Health Alert
TICK AND MOSQUITO-BORNE DISEASE: PREVENTION IS KEY

Summary

The Delaware Division of Public Health (DPH) urges health care providers to remind their patients that simple precautions will reduce a person’s chances of getting tick or mosquito-borne infections this summer.

Background

Ticks are active all year, but during the spring and summer months when human outdoor activities increase, people get tick bites and tick-borne diseases more often than any other time of year. Lyme disease is the most common disease spread by ticks in Delaware. In 2013, Delaware had over 500 confirmed cases of Lyme disease. Other tick-borne diseases such as Rocky Mountain Spotted Fever, Ehrlichiosis, Anaplasmosis, and Babesiosis are diagnosed less frequently in Delaware but can cause severe illness and often require hospitalization.

The symptoms of tick-borne disease depend on the specific disease an individual has acquired. Symptoms common to many of these diseases include fever, chills, fatigue, vomiting, diarrhea, headaches, and muscle and joint aches. Some of the illnesses are characterized by rash, and in some, serious cardiovascular and neurological complications may occur. Early diagnosis and treatment are key to good health outcomes. Advise patients that if they are bitten by a tick they should monitor their health closely, and contact a physician if symptoms develop. Diagnosis of a tick-borne disease is based on an individual’s exposure history, signs and symptoms, and the results of laboratory testing. (See additional information below for guidance regarding specific diseases.)

As with tick bites, spring and summer time is the mostly likely time for mosquito bites. Disease agents that can be transmitted to humans from the bite of mosquito species present in Delaware include, but are not limited to: West Nile virus (WNV), Eastern Equine Encephalitis (EEE), Chikungunya, and Saint Louis Encephalitis virus. In 2003, there were 17 confirmed human cases of WNV in Delaware, two of which were fatal. During 2007, 2008 and 2011, one human case was confirmed each year. There was an increase in 2012 with nine cases, and there were three confirmed cases in 2013. Note that these numbers represent only cases reported to and confirmed by DPH, and the actual number of cases is likely higher.

Of WNV cases, approximately 80 percent of human infections are mild and cause no apparent symptoms. Nearly 20 percent of those infected develop a mild illness (West Nile fever), which includes fever, body and muscle aches, headache, nausea, vomiting, and rash. A small percentage of patients, usually the elderly, develop severe neurological disease.

Another mosquito borne illness, Chikungunya, is a debilitating disease characterized by acute onset of fever and debilitating joint pains occurring after an incubation period of 3-7 days. It is transmitted through the bite of infected Aedes aegypti andAedes albopictus mosquitos. There is an ongoing Chikungunya outbreak in the Caribbean and the disease has been reported in other US States among travelers returning from the Caribbean. No case has been reported in Delaware, but the mosquito vectors of the disease are known to be present in Delaware.

DPH asks that you report any known or suspected case of Chikungunya, West Nile virus (WNV), Eastern Equine Encephalitis (EEE), and Saint Louis Encephalitis virus to the Division of Public Health at the number listed below.

Recommendations

Healthcare providers should remind patients to take appropriate measures to protect themselves from tick and mosquito bites (see links under additional information for specific guidance and patient resource materials).

TICK PREVENTION

Advise patients to do the following:

• Apply tick repellants (Following manufacturer instructions regarding use in children and re-application time).
• Check themselves and their children for ticks after being outdoors; paying special attention to the head area.
• Bear in mind that ticks can enter their homes on pets (which themselves should be treated with tick and flea repellants).

MOSQUITO PREVENTION

Advise patients to do the following:

• Use mosquito netting as appropriate to protect their face and neck when outdoors, to protect children in infant carriages, strollers and playpens.
• Use mosquito repellents containing DEET (following manufacturer instructions regarding use in children and re-application time)

Additional Information

For additional information regarding tick or mosquito borne diseases or to report a case call the Office of Infectious Disease Epidemiology: 1-888-295-5156 or 302-744-1033.

• www.cdc.gov/ticks
• www.dhss.delaware.gov/dhss/dph/epi/lyme.html
• http://www.cdc.gov/lyme/
• http://www.cdc.gov/features/stopmosquitoes/

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