Tag: Lyme disease

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Cottage Life

Ticks in February?

Photo by DuxX/Shutterstock

Mild winter weather may have pet owners itching to hit the trail with their canine companions, but they should be aware that they’re not the only critters taking advantage of warmer than expected temperatures. Some pet owners report that their vets are now recommending keeping their dogs on tick-preventing medication year-round.

We talked to Katie Clow, assistant professor in One Health in the Department of Population Medicine at the Ontario Veterinary College in Guelph for her take. “If it’s above freezing, we should be thinking about ticks,” says Clow.

During the cold winter months, ticks spend most of their time buried down in leaf litter in the forest, says Clow, who helps lead Pets and Ticks. But if there’s limited snow cover and temperatures get warmer, they’re going to crawl out of that layer and come out to feed or at least look for a host, she says.

The general recommendation is that pets be on tick preventatives from April into November, says Clow, which are the months with the highest tick activity. Clow says if pet owners are interested in using tick preventative medication for their animals outside the warmer months, they should have a conversation with their veterinarian. 

Regardless of whether a dog is on tick prevention or not, pet owners can protect their canine companions by checking for ticks following any outdoor time. Clow recommends that owners remove any ticks from their animals as quickly as they can. Owners should use tick pullers or tweezers and make sure to pull the tick directly out of the animal, remove the tick’s mouthpiece in the process. 

Clow also stresses the importance of getting an identification on the removed tick. There are lots of ticks that will feed on dogs, she says. The predominate species to worry about is the backlegged tick, which can carry the bacteria that cause tick-borne illnesses in dogs, including anaplasmosis and Lyme disease. To find out what tick they’ve come across, pet owners can take advantage of eTick.ca, a free public resource where users can submit photos of ticks for identification.

Fact or fiction: Debunking 4 common myths about ticks

Following tick removal, owners should monitor their dogs for symptoms. Clow says to be on the lookout for any signs the dog is not feeling well, such as not eating or being a little sore. Owners can also watch out for any signs of lameness or limping on a certain leg. “These are some of the first signs we see of Lyme disease,” says Clow, adding that they would prompt a visit to the vet right away.

If owners find that they’re repeatedly removing ticks off their dogs, it might be time to reconsider your walking route. “If you seem to be pulling ticks off your dog in certain areas consistently, stay out of those areas when it is peak tick activity: spring, fall, and warm times in the winter,” says Clow. 

For more information on pets and ticks, or to submit reports of tick findings on your pet through the Pet Tick Tracker, visit the Pets and Ticks site. More resources can be found on the Canadian Veterinary Medical Association’s Tick Talk site.

Report card: how effective are these animals at controlling ticks?

 

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Cottage Life

Pfizer and Valneva could soon have a vaccine for Lyme disease

Photo by Erik Karits/Shutterstock

Pharmaceutical companies Pfizer and Valneva are collaborating to create a vaccine designed to protect against tick-borne Lyme disease. The two companies are entering a late-stage clinical trial where they plan to test the vaccine on 6,000 participants.

“With increasing global rates of Lyme disease, providing a new option for people to help protect themselves from the disease is more important than ever,” said Annaliesa Anderson, Pfizer’s head of vaccine research and development, in a statement.

Lyme disease: Interview with a biologist

The companies plan to test the vaccine, known as VLA15, in 50 sites where Lyme disease is “highly endemic”, including Finland, Germany, the Netherlands, Poland, Sweden, and the U.S. Ages of participants will range from five years old and up.

Participants in the trial will receive three doses of either the vaccine or a placebo, plus one booster consisting of a vaccine or placebo.

“Data from the Phase 2 studies continue to demonstrate strong immunogenicity in adults as well as in children, with acceptable safety and tolerability profiles in both study populations,” Pfizer said.

The vaccine works by blocking a protein, known as OspA, in the bacteria that causes Lyme disease. By blocking OspA, the bacterium is unable to leave the tick and infect humans.

Pfizer and Valneva entered into their collaboration in April 2020. If the clinical trials prove successful, Pfizer said it believes it could seek approval from the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) to release the vaccine in the U.S. and Europe by 2025. Considering the FDA’s close partnership with Health Canada, it’s likely the vaccine would be approved in Canada the same year.

This wouldn’t be the first time the FDA has approved a Lyme disease vaccine. In 1998, GlaxoSmithKline released LYMErix, which reduced new infections in vaccinated adults by nearly 80 per cent. But the drug was pulled after three years due to low sales.

Since the 2000s, the number of people affected by Lyme disease has grown. In 2009, Health Canada reported 144 cases of Lyme disease. Case numbers have progressively gotten higher, peaking at 2,851 in 2021. In the U.S., the Centers for Disease Control and Prevention (CDC) estimates that as many as 476,000 Americans are infected with Lyme disease each year.

Lyme disease is spread through the bite of an infected black-legged tick, typically found in areas with high grass or brush. The ticks attach themselves as people pass by, usually migrating to hard-to-see areas, such as the groin, armpits, and scalp. The tick must be attached for 36 to 48 hours for the disease to transfer.

Three simple habits that will help keep you safe from Lyme disease

Signs of infection include fever, chills, headache, fatigue, muscle and joint aches, and swollen lymph nodes. If caught early, Lyme disease can be treated with antibiotics. But if the disease isn’t treated, it could result in facial palsy, arthritis, inflammation of the brain and spinal cord, and heart palpitations known as Lyme carditis.

A number of Canadian celebrities have spoken publicly about their battles with Lyme disease, including singers Justin Bieber and Avril Lavigne.

“Lyme disease continues to spread, representing a high unmet medical need that impacts the lives of many in the Northern Hemisphere,” said Juan Carlos Jaramillo, Valneva’s chief medical officer, in a statement. “We look forward to further investigating the VLA15 candidate in Phase 3, which will take us a step closer to potentially bringing this vaccine to both adults and children who would benefit from it.”

Categories
Cottage Life

Three diseases carried by ticks, and how to stay safe

Move over black flies. Growing tick populations and the diseases they carry are turning these critters into public enemy number one for those who love to be in the outdoors.

“Tick ranges are expanding with the increase in favourable climatic conditions, including warmer temperatures, that permit tick survival and the establishment of reproducing tick populations in more regions,” says Roman McKay, Project Manager for UPTick Research Project, a three-year study examining how urban changes affect human risk for tick-borne diseases from the University of Ottawa.

“Warming temperatures can also extend tick’s active season, allowing them to reproduce and colonize more rapidly.”

Three medical conditions carried by ticks

Cottagers should be aware that there are a number of diseases carried by ticks. Here are three on the radars of researchers:

1. Lyme disease

Lyme disease is caused by the bacterium Borellia burgdorferi. This bacteria is spread to humans through the bites of ticks from the genus Ixodes; in eastern North American the host tick is mainly Ixodes scapularis, better known as the blacklegged tick. In western North America the bacterium is commonly spread by Ixodes pacificus, or the western blacklegged tick.

“The most well-known early sign of Lyme disease infection is a ‘bulls-eye’ or erythema migraines rash, which occurs in approximately seventy percent of infected people,” writes McKay. “It begins at the site of a tick bite in about seven days, and then expands gradually over several days reaching up to thirty centimetres or more across.”

2. Babesiosis

Babesiosis is an infectious disease that affects red blood cells. It is caused by a single-celled parasites called Babesia. Like the bacterium that cause Lyme disease, Babesia parasites can be spread through the bite of infected Ixodes ticks, including Ixodes scapularis, otherwise known as the black-legged tick.

Babesiosis symptoms generally start one to eight weeks following contact with the parasite. Patients may or may not show signs of infection, but symptoms to watch out for include body aches, chills, fatigue, and fever.

Babesiosis is diagnosed through laboratory testing. Because the infection is caused by a parasite, treatment commonly requires use of both anti-parasitic drugs and antibiotics.

What blacklegged ticks look like, and where they’ve been seen:


Courtesy etick.ca

black-legged tick

Where has the black-legged tick been observed? Click link below to see the up-to-date Ixodes scapularis observation map. 

Courtesy etick.ca

I. scapularis female, not engorged

I. scapularis female, not engorged, found in Forêt, Saint-Hippolyte, QC

Courtesy etick.ca

Blacklegged tick on a human

Tick found in Cours arriere, Neuville, QC

Courtesy etick.ca

Non-engorged female blacklegged tick, with ruler for scale

Blacklegged tick, found Cours arriere, Neuville, QC

Courtesy etick.ca

Ixodes scapularis (blacklegged tick)

Engorged I. scapularis female found in Ilderton, ON

Courtesy etick.ca

Engorged female blacklegged tick

Engorged I. scapularis female, found in Saint-Samuel, QC.

Courtesy etick.ca

Blacklegged tick nymph

Blacklegged tick nymph found in Sherebrooke, QC. These are often the most most dangerous medically speaking simply because they are much easier to miss during tick checks due to their smaller size.

Where has the black-legged tick been reported? 

 

3. Alpha-gal syndrome (AGS)

Alpha-gal syndrome is a food allergy to red meat. There is mounting evidence that AGS can be triggered by the bite of Amblyomma americanum, or the lone star tick.

Symptoms of alpha-gal syndrome occur after ingestion of red meat, and it’s worth noting that dairy and gelatin products can also provoke a reaction. A range of allergic responses can occur, from hives and facial swelling, to stomach upset and vomiting, to life-threatening anaphylaxis. Symptoms of anaphylaxis, including having difficulty breathing, indicate that emergency medical treatment is required.

 

What lone star ticks look like, and where they’ve been seen:

 


Courtesy etick.ca

Lone star tick map

Click on link below to see the up-to-date version of this screenshot.

Courtesy etick.ca

Unengorged female lone star tick

Unengorged female lone star tick found in Norfolk, ON.

Courtesy etick.ca

Unengorged female lone star tick

This tick was found in a farm yard in Battle River, SK, after petting a dog.

2502 Brant County ON

Courtesy etick.ca

Unengorged female lone star tick

Lone star tick found in Montréal, Quebec.

Courtesy etick.ca

Partially engorged female lone star tick

Found on on Jackson Creek Trail, Peterborough, ON

Click here to link to the up-to-date observation map for the lone star tick on etick.ca.

How to stay safe

With more ticks on the move, cottagers and other outdoor enthusiasts should take extra precautions to stay safe. McKay says that people can prevent tick bites by covering up when outdoors: wear long pants and shirts and shoes with socks. Use approved insect repellents that contain DEET or icaridin to keep ticks at bay, and always do a full body ‘tick check’ on yourself, children, and pets when coming in from the outdoors.

McKay adds that there are simple landscaping people can use to reduce tick populations around their properties, such as keeping grass mowed short. He also recommends that homeowners focus on the edges of their properties by removing brush and fallen leaves, and even creating a one-metre barrier of wood chips or rock to separate lawns from surrounding woodland.

Get involved

Cottagers who want to report sightings of ticks are encouraged to do so using the eTick mobile app. It provides a public platform for image-based identification and population monitoring of ticks in Canada.

Note that the eTick map shows locations in Canada where ticks have been observed and submitted to the eTick platform. This is not a risk map for tick-borne illnesses but rather a map that displays where ticks have been observed by Canadians. The data points are aggregated but zooming in to specific areas will allow you to see where specifically ticks were found. You can also click on individual points to see the submission information such as the tick species and when it was observed. Note that a maximum of 20000 points can be loaded at once and we suggest using date, province and/or species filters to maximize the number of points loaded in an area of interest.

Categories
Cottage Life

Tick talk: Ontario Lyme Disease Map 2022

Photo by Public Health Ontario

Are you heading to the cottage and thinking about visiting parks and wooded areas? Maybe you fancy going hiking, golfing, hunting, camping, bird-watching, or fishing. Before you jump into this season’s fun, stay safe by checking out Ontario’s annual Lyme Disease Map for 2022: Estimated Risk Areas. The map highlights common high-risk areas, where blacklegged ticks (ticks that have the potential to carry the bacteria causing Lyme disease) are typically found. Many popular cottage spots are on the map.

What exactly is the Ontario Lyme disease map?

The Ontario Lyme disease map is released annually by Public Health Ontario in an effort to assist public health professionals and clinicians to make informed decisions on testing and treatment. According to Public Health Ontario, the risk areas are calculated “as a 20 km radius from the centre of the location where blacklegged ticks were found through drag sampling.” Drag sampling is a surveillance method which involves dragging a white flannel cloth over vegetation to determine if ticks are present. Public Health Ontario decides where to conduct drag sampling based on historical location data of black-legged ticks, assessment of exposure from local human Lyme disease cases, and evidence of  suitable tick habitat. Drag sampling is completed over a three-hour period between May and October where ticks have previously been found, and is conducted twice a year where ticks have not been previously found.

If I’m not in a high-risk area, can I still encounter a blacklegged tick?

You may encounter an infected blacklegged tick almost anywhere in Ontario. They thrive alongside forest edges and in shrubs, leaf litter, wood piles, and long grass. These ticks also feed on and can be transported by migratory birds. The map is not intended to be a fulsome list of where black-legged ticks are found in Ontario, but rather to highlight high-risk exposure locations. 

Is the problem getting worse?

While there is an uptick in trends of Lyme disease for all ages and sexes, according to Public Health Ontario, there was a decrease in cases from 2019 to 2020 (the last year of trend data) in Ontario. Moving to the broader Canadian scale, reported cases of Lyme disease did rise from 1,615 in 2019, to a preliminary case count of 2,851 in 2021. 

Lyme disease rates and cases for all ages for all sexes in Ontario
Photo by Public Health Ontario

There is minor variation in comparing the Ontario Lyme disease maps between the years of 2019-2022, however, similar estimated risk areas have been identified. 

Follow these three simple tips to help protect yourself against Lyme Disease.

Categories
Cottage Life

Lyme carditis: when Lyme disease affects heart function

Lyme disease is a tick-born infection caused by bacteria known as Borrelia burgdorferi. Lyme carditis is an early manifestation of Lyme disease that can occur two to six weeks after the tick bite.

Approximately five to 10 per cent of patients presenting to family doctors’ clinics or emergency departments with symptoms of Lyme disease may develop Lyme carditis. The prevalence of Lyme disease in Canada continues to increase year after year. Nearly 2,700 people were diagnosed with Lyme disease in 2019, but the number of reported cases may not reflect the actual number of cases.

How Lyme carditis affects the heart

Lyme carditis most commonly manifests as high-degree atrioventricular block: a complete shut-down of the electrical system of the heart that can evolve rapidly over minutes, hours or days, producing severe symptoms like fainting, extreme dizziness or sudden death.

Less frequently, other serious cardiovascular manifestations may be present, such as:

  • sinus node disease, marked by alterations to the heart’s “motor” or natural pacemaker,
  • atrial fibrillation, which is a disorganization of the cardiac rhythm that increases the risk of stroke,
  • bundle branch blocks, or lesions in the distal cables of the heart that can interrupt electrical impulses, and
  • myocarditis, pericarditis or endocarditis, which are different degrees of inflammation of the layers of the cardiac walls.

Some of these manifestations can be so severe that total cardiac dysfunction may rapidly occur, and the patient may die despite medical efforts. Sometimes a heart transplant is the only option.

Diagnosing and treating Lyme carditis

The initial symptoms of Lyme disease can be mistaken for other common infections or allergic reactions. Delayed diagnosis and delayed initiation of proper treatment can lead to serious Lyme disease presentations including Lyme carditis in all its forms.

We need ongoing education at all levels (medical and nursing schools, community, governments) to close the gap in knowledge and ensure all participants in the health-care system aware of this preventable condition.

The good news is that prompt diagnosis and appropriate antibiotic therapy leads to a much better prognosis. Lyme carditis responds very effectively to treatment, completely eliminating the cardiac manifestations, with a very favourable prognosis in both short- and long-term followup. We now know that when antibiotics are used according to guidelines, the prognosis two years after the infection reveals no residual disease in the heart.

It is important to remember that most heart conduction abnormalities caused by Lyme carditis resolve with appropriate antibiotic therapy without requiring the implantation of permanent pacemakers. As most patients presenting with Lyme carditis are young and otherwise healthy, any medical strategy that could prevent the need to implant a pacemaker for the rest of their lives is welcomed.

Confirming Lyme disease in the age of COVID-19

The current COVID-19 pandemic is posing a new challenge in the diagnosis of Lyme disease. The two conditions have a lot of overlapping symptoms, such as fever, malaise, generalized pain and lack of energy. During these times, it’s advisable to rule out COVID-19 first before embarking on any other test.

Asking focused questions about personal lifestyle may help guiding the diagnosis of Lyme disease. Some key questions include:

Skin examinations and ECGs

Thorough dermatological examination can clarify difficult cases. This happened in my clinic recently, when a nurse practitioner decided to run a full skin examination and discovered typical bull’s-eye rashes on the patient’s back.

Once the diagnosis is suspected, cardiovascular symptoms such as dizziness, palpitations, fainting or near fainting, chest pain and shortness of breath should be investigated. If the patient reports any of these symptoms, along with any other factors suggesting Lyme disease, a 12-lead ECG (the simple and inexpensive electrocardiogram) should be performed.

Quite recently, a team from the United States did 12-lead ECG to a large series of pediatric patients presenting to the emergency department with high-suspicion of Lyme disease, and discovered that nearly 30 per cent of them had some conduction disturbance. Any evidence of electrical disturbance should prompt admission in hospital for a course of intravenous antibiotics while waiting the results of serological tests.

From the other perspective, any patient presenting with unexpected high-degree atrioventricular block (full electrical shut down of the electrical system of the heart), the way to test for Lyme carditis is by running a risk score called SILC (Suspicious Index in Lyme Carditis), which was developed at Queen’s University and is now used worldwide.

SILC score is based on the risk factor acronym COSTAR (Constitutional symptoms, Outdoor activities/endemic region, Sex male, Tick bite, Age < 50, Rash), which may help in determining the likelihood of early Lyme carditis.

We need to keep teaching and learning about Lyme carditis. In addition to ongoing education, curricula in medical and nursing schools should be updated immediately to be sure that all new health-care providers are trained in the rapid recognition of this condition. When to order serological tests, how to check for cardiovascular symptoms and the value of the 12-lead ECG are all important steps in the management of Lyme carditis.

The effort to eradicate Lyme disease should involve physicians and nurses, patients and families, rigorous science and political decisions for sound policy implementation.The Conversation

 

This article by Adrian Baranchuk, Professor of Medicine, Queen’s University, Ontario, is republished from The Conversation under a Creative Commons license. Read the original article.