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Geographic Expansion of Lyme Disease Emphasizes Importance of Recognizing Modes of Transmission


Geographic Spread and Transmission of Lyme Disease

Multiple tick-borne disease modeling efforts have been dedicated to analyzing the geo­graphic spread and epidemiological charac­teristics of Lyme disease. According to a recent review,4 tick population ecology, effect of dis­ease hosts on persistence of tick-borne diseas­es, dynamics of the seasonal tick population and disease transmission, climatic effects, and spatial invasion of ticks and spreading of the disease have been modeled mathematically to further clarify factors that explain disease risk and transmission.

According to Dr. Salgo, the density of deer populations is commonly associated with pre­sence of infected ticks. “The lifecycle of these ticks involves deer, and where deer are ende­mic, ticks are endemic—that’s part of the pro­blem,” he said.

Dr. Shor identified that the increased development of wilderness has reduced the po­pulation of deer predators and increased the population density of deer, which are vehicles for in­fected adult ticks to spread across wider areas and breed. “The ticks jump on the deer and it takes them from point A to point B,” he said. “It also provides proximity so that the ticks can mate.”

However, deer are not competent hosts for imma­ture ticks (larva or nym­ph), the primary sources of transmission of Borrelia burgdorferi. Thus, management objectives to stabilize or reduce deer populations have not reduced the inci­dence of Lyme disease, and an analysis showed no relationship between spatial distribution of Lyme disease and abundance of deer in New York, Wisconsin, Pennsylvania, and Virginia.5 Thus, other ecological factors likely contribu­ted to the increased spread of Lyme disease in recent years.

Dr. Shor pointed out that small mammals, such as the white fruited mouse, act as a “cul­ture medium” on which the larva or nymph feed. An infected larva or nymph transmits the Borrelia pathogen to the small mammals, which are usually asymptomatic, and the pa­thogen can be transmitted to another tick that feeds on them. Some evidence suggests that the density of small mammals in a gi­ven area is a key determinant of the infected nymph population, the most common source of Lyme disease, and one study showed that the white footed mouse Peromyscus leucopus, Eastern chipmunk Tamias striatus, short-tailed shrew Sorex brevicauda, and masked shrew Sorexcinereus are responsible for infecting 80% to 90% of ticks in the north-eastern United States.6 Furthermore, a shift in the population of small-mammal predators, namely an increase in coyotes and decrease in red foxes, which rely more heavily on small mammals for food than do coyotes, stron­gly predicted spatial distribution of Lyme disease in New York.5

The panelists concluded that ecological factors affecting the spread of Lyme disease are complex, and regardless of how it is spread, the Borrelia spirochete is not going anywhere, according to Dr. Bransfield. “Bor­relia has been around much longer than people,” he said. “It has great adaptive capability. It’s been on this planet longer than we’ve been here, and it may still be here long after we’re gone.”

The video clip of the Peer Exchange panel is available here:
  1. Kugeler KJ, Farley GM, Forrester JD, Mead PS. Geographic distribution and expansion of human Lyme disease, United States. Emerg Infect Dis. 2015;21(8):1455-1457. doi: 10.3201/eid2108.141878.
  2. Centers for Disease Control and Prevention. Lyme disease data tables. Reported cases of Lyme disease by state or locality, 2005-2015.CDC website. Published November 21, 2016. Accessed July 31, 2017.
  3. Centers for Disease Control and Prevention. Summary of notifiable diseases — United States, 2011 [Erratum appears in MMWR. 2014;63(1):24]. MMWR.2012;61(53):1-120. Published July 5, 2013. Accessed July 31, 2017.
  4. Lou Y, Wu J. Modeling Lyme disease transmission. Infect Dis Mod. 2017;, 2(2):229-243.
  5. Levi T, Kilpatrick AM, Mangel M, Wilmers CC. Deer, predators, and the emergence of Lyme disease. Proc Natl Acad Sci U S A. 2012;109(27):10942-10947. doi: 10.1073/pnas.1204536109.
  6. Brisson D, Dykhuizen DE, Ostfeld RS. Conspicuous impacts of inconspicuous hosts on the Lyme disease epidemic. Proc Biol Sci. 2008;275(1631):227-235.

Influenza A (H3N2) has caused most of the illnesses in this severe flu season, but influenza B is becoming increasingly responsible for more infections as the flu season continues to hit the United States.