The Partial Observer from Maureen Dill

Tick-borne Diseases on the Rise Here

According to Cornell University’s “Tick Talk” Community Education Program, tick-borne diseases have become a significant public health issue in New York State, with numerous tick species and diseases currently spreading within the region.

This year, a Lyme and Tick-Borne Disease Summit was held on September 28 and 29 under the auspices of the State University of New York Upstate Medical University in Syracuse and the Central New York Lyme and Tick-Borne Disease Alliance. The Central New York Lyme and Tick-Borne Disease Alliance is a collaborative of providers, scientists, and community members who support research, drive education, and promote awareness to combat tick-borne illnesses. The summit was co-sponsored by the SUNY Upstate Medical University Office of Continuing Medical Education for a target audience of healthcare practitioners in Central New York. The goals were to (a) increase awareness of medical providers regarding risk factors and epidemiological patterns of tick-borne diseases in our region, (b) increase the competence of medical providers to recognize and diagnose Lyme and tick-borne diseases, and (c) increase the competence of medical providers to treat Lyme and other tick-borne diseases.

The summit called for disclosures by each of the presenters—whether MDs, PhDs, etc. —of any relevant financial relationships with ineligible companies, e.g., Pfizer, Merck, AstraZeneca, etc. There were several such disclosures by some of the presenters, with any and all relevant financial relationships mitigated.

The Thangamani Laboratory in the SUNY Upstate Medical University is investigating geographic expansion of ticks and tick-borne diseases in New York. Tick-borne diseases in New York include: Lyme (Borellia burgdorferi), anaplasmosis, babesiosis, Borrelia miyamotoi, Powassan virus, ehrlichiosis, tularemia (rabbit fever) and Rocky Mountain spotted fever. A 2021 estimate based on insurance records suggests that each year approximately 476,000 Americans are diagnosed and treated for Lyme disease. The annual number of tick-borne disease cases has more than doubled in the U.S. in the past two decades—whether bacterial (as in Lyme, anaplasma, ehrlichia, babesia) or viral (as in Powassan). There are several possible reasons for this, including growing tick populations, rising heat and humidity (climate change) that help ticks thrive in more places for longer periods, and improved tracking of these diseases.

Due to the fact that the Centers for Disease Control and Prevention’s data only represents confirmed cases, the actual quantity of Lyme disease cases may be far greater, with an estimate of 1,013,000 true cases of Lyme disease. (Tick-Check Website. E. Stroudsburg University.) All Lyme disease prevalence surveillance data is sourced from the CDC. It is discomforting to note that New York State reportedly has the highest rate of tick-borne illnesses in the United States.

Physicians may often fail to recognize Lyme disease, for example, as the symptoms don’t clearly point to one particular disease but are broad enough to be any of several medical conditions. Ticks can transmit not only Lyme but also other bacterial or viral infections simultaneously. Co-infected patients are more likely to have fatigue, exaggerated changes in mood, nausea, headaches, sweats and chills, and an enlarged spleen more frequently than those infected solely with Lyme disease. Recent studies report babesia is now found in 10 percent of the ticks in New England and more than 15 percent in New York. Babesiosis is an emerging infectious disease about which many clinicians have had little or no training. Unrecognized cases of babesiosis in blood donors have also produced blood transfusion-transmitted cases—as had been the case with the AIDS virus in the early years of that epidemic—which carry a significant mortality risk. Delays in test results can often contribute to delays in timely treatment. It would seem that, these days, local veterinarians are more readily able to identify a tick-borne illness in dogs than are physicians in people.

Patients must be properly diagnosed first, of course, and that doesn’t always happen when many medical providers are unfamiliar with relatively uncommon diseases like anaplasmosis, babesiosis, Powassan, etc. According to Upstate Medical University’s Dr. Saravanan Thangamani, New York State now has one of the highest incidences of Powassan virus in the U.S. There have been reports of Powassan-related deaths in Maine, Massachusetts and Connecticut, with three deaths reported in Maine during the past 18 months. Ten percent of the neuroinvasive Powassan viral infections can result in death, while 50 percent of infected persons will have long-term neurological complications. While Lyme might be transmitted in a 24-48 hour period, the Powassan virus is transmitted immediately, disseminating the virus into the human body where it is only detectable in the blood for a short time. The virus quickly moves from the blood to the spinal column and then to the brain. Sadly, at this time it is reported there are no medications or vaccines to treat Powassan. It may mimic other diseases, making a physician’s diagnosis difficult. Eighty percent of ticks that carry Powassan can also carry Lyme, anaplasma, ehrlichia or babesia. Deer ticks and groundhog ticks reportedly transmit this virus.

Prevention is best in avoiding tick-borne diseases. It is recommended to avoid tick hotspots, use tick repellent on skin and clothes, and, when hiking, stay in the middle of the trail. Ticks must be removed immediately and sent to a lab for testing in order to identify the risk factor. (There are “tick kits” available through Amazon that contain very effective “tick pullers”.) According to Cornell University, the head, shoulders, knees and toes are where one should check for ticks after spending time outdoors.

This fall, Cornell’s researchers are choosing areas in Central New York where they will do “tick drags” in hopes of potentially reducing diseases in ticks. Tick drags are the means by which ticks are captured for testing. In order to conduct a tick drag on one’s property to see how many ticks are present, all that is needed is PVC pipe, a rope and some white fabric. Cornell’s researchers are seeking access to properties in Central New York with around one to two acres, a wooded back yard and evidence of frequent deer. Anyone interested in participating may e-mail hn343@cornell.edu. In addition, there is a five-year research project through a CDC federal grant to study whether a vaccinated bait fed to wild rodents will decrease Lyme.

During this past year or two, several friends and former colleagues had been hospitalized—here in New York, in New Jersey and in Florida–having been diagnosed as having an “autoimmune disease.” Agencies report that the prevalence of autoimmune disease is now common and rising, but experts say the evidence is insufficient to explain the rise in autoimmunity. There are so many possible triggers for autoimmune disease, including stress, diet, lack of exercise, insufficient sleep and smoking. Anything that causes chronic inflammation in the body can eventually lead to the development of an autoimmune disease, which could be one reason they are becoming increasingly common.

Over the years, environmental exposures—including pollutants, medications, dietary components, viral infections, and stress—have also been linked to autoimmunity. Current research, however, indicates that Lyme disease and other tick-borne illnesses may trigger an autoimmune response with symptoms that mimic an autoimmune disease. People infected with Lyme bacteria, for example, have antibodies in their blood against their own tissue, which is a sign of autoimmunity. It is said that the reason why Lyme disease can be mistaken for an autoimmune disorder is because the body’s immune system recognizes the cell that the tick-borne bacteria infects and hides in as foreign, and attacks it, which can cause damage to healthy tissue. At the present time, there is much research being conducted to help the scientific and medical communities better understand whether there is a relationship between Lyme disease and autoimmune diseases.

Maureen Dill is a retired social worker and former disaster preparedness and response planner, having served as human services and emergency services director for two international nonprofit charitable organizations.