1. Lyme disease: Children and Outdoors School Activities Germaine Banza PUBH 6165 Walden University

2. INTRODUCTION • Lyme disease is an infectious disease caused by spirochetal agent (Borreliaburgdorferi) • Most common vector-borne disease in U.S. • Humans are infected from tick bite • Symptoms mimic many others diseases such as stroke • Environmental and behavioral approaches for reducing tick bites among children • Public health interventions and community wide efforts in managing and controlling tick population.

3. INTRODUCTION (CON’T) • Ranks among top 10 notifiable diseases in the U.S. • Rates are highest among children ages 5 to 9 (8.6 cases per 100,000 population). • Lowest rate among adult 20 to 22 years (3 cases per 100,000 population). • Research effort should be focused on vaccines for Lyme disease prevention • Key factors in public health include - Steady increase in reported cases - Threat of geographic expansion of area of endemicity - Insufficiency of current alternative prevention methods

4. OVERVIEW • Inflammatory disease caused by infected ticks. • Etiologic agent: bacteria called Borreliaburgdoferi. • Reservoirs: Small mammals and birds • People are infected in summer by the immature ticks: nymphs

5. Incidence and Prevalence • About 30,000 people are diagnosed annually in the U.S. • Estimated ten fold are underreported • Prevalent in New England, the Upper Midwest, Great Lakes region, and the Pacific Northwest

6. Incidence and Prevalence (Con’t.) • The disease is more prevalent from May to August in the Northeast and Great Lake regions and from January to May in the Pacific Northwest. • Became notifiable in 1991.

7. EPIDEMIOLOGY and SURVEILLANCE • Information generates from several sources. • Data collection obtained from surveillance programs, laboratory services, medical and general communities, and agencies. • Cases reported according to the county of residence, not the place of exposure. • The geographic distribution of cases is highly focused. • About 10% of the disease are underreported.

8. EPIDEMIOLOGY AND SURVEILLANCE (CON’T)

9. RISK FACTORS • Prolong time in wooded or grassy areas • Exposed skin / failure to wear appropriate clothes and shoes • Indoor/outdoor pets • Improper removal of the tick.

10. SIGNS AND SYMPTOMS • Redness, rash like called Erythema migrans (EM) at the infected area. • Swollen lymph nodes, chills, fever, headache, muscles and joints aches, severe fatigue, • Left untreated will result to: Rheumatologic symptoms Cardiac symptoms Neurologic symptoms

11. SIGNS AND SYMPTOMS (Cont) • Facial Paralysis • Bull’s eye rash Arthritis knee

12. DIAGNOSTIC AND TREATMENT • History of exposure to the infected ticks • Signs and symptoms • Blood and CSF testing • Appropriate antibiotics

13. PREVENTION • Management of the environment for tick control. • Education and arise awareness. • Community-based management • Early detection, diagnosis, and treatment for favorable outcome • Dermatologist: skin care and treatment of erythema migrans

14. PREVENTION (Cont.) • Insect repellents in absence of Vaccine • Daily check for ticks after possible exposure • Prompt bath after outdoor activities: camping, walking in the wood, gardening. • Tick removal with tweezers as soon as possible

15. TICK CONTROL • Environmental Management • Chemical control

16. PUBLIC HEALTH INTERVENTION • EDUCATION is crucial • Educate the community, school, parents, and children about the disease and preventive measures. • Adopt the TickNET network program for Lyme disease

17. LYME DISEASE: CHALLENGES • Public health practice: Old guidelines used. • Need for new guidelines for Lyme disease education and prevention information. • Clinical misdiagnosis, and delay in treatment • Prevention: vaccine unavailability • Underreported cases • Inadequate funds • High standards needed regarding safety, efficacy, cost, and public acceptance

18. SKATEBOARDS IMPLICATION • Increase Lyme disease awareness • Prompt surveillance system • Reconsider the use of vaccine • Establish effective testing and diagnosis measures • Guidelines update for school • Promote research

19. AUDIENCE / STAKEHOLDERS • Parents • Health care providers (doctors, nurses, social workers) • Faculty members from schools • Grand Prairie Health Department • Infection Disease Society of America (ISIDA) guidelines • TickNET program

20. CONCLUSION • Lyme disease is caused by bacterium Borreliaburgdorferi. • Rate are highest in children ages 5 to 9. • Relevant to public health due to incidence and prevalence. • Can become a chronic and serious illness if left untreated. • Early diagnostic and antibiotic treatment are essential. • Education and effective prevention measures contribute to disease control. • Prevention efforts focused on combination of efforts and approaches such as management of deer population. • Lyme disease is a multi-faced condition requiring joint efforts and adequate funding for further research.

21. REFERENCE Centers for Disease Control and Prevention (2013). Lyme Disease. http://www.cdc.gov Center for Disease Control and Prevention (2013). Lyme disease: Prevalence. Retrieved from http://www.cdc.gov Center for Disease Control and Prevention (2008). Surveillance for Lyme disease: United States, 1992-2006. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5710a1.htm Centers for Disease Control and Prevention (2013): Sign and symptoms of Lyme Disease. Retrieved from http://www.cdc.gov Health Communities (2014). Lyme Disease overview, Incidence and Prevalence of Lyme Disease. http://www.healthcommunities.com/lyme-disease/overview-of-lyme-disease.shtml Department of Health (2011). Lyme Disease (tick-borne borreliosis, Lyme arthritis). www.health.ny.gov/diseases/communicable/lyme/fact_sheet.htm MayoClinic(2014): Lyme Disease: Tests and Diagnosis. Retrieved from http://www.mayoclinic.org/diseases_condition/lyme_disease/basic/treatment White J. D. (1991). Epidemiology of Lyme disease. The Canadian Journal of Infectious Diseases. V2(2): 58-60 Summer 1991. PMC3327991. Center for Disease Control and Prevention (2013). Lyme Disease : Current Challenges. U.S. Department of Health and Human Services. Retrieved from http://www.cdc.gov Health Communities (2011). Lyme Disease Cause and Risk Factors. Retrieved from http://www.healthcommunities.com/lyme-disease/causes-risk-factors-for-lyme-disease.shtml Shen K. A. et al (2011). The Lyme Disease Vaccine- A Public Health Perspective. Clinical Infectious Diseases Oxford Journals. Retrieved from http://cid.oxfordjournals.org/content/52/suppl_3/s247.long Sobell, J. (2013). Beware! Lyme Disease is Looming! Medical Dermatology. http://www.skincarephysicians.net/medical-dermatology/lymedisease-disease-is-looming Lyme Disease Association (2014). Treatment Guidelines . Lymes: Kids & Schools. www.lymediseasassociation.org