EID Journal: Seroprevalence Of B. Miyamotoi In N.E. United States

(Photo Credit- CDC)

 

# 8794

 

 

Although they’ve undoubtedly been around and infecting mankind for a long time, in recent years we’ve seen a surge in the number of `new’ tickborne illnesses identified in the United States and around the world.  And as new tests are being developed and deployed, we are finding out that the number of tick borne infections reported previously have only represented  `the tip of the iceberg’.

 

Last year, the CDC revised their Estimate Of Yearly Lyme Disease Diagnoses In The United States, indicating that the number of Lyme Disease diagnoses in the country is probably closer to 300,000 than the 30,000 that are officially reported each year to the CDC.

 

In 2012, the CDC announced the identification of the The Heartland Virus in two farmers from the Midwest (see a New Phlebovirus Discovered In Missouri). Last March (see MMWR: Heartland Virus Disease — United States, 2012–2013) we saw an update from the CDC indicating that 6 more cases had been identified (5 in Missouri, 1 in Tennessee), and last month we saw the  Oklahoma DOH Reports 1st Heartland Virus Fatality.

 

Like many vector-transmitted diseases, the Heartland Virus is likely under-reported.

 

A couple of weeks ago, in The Tick Borne Identity, we looked at a study out of the University of North Florida, that claims to have found a new strain of Borellia (aka Lyme Disease), that is prevalent in ticks in the Southeastern states. In 2011 we saw the NEJM: Emergence Of A New Bacterial Cause Of Ehrlichiosis, while in recent years Babesia microti infection (see Maryn McKenna On Babesia And The Blood Supply) is increasingly viewed as a serious public health concern.

 

One of the more recent discoveries involves a tickborne bacteria called Borrelia miyamotoi, which was first described in ticks Japan in the mid-1990s, .  We’ll let the CDC carry the narrative for a spell:

 

What you need to know about Borrelia miyamotoi, a newly described human pathogen

What is Borrelia miyamotoi?

Borrelia miyamotoi are spiral-shaped bacteria that are closely related to bacteria that cause tick-borne relapsing fever (TBRF). They are more distantly related to the bacteria that cause Lyme disease. First identified in 1995 in ticks from Japan, the bacteria have since been detected in two species of North American ticks, the black-legged or “deer” tick (Ixodes scapularis) and the western black-legged tick (Ixodes pacificus). These ticks are already known to transmit several diseases, including Lyme disease, anaplasmosis, and babesiosis.

What type of illness does B. miyamotoi cause?

Human infections with B. miyamotoi were first described in 2011 in a report from Russia. Most of the patients had fever, headache, and muscle aches--symptoms typical of TBRF. Symptoms similar to those of Lyme disease, such as the erythema migrans rash (bull’s-eye rash), arthritis, or facial palsy, were uncommon.

Recently, three cases of human infection with B. miyamotoi were identified in the United States. One patient was an elderly, immunocompromised woman with confusion and an unsteady gait. The bacteria were seen in samples of the patient’s spinal fluid, and she recovered when treated with antibiotics. The two other patients had fever, chills, and muscle aches, similar to the symptoms of the patients in Russia.

 

While the number of  B. miyamotoi cases reported in the United States remains small, surveillance and testing is just in its infancy.  To that end we have research, published in the July edition of the EID Journal, that looks at the seroprevalence of  B. miyamotoi  infection in archived blood samples (collected 1991–2012) from residents of the Northeastern United States.

 

Volume 20, Number 7—July 2014

Research

Borrelia miyamotoi sensu lato Seroreactivity and Seroprevalence in the Northeastern United States

Peter J. Krause , Sukanya Narasimhan, Gary P. Wormser, Alan G. Barbour, Alexander E. Platonov, Janna Brancato, Timothy Lepore, Kenneth Dardick, Mark Mamula, Lindsay Rollend, Tanner K. Steeves, Maria Diuk-Wasser, Sahar Usmani-Brown, Phillip Williamson, Denis S. Sarksyan, Erol Fikrig, Durland Fish, and the Tick Borne Diseases Group

Abstract

Borrelia miyamotoi sensu lato, a relapsing fever Borrelia sp., is transmitted by the same ticks that transmit B. burgdorferi (the Lyme disease pathogen) and occurs in all Lyme disease–endemic areas of the United States. To determine the seroprevalence of IgG against B. miyamotoi sensu lato in the northeastern United States and assess whether serum from B. miyamotoi sensu lato–infected persons is reactive to B. burgdorferi antigens, we tested archived serum samples from area residents during 1991–2012.

Of 639 samples from healthy persons, 25 were positive for B. miyamotoi sensu lato and 60 for B. burgdorferi. Samples from ≈10% of B. miyamotoi sensu lato–seropositive persons without a recent history of Lyme disease were seropositive for B. burgdorferi.

Our results suggest that human B. miyamotoi sensu lato infection may be common in southern New England and that B. burgdorferi antibody testing is not an effective surrogate for detecting B. miyamotoi sensu lato infection.

In the same EID journal edition, in -  Human Exposure to Tickborne Relapsing Fever Spirochete Borrelia miyamotoi, the Netherlands by Fonville M, Friesema IHM, Hengeveld PD, Docters van Leeuwen A, Jahfari S, Harms MG, et al. - we see a case described as:

 

Conditions reported to be associated with B. miyamotoi infection were systemic, including malaise and fever, meningoencephalitis, and neurologic symptoms. Because of the nature of these manifestations and because regular diagnostic tests for B. burgdorferi will most probably not detect B. miyamotoi infections (3,5), B. miyamotoi infections may remain undiagnosed.

Nevertheless, the relationship between B. miyamotoi infection and illness is not very well established; the case-patients reported, including the patient in the Netherlands, were usually hospitalized, severely ill, and often immunocompromised (3–5). The extent to which B. miyamotoi causes infection and disease in immunocompetent persons is unknown.

 

The authors of the first EID report (both of which are worth reading in their entirety), conclude by writing:

 

The determination of B. miyamotoi sensu lato seroprevalence in our population is important because it indicates that this pathogen may infect persons at a rate that is similar to that of B. microti in the northeastern United States (16,23,24). Our data suggest that acute B. miyamotoi sensu lato infection in some persons may be misdiagnosed as Lyme disease because of the presence of antibody to B. burgdorferi from a previous B. burgdorferi infection, a false-positive test reaction, and/or cross-reactivity.

Antibody testing for B. burgdorferi, however, is not adequate to detect infection with B. miyamotoi sensu lato in the United States. The potential for misdiagnosis may be greater in locations like northern California, were the prevalence of B. miyamotoi sensu lato in ticks equals or exceeds the prevalence of B. burgdorferi in ticks (32). Further studies are needed to better characterize the epidemiology and improve the serodiagnosis of human B. miyamotoi sensu lato infection.

The Tick Borne Identity

Tickborne Diseases of The United States – CDC

 

# 8768

 

While mosquito-borne diseases are getting a publicity boost due to the recent arrival of Chikungunya to the Americas (see Florida Surveillance: Imported Chikungunya, Dengue, Malaria) -  ticks  - and the myriad of diseases they can carry, are back in the news again as well.

 

Last night CIDRAP NEWS carried a summary of a recent PLoS One study (Co-Infection of Blacklegged Ticks with Babesia microti and Borrelia burgdorferi Is Higher than Expected and Acquired from Small Mammal Hosts) that found that nearly 7% of deer ticks  sampled in upstate New York carried both Lyme bacteria (B burgdorferi) and a malaria-like parasite called Babesia microti.

And earlier this year, a researcher at  the University of North Florida – Dr. Kerry Clark – published a paper showing that two ’strains of Borrelia are present in the ticks in the Southeastern states (Florida & Georgia) – areas not commonly thought of as being `Lyme territory’ - and are capable of causing human illness.

 

Press Release for Tuesday, May 13, 2014

UNF Professor Confirms Lyme Disease in Humans from Southern States

Media Contact: Joanna Norris, Director
Department of Public Relations
(904) 620-2102

Dr. Kerry Clark, associate professor of public health at the University of North Florida, and his colleagues have found additional cases of Lyme disease in patients from several states in the southeastern U.S. These cases include two additional Lyme disease Borrelia species recently identified in patients in Florida and Georgia.

Overall, 42 percent of 215 patients from southern states tested positive for some Lyme Borrelia species. More than 90 cases of Lyme infection were confirmed among patients from Florida, Georgia, North Carolina, Texas and Virginia. Of these southern cases, 69 percent were found to have infection with B. burgdorferi, 22 percent with B. americana and 3 percent with B. andersonii.

“For years, medical practitioners and the public have been told that Lyme disease is rare to nonexistent in the southern United States. Our earlier research demonstrated that Lyme disease bacteria were present in animals and ticks in our region,” said Clark. “The more recent evidence shows that the disease is also present in human patients in the South, and suggests that it’s common among patients presenting with signs and symptoms consistent with the clinical presentation of Lyme disease recognized in the northeastern part of the country.”

(Continue . . . )

Of particular note, the authors indicate that patients infected with these two strains of Borrelia may not be reliably detected using standard Lyme tests.

 

Something, that if validated, might help explain the large number of people who have complained of Lyme-like illness, but have tested negative for the disease.

 

In 2012, The Heartland Virus – a New Phlebovirus Discovered In Missouri – made headlines when it was detected in two Missouri farmers with no epidemiological links and living 60 miles apart. Last March (see MMWR: Heartland Virus Disease — United States, 2012–2013) we saw an update from the CDC indicating that 6 more cases had been identified (5 in Missouri, 1 in Tennessee). 

 

And  at the end of last month, we saw Oklahoma DOH Reports 1st Heartland Virus Fatality. Like many vector-transmitted diseases, the Heartland Virus is likely under-reported.

 

Last year, the CDC revised their Estimate Of Yearly Lyme Disease Diagnoses In The United States, indicating that the number of Lyme Disease diagnoses in the country is probably closer to 300,000 than the 30,000 that are officially reported each year to the CDC. 

 

The CDC lists a growing number of diseases carried by ticks in the United States, including: Anaplasmosis, Babesiosis , Ehrlichiosis, Lyme disease, Rickettsia parkeri Rickettsiosis, Rocky Mountain Spotted Fever (RMSF), STARI (Southern Tick-Associated Rash Illness), Tickborne relapsing fever (TBRF), Tularemia, and 364D Rickettsiosis.

 

And not only are the number of known tickborne diseases increasing, so are the number of ticks.  This all-too-common report comes from WPRI.com, in Rhode Island.

 

Despite harsh winter, tick count expected to grow

By Sara Lapointe with Angie Angers Published: June 20, 2014, 2:49 pm

KINGSTON, R.I. (WPRI) — Summer is here and tick season is fast approaching.

The University of Rhode Island’s tick expert and Director of the URI Center for Vector-Borne Disease, Tom Mather, says that even though you may have trouble noticing the tiny deer ticks in the woods, there are “really a lot of them out there right now.” The nymphal deer tick counts are 85 percent higher than average over the past 5 years.

(Continue . . . )

 

The reasons behind an increase in ticks in recent decades are complex, and not completely understood, but some of the factors commonly cited are:

 

• Warmer winters;
• Encroachment of humans into rural and suburban areas;
• A decrease in the use of insecticides.

 

In 2011, in NRDC Report: Climate Change and Health Threats, we looked at a study that suggested that climate change could exacerbate a number of vector-borne illnesses.

 

Last April, in anticipation of this summer’s tick season, the CDC held a COCA Call on Tickborne diseases, with an emphasis on Lyme Disease and Rocky Mountain Spotted Fever. Although primarily of interest to clinicians, this presentation would be of interest to many in the public health arena. 

This webinar is archived on the CDC site.

 

 

Tickborne Diseases: A Springtime Review of Diagnosis, Treatment and Prevention

Date:Thursday, April 10, 2014

Presenter(s)

Christina Nelson, MD, MPH
Medical Epidemiologist
Bacterial Diseases Branch
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention

Naomi Drexler, MPH
Epidemiologist
Rickettsial Zoonoses Branch
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention

Overview

From May through July, people get tick bites and tickborne diseases more often than any other time of year in the United States. In 2012, over 4,000 cases of Rocky Mountain spotted fever and 30,000 cases of Lyme disease were reported to CDC. Tickborne diseases can cause symptoms that range from mild to life-threatening. Early recognition and treatment of tickborne diseases decreases the risk of serious complications. During this COCA call, CDC subject matter experts will describe the signs and symptoms, treatment, management, and prevention of tickborne diseases in the U.S., with an emphasis on Lyme disease and Rocky Mountain spotted fever.

• Slides: View Now
• Webcast: Watch Now
• Audio: Listen Now
• Transcript: Read Now

(Continue . . . )

 

Given the smorgasbord of  of diseases carried by ticks it makes sense to avoid their bites whenever possible.  This advice from the Minnesota Department of Health.

 

And for some more Tick-borne disease related blogs, you may wish to revisit:

 

PHAC: Lyme Disease Risk Increasing In Canada

EID Journal: Novel Bunyavirus In Livestock – Minnesota

Korean CDC On SFTS Cases

Referral: Maryn McKenna On Babesia And The Blood Supply

NEJM: Emergence Of A New Bacterial Cause Of Ehrlichiosis

tick . . . tick . . . tick . . .

Minnesota: Powassan Virus Fatality

Oklahoma DOH Reports 1st Heartland Virus Fatality

Lone Star Tick - Credit CDC MMWR

 

# 8671

 

In August of 2012, in a New Phlebovirus Discovered In Missouri, I wrote about the CDC’s announcement of a new tick-borne virus phlebovirus detected in two Missouri farmers with no epidemiological links and living 60 miles apart.

 

Dubbed `The Heartland Virus’ (HLV),  the virus was  named after the Heartland Regional Medical Center in St. Joseph, Mo which alerted the CDC back in 2009 about these cases.

Phleboviruses are part of the large family Bunyaviridae - which includes such infamous pathogens as Crimean-Congo hemorrhagic fever and Rift Valley Fever.  Bunyaviruses -  are mostly spread via arthropod vectors (ticks, mosquitoes & sand flies).

 

This newly described `Heartland virus’  is genetically similar to another tickborne disease identified in China in 2011 called the SFTS virus (see EID Journal  dispatch Severe Fever with Thrombocytopenia Syndrome Virus, Shandong Province, China Jun 2012).  Since then, SFTS-like viruses have been found in ticks in Japan, Korea, and Australia.

 

Last March (see MMWR: Heartland Virus Disease — United States, 2012–2013) we saw an update from the CDC indicating that 6 more cases had been identified (5 in Missouri, 1 in Tennessee).   This from CDC’s emailed press release:

 

CDC studies to date have shown Heartland virus is carried by Lone Star ticks, which are primarily found in the southeastern and eastern United States. Additional studies seek to confirm whether ticks can spread the virus to people and to learn what other insects or animals may be involved in the transmission cycle. CDC is also looking for Heartland virus in other parts of the country to understand how widely it may be distributed.

 

Today, via the Oklahoma State Health Department  we learn that the number of cases has grown to 10, and that Oklahoma is reporting its first Heartland virus related fatality.

 

 

For Release:  May 27, 2014 – Pamela Williams, Office of Communications – 405-271-5601

Oklahoma State Health Department Confirms First Case and Death of Heartland Virus

The Oklahoma State Department of Health has confirmed the state's first case and death of Heartland virus. A Delaware County resident died recently from complications of the virus. The virus is found in the Lone Star tick (Amblyomma americanum), and is likely spread through tick bites. 

Heartland virus was first identified in Missouri in 2009. The Oklahoma case is only the tenth person confirmed with the virus and the second person to die from it. Other cases have occurred in Missouri and Tennessee. All of the patients diagnosed with Heartland virus reported spending several hours per day in outside activities or occupations.

Symptoms can include fever, fatigue, headaches, muscle aches, loss of appetite, nausea, bruising easily and diarrhea. There is no routine testing available for Heartland virus. However, protocols are in place for investigational diagnostic testing. Healthcare providers can contact the Oklahoma State Department of Health's Acute Disease Service at (405) 271-4060 for consultation regarding protocol enrollment for patients who have acute illnesses compatible with Heartland virus infection.

There is no vaccine or drug to prevent or treat the disease. Preventing bites from ticks and mosquitoes may prevent this and other infections. The Oklahoma State Department of Health recommends the following:

--Use insect repellents, following package instructions.
--Wear long sleeves and pants when outdoors so that ticks are easily seen and removed.
--Avoid bushy and wooded areas where ticks can be transferred onto you.
--Perform thorough tick checks soon and daily after spending time outdoors.
For more information on reducing exposure to ticks, visit:

http://www.ok.gov/health/Disease,_Prevention,_Preparedness/Acute_Disease_Service/Disease_Information/Tickborne_and_Mosquitoborne_Diseases/index.html.

 

The CDC’s Heartland Virus FAQ (updated March 26th), provides the following advice regarding HLV.

How can people reduce the chance of getting infected with Heartland virus?

There is no vaccine or drug to prevent or treat the disease. Preventing bites from ticks and mosquitoes may prevent this and other infections.

• Use insect repellents
• Wear long sleeves and pants
• Avoid bushy and wooded areas
• Perform thorough tick checks after spending time outdoors

Additional information on reducing exposure to ticks is available on the CDC Ticks website.

 

For more on this virus, and SFTS-like viruses in North America, you may wish to revisit: EID Journal: Novel Bunyavirus In Livestock - Minnesota

CDC: Upcoming COCA Call On Tickborne Diseases

CDC Tickborne Diseases of the United States: A Reference Manual for Health Care Providers – PDF

# 8421

 

An early head’s up, perhaps - but given the interest in the topic - I’m sure a lot of people will want to adjust their schedule accordingly.   Next week – Thursday April 10th – the CDC will hold a 1 hour COCA Call / Webinar on tickborne diseases, with an emphasis on Lyme Disease and Rocky Mountain Spotted Fever.

Although primarily of interest to clinicians, the CDC holds frequent COCA (Clinician Outreach Communication Activity) calls which are designed to ensure that practitioners have up-to-date information for their practices.

 

If you are unable to attend the call at the time it is presented, transcripts, audio, and often video are usually posted on the CDC  website within a few days.

 

 

Tickborne Diseases: A Springtime Review of Diagnosis, Treatment and Prevention

Date:Thursday, April 10, 2014

Time:2:00 – 3:00 PM (Eastern Time)

Click to Join

https://www.mymeetings.com/nc/join.php?i=PW4464425&p=8291522&t=c

Dial:800-779-0651

Passcode:8291522

---

Presenter(s)

Christina Nelson, MD, MPH
Medical Epidemiologist
Bacterial Diseases Branch
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention

Naomi Drexler, MPH
Epidemiologist
Rickettsial Zoonoses Branch
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention

Overview

From May through July, people get tick bites and tickborne diseases more often than any other time of year in the United States. In 2012, over 4,000 cases of Rocky Mountain spotted fever and 30,000 cases of Lyme disease were reported to CDC. Tickborne diseases can cause symptoms that range from mild to life-threatening. Early recognition and treatment of tickborne diseases decreases the risk of serious complications. During this COCA call, CDC subject matter experts will describe the signs and symptoms, treatment, management, and prevention of tickborne diseases in the U.S., with an emphasis on Lyme disease and Rocky Mountain spotted fever.

Objectives

At the conclusion of the session, the participant will be able to accomplish the following:

• Discuss the geographic distribution of Lyme disease, Southern tick-associated rash illness (STARI), Rocky Mountain spotted fever, ehrlichiosis, and anaplasmosis.
• Explain the signs and symptoms of tickborne diseases.
• Describe the appropriate use of serologic tests for confirming diagnoses of tickborne diseases.
• State the appropriate use of antibiotics in treatment of tickborne diseases.

(Continue . . .)

 

 

For more background, some recent blogs on tickborne illnesses include:

 

MMWR: Heartland Virus Disease — United States, 2012–2013

CDC: Estimate Of Yearly Lyme Disease Diagnoses In The United States

PHAC: Lyme Disease Risk Increasing In Canada

EID Journal: Novel Bunyavirus In Livestock – Minnesota

Korean CDC On SFTS Cases

MMWR: Heartland Virus Disease — United States, 2012–2013

Lone Star Tick - Credit CDC MMWR

 

 

# 8408

 

In August of 2012, in a New Phlebovirus Discovered In Missouri, I wrote about the CDC’s announcement of a new tick-borne virus detected in two Missouri farmers – living 60 miles apart, and with no epidemiological links - that was dubbed `The Heartland Virus’ (HLV) - named after the Heartland Regional Medical Center in St. Joseph, Mo which alerted the CDC back in 2009 about these cases

 

A 2012 NEJM report (A New Phlebovirus Associated with Severe Febrile Illness in Missouri), described the process that led to the identification of this novel virus:

 

Electron microscopy revealed viruses consistent with members of the Bunyaviridae family. Next-generation sequencing and phylogenetic analysis identified the viruses as novel members of the phlebovirus genus.

<SNIP>

This novel virus (which we called the Heartland virus) is a distinct member of the phlebovirus genus and is most closely related to tickborne phleboviruses, notably the recently isolated SFTSV

 

Phleboviruses are part of the family Bunyaviridae - which includes such nasties as Crimean-Congo hemorrhagic fever, Hantaviruses, and Rift Valley Fever. Bunyaviruses -  are mostly spread via arthropod vectors (ticks, mosquitoes & sand flies), with the exception of Hantaviruses (see Hantaviruses Revisited), which are spread via the feces and urine of rodents.

 

This newly described `Heartland virus’  is genetically similar to another tickborne disease identified in China in 2011 called the SFTS virus (see EID Journal  dispatch Severe Fever with Thrombocytopenia Syndrome Virus, Shandong Province, China Jun 2012).

 

Since then we’ve seen reports of SFTS in Japan and Korea as well (see Japan Announces 4th SFTS Fatality,  Korean CDC On SFTS Cases).  

 

And in September of 2013, we saw a report in the CDC’s EID Journal (Novel Bunyavirus in Domestic and Captive Farmed Animals, Minnesota, USA), where researchers found an unexpectedly high prevalence (10%-18%) of antibodies (using an ELSIA reagent kit developed by China’s CDC) to SFTS in the cattle, goats, sheep, and elk they tested.   

 

Since the Heartland Virus (HLV) and SFTF are antigenically cross reactive, the authors believed `the viruses detected in this region are most likely HLV or close relatives of HLV.’

 

Given the geographical separation of the first two cases in Missouri, and the detection of HLV-like antibodies in farmed animals as far away as Minnesota, one cannot be too surprised to learn that additional human cases of HLV (5 in Missouri, 1 in Tennessee) have now been identified, as is reported today by  the CDC’s MMWR.

 

Notes from the Field: Heartland Virus Disease — United States, 2012–2013

March 28, 2014 / 63(12);270-271

Daniel M. Pastula, MD1, George Turabelidze, MD2, Karen F. Yates, MS2, Timothy F. Jones, MD3, Amy J. Lambert, PhD4, Amanda J. Panella, MPH4, Olga I. Kosoy, MA4, Jason O. Velez4, Marc Fischer, MD4, J. Erin Staples, MD4 (Author affiliations at end of text)

Heartland virus is a newly identified phlebovirus that was first isolated from two northwestern Missouri farmers hospitalized with fever, leukopenia, and thrombocytopenia in 2009 (1). Based on the patients' clinical findings and their reported exposures, the virus was suspected to be transmitted by ticks. After this discovery, CDC worked with state and local partners to define the ecology and modes of transmission of Heartland virus, develop diagnostic assays, and identify additional cases to describe the epidemiology and clinical disease. From this work, it was learned that Heartland virus is found in the Lone Star tick (Amblyomma americanum) (Figure) (2). Six additional cases of Heartland virus disease were identified during 2012–2013; four of those patients were hospitalized, including one with comorbidities who died.

(Continue . . . )

 

The CDC’s emailed press release summarizes  the cases:

 

Ongoing investigations have yielded six more cases of Heartland virus disease, bringing to eight the total number of known cases. All of the six case-patients were white men over the age of 50. Their symptoms started in May to September and included fever, fatigue, loss of appetite, headache, nausea, or muscle pain. Four of the six new cases were hospitalized. One patient, who suffered from other health conditions, died. It is not known if Heartland virus was the cause of death or how much it contributed to his death. Five of the six new cases reported tick bites in the days or weeks before they fell ill.

Nearly all of the newly reported cases were discovered through a study conducted by the Missouri Department of Health and Senior Services and CDC who are actively searching for human cases at six Missouri hospitals.

<SNIP>

CDC studies to date have shown Heartland virus is carried by Lone Star ticks, which are primarily found in the southeastern and eastern United States. Additional studies seek to confirm whether ticks can spread the virus to people and to learn what other insects or animals may be involved in the transmission cycle. CDC is also looking for Heartland virus in other parts of the country to understand how widely it may be distributed.

The CDC’s Heartland Virus FAQ (updated yesterday, March 26th), provides the following advice regarding HLV.

How can people reduce the chance of getting infected with Heartland virus?

There is no vaccine or drug to prevent or treat the disease. Preventing bites from ticks and mosquitoes may prevent this and other infections.

• Use insect repellents
• Wear long sleeves and pants
• Avoid bushy and wooded areas
• Perform thorough tick checks after spending time outdoors

Additional information on reducing exposure to ticks is available on the CDC Ticks website.

 

How do I know if I have been infected with Heartland virus?

Currently, no tests are routinely available to tell if a person is infected with Heartland virus. Tests that will help a doctor diagnose Heartland virus infection are being developed. Consult your healthcare provider if you have any symptoms that concern you.

 

What is the treatment for Heartland virus disease?

There is no specific treatment for Heartland virus disease. Antibiotics are not effective against viruses. Supportive therapy can treat some symptoms. Some patients may need to be hospitalized for intravenous fluids, and treatment for pain or fever.

 

What should I do if I think someone might be infected with Heartland virus?

Consult your healthcare provider for proper diagnosis if you have any symptoms that concern you.

CDC: Estimate Of Yearly Lyme Disease Diagnoses In The United States

Tickborne Diseases of The United States – CDC

 

 

# 7580

 

 

We’ve a press release from the CDC today outlining their findings that the estimated number of Lyme Disease diagnoses in the country is probably closer to 300,000 than the 30,000 that are officially reported each year to the CDC.

 

 

The CDC lists a growing number of diseases carried by ticks in the United States, including: Anaplasmosis, Babesiosis , Ehrlichiosis, Lyme disease, Rickettsia parkeri Rickettsiosis, Rocky Mountain Spotted Fever (RMSF), STARI (Southern Tick-Associated Rash Illness), Tickborne relapsing fever (TBRF), Tularemia, and 364D Rickettsiosis.

 

Last month, in PHAC: Lyme Disease Risk Increasing In Canada, we saw rising concerns in Canada over the incidence of Lyme and tickborne diseases as well. All of which makes tick awareness, and tick-bite prevention a growing public health issue.

 

 

Here is the CDC’s press release.

 

CDC provides estimate of Americans diagnosed with Lyme disease each year

Preliminary estimates released by the Centers for Disease Control and Prevention indicate that the number of Americans diagnosed with Lyme disease each year is around 300,000. The preliminary estimates were presented Sunday night in Boston at the 2013 International Conference on Lyme Borreliosis and Other Tick-Borne Diseases.

 

This early estimate is based on findings from three ongoing CDC studies that use different methods, but all aim to define the approximate number of people diagnosed with Lyme disease each year. The first project analyzes medical claims information for approximately 22 million insured people annually for six years, the second project is based on a survey of clinical laboratories and the third project analyzes self-reported Lyme disease cases from a survey of the general public.

 

Each year, more than 30,000 cases of Lyme disease are reported to CDC, making it the most commonly reported tick-borne illness in the United States. The new estimate suggests that the total number of people diagnosed with Lyme disease is roughly 10 times higher than the yearly reported number.  This new estimate supports studies published in the 1990s indicating that the true number of cases is between 3- and 12-fold higher than the number of reported cases.

 

“We know that routine surveillance only gives us part of the picture, and that the true number of illnesses is much greater,” said Paul Mead, M.D., M.P.H, chief of epidemiology and surveillance for CDC’s Lyme disease program. “This new preliminary estimate confirms that Lyme disease is a tremendous public health problem in the United States, and clearly highlights the urgent need for prevention.”

 

CDC continues to analyze the data in the three studies to refine the estimates and better understand the overall burden of Lyme disease in the United States and will publish finalized estimates when the studies are complete. Efforts are also underway at CDC and by other researchers to identify novel methods to kill ticks and prevent illness in people.

 

“We know people can prevent tick bites through steps like using repellents and tick checks. Although these measures are effective, they aren’t fail-proof and people don’t always use them,” said Lyle R. Petersen, M.D., M.P.H, director of CDC’s Division of Vector-Borne Diseases. “We need to move to a broader approach to tick reduction, involving entire communities, to combat this public health problem.”

 

This community approach would involve homeowners trying to kill ticks in their own yards, and communities addressing a variety of issues. These issues include rodents that carry the Lyme disease bacteria, deer that play a key role in the ticks’ lifecycle, suburban planning, and the interaction between deer, rodents, ticks, and humans. All must be addressed to effectively fight Lyme disease.

 

Most Lyme disease cases reported to CDC through national surveillance are concentrated heavily in the Northeast and upper Midwest, with 96 percent of cases in 13 states. Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system.

 

CDC recommends people take steps to help prevent Lyme disease and other tickborne diseases:

• Wear repellent
• Check for ticks daily
• Shower soon after being outdoors
• Call your doctor if you get a fever or rash

For more information on Lyme disease, visit www.cdc.gov/lyme.

EID Journal: Novel Bunyavirus In Livestock - Minnesota

(Credit CDC)

 

 

# 7542

 

Bunyaviruses are an incredibly diverse family of negative stranded enveloped RNA viruses that are responsible for such dreaded diseases as Rift Valley Fever, Crimean - Congo Hemorrhagic Fever (CCHF), and Hantavirus.

 

While these viruses most commonly infect arthropods and rodents (and occasionally humans), curiously, one variety even infects plants - the (Tospovirsus) – and is responsible for tomato spotted wilt.

 

In the United States, probably the most common Bunyavirus infection reported is La Crosse (LAC) encephalitis, and less commonly Jamestown Canyon (JCV) and California encephalitis (CE). 

 

All three being mosquito vectored illnesses.

 

Over the past few years we’ve seen a new, often serious human infection emerge in Asia  - Severe Fever with Thrombocytopenia Syndrome (SFTS) - that produces a high fever, a low platelet count and and can lead to multiple organ failure.

 

SFTS first came to our attention in the spring and summer of 2009  after outbreaks were identified in China’s Hubei and Henan provinces.  While ticks were suspected as vectors, the pathogen behind this disease was not initially known.

 

In 2011, the NEJM published a study Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China.  STFS has been associated with a 12% mortality rate in China.

 

Over the past year, we’ve seen reports of SFTS in Japan and Korea as well (see Japan Announces 4th SFTS Fatality,  Korean CDC On SFTS Cases).  Of note, we’ve also seen evidence of limited human-to-human transmission of this virus.

 

Person-to-person transmission of severe fever with thrombocytopenia syndrome virus.

Liu Y, Li Q, Hu W, Wu J, Wang Y, Mei L, Walker DH, Ren J, Wang Y, Yu XJ.

(Excerpt)

We concluded that SFTSV can be transmitted from person to person through contacting patient's blood.

 

Last year, in New Phlebovirus Discovered In Missouri we also learned of the discovery of another novel Bunyavirus – dubbed the Heartland Virus (HLV) - in two residents of Western Missouri. Last month CIDRAP NEWS reported that Researchers trace novel Heartland virus to Missouri ticks.

 

All of which serves as prelude to today’s report in the CDC’s EID Journal, where researchers in Minnesota conducted serological testing of domestic and captive farmed animals looking for evidence of SFTS and the Heartland virus.

 

What they found was an unexpectedly high prevalence (10%-18%) of antibodies (using an ELSIA reagent kit developed by China’s CDC) to SFTS in the cattle, goats, sheep, and elk they tested.   

 

Since the HLV and SFTF are antigenically cross reactive, the authors believe `the viruses detected in this region are most likely HLV or close relatives of HLV.’

 

The entire study is well worth reading, and is available at the link below.  I’ve excerpted the abstract and a small portion from the conclusion, as it speaks to the impact this discovery may have on public health.

 

Volume 19, Number 9—September 2013

Dispatch

Novel Bunyavirus in Domestic and Captive Farmed Animals, Minnesota, USA

Zheng Xing , Jeremy Schefers, Marc Schwabenlander, Yongjun Jiao, Mifang Liang, Xian Qi, Chuan Li, Sagar Goyal, Carol J. Cardona, Xiaodong Wu, Zerui Zhang, Dexin Li, James Collins, and Michael P. Murtaugh

Abstract

We tested blood samples from domestic and captive farmed animals in Minnesota, USA, to determine exposure to severe fever with thrombocytopenia syndrome virus and Heartland-like virus. We found antibodies against virus nucleoproteins in 10%–18% of samples from cattle, sheep, goats, deer, and elk in 24 Minnesota counties.

 

<SNIP>

Conclusion (EXCERPT)

Farmers, hunters, and persons with outdoor lifestyles may become infected when they are bitten by infected ticks. In addition, direct contact with secretions, body liquids, or feces from viremic animals would also put these persons and veterinarians at risk, if HLV- infected animals have substantial amounts of virus in blood and other tissues. The direct contact transmission of SFTSV has been reported in family clusters among persons with no history of tick bites, suggesting that person-to-person transmission may also occur (13–15).

 

Evidence that a novel phlebovirus infects domesticated and captive farmed animals as shown in this study validates the concern that an SFTSV- or HLV-like emerging pathogen could pose a serious public health threat in the United States. Epidemiologic studies with a broader scope need to be conducted to elucidate viral ecology, and effective measures must be adopted to control this virus before it spreads among humans.

 

 

 

Although most people think first of Lyme disease when they get a tick bite, The CDC lists a growing number of diseases carried by ticks in the United States, including: Anaplasmosis, Babesiosis , Ehrlichiosis, Lyme disease, Rickettsia parkeri Rickettsiosis, Rocky Mountain Spotted Fever (RMSF), STARI (Southern Tick-Associated Rash Illness), Tickborne relapsing fever (TBRF), Tularemia, and 364D Rickettsiosis.

We’ve discussed a number these in the past, including:

 

Referral: Maryn McKenna On Babesia And The Blood Supply

NEJM: Emergence Of A New Bacterial Cause Of Ehrlichiosis

tick . . . tick . . . tick . . .

Minnesota: Powassan Virus Fatality

 

Given the smorgasbord of  of diseases carried by ticks it makes sense to avoid their bites whenever possible.  This advice from the Minnesota Department of Health.

PHAC: Lyme Disease Risk Increasing In Canada

Female blacklegged ticks in various
stages of feeding. Note the change in
size and colour.-  Credit PHAC

 

#7527

 

Lyme disease, spread by infected ticks, has become a major vector-borne disease in the United States with nearly 35,000 confirmed or suspected cases reported in 2011 (cite Reported Cases of Lyme Disease by Year, United States, 2002-2011).

 

While cases have been reported in Canada (Lyme became a reportable disease there in 2009), they have run about 1/100th the rate seen in the United States (just 258 cases in 2011).

 

But those numbers may poised to increase, according to the following public health notice posted today by the PHAC, as infected ticks appear to be spreading into new regions of Canada.

 

 

Public Health Notice: Lyme disease

Why you should take note

Lyme disease is a serious illness spread by the bite of certain ticks; specifically, blacklegged ticks. Ticks are small, insect-like parasites that feed on the blood of animals, including humans. In regions where blacklegged ticks are found, people can come into contact with ticks by brushing against vegetation while participating in outdoor activities, such as, hiking, camping and gardening. When a tick bites, it attaches to the skin and the bite is usually painless. For most Canadians, the risk of getting Lyme disease is fairly low, but is increasing.

 

Risk to Canadians

The Public Health Agency of Canada, in partnership with provincial and territorial public health authorities, conducts surveillance for Lyme disease in Canada and studies show the risk of the disease is growing in this country. Risk occurs in parts of Manitoba, Ontario, southern Quebec, New Brunswick, Nova Scotia and southern British Columbia, and is increasing in south eastern and south central Canada due to spread of populations of the ticks that carry the bacterium that causes Lyme disease.

 

You are most at risk of being exposed to Lyme disease in the regions listed above where blacklegged and western blacklegged ticks are found. But migratory birds can also carry these ticks to other parts of Canada. Current research tells us that blacklegged ticks may be establishing themselves in new areas that are not identified yet. This may mean that risk of Lyme disease may occur over broader regions of Canada than we are presently aware of.

 

Although blacklegged ticks can be active throughout much of the year in some locations, your risk of acquiring Lyme disease, especially in areas where tick populations are established, is greatest during the summer months when younger ticks are most active.

 

Lyme disease is much more common in the United States than in Canada, with risk areas in the Midwest and northeastern states. In 2011, approximately 35,000 cases of Lyme disease were reported in the United States compared to approximately 258 cases in Canada for the same year.

 

(Continue . . . )

 

As Public Health Canada’s Lyme FAQ explains, black legged ticks carry and can transmit more than just Lyme disease:

 

Although rarer than Lyme disease, there are other infections that can also be contracted from blacklegged ticks. These include Anaplasma phagocytophilum, the agent of human granulocytic anaplasmosis; Babesia microti, the agent of human babesiosis and Powassan encephalitis virus. Most of the precautions outlined above will also help to protect individuals from these infections.

 

The CDC lists a growing number of diseases carried by ticks in the United States, including: Anaplasmosis, Babesiosis , Ehrlichiosis, Lyme disease, Rickettsia parkeri Rickettsiosis, Rocky Mountain Spotted Fever (RMSF), STARI (Southern Tick-Associated Rash Illness), Tickborne relapsing fever (TBRF), Tularemia, and 364D Rickettsiosis.

 

We’ve discussed a number these in the past, including:

 

Referral: Maryn McKenna On Babesia And The Blood Supply

NEJM: Emergence Of A New Bacterial Cause Of Ehrlichiosis

New Phlebovirus Discovered In Missouri

tick . . . tick . . . tick . . .

Minnesota: Powassan Virus Fatality

 

When you consider the wide panoply of diseases carried by ticks it makes sense to avoid tick bites whenever possible.

 

This from the Minnesota Department of Health.

 

Lastly, the CDC offers the following advice:

 

Preventing Tick Bites

While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months (April-September) when ticks are most active.

Avoid Direct Contact with Ticks

• Avoid wooded and bushy areas with high grass and leaf litter.
• Walk in the center of trails.

Repel Ticks with DEET or Permethrin

• Use repellents that contain 20% or more DEET (N, N-diethyl-m-toluamide) on the exposed skin for protection that lasts up to several hours. Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth.
• Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents. It remains protective through several washings. Pre-treated clothing is available and remains protective for up to 70 washings.
• Other repellents registered by the Environmental Protection Agency (EPA) may be found at http://cfpub.epa.gov/oppref/insect/.

Find and Remove Ticks from Your Body

• Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you.
• Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.
• Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs. Tumble clothes in a dryer on high heat for an hour to kill remaining ticks.

Korean CDC On SFTS Cases

Korean CDC  Alert For SFTS

 

# 7355

 

Catching up on an emerging disease we last looked at in February of this year  (see Japan Announces 4th SFTS Fatality) – Severe Fever With Thrombocytopenia Syndrome (SFTS) – caused by a tick borne Bunyavirus, has recently been confirmed in Korea.

 

To date over three hundred Bunyaviruses have been identified around the world, with rodents often cited as carriers. While not all Bunyaviruses are dangerous to humans (some only infect plants), the Bunyavirus family include such nasties as Crimean-Congo hemorrhagic fever, Hantaviruses, and Rift Valley Fever.

 

Most are spread via arthropod vectors (ticks, mosquitoes & sand flies), with the exception of Hantaviruses (see Hantaviruses Revisited), which are spread via the feces and urine of rodents.

 

SFTS first came to our attention in the spring and summer of 2009  after outbreaks were identified in China’s Hubei and Henan provinces.  While ticks were suspected as vectors, the pathogen behind this disease was not initially known.

 

In 2011, the NEJM published a study Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China.  STFS has been associated with a 12% mortality rate in China.

 

Earlier this year (see SFTS Fatality Reported In Japan) we learned of the first known SFTS case in the country of Japan, and since then at least 15 cases have been identified in Japan (with 8 fatalities).

 

Last month, while our attentions were focused primarily on H7N9 and MERS-CoV, Korea’s CDC announced that retrospective testing of a patient who died in 2012 had confirmed Korea’s first known death from the SFTS causing virus (see Korea Times story First death by SFTS virus from tick bite confirmed).

The story goes on to say that another death was suspected, and that five others had been hospitalized with similar symptoms.

 

Fast forward to today, and the Yonhap News Agency is reporting on three additional deaths in Korea, now attributed to this virus.

 

Disease control agency says tick-borne virus kills four South Koreans

SEOUL, June 3 (Yonhap) -- A deadly tick-borne virus has killed four South Koreans and sickened two others, the state-run disease control agency said Monday.

 

The severe fever with thrombocytopenia syndrome virus killed a 63-year-old woman in the country's eastern region in August last year, though her infection of the virus was confirmed last month, according to the Korea Centers for Disease Control and Prevention (KCDC).

 

It was the country's first death caused by the virus, the KCDC said.

 

Last month, the virus also killed three other South Koreans -- a 73-year-old man and an 82-year-old woman, both in the country's southern resort island of Jeju, and a 74-year-old woman in the southeastern region, according to the KCDC.

(Continue . . . )

 

If you visit the Korean CDC’s homepage you’ll find an SFTS Q&A, a reporting  Hotline 043-719-7086, and a a brief press release on the identified cases.

 

As with many emerging and re-emerging pathogens, the Bunyavirus behind these infections has almost certainly in the environment, and causing human illness, for many, many years. 

 

We are only now starting to recognize SFTS as a specific illness, and with modern diagnostic tests, can now identify the causative virus. Whether this virus’s geographic range is expanding, or its incidence in humans is increasing, is something we simply don’t know yet.

 

But tickborne diseases certainly appear to be on the rise in the United States and around the world, with Lyme disease alone blamed for 20,000+ infections each year (MMWR Lyme Disease --- United States, 2003—2005).

The CDC lists a number of diseases carried by ticks in the United States. Included are:

 

Anaplasmosis, Babesiosis , Ehrlichiosis, Lyme disease, Rickettsia parkeri Rickettsiosis, Rocky Mountain Spotted Fever (RMSF), STARI (Southern Tick-Associated Rash Illness), Tickborne relapsing fever (TBRF), Tularemia, and 364D Rickettsiosis.

And last year in New Phlebovirus Discovered In Missouri we learned of another emerging virus carried by ticks, dubbed the `Heartland Virus’.

 

 

Whether a new and emerging threat, or simply noticed now due to our ability to recognize a long-time nemesis – without a vaccine – your best bet is to avoid infection. So it makes sense to take precautions against ticks and other vector-borne diseases.

 

This from the Minnesota Department of Health.

 

Lastly, the CDC offers advice on:

 

Preventing Tick Bites

While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months (April-September) when ticks are most active.

Japan Announces 4th SFTS Fatality

 

Photo Credit Wikipedia Tick Species Associated with SFTS in China

# 6952

 

 

SFTS or Severe Fever with thrombocytopenia syndrome emerged as a diagnosis in China after outbreaks were identified in Hubei and Henan provinces during the spring and summer of 2009.  While ticks were suspected as vectors, the pathogen behind this disease was not initially known.

 

In 2011, the NEJM published a study Fever with Thrombocytopenia Associated with a Novel Bunyavirus in China.  STFS has been associated with a 12% mortality rate in China.

 

To date over three hundred Bunyaviruses have been identified, with rodents often cited as carriers. While not all Bunyaviruses are dangerous to humans (some only infect plants), the Bunyavirus family include such nasties as Crimean-Congo hemorrhagic fever, Hantaviruses, and Rift Valley Fever.

 

Most are spread via arthropod vectors (ticks, mosquitoes & sand flies), with the exception of Hantaviruses (see Hantaviruses Revisited), which are spread via the feces and urine of rodents.

 

Just three weeks ago (see SFTS Fatality Reported In Japan) we learned of the first known SFTS case in the country of Japan. Just two weeks later, headlines read Japan Reports Two Additional SFTS Fatalities.

 

Today, news of a 4th confirmed fatality in Japan, and word that 9 more cases are under investigation.  Links to two news report and a Japan Ministry of Health Statement, and then I’ll return with a little more.

 

Tick-borne virus claimed 4th victim last summer

Jiji Press

A man died in Hiroshima Prefecture last summer after being infected with a tick-borne virus, becoming the fourth known victim of the viral infection in the country, the health ministry said Tuesday

(Continue . . .)

 

 

Concern rises over deadly tick-borne virus in Japan

February 20, 2013

THE ASAHI SHIMBUN

A newly identified deadly virus probably transmitted by blood-sucking ticks is causing concern after experts confirmed it in Japan only a few years after it first surfaced in China.

 

(Continue . . . )

 

 

From Japan’s Ministry of Health (warning, awkward machine translation ahead).

 

Situation in the country confirmed thrombocytopenia syndrome in patients with severe febrile (SFTS)

Recently, "syndrome thrombocytopenia febrile severe (Severe Fever with Thrombocytopenia Syndrome: SFTS)" disease tickborne new response to the fact that cases have been confirmed for the first time in the country, with respect to medical institutions, we have examined the patient similar If you provide information that has been requested through the local government cooperation (Annex 1).

Then out of the case, written by a medical institution, it was a SFTS is confirmed by inspection of the National Institute of Infectious Diseases (. suspected domestic infection. died last summer. Hiroshima adult males) one new case Since, in municipalities across the country that I have provided information effect (Annex 2).
Continue to conduct research and gather information about the disease, in the Ministry of Health, Labour and Welfare, we will take appropriate action.

 

While the sudden identification of 4 fatal cases linked to a recently discovered virus may be a bit disconcerting, it doesn’t necessarily indicate a new threat has emerged on the Japanese landscape. 

 

Often detections of a novel infectious disease come about as the inevitable result of better diagnostic tests that can now identify pathogens that - until recently - were misidentified or missed altogether.

 

Tickborne diseases are on the rise in the United States and around the world, with Lyme disease alone blamed for 20,000+ infections each year (MMWR Lyme Disease --- United States, 2003—2005).

The CDC lists a number of diseases carried by ticks in the United States, including: Anaplasmosis, Babesiosis , Ehrlichiosis, Lyme disease, Rickettsia parkeri Rickettsiosis, Rocky Mountain Spotted Fever (RMSF), STARI (Southern Tick-Associated Rash Illness), Tickborne relapsing fever (TBRF), Tularemia, and 364D Rickettsiosis.

 

And last year in  New Phlebovirus Discovered In Missouri we learned of another emerging virus carried by ticks, dubbed the `Heartland Virus’.

 

Whether a new and emerging threat, or simply our ability to finally recognize a long-time nemesis, it makes sense to take precautions against ticks and other vector-borne diseases.

 

This from the Minnesota Department of Health.

Lastly, the CDC offers advice on:

 

Preventing Tick Bites

While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months (April-September) when ticks are most active.