data is available through the Maine Tracking Network at: Data Portal - Lyme