More Americans are living in wooded suburbs near deer, which carry the ticks that spread Lyme disease, anaplasmosis, Rocky Mountain spotted fever, babesiosis, rabbit fever and Powassan virus. Credit Scott Camazine/Science Source
The number of people who get diseases transmitted by mosquito, tick and flea bites has more than tripled in the United States in recent years, federal health officials reported on Tuesday. Since 2004, at least nine such diseases have been newly discovered or introduced into the United States.
Warmer weather is an important cause of the surge in cases reported to the Centers for Disease Control and Prevention, according to the lead author of a study in the agency’s Morbidity and Mortality Weekly Report.
But the author, Dr. Lyle R. Petersen, the agency’s director of vector-borne diseases, repeatedly declined to connect the increase to the politically fraught issue of climate change, and the report does not mention either climate change or global warming.
Many other factors are at work, he emphasized, while noting that “the numbers on some of these diseases have gone to astronomical levels.”
C.D.C. officials called for more support for state and local health departments. Local agencies “are our first line of defense,” said Dr. Robert Redfield, the C.D.C.’s new director. “We must enhance our investment in their ability to fight these diseases.”
Although state and local health departments get brief infusions of cash during scares like the 2016 Zika epidemic, they are chronically underfunded. A recent survey of mosquito control agencies found that 84 percent needed help with basics like surveillance and pesticide-resistance testing, Dr. Petersen said.
While the C.D.C. did not suggest that Americans drop plans for playing outdoors or lying in hammocks this summer, Dr. Redfield emphasized that everyone — especially children — needed to protect themselves against tick and mosquito bites.
Between 2004 and 2016, about 643,000 cases of 16 insect-borne illnesses were reported to the C.D.C. — 27,000 a year in 2004, rising to 96,000 by 2016. (The year 2004 was chosen as a baseline because the agency began requiring more detailed reporting then.)
The study did not delve into the reasons for the increase, but Dr. Petersen said it was probably caused by many factors, including two related to weather: Ticks thriving in regions previously too cold for them, and hot spells triggering outbreaks of mosquito-borne diseases.
Other factors, he said, include expanded human travel, suburban reforestation and a dearth of new vaccines to stop outbreaks.
In an interview, Dr. Petersen said he was “not under any pressure to say anything or not say anything” about climate change and that he had not been asked to keep mentions of it out of the study.
More jet travel from the tropics means that previously obscure viruses like dengue and Zika are moving long distances rapidly in human blood. (By contrast, malaria and yellow fever are thought to have reached the Americas on slave ships three centuries ago.)
A good example, Dr. Petersen said, was chikungunya, which causes joint pain so severe that it is called “bending-up disease.”
Tickborne diseases, the report found, are rising steadily in the Northeast, the Upper Midwest and California. Ticks spread Lyme disease, anaplasmosis, babesiosis, Rocky Mountain spotted fever, rabbit fever, Powassan virus and other ills, some of them only recently discovered.
Ticks need deer or rodents as their main blood hosts, and those have increased as forests in suburbs have gotten thicker, deer hunting has waned, and rodent predators like foxes have disappeared.
(A century ago, the Northeast had fewer trees than it now does; forests made a comeback as farming shifted west and firewood for heating was replaced by coal, oil and gas.)
Most disease outbreaks related to mosquitoes since 2004 have been in Puerto Rico, the Virgin Islands and American Samoa. But West Nile virus, which arrived in 1999, now appears unpredictably across the country; Dallas, for example, saw a big outbreak in 2012.
For most of these diseases, there are no vaccines and no treatment, so the only way to stop outbreaks is through mosquito control, which is expensive and rarely stops outbreaks. Miami, for instance, was the only city in the Western Hemisphere to halt a Zika outbreak with pesticides.
The only flea-borne disease in the report is plague, the bacterium responsible for the medieval Black Death. It remains rare but persistent: Between two and 17 cases were reported from 2004 to 2016, mostly in the Southwest. The infection can be cured with antibiotics.
The 2003-2014 period fell during what he described as “a pause” in global warming, although the notion of a long trend having pauses is disputed.
Also, disease-transmission dynamics are complicated, and driven by more than temperature. For example, transmission of West Nile virus requires that certain birds be present, too.
In the Dust Bowl years of the 1930s, St. Louis encephalitis, a related virus, surged, “and it looked like climate issues were involved,” Dr. Reiter said. But the surge turned out to depend more on varying hot-cold and wet-dry spells and the interplay of two different mosquito species. St. Louis encephalitis virtually disappeared, weather notwithstanding.
“It’s a complicated, multidimensional system,” he said.
Warm weather helps mosquitoes and ticks breed and transmit disease faster, he explained. But after a certain point, the hotter and drier it gets, the more quickly the pests die. So disease transmission to humans peaks somewhere between mildly warm and hellishly hot weather.
Experts also pointed out that the increase in reports of spreading disease may have resulted partially from more testing.
Lyme disease made family doctors begin to suspect tick bites in patients with fevers. Laboratories began looking for different pathogens, especially in patients who did not have Lyme. That led to the discovery of previously unknown diseases.
I for one appreciate Peterson’s refusal to push the climate change model. Finally, someone who refuses to fall for the bait.
Ottmar Edenhofer, lead author of the IPCC’s fourth summary report released in 2007 candidly expressed the priority. Speaking in 2010, he advised, “One has to free oneself from the illusion that international climate policy is environmental policy. Instead, climate change policy is about how we redistribute de facto the world’s wealth.”
PURPOSE OF REVIEW:
This article reviews bacterial, viral, fungal, and parasitic pathogens associated with myelopathy. Infectious myelopathies may be due to direct infection or parainfectious autoimmune-mediated mechanisms; this article focuses primarily on the former.
Some microorganisms exhibit neurotropism for the spinal cord (eg, enteroviruses such as poliovirus and flaviviruses such as West Nile virus), while others are more protean in neurologic manifestations (eg, herpesviruses such as varicella-zoster virus), and others are only rarely reported to cause myelopathy (eg, certain fungal and parasitic infections). Individuals who are immunocompromised are at increased risk of disseminated infection to the central nervous system. Within the last few years, an enterovirus D68 outbreak has been associated with cases of acute flaccid paralysis in children, and emerging Zika virus infection has been concurrent with cases of acute flaccid paralysis due to Guillain-Barré syndrome, although cases of myelitis have also been reported. Associated pathogens differ by geographic distribution, with myelopathies related to Borrelia burgdorferi (Lyme disease) and West Nile virus more commonly seen in the United States and parasitic infections encountered more often in Latin America, Southeast Asia, and Africa. Characteristic CSF and MRI patterns have been identified with many of these infections.
SUMMARY: A myriad of pathogens are associated with infectious myelopathies. Host factors, geographic distribution, clinical features, CSF profiles, and MRI findings can assist in formulating the differential diagnosis and ultimately guide management.
Myelopathy is a neurologic deficit related to the spinal cord which can be caused by trauma (spinal cord injury) or inflammation(myelitis). Inflammation can be caused by numerous things including pathogens such as Borrelia burgdorferi (Bb), the causative agent of Lyme Disease, as well as numerous viruses that can also be a part of the Lyme/MSIDS symptom picture which can be transmitted directly from ticks or activated due to the reaction of the body to the tick bite. Much research is needed in this particular area.
Myelopathy is typically a clinical diagnosis with patients complaining of weakness, clumsiness, muscle atrophy, sensory deficits, bowel/bladder symptoms, sexual dysfunction, altered tons, spasticity, and hyperreflexia among other symptoms. https://en.wikipedia.org/wiki/Myelopathy Treatment depends upon the underlying cause. If infectious, pathogen specific antibiotics, and/or things to reduce inflammation are in order.
Wednesday Nite @ The Lab
Published on Jan 16, 2018
“Susan Paskewitz’s talk will focus on the activities of the newly created Midwest Center of Excellence for Vector-Borne Disease. The center was established in 2017 as a response to the increasing rate of human illness caused by tick and mosquito-transmitted diseases in the region, including Lyme disease and West Nile encephalitis. In addition to these familiar problems, new ticks, mosquitoes, and pathogens have been discovered. Solving these issues will require a new generation of trained vector biologists, cooperation and collaboration among public-health professionals and scientists, and creative and innovative research to reduce human and insect contact.”
About the Speaker
Paskewitz is the director of the Midwest Center of Excellence for Vector-Borne Disease and the chair of the Department of Entomology at UW–Madison. Her research focuses on the ecology, epidemiology, and management of ticks and mosquitoes. She teaches classes in global health, medical and veterinary entomology, and the One Health concept, during which she enjoys working with undergraduate and graduate students who seek to gain experience in public health, infectious disease, and vector-biology research. Paskewitz earned her bachelor’s and master’s degrees at Southern Illinois University–Carbondale and her doctorate at the University of Georgia–Athens.
4:45 Believe it or not, Wisconsin used to have cases of Malaria.
Zika, discovered in 1947, wasn’t even in our hemisphere. Very few people infected until 2007 when there were 13-14 cases. 2015 it showed up in Brazil. First time a mosquito spread disease that is also sexually transmitted. A medical entomologist felt he gave it to his wife and then wrote a paper on it.
UW did a lot of work on Zika. Cases in the U.S. occurred when people traveled abroad, became infected, were bit by mosquitoes here, and then spread from there. Only 63 infected people in 2016, 9 more in 2017.
Do we have the mosquitoes that can pick up the virus and transmit it? The Yellow Fever mosquito is the one transmitting Zika. The mosquito is here in U.S. but NOT in WI. The Asian Tiger mosquito is a secondary vector that transmits the same viruses but not as well. Has a wider distribution and is a daytime feeder.
She looked in all the records – couldn’t find the Asian Tiger in Wisconsin. It is found in Illinois and Indiana. However, since that time they have laid many traps and found the Asian Tiger Mosquito here but she doesn’t feel they are abundant or wide spread. She also feels they won’t survive our winters but experiments are in progress. Females bite, lay eggs in wet aquatic spots, as larvae need water to grow.
(The same sort of diligence needs to happen in the world of Lyme. For instance, borrelia has been found in other insects, but entomologists downplay it and say numbers are small. This is a great example of how Lyme is treated differently then other diseases that are big money-makers for researchers.)
25:32 The Lone star tick has popped up in a number of places in WI – she doesn’t feel they will survive our winters.
Spent a lot of time talking about mosquito issues happening down South.
She admits the Center was created due to Zika.
(Don’t be shocked when all the research dollars go to Zika & not tick borne illness despite the much higher prevalence of TBI’s in WI)
Wisconsin has cases of West Nile, La Crosse Virus, and Jamestown Canyon Virus – which has increased human cases – they don’t know why.
They are working on a bacterial based topical repellent. Also working on using fish and copepods to eat mosquitos at the larval stage.
Ticks transmit Lyme Disease – a lot and it’s not just in the North. Could pick it up anywhere in Wisconsin.
The Miami-Dade Country Mosquito Reduction Test Program, a collaboration between the University of Kentucky and biotech company MosquitoMate, is releasing lab-bred mosquitoes infected with Wolbachia into the wild to supposedly depopulate Aedes aegypti mosquitos that carry dengue fever, yellow fever, and Zika. They are conducting an initial test phase to see if it can become operational.
Wolbachia stops mosquitoes from reproducing. The eggs die before they hatch.
Here are some potential problems:
What if Wolbachia causes a mutation?
Evidently, consent has not been given. Humans live here.
Dogs treated for Heart Worm have severe inflammation due to released Wolbachia in the blood stream
Wolbachia enhances other pathogens
https://madisonarealymesupportgroup.com/2017/07/10/wolbachia-the-next-frankenstein/ Wolbachia, a Gram-negative bacterium of the family Rickettsiales first found in 1924 and in 60% of all the insects, including some mosquitoes, crustaceans, and nematodes (worms). It was largely unknown until the 90’s due to its evasion tactics. It has been used in human diseases such as elephantiasis and River Blindness, both caused by filiarial nematodes.
Wolbachia’s favorite hosts are filarial nematodes and arthropods.
Here’s where it gets tricky. It is commonly known that nematodes (worms) are often a part of the Lyme/MSIDS patient picture & explains the importance of the following animal study.
Dogs treated for heart worm (D. immitis) have trouble due to the heart worm medication causing Wolbachia to be released into the blood and tissues causing severe Inflammation in pulmonary artery endothelium which may form thrombi and interstitial inflammation.Wolbachia also activates pro inflammatory cytokines. Pets treated with tetracycline a month prior to heart worm treatment will kill some D. immitis as well as suppress worm production. When given after heart worm medication, it may decrease the inflammation from Wolbachia kill off. http://www.critterology.com/articles/wolbachia-and-their-role-heartworm-disease-and-treatment
The words worms and inflammation should cause every Lyme/MSIDS patient to pause. Many of us are put on expensive anthelmintics like albendazole, ivermectin, Pin X, and praziquantel to get rid of worms and are told to avoid anything causing inflammation due to the fact we have enough of it already. We go on special anti-inflammatory diets and take systemic enzymes and herbs to try and lower inflammation. https://madisonarealymesupportgroup.com/2016/04/22/systemic-enzymes/
Seems to me, many MSIDS/LYME patients when treated with anthelmintics, will have Wolbachia released into their blood and tissues causing wide spread inflammation, similarly to dogs.
And that’s not all.
According to a study by Penn State, mosquitoes infected with Wolbachia are more likely to become infected with West Nile – which will then be transmitted to humans.“This is the first study to demonstrate that Wolbachia can enhance a human pathogen in a mosquito,“ one researcher said. “The results suggest that caution should be used when releasing Wolbachia-infected mosquitoes into nature to control vector-borne diseases of humans.” “Multiple studies suggest that Wolbachia may enhance some Plasmodium parasites in mosquitoes, thus increasing the frequency of malaria transmission to rodents and birds,” he said. https://www.sciencedaily.com/releases/2014/07/140710141628.htm
So besides very probable wide spread inflammation, and that other diseases may become more prevalent due to Wolbachia laced mosquitoes, studies show Wolbachia enhances Malaria in mosquitos.
Lyme/MSIDS patients are often co-infected with Babesia, a malarial-like parasite that requires similar treatment and has been found to make Lyme (borrelia) much worse.
I hate bugs as much as the next person, but careful long-term studies of Wolbachia are required here.
Hopefully it is evident that many man-made interventions have been introduced into the environment causing important health ramifications: Wolbachia laced mosquitoes and eggs, GMO mosquitoes including CRISPR, and in the case of Zika in Brazil, whole-cell pertussis vaccinations (DTap) for pregnant women up to 20 days prior to expected date of birth, a pyriproxyfen based pesticide applied by the State in Brazil on drinking water, as well as aerial sprays of the insect growth regulators Altosid and VectoBac (Aquabac, Teknar, and LarvX, along with 25 other Bti products registered for use in the U.S.) in New York (Brooklyn, Queens, Staten Island, and The Bronx) to combat Zika. “We feel it’s critical that the scientific community consider the potential hazards of all off-target mutations caused by CRISPR, including single nucleotide mutations and mutations in non-coding regions of the genome … Researchers who aren’t using whole genome sequencing to find off-target effects may be missing potentially important mutations. Even a single nucleotide change can have a huge impact.” http://articles.mercola.com/sites/articles/archive/2017/06/13/crispr-gene-editing-dangers.aspx?utm_source=dnl&utm_medium=email&utm_content=art3&utm_campaign=20170613Z1_UCM&et_cid=DM147520&et_rid=2042753642
All of this is big, BIG business.
Is the introduction of Wolbachia another puzzle piece in the perfect storm of events causing or exacerbating human health issues?
The jury’s still out, but it’s not looking good – particularly for the chronically ill.
https://articles.mercola.com/sites/articles/archive/2018/02/13/lab-made-mosquitoes-released-in-miami.aspx? “If preventing Zika was their aim, government officials missed the boat on this one; although Miami-Dade County was previously designated as a Zika cautionary area, that designation was removed June 2, 2017.No Zika virus disease cases have been reported with illness onset in 2018 in the U.S., while in 2017 there were only four cases of Zika virus reported that were presumably acquired via local mosquitoes (two in Florida and two in Texas).There is a major push to combat mosquito-borne diseases in the continental U.S. with the use of lab-made and GE mosquitoes, even though in the U.S. mosquito-borne illnesses are not a grave threat, especially compared to other major public health crises like the opioid epidemic.”
And I will add the tick borne illness crisis, which truly is a pandemic.
Zika vs. Aluminum: Double Standards on Levels of Evidence and Media Liability
Millions of Dollars spent, Massive Media Coverage for Zika and Microcephaly – Based on One Autospy Report. Aluminum Found in Five Autistic Brains (N=5)… Media Crickets.
WHEN THE CDC announced that Zika virus had been found in 1 (ONE) brain of an aborted fetus from Brazil back in 2016, they heralded that 1 (ONE) data point as “The Srongest Evidence Yet”. Here’s the BBC News’s webpage from 10 Feb 2016:
Some have criticized the Exley study for not having “controls”. I’m sorry? There is not supposed to be ANY aluminum in children’s brains. Tested against the null hypothesis, yes, there is significantly more than zero.
CDC’s fetus with Zika virus came from a population in which Zika virus infection was high. Most cases of Zika virus infection during pregnancy did not lead to microcephaly. And microcephaly was highest in the northeastern part of Brazil, in poor women from the slums… who were being experimented on with whole-cell pertussis.
Yes, you read that right. WHOLE cell pertussis.
Well, it’s one thing to say the media is biased. After all, Exley’s study provides the strongest evidence to date that aluminum from vaccines is involved as a cause of autism. In fact, the study leaves no room for doubt, if we apply the same standard of the level of evidence used to support the idea that Congress had to pony up $1.1 Billion dollars for a vaccine against Zika.
But there is AMPLE room for doubt that Zika drove the microcephaly increase in Brazil.
Here is a timeline of microcephaly in Brazil:
Note that the microcephaly increase actually started in July 2012,a year after the advent of the national Stork program, a prenatal care program that includes vaccination during pregnancy. And note that July 2012 is BEFORE Zika landed on the continent of S. America in July 2014. In December 2014, Brazil’s mandatory Tdap vaccination program started. But vaccination during pregnancy had already begun. The CDC’s autopsied fetus study was published in early 2016 – that’s the CDC’s best evidence to date.
So it turns out that Zika infection rates are seasonal in Brazil. So we’d expect another surge in microcephaly with the annual increase in Zika infections, right?
No, not at all. Why?
Zika does not cause microcephaly. The American taxpayer has been duped. And sprayed with pesticides to “protect” against Zika – in NYC even before any reported cases of Zika – with pesticides that are known to cause autism.
So when can we start asking: Is the media bias in the US now a causal factor in the autism epidemic? How can the media be held accountable?
What Can You Do?
You can write to the reporters on each of these stories and ask them to report on Dr. Exley’s study as providing “proof” that aluminum causes autism – be sure to send them the link to this blog.
If bona fide, objective reporters write to me, I’ll share a manuscript that was not published by PLOS One because they found it too “confusing”. The manuscript simply listed all of the reported possible causes of microcephaly and examined the available evidence at that time.
Lyme/MSIDS isn’t the only topic of media bias. The only way things are going to change is if we all play an active role and hold scientists and journalists accountable. I’ve often pointed out the obvious bias in the handling of Zika vs the handling of Lyme/MSIDS. While research for Lyme boasts 230 peer-reviewed studies showing borrelia persistence,Zika has 1 autopsy.
TheCaseforthePersistenceofLymeDiseaseAfterAntibioticTherapy The truth is that over 50% of the IDSA’s guidelines are based on “expert opinion” rather than “evidence-based medicine” as their publication suggests. A further 31% of the IDSA guidelines are based on observational studies. Only a meagre 29% of the IDSA Guidelines fit into “evidence-based medicine”.(22,23,24,25,27) Importantly, the IDSA’s own research supports these very findings.(22)
Please understand for those of you just tuning in – THIS IS A WAR of epic proportions.
Most visitors go to the Alsace region of France to drink its fine white wines and to Lorraine for its ornate architecture. I went to see if the French are dealing with Lyme disease better than we are here in Massachusetts and across the U.S.
Last September, Francebecame the first country to release a national plan to address tick-borne diseases like Lyme. It ranges from ramped-up surveillance of ticks and infections to better treatment protocols and diagnostic tests.
In May, Canadareleased its own federal action planto address Lyme. In the United States, we have at least 10 times more cases of Lyme than France or Canada:over 300,000 cases annually, compared to about 33,000 in France and probably less than 10,000 in Canada. But we lag far behind on concerted national action, even as the problem of tick-borne diseases continues to grow.
So what can we learn from the French? A lot, I concluded. The officials, doctors and researchers I spoke with there emphasized that their national plan is still evolving. But already they are launching a sweeping initiative to tackle Lyme disease as a major public health problem.
An All-Hands-On-Deck Approach
Tune in to French radio this summer and you might hear this: Birds chirping, footsteps crunching on forest leaves, and a woman asking, “Ehhh, have you thought about protecting yourself against ticks?”
“C’est bon,” her male companion responds jovially. “The little beast won’t eat the big one.”
The woman shares a few anti-tick tips to avoid catching la maladie de Lyme, and the spot finishes up with a slogan: Against ticks — tiques in French — “to be watchful is to win.”
The 30-second spot from France’s public health agency is one of many on the airwaves this summer; others include experts answering questions about ticks and Lyme disease itself.
You’ll also find posters detailing how to prevent tick bites in pharmacies, medical clinics and even the Alpine Club of Nancy, housed in an art nouveau building just off the famous Place Stanislas downtown.
At the entrance to forests in eastern France — in Kintzheim in Alsace, or La Haye in Lorraine — you’ll find more “beware of ticks” signs, with tips on what to look for and how to remove them.
France doesn’t have a magic prevention toolkit. In fact, much of what they’re doing — education, tracking ticks and counting Lyme cases — is similar to what we do, some of it at the federal level and some of it piecemeal, at the local level. They’re just doing much more of it, more thoroughly and robustly, than we do.
And they don’t need to rely on local public health heroes, as we often do in the United States. Here in Massachusetts, the heroes include Larry Dapsis, the entomologist for Barnstable County, who spends the spring and summer doing 70 tick-borne disease workshops up and down Cape Cod. Or Catherine Brown, the state public health veterinarian, who finds time among her innumerable responsibilities to also teach the public about Lyme. Their personal passion is key because their tick-related work runs on a shoestring.
France, in contrast, is putting strong systems in place and attacking the problem from multiple angles — coordinating between government agencies and recognizing that the complex problem of Lyme disease requires multiple simultaneous solutions.
“If we do a good job at prevention, we’ll have fewer patients who end up seeking care and struggling in the medical system,” said Lucie Chouin, a public health official for the Greater Eastern region of France. “For me, prevention is part of a package; if we only do so much, and do not do anything upstream, the problem won’t be resolved.”
And France is allotting the money to take that holistic approach. Though it does not specify a budget, the national French plan sets the priorities at high levels of government. The then-minister of health herself, Marisol Touraine, announced the release of the national plan this past September.
2,000 Forest Signs
Take education. Along with those radio spots and posters in the northeast of France, the government is paying to educate hundreds of doctors and place thousands of pamphlets in medical offices. At the cost of about 1,000 euros each it’s placing 2,000 of those “beware of ticks” signs across the country.
That is a much more sweeping and energetic program than I’ve seen in the Lyme hotbed of Massachusetts, which leaves most Lyme disease issues to local officials. The state produces free educational materials, but it’s up to towns to use them. If a town wants to go beyond education — which experts think will be required to turn the tide against tick borne illnesses — they need to drum up the cash. So far, few towns do.
Compare that to what the all-hands-on-deck approach against Lyme looks like in France. Initiatives there, in addition to better educating the public, include:
Public health “Regional Intervention Units” to track Lyme and tick-borne diseases better, including an ongoing multi-year study of the number of Lyme cases in the Lyme-heavy northeast region
The Agricultural Social Mutual Fund, a social security system to protect agricultural workers, is supporting pamphlets and a push to pinpoint tick hot spots
And the medical system and the public health department are doing most of the heavy lifting to carry out the national plan
The app is just one of many French initiatives under way to improve research on ticks and Lyme. The national plan puts heavy emphasis on practical research, and the ecology research that is crucial for fighting Lyme does not fall through funding cracks as it does here in the U.S.
Here, about two-thirds of our annual Lyme research spending is on basic biology. Research budgets tend to be smaller in France, but the emphasis is also different — more focus on projects that have immediate practical applications, such as identifying local tick hotspots or tracking what proportion of ticks carry diseases.
“We get money from time to time, and we’re used to working with less money for basic research,” said Benoit Jaulhac, an expert on Borrelia — the Lyme bacterium — and director of the National Reference Center for Borrelia in Strasbourg, where all French Lyme researchers are located. (No, we don’t have one of those either.)
But because some funding comes from the Institute for Public Health Surveillance, much of their research must yield “immediately applicable information,” Jaulhac said, such as tick-tracking and diagnostic tests. Few resources go to tick-tracking here; public health official argue that it is because tick numbers can vary dramatically from spot to spot, but another reason is that most simply don’t have the money for it.
Some particularly intriguing French research still in the planning phase: a study on what happens to people who get tick bites, looking not just at tick-borne illness but at whether the tick bites themselves could make people chronically sick over time.
The National Borrelia Center is also working with the the National Institute for Agricultural Research on tick surveillance and ecology research to figure out what could stem the tick invasion. In the U.S., the focus on basic biological research leaves ecologists often struggling to find grants to fund their tick-borne disease research.
Months Of Medical Care In A Day
Abdel Hafiz Abid can remember the exact day he became ill: July 5, 2014. He started to feel pain in his left leg, and particularly his ankle. At first it was occasional, but soon it afflicted him every day, and extended to his knees and back. He was also beset by fatigue — “Walking 200 meters feels like I’ve walked 25 kilometers,” he said — and by problems with short-term memory.
Family members suggested he had Lyme disease. “We vaguely talked about it, like everybody else,” he said. A number of them have that diagnosis, and he lives outside the city of Metz, in the Lorraine region of northern France, which has one of the country’s highest rates of Lyme.
The testing began. In a 2-inch black notebook, Abid keeps multiple yellow folders from each different laboratory and clinic he’s visited on his quest for a diagnosis. He’s been to clinics in France and one in Germany, spent thousands of euros outside what the national health plan covers, and tried multiple courses of antibiotics, some as long as six months. So far, nothing has worked.
So he came recently to Nancy, the biggest city in Lorraine, to spend the day at a new multi-disciplinary Lyme disease clinic run by Dr. François Goehringer, an infectious disease doctor.
“Ten years ago we used to say, ‘It’s not Lyme, we don’t know what it is,’ and they left our clinic with us saying, ‘We know you’re sick, but we don’t know what it is, au revoir, monsieur, au revoir, madam,'” Goehringer explained. Patients would then bounce from specialist to specialist getting different, confusing answers.
“We decided we could gain a lot of efficiency by trying to offer a day of hospitalization at the center of our approach,” he said. “The maximum of complementary exams and specialist advice to be able to weigh in on what the patient is suffering from.”
There are many specialized Lyme clinics in France and in the United States as well. What makes the Nancy clinic stand out is that one-stop shop organization. For a day, patients come to the hospital, get all the tests and scans, see various specialists and get started on treatments that fit their diagnosis.
Goehringer and his intern, Dr. Marie Geisler, go through Abid’s black folder in detail, reviewing all prior test results and consultations. Geisler sits with Abid to fill out the 10-page “Multidisciplinary Diagnostic Approach for Patients Suspected of Lyme,” a standardized questionnaire. There’s a cognitive assessment as well. Geisler then does a thorough, 30-minute physical exam, an EKG, and reports her findings to Goehringer.
Almost all of Abid’s tests for Lyme and other diseases are negative, except one 100 euro test from Germany that often returns false positives. His western blots, which would confirm the presence of proteins related to the Lyme bacteria, are all negative.
“He has no objective evidence of Lyme,” Goehringer said after reviewing all the files. But Abid’s parathyroid hormone — which controls calcium and bone health — is elevated. It could be an explanation for some of Abid’s symptoms. Endocrinologists aren’t part of the Lyme clinic, but Geisler books him for a rapid follow-up appointment to check into it.
Like all patients who come to the clinic, Abid also sees Lorraine Callins, a psychologist who specializes in chronic illness and hypnotherapy. Many of her chronic autoimmune disease or hemophilia patients “feel abandoned by medicine, so they seek other roads,” she says.
If his symptoms warranted it, Abid would also have seen a rheumatologist or neurologist – common specialties for people with suspected Lyme symptoms.
Goehringer sees only four patients every Friday and has seen about 100 patients total since the one-stop-shop program began in January. He also aims to start a monthly meeting of various specialists to develop plans for some of the most challenging patients.
Some American clinics hope to organize similar one-stop shops. But since we have a fee-for-service system, expensive specialists are difficult to organize unless there is sufficient patient volume. It’s not impossible here, but it’s quite a financial challenge.
France faces its own challenges: The national Lyme plan aims to improve medical care, including with clinics like Goehringer’s, and sets ambitious targets to develop standardized treatment guidelines by the end of 2017. That appears unlikely, with doctors and Lyme advocacy groups still far apart on what the guidelines should be.
But while standardized guidelines are in the works, the Nancy clinic will at least offer a respite for patients who have spent months seeing myriad specialists in search of a diagnosis.
Will it improve outcomes? It’s too early to tell, but at least from the patient’s point of view it’s a step forward as it streamlines what is usually a months-long process into a single day.
Maybe my starting point — What we can learn from the French? — wasn’t a fair one. We have deeply different health systems that reflect different cultures. France provides some of the best overall health care in the world and has a long tradition of viewing health care as a right, even enshrined in their constitutions.
It also has a national health system that pays for medical care. In this cultural context, spending on public health and prevention isn’t just seen as the right thing to do, but a way to reduce health costs later.
In contrast, in the U.S. we spend the most money on health care per person in the world, but don’t get more bang for our buck.
There are some hopeful signs of support for our fight against Lyme disease: The U.S. federal government has recently committed $40 million to create four regional centers of excellence for vector-borne diseases — which include Lyme — as part of its efforts to control the Zika virus.
But most of that money is expected to go toward fighting Zika, so it will likely do little to help fill the public health funding gaps that are leaving us far behind France in the fight against Lyme.
Reporting for this project was supported by the Pulitzer Center for Crisis Reporting. Dr. David Scales, MD, Ph.D. is an internal medicine physician at Cambridge Health Alliance and an instructor at Harvard Medical School. His doctorate in sociology included examining national flu pandemic preparedness plans while at the World Health Organization. He can be found on Twitter @davidascales.
This segment aired on August 16, 2017.
All the tests in the world may not diagnose Lyme/MSIDS. Lyme and the coinfections that typically tag along are some of the most complex pathogens known to man and defy testing again and again. Without a doctor’s sound, educated clinical judgement, tests for TBI’s are abysmal at best and miss over half the cases. https://www.lymedisease.org/lyme-basics/lyme-disease/diagnosis/.
The 40 million going to regional centers for excellence in the U.S. needs to be watch-dogged as the author is correct in his statement that the preponderance of that money will be ear-marked for Zika, a disease that has caused 254 symptomatic cases of which 251 are from travelers returning from affected areas (outside the U.S.), 0 cases through presumed local mosquito-borne transmission, and 3 cases acquired through sexual transmission. https://www.cdc.gov/zika/reporting/2017-case-counts.html The CDC currently is estimating over 300,000 new cases of Lyme Disease EACH YEAR and the true number to likely be much higher. https://www.cdc.gov/lyme/stats/humancases.html
As we head into the Maine outdoors this summer, the all-too-familiar warnings about how to avoid ticks reverberate in many of our heads.
Stay on the trail. Steer clear of wooded and brushy areas where ticks congregate.
But while most of us take pains to dodge the eight-legged pests, Chuck Lubelczyk heads straight for them.
As a field biologist at the Maine Medical Center Research Institute’s Lyme and Vector-Borne Disease Laboratory, he studies the spread of diseases carried by ticks, as well as by mosquitoes. That means venturing out into the fields, forests and coastlines of Maine to collect the bugs and evaluate where they pose the most risk to humans.
On a recent June day, Lubelczyk trudged into the greenery of the Wells Reserve, a 2,250-acre spread in York County headquartered at a restored saltwater farm. He partnered with researchers from the Biodiversity Research Institute in Portland to collect ticks from creatures less often associated with them: birds.
The team, assisted by several interns, set up wide nets to ensnare the birds as they flew through the area. They then delicately extricated them, tucked the birds into breathable collection bags, and toted them to a shady picnic table for easier handling. Using tweezers, the team plucked off each tick — typically feasting around the birds’ eyes, bills, and throats — and preserved the bugs for later testing at the lab.
Lubelczyk held up a vial containing at least 50 tiny nymphal deer ticks swirling in a preservative solution. They’d been tweezed off a single bird, a towhee, that morning.
Once free of ticks, the birds were then safely released to continue on their way.
While mice, chipmunks and deer get most of the attention as hosts for ticks, “Not a lot of people talk about the bird issue,” he said. “They’re understudied in a big way, I think. They do have a real role to play.”
Ticks are an annoyance to birds, but they don’t transmit disease to them or slowly and lethally drain them of blood, as researchers have seen among moose calves in Maine. But birds facilitate the spread of ticks, picking them up in Maryland, Connecticut and other eastern states as they fly north in the spring, Lubelczyk explained.
“As they’re migrating, they’re either dropping the ticks off as they fly or when they land. They’re kind of seeding them along migration patterns.”
By tracking the birds and the ticks they carry, researchers hope to predict where Lyme and other tick-borne diseases are most likely to accelerate. Lyme is now present in every county in the state, after hitting a record of 1,488 cases in 2016, but ticks are just getting established in areas such as Aroostook and Washington counties, Lubelczyk said.
Along with Lyme, Lubelczyk tested the ticks for other two other emerging diseases, anaplasmosis and the rare but potentially devastating Powassan virus. Powassan, carried by both the deer tick and the groundhog or woodchuck tick, recently sickened two people in midcoast Maine, following the death in 2013 of a Rockland-area woman.
A recent survey Lubelczyk led found the virus in ticks crawling around southern Maine, Augusta and on Swan’s Island in Hancock County.
In the modest Scarborough lab, medical entomologist Rebecca Robich furthered the findings of that survey. Clad in a white coat and blue gloves, she cloned a tiny band of the Powassan virus’ inactivated RNA, using a sample derived from the ticks that tested positive in the survey. Robich began the work, designed to confirm the earlier test results, last winter.
She expects to know conclusively within the next month what percentage of the sampled ticks were infected with Powassan, she said.
“We’re this close to finishing,” Robich said.
Ticks have become so prevalent in Maine that Lubelcyzk and his colleagues are increasingly called upon to educate the public about the health risks the arachnids pose. That includes speaking at community forums, town meetings, garden clubs and even to groups of employees.
“They’re widespread enough now that DOT, CMP, people like that are bumping into them on a regular basis,” he said. “Even people like law enforcement. The warden service, regular police with police dogs, they’re exposed.”
Their outreach also includes plenty of phone calls to the lab, fielded by its small staff of four, not counting summer interns.
“If somebody calls, we never really turn them down,” he said.
Many people don’t realize that the lab no longer identifies ticks for the public, Lubelczyk said. Now located in Scarborough along with MMC’s medical and psychiatric research centers, the lab formerly operated in South Portland, where it identified a tick’s species for anyone who walked in the door or mailed a sample. The University of Maine Cooperative Extension in Orono has since taken over that service (it does not test ticks for disease).
“It’s very hard to say no to someone when they’re really frantic because they found a tick on themselves, or their child, or even their pet,” he said. “And they’re sitting out in the parking lot.”
So far this season, the lab has fielded numerous calls from worried residents only to discover after viewing a photograph that the tick in question is a dog tick, not a deer tick. Maine is home to 15 species of ticks, and the dog tick is not among those that transmit disease to humans, at least in this region.
Through its outreach work, the lab has also found itself at the center of debates about how to manage ticks. Lubelczyk recalled a town forum on Long Island a couple of years ago that grew tense as residents discussed the use of pesticides.
“As soon as the topic of any kind of spray was brought up, not even by us, by somebody else, the fishing community was dead set against it,” he said. “Understandably, they’re worried about the stock. It really makes that difficult because you start to have divisions in how to control the ticks.”
The lab’s research on the role of birds in spreading tick-borne disease is similarly delicate, because many birds are under threat ecologically, Lubelczyk said.
“No one really cares if you try to target mice. Birds are federally protected in a lot of cases,” he said.
That other biting pest
Educating the public represents a large part of the lab’s mission but only a small part of its budget. Its outreach work is funded largely through small grants from foundations, Lubelczyk said.
Most of its research funding is targeted toward mosquitoes rather than ticks, boosted by the federal government’s initiative to combat the Zika virus, he said. While Zika hasn’t appeared in Maine, warming temperatures due to future climate change could make the state habitable for one of the mosquito species that carries it.
Lubelczyk explained this as he stood in the lab’s testing area, next to a large freezer storing petri dishes packed with frozen mosquitoes. A piece of yellow tape affixed to the door warned, “Not for food.”
While Lyme is far more prevalent, diseases carried by mosquitoes, such as West Nile virus and Eastern Equine Encephalitis, can lead to more acute illness. Both can cause inflammation of the brain and other serious complications.
Funding for tick research is generally less reliable, Lubelczyk said. The recent Powassan survey, for example, was funded by the Maine Outdoor Heritage Fund, which collects money through the sale of instant scratch lottery tickets.
A continuing threat
The lab’s role in helping to prevent tick-borne diseases has only grown as the tick population and the diseases they carry spread. The incidence of Lyme in Maine is among the highest rates in the country, averaging 82.5 cases per 100,000 people between 2013 and 2015.
Anaplasmosis and babesiosis are less common but becoming increasingly worrisome.
Lubelczyk understands the illnesses on both a professional and personal level. He contracted Lyme several years ago, after a deer tick latched onto him while he made a pitstop on the way home from work one steamy July day, he said. He had just changed into shorts and sandals and jumped out of his car for 30 seconds to hang a mosquito trap in Wells, he recalled.
A day and a half later, he spotted the tick bite. After a round of antibiotics, he recovered, Lubelczyk said.
His usual garb for field work includes long sleeves and pants treated with permethrin, along with gaiters over his boots.
“It’s embarrassing,” he said, wincing. “We always talk about wearing appropriate clothing.”
I’m thankful someone is dealing with the bird issue in relation to tick propagation as I believe it will be found to be much more of an issue than previously thought. It would help explain why folks insist they’ve been infected while near trees as birds would drop them onto trees (as well as various rodents). Like deer, birds serve primarily as transits that can spread ticks far and wide.
https://madisonarealymesupportgroup.com/2017/08/14/canadian-tick-expert-climate-change-is-not-behind-lyme-disease/John explains, “The climate change range expansion model is what the authorities have been using to rationalize how they have done nothing for more than thirty years. It’s a huge cover-up scheme that goes back to the 1980’s. The grandiose scheme was a nefarious plot to let doctors off the hook from having to deal with this debilitating disease. I caught onto it very quickly. Most people have been victims of it ever since.” “This climate change ‘theory’ is all part of a well-planned scheme. Even the ticks are smarter than the people who’ve concocted this thing,” he says. “Climate change has nothing to do with tick movement. Blacklegged ticks are ecoadaptive, and tolerate wide temperature fluctuations. On hot summer days, these ticks descend into the cool, moist leaf litter and rehydrate. In winter, they descend into the leaf litter, and are comfortable under an insulating blanket of snow. Ticks have antifreeze-like compounds in their bodies, and can tolerate a wide range of temperatures. For instance, at Kenora, Ontario, the air temperature peaks at 36°C and dips to –44°C, and blacklegged ticks survive successfully.
Also, please note that although there has only been one Zika death in an elderly man with a preexisting health condition in the continental U.S., all the funding is going to it and mosquito research. This is causing untold harm here where Lyme is causing around 400,000 new cases per year. There is no official tally on all the other coinfections that often come with Lyme as they aren’t even reportable in many states but are a crucial detail in understanding the complexity of Lyme/MSIDS. People are often infected with numerous pathogens. https://madisonarealymesupportgroup.com/2017/07/01/one-tick-bite-could-put-you-at-risk-for-at-least-6-different-diseases/
To treat this complex as a one organism/one disease would be folly.