Tick Borne Diseases

Carey: 00:00

Welcome to the Talking Total Farmer Health podcast from AgriSafe Network. At Aggressive. We work to protect the people that feed the world by supporting the health and safety professionals, ensuring access to preventative services for farm families and the agriculture community. Today's episode is brought to you by the Network of the National Libraries of Medicine Region Three.

Carey: 00:29

May is National Lyme Disease Awareness Month in the US. And while April is only just the beginning ticks become active as early as March. Depending on where you live in the US, the ticks might stay active all year, weather depending. So for today's episode we are going to talk about ticks, ticks borne diseases and tick bite prevention. I am your host, Carey Portell, and I am joined by Adina Bercowicz. Thank you for joining us today on the Total Farmer Health podcast, Adina.

Adina: 00:55

Thank you for having me today Carey. Uh It's always great to partner with AgriSafe. You guys do a lot of great work.

Carey: 01:03

Yeah. Can you give us a little bit about your background and how you got involved in Lyme disease?

Adina: 01:11

Sure. Actually, my background is in non-profit leadership. Prior to launching Lyme TV, I did work with other non-profits, both domestically and abroad. I worked for a nonprofit in Calcutta, India, as well as did some disaster relief work in Haiti after the 2010 earthquake. And my story kind of began with me getting sick with a tick bite. And I had. A wide range of tick borne diseases that resulted from that. Although I do not have tick diseases any longer, I do suffer from permanent damage to my neurological systems as a result of the infectious diseases and thought that I would take my experience as a patient and kind of merge it together with my background in non-profit leadership and launch an educational non-profit to prevent tick borne diseases.

Carey: 02:06

Wow, isn't that crazy? What good things come from our challenges that we go through. Can you tell us what is Lyme disease and how you actually contract it?

Adina: 02:16

Sure. Lyme disease is a bacterial vector borne infectious disease that is transmitted by ticks. Lyme can be simple to treat and also very complicated and debilitating for others. So it's not cut and dry either way. It is very complicated. The bacteria has protean manifestations, meaning it tends or is able to change frequently in size or easily. So that helps it kind of dig into tissues and also possibly evade the immune system. It's a smart bacteria. Lyme disease is also prevalent across the United States and throughout the world. So currently it's in over 80 countries worldwide and there's an estimate of about 476,000 new cases of Lyme disease every year in the United States alone. And taking the calculations of how the CDC gets to that number based on insurance cases and case reportable cases by true positives, it's easy to calculate and surmise that other tick borne diseases range about 250,000 cases per year. So we're looking at approximately 750,000 new cases of tick borne diseases every year. And that's a problem that makes ticks a public health crisis.

Carey: 03:39

Yeah, that is much higher than I ever would have guessed. Can you tell our listeners what the signs and symptoms are if they suspect that they have Lyme disease?

Adina: 03:48

Sure. Well, there are stages to Lyme disease, just as with many other diseases. So late stage is far more debilitating and dangerous. Many people are diagnosed late stage and have had clinical symptoms for years before being properly diagnosed. So in early stage, Lyme disease, most cases seem to be fairly easily treated with a typical course of antibiotics. That can present with initial onset of symptoms like flu, like illness, fever, headache, extreme fatigue, maybe some kind of like red ear lobes or even like TMJ, like jaw pain or temporary, like some kind of like joint dysfunction, maybe neck and back pain and other kinds of joint pain and swelling and bone pain. So late stage presents with different types of clinical symptoms as well, which can be more neurological in nature and affect the GI system. So there are a multitude of clinical symptoms that could be present with Lyme disease. I do want to note also that Lyme is not the only dangerous infectious disease that ticks spread. Many ticks are affected with multiple bacterial, viral, and other parasitic diseases that can transmit to humans and mammals. And most of those can cause death. So the most dangerous of them in the United States is Rocky Mountain Spotted Fever. So it's just a note that these diseases, some of their symptoms, can overlap with one another, and some are very specific to them. It is vital to protect from tick bites daily.

Carey: 05:28

Now, do physicians tests for all the tick borne diseases or only just a panel of the top three most common?

Adina: 05:34

It would depends, I guess, on the region and the states, because there are prevalent tick diseases in different areas. Clinicians really should keep up to date with the prevalence of tick diseases in the state and not just test for those three or they should do a wider panel because with the ecological changes, their tickborne disease trends are increasing and there are other factors like migratory birds which breed tick species and diseases to a region that weren't before. So the doctors and I know they're busy, but typically they should be keeping abreast of what's prevalent in the state and kind of watching those trends, the epidemiological trends, so they know what to test for.

Carey: 06:20

Shifting gears a bit, I know that Lyme disease is often misdiagnosed. Is this because there is just a multitude of signs and symptoms.

Adina: 06:28

That that is one reason. So we all touch upon that. But another factor that that's being that is recognized by the greater science and clinical community is that the tests are poor. So it's important to note that you could have a negative Lyme disease test and still be infected. The tests are designed for surveillance purposes only, not for diagnosing. And so doctors should really rely on the clinical symptoms and not rely on blood tests to begin treatment.

Carey: 07:02

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Carey: 07:56

Now we always hear about one of the the symptoms is this red rash around the tick bite. Does everybody get that red rash?

Adina: 08:04

No, not everyone will get a rash or even see a rash if it's somewhere like on the scalp or on the back if they can't see it in the mirror. So the bacteria that causes Lyme has multiple species and strains with subspecies and strains. So in different regions of the world and even in different regions of the US. So there's approximately 300 strains of the bacteria globally. But the strains in the United States that affect humans are approximately 20 that have been discovered so far. So the genetic diversity of the bacteria actually contributes to rash presentation. The rash comes from the bacteria spreading under the skin, not from the bite itself. So you can definitely have Lyme without a rash or without a positive blood test.

Carey: 08:53

Okay. And in talking about the the signs of that rash, does it always appear as that typical bull's eye?

Adina: 09:02

The rash can appear in many shapes and sizes, which is also a little deceptive, too. And so typically what you want to look for is that it does spread out, that it continues to spread. The rash may even show up in an area that is not actually near where the tick bit the person. So you can have a tick bite on your leg and a rash may show up on your shoulder. So that's also something to know. What is also very important to note is that rashes on darker skin looks like a bruise. So it's not going to look like the typical red, bright bull's eye rash that we come and see on Caucasian skin in pictures. So if somebody has darker skin, it could certainly look like a bruise. It could show up on the part of the body that far from the tick bite and it could take up to a month to show up. It won't be it may not be immediate.

Carey: 09:56

Okay. Yeah. So you really have to keep an eye out. Now, we know that Lyme disease can transfer from tick to human, but can it transfer from person to person contact?

Adina: 10:08

Contact know Lyme disease is a vector borne infectious disease such as malaria or dengue fever that are transmitted by mosquitoes. And a person will need to be bitten by an affected tick to contract Lyme disease.

Carey: 10:20

Yeah, I think that's important to know because when you when you're around somebody and you have this awful looking rash, you're always wondering, you know, is it contagious? You don't know what it is. Is maternal transmission of Lyme disease possible?

Adina: 10:31

Yes, absolutely. There are conflicting studies on the effects of Lyme disease upon pregnancy and the subject kind of remains insufficiently studied. Of course, we need more funding for research. And this is happening right now actually on the government level and in private sectors as well, funding research at universities. But this is something that this particular topic here does need to be studied further. However, there are individual cases that have been reported over, over decades that show adverse outcomes with gestational transmission. So these cases are published, and the CDC recently added to its website that transmission from mother to baby is possible to note the complications from untreated Lyme disease can include miscarriage or stillbirth, congenital heart defects, neurological defects and other less common anomalies like orthopedic issues with the baby. And also, there's a risk of Lyme disease and coinfection transmission through the placenta if the woman is pregnant with Lyme disease. So studies have noted, and I believe the CDC as well notes that it is safer to be treated with antibiotics while you're pregnant. If you have Lyme disease, you should be treating that Lyme disease and not waiting to treat it until after the baby is born.

Carey: 12:03

Yeah, I think our listeners who are mothers are really going to be interested in that aspect. Now, once you contract Lyme disease, does that create a kind of immunity or can you get it multiple times?

Adina: 12:15

Unfortunately, it does not create an immunity. You can absolutely get it again and again and again. And having Lyme disease, yes, having it once does not prevent reinfection and it also doesn't prevent especially infection from a more serious strain. Right. So each case can present with different clinical symptoms because of strain variation. And each case may also vary in how easy or difficult it is to treat.

Carey: 12:46

Okay. It seems like Lyme disease is becoming more prevalent. Is there a part of the US or another country that is more prone to contracting Lyme disease?

Adina: 12:55

Oh, well, it can be contracted across the United States and it is in over 80 countries, as I mentioned. It's more typically in the northern hemisphere of the United States. So, yeah, there's basically in the United States, there's a high prevalence in in the northeastern states as well as states bordering Canada. There's prevalence of Lyme disease as well in Canada. So I think the United States and it might be a factor of testing or awareness in the clinical workforce about Lyme disease and an understanding that it is an epidemic in this country, that people are tested more. It may be a factor that there's other nations and other countries may be in Europe that may not see on paper as high of a case count with Lyme disease. Maybe because the population isn't being tested as much as it should be, it doesn't mean it's not there. But definitely we know that in over 80 countries around the world, Lyme is a problem.

Carey: 13:58

Okay, now here at AgriSafe, we're all about keeping the ag and farm workers safe. So are there any preventative measures people can take to reduce the risk of Lyme disease?

Adina: 14:09

So our organization, our mission is all about preventing tick borne diseases. And the first thing we try to inform people about is where ticks live and urge them to stay out of tick habitats. Right. But staying out of tick habitats is usually is nearly impossible for the agricultural workforce. So the first thing I'd like to recommend is permethrin treated clothing. It's easy to buy permethrin to spray your clothes at home. You definitely want to wear a mask and gloves and eye protection and sprayed it in a well-ventilated area. That protection lasts about four weeks, and it is fine to wash the clothes and put it in the dryer. There's also, um, there's also clothing that can be purchased, already treated with permethrin that's industrially treated. So it lasts longer, the protection, but it does cost more money. But that would be the first thing I recommend is permethrin treated clothing. Additionally, you always want to spray your skin with a skin safe EPA approved tick repellent. The tick repellent needs to be at 20% concentration or higher. Anything less will only protect against mosquitoes. So DEET, picaridin, IR3535. Anything that's EPA approved as a tick repellent should be on the skin. And additionally, as far as clothing goes, you always want to pull your socks over your pants to kind of create a barrier so the ticks don't crawl up under your pants onto your skin, tuck in your shirts, you know, same thing. So ticks are on the pants and they crawl up. They can't get to the stomach area because the shirts are tucked in. And it's so important that every day when people come home that they do a thorough daily tick check on themselves and take a shower right away. And look, look for any ticks that are on them. If there's any ticks attached, they want to remove the tick with fine tip tweezers and save that tick. You want to want to save the ticket, send it for testing because you want to know what pathogens that tick may have infected you with. You don't want to wait until you get sick to try to find out, especially with how unreliable the tests are. One last note thing to note is that it's it could be helpful to put your clothes in the dryer if they're closed in the dryer for 20 to 30 minutes on high heat once they get home. And that'll kill the ticks that are hitchhiking on the clothes when they get in.

Carey: 16:43

Now, you did talk about sending the tick off to get tested. Where would people actually take that to? Is it your doctor's office or something else?

Adina: 16:52

Unfortunately, many doctor's offices don't take ticks. In the past, they may have, especially in the in the northeastern states where it is a bit more prevalent in the United States, they don't do that anymore. Some states have tick testing labs that are free or very low cost. In Maine, we do not have a free tick testing lab, but they charge $15 a tick. That could be a significant cost to people if they're constantly getting bitten by ticks. In Pennsylvania, for instance, the state has a free tick testing lab, so they also monitor the data with disease trends in the state right by the ticks that are coming in. So they're using that data for scientific surveillance purposes as well. But it would depend, I guess the person would need to find out if there's a tick testing lab in their area. I do like to promote the Bay Area Lyme Foundation's tick testing lab there in California. They do have a free tick testing lab, that is, that will receive ticks from anywhere in the nation. However, they're grant funded. So some years they're open and some years they're not just really depends on funding. And I believe the last I heard was that they're not open at this time, but they are going to be having some funding and reopening it at some point soon. I'm just not sure when. So I would I would urge anyone, if they find an attached tick to if they have access to the Internet, try to find a testing lab in their area or where they can send it to. That has a low cost.

Carey: 18:31

Okay. I think this podcast episode is really going to interest our listeners. Is there a place that they can go to maybe? I don't know if it's speak with you directly or your corporation where they can get more information easily.

Adina: 18:48

Absolutely. So our website is LymeTV.org. And you know what? If anyone's listening and they have any questions, they can reach out to us at info@lymetv.org via email and we'll be very happy to answer those questions for them.

Carey: 19:07

Awesome. Adina, you are a wealth of information today and I'm so glad that we had you on our podcast thing that you told us today is really going to help our workers in the farming and ranching communities. So thank you so much for being our guest today on the Total Farmer Health Podcast.

Adina: 19:21

Thank you for having me.

Carey: 19:23

Thanks, Adina. And that concludes today's episode. Thanks to our listeners for joining us for another episode of Talking Total Farmer Health. Be sure to subscribe to this podcast to hear more from AgriSafe on the health and safety issues impacting agricultural workers. To see more from AgriSafe, including webinars and our newsletter, visit www.agrisafe.org. This episode was created by the AgriSafe Network with the network of National Library of Medicine Region Three. Script arranged by Laura Siegel, hosted by Carey Portell, edited by Joel Sharpton, and special guest was Adina Bercowicz.