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R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA 1
11Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
The Lyme Disease Association of Southeastern Pennsylvania, Inc. The Lyme Disease Association of Southeastern Pennsylvania, Inc.
(LDASEPA), an all volunteer non(LDASEPA), an all volunteer non--profit 501(c)3 organization, isprofit 501(c)3 organization, is
intended as a resource for individuals interested in learning intended as a resource for individuals interested in learning
about Lyme disease and other tickabout Lyme disease and other tick--borne diseases. borne diseases.
SE PASE PA
New CastleNew Castle
County, DECounty, DE
Cecil County,Cecil County,
MDMD
22Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
The most common insect-borne
disease in the US
Lyme diseaseLyme disease……A little bite to A little bite to
possible major consequencespossible major consequences
Key components
33Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
The most common insect-borne
disease in the US
Key components
deer deer ticktick
Lyme diseaseLyme disease……A little bite to A little bite to
possible major consequencespossible major consequences
44Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
spirochetespirochete
The most common insect-borne
disease in the US
Key components
deer deer ticktick
Lyme diseaseLyme disease……A little bite to A little bite to
possible major consequencespossible major consequences
55Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
spirochetespirochete
spirochetespirochetereservoirsreservoirs
The most common insect-borne
disease in the US
Key components
deer deer ticktick
Lyme diseaseLyme disease……A little bite to A little bite to
possible major consequencespossible major consequences
66Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
spirochetespirochete
spirochetespirochetereservoirsreservoirs
deer tick deer tick reproduction reproduction (primary) (primary) & dispersal& dispersal
The most common insect-borne
disease in the US
Key components
deer deer ticktick
Lyme diseaseLyme disease……A little bite to A little bite to
possible major consequencespossible major consequences
R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA 2
77Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
spirochetespirochete
spirochetespirochetereservoirsreservoirs
The most common insect-borne
disease in the US
Key components
deer deer ticktick
Lyme diseaseLyme disease……A little bite to A little bite to
possible major consequencespossible major consequences
deer tick deer tick reproduction reproduction (primary) (primary) & dispersal& dispersal
populationgrowth
88Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
spirochetespirochete
our desireour desireto live in to live in previous previous
deer habitat,deer habitat,““residentialresidentialdevelopmentdevelopment””
spirochetespirochetereservoirsreservoirs
The most common insect-borne
disease in the US
Key components
deer deer ticktick
Lyme diseaseLyme disease……A little bite to A little bite to
possible major consequencespossible major consequences
deer tick deer tick reproduction reproduction (primary) (primary) & dispersal& dispersal
populationgrowth
99Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
�� SymptomsSymptoms
�� The microbe The microbe ““spirochetespirochete””
�� Lyme disease dilemmasLyme disease dilemmas
�� Endemic regions/ages at riskEndemic regions/ages at risk
�� Infection incidence (CDC)Infection incidence (CDC)
�� Ticks/risk of being bittenTicks/risk of being bitten
�� Protection practicesProtection practices
The most common insect-borne
disease in the US
Key components
Lyme diseaseLyme disease……A little bite to A little bite to
possible major consequencespossible major consequences
1010
SymptomsSymptoms……more than a rash!more than a rash!
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
deer tick
“classic” rash, but any rash is suspect
can be hidden!
1111
SymptomsSymptoms……more than a rash!more than a rash!
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
deer tick
“classic” rash, but any rash is suspect
can be hidden!
only 50-60% of patients report a rash!
1212
SymptomsSymptoms……more than a rash!more than a rash!
�� FluFlu--like symptomslike symptoms…fever, chills (May, June, July)
�� FatigueFatigue…unrelenting
�� Musculoskeletal pain, arthritisMusculoskeletal pain, arthritis…severe
�� Heart, eye, hearing & GIHeart, eye, hearing & GI…serious
�� Neurologic symptomsNeurologic symptoms…headache, stiff-neck, balance, facial paralysis,
cognitive impairment, sleep disturbance, nightmares, hyper-sensitivities
�� Neuropsychiatric symptomsNeuropsychiatric symptoms…depression, anxiety, panic attacks, suicide, oppositional, ADHD, and possibly ASD behavior (children)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
deer tick
“classic” rash, but any rash is suspect
can be hidden!
only 50-60% of patients report a rash!
R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA 3
1313
SymptomsSymptoms……more than a rash!more than a rash!
�� FluFlu--like symptomslike symptoms…fever, chills (May, June, July)
�� FatigueFatigue…unrelenting
�� Musculoskeletal pain, arthritisMusculoskeletal pain, arthritis…severe
�� Heart, eye, hearing & GIHeart, eye, hearing & GI…serious
�� Neurologic symptomsNeurologic symptoms…headache, stiff-neck, balance, facial paralysis,
cognitive impairment, sleep disturbance, nightmares, hyper-sensitivities
�� Neuropsychiatric symptomsNeuropsychiatric symptoms…depression, anxiety, panic attacks, suicide, oppositional, ADHD, and possibly ASD behavior (children)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
deer tick
“classic” rash, but any rash is suspect
can be hidden!
only 50-60% of patients report a rash!
Bell’s palsy
1414
SymptomsSymptoms……more than a rash!more than a rash!
�� FluFlu--like symptomslike symptoms…fever, chills (May, June, July)
�� FatigueFatigue…unrelenting
�� Musculoskeletal pain, arthritisMusculoskeletal pain, arthritis…severe
�� Heart, eye, hearing & GIHeart, eye, hearing & GI…serious
�� Neurologic symptomsNeurologic symptoms…headache, stiff-neck, balance, facial paralysis,
cognitive impairment, sleep disturbance, nightmares, hyper-sensitivities
�� Neuropsychiatric symptomsNeuropsychiatric symptoms…depression, anxiety, panic attacks, suicide, oppositional, ADHD, and possibly ASD behavior (children)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
deer tick
“classic” rash, but any rash is suspect
can be hidden!
only 50-60% of patients report a rash!
Bell’s palsy
diverse and fluctuating symptoms!diverse and fluctuating symptoms!
1515
SymptomsSymptoms……children in schoolchildren in school
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Dozing in class, missing class due to tiredness
1616
SymptomsSymptoms……children in schoolchildren in school
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Dozing in class, missing class due to tiredness
Difficulty seeing and following visually presented material, frequent blinking or tics, inability to coordinate
eye movement
1717
SymptomsSymptoms……children in schoolchildren in school
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Dozing in class, missing class due to tiredness
Difficulty seeing and following visually presented material, frequent blinking or tics, inability to coordinate
eye movement
Thinking sluggishness,slowness of word
retrieval
1818
SymptomsSymptoms……children in schoolchildren in school
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Dozing in class, missing class due to tiredness
Difficulty seeing and following visually presented material, frequent blinking or tics, inability to coordinate
eye movement
Thinking sluggishness,slowness of word
retrieval
Poor frustration management,aggression, explosive outbursts,
irritability, hyperactivity
R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA 4
1919
SymptomsSymptoms……children in schoolchildren in school
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Dozing in class, missing class due to tiredness
Difficulty seeing and following visually presented material, frequent blinking or tics, inability to coordinate
eye movement
Thinking sluggishness,slowness of word
retrieval
Poor frustration management,aggression, explosive outbursts,
irritability, hyperactivity
Inability to perform previously mastered tasks
2020
SymptomsSymptoms……children in schoolchildren in school
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Dozing in class, missing class due to tiredness
Difficulty seeing and following visually presented material, frequent blinking or tics, inability to coordinate
eye movement
Thinking sluggishness,slowness of word
retrieval
Poor frustration management,aggression, explosive outbursts,
irritability, hyperactivity
Short-term sequential or spatial memory deficit
Inability to perform previously mastered tasks
2121
SymptomsSymptoms……children in schoolchildren in school
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Dyslexic-like behaviors, poor reading comprehension
and handwriting skill
2222
SymptomsSymptoms……children in schoolchildren in school
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Dyslexic-like behaviors, poor reading comprehension
and handwriting skillInability to activate or sustain effort and attention
2323
SymptomsSymptoms……children in schoolchildren in school
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Dyslexic-like behaviors, poor reading comprehension
and handwriting skillInability to activate or sustain effort and attention
Inconsistent or sloppyschool work, late assignments, decline in grades, overwhelmed
by schoolwork
2424
SymptomsSymptoms……children in schoolchildren in school
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Dyslexic-like behaviors, poor reading comprehension
and handwriting skillInability to activate or sustain effort and attention
Missed school days, school phobia
Inconsistent or sloppyschool work, late assignments, decline in grades, overwhelmed
by schoolwork
R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA 5
2525
SymptomsSymptoms……children in schoolchildren in school
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Dyslexic-like behaviors, poor reading comprehension
and handwriting skillInability to activate or sustain effort and attention
Withdrawal from peers or shift to a lower functioning group,
cessation of involvement in sportsor other extra-curricular activities
Missed school days, school phobia
Inconsistent or sloppyschool work, late assignments, decline in grades, overwhelmed
by schoolwork
2626Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
The microbeThe microbe……Borrelia burgdorferiBorrelia burgdorferi
SpirocheteSpirochete…related to ”syphilis”Several physical formsSeveral physical forms
Genetically complexGenetically complex
2727Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
The microbeThe microbe……Borrelia burgdorferiBorrelia burgdorferi
SpirocheteSpirochete…related to ”syphilis”Several physical formsSeveral physical forms
Genetically complexGenetically complex
SystemicSystemic
Evades immune responseEvades immune response
2828Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
The microbeThe microbe……Borrelia burgdorferiBorrelia burgdorferi
�� A mechanism to evade immune response: A mechanism to evade immune response:
““cyclic change in spirochete antigen expressioncyclic change in spirochete antigen expression””
infection
relapserelapse
immuneresponsestarts
initialimmuneresponseevaded
2nd
responsestarts
illnessseverity
2nd
immuneresponseevaded
3nd
responsestarts
2929Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
The microbeThe microbe……Borrelia burgdorferiBorrelia burgdorferi
SpirocheteSpirochete…related to ”syphilis”Several physical formsSeveral physical forms
Genetically complexGenetically complex
SystemicSystemic
Evades immune responseEvades immune response
Invades cells &Invades cells &
the central nervous systemthe central nervous system
3030Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
The microbeThe microbe……Borrelia burgdorferiBorrelia burgdorferi
SpirocheteSpirochete…related to ”syphilis”Several physical formsSeveral physical forms
Genetically complexGenetically complex
SystemicSystemic
Evades immune responseEvades immune response
Invades cells &Invades cells &
the central nervous systemthe central nervous system
Transmitted by a deer tickTransmitted by a deer tick
(other biting insects, blood, across placenta, & sexual contact?)
R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA 6
3131
Lyme diseaseLyme disease……dilemmasdilemmas
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Public and physicians arePublic and physicians are
not sufficiently informednot sufficiently informed
3232
Lyme diseaseLyme disease……dilemmasdilemmas
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Public and physicians arePublic and physicians are
not sufficiently informednot sufficiently informed Lab tests are inadequateLab tests are inadequate(physician default)
3333
Lyme diseaseLyme disease……dilemmasdilemmas
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Public and physicians arePublic and physicians are
not sufficiently informednot sufficiently informed
MisdiagnosisMisdiagnosis…flu, spider bite, ADD, CFS, FM, MS, ALS, Parkinson’s and Alzheimer’s disease
Lab tests are inadequateLab tests are inadequate(physician default)
3434
Lyme diseaseLyme disease……dilemmasdilemmas
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Public and physicians arePublic and physicians are
not sufficiently informednot sufficiently informed
MisdiagnosisMisdiagnosis…flu, spider bite, ADD, CFS, FM, MS, ALS, Parkinson’s and Alzheimer’s disease
Lab tests are inadequateLab tests are inadequate(physician default)
Missed coMissed co--infectionsinfections…(Babesia, Bartonella,
Ehrlichia, Anaplasma, etc.
3535
CoCo--infectionsinfections
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
�� BabesiaBabesia (Babesiosis)(Babesiosis)…malaria-like parasite; infection of red-blood cells; chills, fatigue, night sweats (drenching), spaciness sense,
depression, headache, muscle pain
�� BartonellaBartonella (Bartonellosis)(Bartonellosis)…bacterium; cat scratch fever; agitated fatigue, insomnia, sweats, headaches, anxiety, panic, agitation, rage, aggression, confusion, (CNS > Lyme symptoms), heel pain, gastritis, red stretch-like marks
�� Ehrlichia/AnaplasmaEhrlichia/Anaplasma (Ehrlichiosis/Anaplasmosis)(Ehrlichiosis/Anaplasmosis)…rickettsial bacterium; similar to Lyme symptoms, except violent headaches and high fever
3636
Lyme diseaseLyme disease……dilemmasdilemmas
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Public and physicians arePublic and physicians are
not sufficiently informednot sufficiently informed
MisdiagnosisMisdiagnosis…flu, spider bite, ADD, CFS, FM, MS, ALS, Parkinson’s and Alzheimer’s disease
Lab tests are inadequateLab tests are inadequate(physician default)
No vaccineNo vaccine(LYMErix™
hla-dr4 gene?)
Missed coMissed co--infectionsinfections…(Babesia, Bartonella,
Ehrlichia, Anaplasma, etc.
R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA 7
3737
Lyme diseaseLyme disease……dilemmasdilemmas
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Public and physicians arePublic and physicians are
not sufficiently informednot sufficiently informed
ShortShort--term antibiotic term antibiotic
treatment failurestreatment failures
No vaccineNo vaccine(LYMErix(LYMErix™™
hlahla--dr4 gene?)dr4 gene?)
MisdiagnosisMisdiagnosis…flu, spider bite, ADD, CFS, FM, MS, ALS, Parkinson’s and Alzheimer’s disease
Lab tests are inadequateLab tests are inadequate(physician default)
Missed coMissed co--infectionsinfections…(Babesia, Bartonella,
Ehrlichia, Anaplasma, etc.
3838
Lyme diseaseLyme disease……dilemmasdilemmas
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Public and physicians arePublic and physicians are
not sufficiently informednot sufficiently informed
ShortShort--term antibiotic term antibiotic
treatment failurestreatment failures
MisdiagnosisMisdiagnosis…flu, spider bite, ADD, CFS, FM, MS, ALS, Parkinson’s and Alzheimer’s disease
Lab tests are inadequateLab tests are inadequate(physician default)
ControversyControversy…medical/political (antibiotic treatment duration & chronic infection)
No vaccineNo vaccine(LYMErix(LYMErix™™
hlahla--dr4 gene?)dr4 gene?)
Missed coMissed co--infectionsinfections…(Babesia, Bartonella,
Ehrlichia, Anaplasma, etc.
3939
Endemic regions & ages at risk Endemic regions & ages at risk Centers for Disease Control (CDC)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
CDC surveillance criteria record only ~1 out of 10 casesCDC surveillance criteria record only ~1 out of 10 cases
32
1
~95% of cases
hyper-
endem
ic
region
:
4040
Endemic regions & ages at risk Endemic regions & ages at risk Centers for Disease Control (CDC)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
CDC surveillance criteria record only ~1 out of 10 casesCDC surveillance criteria record only ~1 out of 10 cases
32
1
~95% of cases
cases of Lyme Disease, 1991cases of Lyme Disease, 1991--2005 2005
> 20,000 cases/yr reported
hyper-
endem
ic
region
:
4141
Endemic regions & ages at risk Endemic regions & ages at risk Centers for Disease Control (CDC)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
CDC surveillance criteria record only ~1 out of 10 casesCDC surveillance criteria record only ~1 out of 10 cases
32
1
~95% of cases
cases of Lyme Disease, 1991cases of Lyme Disease, 1991--2005 2005
> 20,000 cases/yr reported
children/teenagers outdoor adult population
hyper-
endem
ic
region
:
4242
Endemic regions & ages at risk Endemic regions & ages at risk Centers for Disease Control (CDC)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
CDC surveillance criteria record only ~1 out of 10 casesCDC surveillance criteria record only ~1 out of 10 cases
32
1
~95% of cases
hyper-
endem
ic
region
:
cases of Lyme Disease, 1991cases of Lyme Disease, 1991--2005 2005
> 20,000 cases/yr reported
children/teenagers outdoor adult population
ages of individuals
from whom deer ticks
were removed
R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA 8
4343Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
LD survey of Cecil County, 21921 zip code LD survey of Cecil County, 21921 zip code & Pocopson Township, Chester County, PA& Pocopson Township, Chester County, PA
4444Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
23 (23)
84 (34)
103 (16)
554/675 (84)
Cecil County 21921 zip code
68 (31)
164 (48)
211 (21)
795/1006(79)
Pocopson Township
Individuals (%) reporting post-treatment
symptoms
Households (%) with member(s) with LD
Individuals (%)
diagnosed with LD
Individuals(%) NOTdiagnosed with LDSurvey site
LD survey of Cecil County, 21921 zip code LD survey of Cecil County, 21921 zip code & Pocopson Township, Chester County, PA& Pocopson Township, Chester County, PA
4545Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
2006 CDC 2006 CDC ““surveillancesurveillance””Lyme disease cases (19,931)Lyme disease cases (19,931)
*cases per 100,00 population (8% US average)*cases per 100,00 population (8% US average)
5555-289New Castle County
565610478DE
6363-63Cecil County
222271,248MD
102102-~550Chester County
262623,242PA
Incidence*Incidence*RankRankCasesCasesState/CountyState/County
CDC surveillance criteria record only ~1 out of 10 casesCDC surveillance criteria record only ~1 out of 10 cases
4646Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
2006 CDC 2006 CDC ““surveillancesurveillance””Lyme disease cases (19,931)Lyme disease cases (19,931)
*cases per 100,00 population (8% US average)*cases per 100,00 population (8% US average)
Lyme disease was ~8X the number of U.S. West Nile cases!Lyme disease was ~8X the number of U.S. West Nile cases!
CDC surveillance criteria record only ~1 out of 10 casesCDC surveillance criteria record only ~1 out of 10 cases
5555-289New Castle County
565610478DE
6363-63Cecil County
222271,248MD
102102-~550Chester County
262623,242PA
Incidence*Incidence*RankRankCasesCasesState/CountyState/County
4747Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
2007 provisional CDC 2007 provisional CDC ““surveillancesurveillance””Lyme disease cases (20,599)Lyme disease cases (20,599)
*cases per 100,00 population (8% US average)*cases per 100,00 population (8% US average)
Lyme disease was ~8X the number of U.S. West Nile cases!Lyme disease was ~8X the number of U.S. West Nile cases!
CDC surveillance criteria record only ~1 out of 10 casesCDC surveillance criteria record only ~1 out of 10 cases
55>?55>?--NC County
56>8256>8210>9482 > 697DE
63>?63>?--Cecil County
22>4122>417>31,248 > 2298MD
102>111102>111--Chester County
26>3826>382>13,242 > 4,666PA
Incidence*Incidence*RankRankCases Cases ’’06>06>’’0707State/CountyState/County
4848
Residential development impactResidential development impact……increase in infected ticksincrease in infected ticks
Low-? (migratory/feeders)Birds (~ground feeding)
Low White-tailed deer**
LowRed and grey squirrel**
LowStriped skunk**
LowOpossum**
LowRaccoon**
Very highVery highShrewsShrews
Very highVery highEastern chipmunkEastern chipmunk
Very highVery highWhiteWhite--footed mousefooted mouse
Ability to transmit the
Lyme disease spirochete
Species
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
*high numbers of ticks, but poor transmitters = dilution effect
R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA 9
4949
Ticks & risk of being bittenTicks & risk of being bitten
adultnymph (poppy seed size)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Deer tickIxodes scapularis
adult females
deer tick
STARILymedisease
5050
Ticks & risk of being bittenTicks & risk of being bitten
adultnymph (poppy seed size)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Deer tickIxodes scapularis
adult females
deer tick
STARILymedisease
5151
Ticks & risk of being bittenTicks & risk of being bitten
adultnymph (poppy seed size)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Deer tickIxodes scapularis
adult females
deer tick
Lymedisease
engorged deer tick
female laying eggs
5252
Ticks & risk of being bittenTicks & risk of being bitten
adultnymph (poppy seed size)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Deer tickIxodes scapularis
adult females
deer tick lone star tick
Lymedisease
engorged deer tick
female laying eggs
STARI
larvalmassattack
5353
Ticks & risk of being bittenTicks & risk of being bitten
adultnymph (poppy seed size)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Deer tickIxodes scapularis
adult females
deer tick lone star tick
Lymedisease
engorged deer tick
female laying eggs
STARI
tick salivatick saliva……immunosuppressorsimmunosuppressorsprotects spirochete protects spirochete
larvalmassattack
5454
Ticks & risk of being bittenTicks & risk of being bitten
adultnymph (poppy seed size)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Deer tickIxodes scapularis
adult females
deer tick lone star tick
Lymedisease
Increasing risk of being bitten
Risk:
anytime
~28° F
nymphs
adults
adults
engorged deer tick
female laying eggs
STARI
tick salivatick saliva……immunosuppressorsimmunosuppressorsprotects spirochete protects spirochete
larvalmassattack
R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA 10
5555
Ticks & risk of being bittenTicks & risk of being bitten
adultnymph (poppy seed size)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Deer tickIxodes scapularis
adult females
deer tick lone star tick
Lymedisease
Increasing risk of being bitten
Risk:
anytime
~28° F
nymphs
adults
adults
How long must an How long must an
infected tick be infected tick be
attached for attached for
transmission?transmission?
engorged deer tick
female laying eggs
STARI
tick salivatick saliva……immunosuppressorsimmunosuppressorsprotects spirochete protects spirochete
larvalmassattack
5656
Ticks & risk of being bittenTicks & risk of being bitten
adultnymph (poppy seed size)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Deer tickIxodes scapularis
adult females
deer tick lone star tick
Lymedisease
Increasing risk of being bitten
Risk:
anytime
~28° F
nymphs
adults
adults
tick salivatick saliva……immunosuppressorsimmunosuppressorsprotects spirochete protects spirochete
How long must an How long must an
infected tick be infected tick be
attached for attached for
transmission?transmission?
~24~24--36 hours?36 hours?difficult in most cases to difficult in most cases to
determine the length of time determine the length of time from bite to detection!from bite to detection!
engorged deer tick
female laying eggs
STARI
larvalmassattack
5757
Life of a deer tickLife of a deer tick……2 years, 4 stages, and 3 bites2 years, 4 stages, and 3 bites
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
eggs larvae
Year 1
Spring Summer Spring Fall/winterSummerFall/winter
change to nymph,
over-winter
miceChipmunks(reservoir)
1st bite
hatch
5858
Life of a deer tickLife of a deer tick……2 years, 4 stages, and 3 bites2 years, 4 stages, and 3 bites
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
eggs larvae adults
Year 1 Year 2
3rd bite
♀♀♀♀
Spring Summer Spring Fall/winterSummerFall/winter
change to nymph,
over-winter
miceChipmunks(reservoir)
poppy seed size
1st bite nymphs
hatch
2nd bite
micecatsdogs
humans
3-5 daysattached
deer primary reproductive host
majority of cases reported: May-June
deer, etc.humans
5959
Life of a deer tickLife of a deer tick……2 years, 4 stages, and 3 bites2 years, 4 stages, and 3 bites
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
eggs larvae adults
Year 1 Year 2
3rd bite
♀♀♀♀
Spring Summer Spring Fall/winterSummerFall/winter
change to nymph,
over-winter
female over-winters
miceChipmunks(reservoir)
poppy seed size
1st bite nymphs
hatch
2nd bite
3-5 daysattached
deer primary reproductive host
majority of cases reported: May-June
deer, etc.humans
~2,000 eggs
micecatsdogs
humans
6060
Life of a deer tickLife of a deer tick……2 years, 4 stages, and 3 bites2 years, 4 stages, and 3 bites
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
eggs larvae adults
Year 1 Year 2
3rd bite
♀♀♀♀
Spring Summer Spring Fall/winterSummerFall/winter
change to nymph,
over-winter
miceChipmunks(reservoir)
poppy seed size
1st bite nymphs
hatch
2nd bite
3-5 daysattached
deer primary reproductive host
majority of cases reported: May-June
deer, etc.humans
95% of the tick’s life is on the ground, in leaf litter, on grass, etc!
~2,000 eggs
female over-winters
micecatsdogs
humans
R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA 11
6161
Life of a deer tickLife of a deer tick……2 years, 4 stages, and 3 bites2 years, 4 stages, and 3 bites
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
eggs larvae adults
Year 1 Year 2
3rd bite
♀♀♀♀
Spring Summer Spring Fall/winterSummerFall/winter
change to nymph,
over-winter
miceChipmunks(reservoir)
poppy seed size
1st bite nymphs
hatch
2nd bite
3-5 daysattached
deer primary reproductive host
majority of cases reported: May-June
deer, etc.humans
95% of the tick’s life is on the ground, in leaf litter, on grass, etc!
~2,000 eggs
female over-winters
micecatsdogs
humans
6262
ProtectionProtection……why?why?
� Every bite Every bite increases the riskincreases the risk of gettingof getting……
�� More spirochetesMore spirochetes…”the dose makes the poisonthe dose makes the poison””
�� More virulent strainsMore virulent strains…increase disease severityincrease disease severity
�� Other tickOther tick--borne infectious microorganismsborne infectious microorganisms…
Babesia, Anaplasma, Erhlichia, BartonellaBabesia, Anaplasma, Erhlichia, Bartonella, etc., etc.
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
6363
� Every bite Every bite increases the riskincreases the risk of gettingof getting……
�� More spirochetesMore spirochetes…”the dose makes the poisonthe dose makes the poison””
�� More virulent strainsMore virulent strains…increase disease severityincrease disease severity
�� Other tickOther tick--borne infectious microorganismsborne infectious microorganisms…
Babesia, Anaplasma, Erhlichia, BartonellaBabesia, Anaplasma, Erhlichia, Bartonella, etc., etc.
� Protection Reality!Protection Reality!� No existing method will eliminate deer ticks
� Can reduce tick numbers and risk of infection
�� Key is to integrateKey is to integrate control practicescontrol practices
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
ProtectionProtection……why?why?
6464
� Every bite Every bite increases the riskincreases the risk of gettingof getting……
�� More spirochetesMore spirochetes…”the dose makes the poisonthe dose makes the poison””
�� More virulent strainsMore virulent strains…increase disease severityincrease disease severity
�� Other tickOther tick--borne infectious microorganismsborne infectious microorganisms…
Babesia, Anaplasma, Erhlichia, BartonellaBabesia, Anaplasma, Erhlichia, Bartonella, etc., etc.
� Protection Reality!Protection Reality!� No existing method will eliminate deer ticks
� Can reduce tick numbers and risk of infection
�� Key is to integrateKey is to integrate control practicescontrol practices
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
despite adequate knowledge about despite adequate knowledge about the risk of infection, many people do not follow the risk of infection, many people do not follow
behaviors to reduce this riskbehaviors to reduce this risk
ProtectionProtection……why?why?
6565
Landscape modificationsLandscape modifications
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
higher risk! lower risk
�� Ticks need Ticks need high humidityhigh humidity
�� Increase areas of sunlightIncrease areas of sunlight
�� Relocate play equipmentRelocate play equipment…high risk are lawns next to woods
6666
Landscape modificationsLandscape modifications
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
higher risk! lower risk
Tick-safe zone
Tick zone
Tick-safe zone
�� CreateCreate 3+ ft wood chip
barrier
�� Keep lawn mowedKeep lawn mowed
�� Deer fencingDeer fencing
�� Ticks need Ticks need high humidityhigh humidity
�� Increase areas of sunlightIncrease areas of sunlight
�� Relocate play equipmentRelocate play equipment…high risk are lawns next to woods
CDC
R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA 12
6767
Perimeter insecticide Perimeter insecticide applicationsapplications
�� CommercialCommercial……
tree/lawn care companies
�� DoDo--itit--yourselfyourself……
hose-on application, coarse spray directed to the ground, leaf
litter, and low shrubs;
granular application
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Tick zone
6868
Perimeter insecticide Perimeter insecticide applicationsapplications
�� CommercialCommercial……
tree/lawn care companies
�� DoDo--itit--yourselfyourself……
hose-on application, coarse spray directed to the ground, leaf
litter, and low shrubs;
granular application
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
nymphs
adults
Increasing risk of being bitten
Tick zone
6969
Control ticks on reservoirs & deerControl ticks on reservoirs & deer
�� DamminixDamminix®®..……ppermethrin® treated cotton balls
Place near mice nesting Place near mice nesting
areasareas…wood/brush piles, stone
walls, rock piles, etc.
www.damminix.com/default.asp
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Increasing risk of being bitten
Fall
Spring
7070
Control ticks on reservoirs & deerControl ticks on reservoirs & deer
�� DamminixDamminix®®..……ppermethrin® treated cotton balls
Place near mice nesting Place near mice nesting
areasareas…wood/brush piles, stone
walls, rock piles, etc.
www.damminix.com/default.asp
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Increasing risk of being bitten
Fall
Spring
90% of tickson head/neck
�� 44--poster deer feeder (USDA)poster deer feeder (USDA)
Corn reservoir
Paint rollers containing permethrin®®
www.crdaniels.com/dandux/outdoors.htm
7171
Protect yourselfProtect yourself
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Avoid risky behaviorsAvoid risky behaviors…leaf litter, deer paths, logs/stone walls,
untreated pets, bird feeders
7272
Protect yourselfProtect yourself
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Avoid risky behaviorsAvoid risky behaviors…leaf litter, deer paths, logs/stone walls,
untreated pets, bird feeders
Wear light colorsWear light colors……
long pants, shirt, hat, tight-weave socksover cuffs (tape)
R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA 13
7373
Protect yourselfProtect yourself
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Avoid risky behaviorsAvoid risky behaviors…leaf litter, deer paths, logs/stone walls,
untreated pets, bird feeders
Wear light colorsWear light colors……
long pants, shirt, hat, tight-weave socksover cuffs (tape)
DEETDEET®®…skin & clothing PermethrinPermethrin…clothing,
~ 4 weeks (0.5%)
7474
Protect yourselfProtect yourself
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Avoid risky behaviorsAvoid risky behaviors…leaf litter, deer paths, logs/stone walls,
untreated pets, bird feeders
Wear light colorsWear light colors……
long pants, shirt, hat, tight-weave socksover cuffs (tape)
DEETDEET®®…skin & clothing
Do tick checkDo tick check…hairline & where clothes fit tightly
PermethrinPermethrin…clothing, ~ 4 weeks (0.5%)
7575
Protect yourselfProtect yourself
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Avoid risky behaviorsAvoid risky behaviors…leaf litter, deer paths, logs/stone walls,
untreated pets, bird feeders
Wear light colorsWear light colors……
long pants, shirt, hat, tight-weave socksover cuffs (tape)
DEETDEET®®…skin & clothing
Shower immediatelyShower immediately
Do tick checkDo tick check…hairline & where clothes fit tightly
PermethrinPermethrin…clothing, ~ 4 weeks (0.5%)
7676
Protect yourselfProtect yourself
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Avoid risky behaviorsAvoid risky behaviors…leaf litter, deer paths, logs/stone walls,
untreated pets, bird feeders
Wear light colorsWear light colors……
long pants, shirt, hat, tight-weave socksover cuffs (tape)
DEETDEET®®…skin & clothing
Shower immediatelyShower immediately
Keep outdoor clothesKeep outdoor clothes
in the garagein the garage
Do tick checkDo tick check…hairline & where clothes fit tightly
PermethrinPermethrin…clothing, ~ 4 weeks (0.5%)
7777
Protect yourselfProtect yourself
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Avoid risky behaviorsAvoid risky behaviors…leaf litter, deer paths, logs/stone walls,
untreated pets, bird feeders
Wear light colorsWear light colors……
long pants, shirt, hat, tight-weave socksover cuffs (tape)
DEETDEET®®…skin & clothing
Shower immediatelyShower immediately
Keep outdoor clothesKeep outdoor clothes
in the garagein the garage
Do tick checkDo tick check…hairline & where clothes fit tightly
PermethrinPermethrin…clothing, ~ 4 weeks (0.5%)
Insect ShieldInsect Shield™™ ((Buzz Off)Buzz Off)…permethrin treated outdoor apparel
by Exofficio, etc.
7878
Protect yourselfProtect yourself
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
washing with detergent will washing with detergent will NOTNOT kill ticks; clothes dryer at high temperature willkill ticks; clothes dryer at high temperature will
Avoid risky behaviorsAvoid risky behaviors…leaf litter, deer paths, logs/stone walls,
untreated pets, bird feeders
Wear light colorsWear light colors……
long pants, shirt, hat, tight-weave socksover cuffs (tape)
DEETDEET®®…skin & clothing
Shower immediatelyShower immediately
Keep outdoor clothesKeep outdoor clothes
in the garagein the garage
Do tick checkDo tick check…hairline & where clothes fit tightly
PermethrinPermethrin…clothing, ~ 4 weeks (0.5%)
Insect ShieldInsect Shield™™ ((Buzz Off)Buzz Off)…permethrin treated outdoor apparel
by Exofficio, etc.
R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA 14
7979
Protect pets from ticksProtect pets from ticks……unprotected pets = high risk to unprotected pets = high risk to
children and adultschildren and adults
�� Frontline: Top SpotFrontline: Top Spot®®,, Top SpotTop Spot®® Plus, and Plus, and LiquidLiquid®®
- ticks and fleas (Plus), dogs and cats
- 1 month tick protection (systemic)
- Also monthly liquid application
in/on ears (cats)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc. 8080
Protect pets from ticksProtect pets from ticks……unprotected pets = high risk to unprotected pets = high risk to
children and adultschildren and adults
�� Frontline: Top SpotFrontline: Top Spot®®,, Top SpotTop Spot®® Plus, and Plus, and LiquidLiquid®®
- ticks and fleas (Plus), dogs and cats
- 1 month tick protection (systemic)
- Also monthly liquid application
in/on ears (cats)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
�� PreventicPreventic®®
dogdog collarcollar
8181
Protect pets from ticksProtect pets from ticks……unprotected pets = high risk to unprotected pets = high risk to
children and adultschildren and adults
�� Frontline: Top SpotFrontline: Top Spot®®,, Top SpotTop Spot®® Plus, and Plus, and LiquidLiquid®®
- ticks and fleas (Plus), dogs and cats
- 1 month tick protection (systemic)
- Also monthly liquid application
in/on ears (cats)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
�� PreventicPreventic®®
dogdog collarcollar
�� Dogs as Lyme disease sentinels:Dogs as Lyme disease sentinels:
SNAPSNAP®® 4Dx test4Dx test…Lyme disease, heartworm, etc.
8282
Protect pets from ticksProtect pets from ticks……unprotected pets = high risk to unprotected pets = high risk to
children and adultschildren and adults
�� Frontline: Top SpotFrontline: Top Spot®®,, Top SpotTop Spot®® Plus, and Plus, and LiquidLiquid®®
- ticks and fleas (Plus), dogs and cats
- 1 month tick protection (systemic)
- Also monthly liquid application
in/on ears (cats)
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
�� PreventicPreventic®®
dogdog collarcollar
�� Dogs as Lyme disease sentinels:Dogs as Lyme disease sentinels:
SNAPSNAP®® 4Dx test4Dx test…Lyme disease, heartworm, etc. pets should be inside or outsidepets should be inside or outside
8383
If If ““@%it@%it”” happenshappens
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
embedded tick
8484
If If ““@%it@%it”” happenshappens
�� Use clean tweezers or tick Use clean tweezers or tick
removal toolremoval tool
�� Grasp the tick close to skinGrasp the tick close to skin
�� Slowly and steadily pull Slowly and steadily pull
upward until the tick upward until the tick
releasesreleases
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
embedded tick
R. Hamlen, PhD
Lyme Disease Assoc. of Southeastern PA 15
8585
If If ““@%it@%it”” happenshappens
�� Use clean tweezers or tick Use clean tweezers or tick
removal toolremoval tool
�� Grasp the tick close to skinGrasp the tick close to skin
�� Slowly and steadily pull Slowly and steadily pull
upward until the tick upward until the tick
releasesreleases
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
�� NeverNever…use alcohol, Vaseline, match, etc. May trigger injection of salivary fluids and disease-causing microbes!
�� Save tick to show physicianSave tick to show physician
�� Tick testing (NJ Labs., 1Tick testing (NJ Labs., 1--877877--Tick Test orTick Test or
732732--249249--0148)0148)
embedded tick
8686
If If ““@%it@%it”” happenshappens
�� Use clean tweezers or tick Use clean tweezers or tick
removal toolremoval tool
�� Grasp the tick close to skinGrasp the tick close to skin
�� Slowly and steadily pull Slowly and steadily pull
upward until the tick upward until the tick
releasesreleases
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
�� NeverNever…use alcohol, Vaseline, match, etc. May trigger injection of salivary fluids and disease-causing microbes!
�� Save tick to show physicianSave tick to show physician
�� Tick testing (NJ Labs., 1Tick testing (NJ Labs., 1--877877--Tick Test orTick Test or
732732--249249--0148)0148)
unattached ticks can survive indoors for daysunattached ticks can survive indoors for days
embedded tick
8787Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
Thank you andThank you and……
8888
Helpful Lyme disease linksHelpful Lyme disease links
� Lyme Disease Association of Southeastern PA (LDASEPA):
www.lymepa.org/
� The National Lyme Disease Association (LDA): www.lymediseaseassociation.org
� ILADS - the International Lyme and Associated Diseases Society:Professional medical society about Lyme disease. www.ilads.org
� Columbia University Lyme Disease Research: www.columbia-lyme.org
� Physician referrals call LDASEPA at 610-388-7333 or email [email protected]
� Find a support group: www.Lymenet.org
� IGeneX, Inc., Palo Alto, California: (lab/explanations of tests)
www.igenex.com
� MDL, New Jersey: http://www.mdlab.com/html/home.html (testing lab)
� The Centers for Disease Control and Prevention (CDC):
http://www.cdc.gov/ncidod/dvbid/lyme/index.htm
Ron Hamlen, PhD – Lyme Disease Association of Southeastern Pennsylvania, Inc.
