Public Health’s Role in Lyme Disease

Chester County Health Department

Jeanne E. Casner, MPH
chesco.org/health

May 9, 2019
 Our Discussion Today
• Epidemiology/Data Overview
• Role of Public Health
–Federal, State, Local
• Focus on Prevention
National Trend Over 25 Years
Lyme Disease in Pennsylvania
Most commonly reported tickborne
LD disease in PA

All 67 Counties identified as

2015 having blacklegged/deer tick

Nationally ranked highest

#1 confirmed cases for last 7 years
Lyme Disease in Pennsylvania

#1 Nationally with 11,900 confirmed and

probable cases of LD (2017, CDC)

Nationally in LD incidence rate of

#3 93.1 per 100,000 persons (2017)

Typical season is May – September

 Seasonal Trends of Lyme
Count of Lyme Disease Throughout Year
Chester County 2018
160

140

120

100

80

60

40

20

0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Lyme Disease in Chester County
Lyme Disease Cases by Gender
Chester County 2018

Female, 41%

Male, 59%

Total Cases = 676

 Lyme Disease in Chester County
Lyme Disease Cases by Age Group and Gender
Chester County 2018
40
39
38

35

32
Gender - Female
27 Gender - Male
26 26
25

22
20 20
19
18 18 18
17 17
16 16
15 15
14 14
13 13 13 13
12 12 12
10
9 9
7
5

0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-85 >85
Age Group

Total Cases = 676

 Public Health Approach
10 Essential Services of
Public Health

Framework of activities that

communities should undertake for
public health priorities

Lyme disease persists as a growing

health problem that has prompted a
lot of federal, state and local
attention and initiatives.
 Federal Public Health
Focus Areas:
• Epidemiology and Ecology
• Prevention
• Diagnosis
• Treatment
• Access to Care, Patient
Outcomes
 Federal Public Health
Focus Areas:
• Tickborne Diseases in US (12)
o Disease Overview
o Agent
o Where Found
o Incubation Period
o Signs and Symptoms
o Laboratory Findings
o Laboratory Diagnosis
o Treatment
• Tickborne Diseases Aboard
• Tick Bites and Prevention
• Tick Prophylaxis
 Federal Public Health
Top Zoonotic Diseases of National
Concern in US
1. Zoonotic Influenza
2. Salmonellosis
3. West Nile Virus
4. Plague
5. Emerging Coronarviruses
6. Rabies
7. Brucellosis
8. Lyme Disease
April 24, 2019
 Federal Public Health
Cross Sector Collaborations Working Toward:
 Developing better insect repellents
 Evaluating permethrin-treated clothing
 Reducing ticks around homes
 Exploring rodent-targeted vaccines
 Calculating the true cost of Lyme disease
 Discovering new tickborne diseases
 Improving Early and Accurate Diagnosis
 Funding state health departments to improve surveillance and
prevention
 Supporting vector-borne disease Centers of Excellence
 Supporting large-scale prevention research
 Consistent educational materials
Public Health in Pennsylvania
Focus Areas:
• Prevention
• Education & Awareness
• Surveillance
 Public Health in Pennsylvania
Statewide 5-Year Study
• $2.5 million in funding
• Surveillance of ticks in all 67 counties to
track ticks’ habitats, life stages, and
peak activity levels and test them for
diseases (tick drags)
• Case interviews in each county
o Demographics, Symptoms and Treatment,
Lifestyle, Attitudes
o 57 people will be interviewed in Chester
County
 Public Health in Pennsylvania
Legislation
• Require health insurers to cover treatment plans
for Lyme disease regardless if the treatment plan
includes short-term OR long-term antibiotic
treatment
• No healthcare practitioner shall be subject to
disciplinary action solely for
diagnosing and treating Lyme disease
and other tick-borne infections
 Focus on Prevention
Education
Educating
Exposure
physicians, outdoor Control
professionals, and Reducing human
the public exposure to vector
ticks Identifying novel
Transmission
methods for
controlling ticks and Conducting further
tick-borne studies and
pathogens validating strategies
aimed at blocking
the transmission of
tick-borne
pathogens to
humans and
animals.
Chester County’s Focus on Prevention
Education
 Health Educators conduct various outreaches to increase
education and awareness to variety of audiences
- Identification, tick removal, personal protective measures,
household protective measures, messaging, and awareness of
available resources
- Reached 3,700+ individuals through education and awareness
outreach efforts (2018)
 Disease investigators distribute health alerts to physicians
throughout the county with guidance on reporting, testing,
signs/symptoms, etc.
 Active engagement in PA Lyme Disease Awareness Committee
Chester County’s Focus on Prevention

Exposure

 Daily surveillance of all lab reports

- Each lab report is matched with clinical
presentation for case determination
 Deer 4-post stations maintained in key County
parks
 Tick prevention signage in County parks and trails
Chester County’s Focus on Prevention

Control

 Deer 4-post stations maintained in key County

parks
 Local tick drags conducted by Health Department
staff in support of PA DEP study
Chester County’s Focus on Prevention

Transmission

 Attendance at key conferences

 Monitoring research and providing input to State
initiatives
 Active engagement in PA Lyme Disease Awareness
Committee
 Barriers to Prevention

Varying Levels of
Age, Culture,
Knowledge and Up
Gender, Language
Take of Preventive
Factors
Measures

Lack of Personal Perceived Personal

Experience Risk
 Thank You!

Chester County Health Department

Jeanne E. Casner, MPH
chesco.org/health
jcasner@chesco.org