P. Bryon Backenson

1
The Bugs of Summer!
P. Bryon Backenson Geraldine S.
Johnson Arthropod-Borne Disease Program,
NYSDOH 5/2002
2
Tick Borne Diseases Lyme Disease
Babesiosis Ehrlichiosis Rocky Mountain
Spotted Fever Mosquito-Borne Diseases Viral
Encephalitides ? West Nile Virus ? Eastern
Equine Encephalitis ? St Louis Encephalitis ?
California Viruses--Lacrosse, JC, others
Malaria
3
Ticks and Tick-Borne Diseases
4
Tick-borne Diseases in New York State
Disease Vector
Lyme disease Ixodes scapularis (deer tick)
Babesiosis I. scapularis (deer tick)
Human granulocytic ehrlichiosis (HGE) I. scapularis (deer tick)
Human monocytic ehrlichiosis (HME) Amblyomma americanum (Lone Star tick)
Rocky Mountain spotted fever Dermacentor variabilis (American dog tick)
Powassan encephalitis Ixodes cookei (woodchuck tick)
Tularemia D. variabilis (American dog tick), A. americanum (Lone Star tick)
5
Lyme Disease

• Causative Agent Borrelia burgdorferi, a
  bacteria
• Reservoir White footed mouse
• Vector Deer tick - Ixodes scapularis
• Host White tailed deer

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Lyme Disease Clinical Symptoms

• Early Lyme disease
• 3 to 30 days after bite of infected tick
• Erythema migrans (EM) rash (60-80)
• Fatigue, fever, headache, muscle aches, joint
  pain and mild neck stiffness
• Late Lyme Disease
• weeks to years after tick bite
• arthritis, neurologic
• cardiac (rare)

8
Lyme Disease Diagnosis and Treatment

• Erythema migrans rash
• Testing
• Serologic antibody testing
• Screening ELISA/EIA/IFA
• Secondary Western Blot
• Proper antibiotic treatment
• Usually rapid and complete recovery, especially
  when treated early

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Lyme Disease Cases Reported by State Health
Departments, 1990-1999
Centers for Disease Control and Prevention
13
Distribution of Ixodes scapularis In New York
State (1977 2002)
CLINTON
FRANKLIN
ST LAWRENCE
ESSEX
JEFFERSON
LEWIS
WARREN
HAMILTON
OSWEGO
ORLEANS
WASHINGTON
HERKIMER

• NIAGARA

WAYNE
ONEIDA
MONROE
ONONDAGA
FULTON
SARATOGA
GENESEE
ERIE
MONTGOMERY
ONTARIO
MADISON
SCHENECTADY
RENSSELAER
CAYUGA
WYOMING
CORTLAND
OTSEGO
ALBANY
LIVINGSTON
YATES
CHENANGO
SENECA
SCHOHARIE
TOMPKINS
SCHUYLER
ALLEGANY
STEUBEN
CATTARAUGUS
GREENE
COLUMBIA
CHAUTAUQUA
DELAWARE
TIOGA
CHEMUNG
BROOME
ULSTER
DUTCHESS
Counties with confirmed distribution (one or more
locally acquired specimens submitted)
SULLIVAN
PUTNAM
ORANGE
WESTCHESTER
Counties with no confirmed distribution (No
locally acquired specimens submitted)
ROCKLAND
SUFFOLK
NEW YORK CITY
NASSAU
14
Lyme Disease Cases by Year of Report New York
State (Excluding New York City) 1986-2001
Number of Cases
15
NYS Lyme Disease Cases by month of onset,
1996-2001n 5303 (96), 3325 (97), 4554 (98),
4403 (99), 4330 (00), 3479 (01)
1996 1997 1998 1999 2000
2001
16
Average Annual Lyme Disease Incidence Rate by
Sex and Age Group in New York State (Excluding
New York City)1986 - 2001
Incidence Rate per 100,000 Population
Number of cases per 100,000 population
17
Lyme Disease Cases by Sex and Age GroupNew York
State (Excluding New York City) 1986 - 2001
Number of Cases
18
Average Annual Lyme Disease Incidence
by County in New York State (Excluding New York
City)
1986 - 2001
Per 100,000 population
19
Lyme Disease Incidence
by County in New York State
CLINTON
(Excluding New York City)
FRANKLIN
ST LAWRENCE
2000
lt 9
ESSEX
JEFFERSON
10 - 49
LEWIS
WARREN
HAMILTON
50 - 99
OSWEGO
ORLEANS
WASHINGTON
100-946
HERKIMER
WAYNE
ONEIDA

• NIAGARA

MONROE
ONONDAGA
FULTON
SARATOGA
GENESEE
ERIE
MONTGOMERY
ONTARIO
MADISON
SCHENECTADY
RENSSELAER
CAYUGA
WYOMING
CORTLAND
OTSEGO
ALBANY
LIVINGSTON
YATES
CHENANGO
SENECA
SCHOHARIE
TOMPKINS
SCHUYLER
ALLEGANY
STEUBEN
CATTARAUGUS
GREENE
COLUMBIA
CHAUTAUQUA
DELAWARE
TIOGA
CHEMUNG
BROOME
ULSTER
DUTCHESS
SULLIVAN
PUTNAM
ORANGE
WESTCHESTER
ROCKLAND
SUFFOLK
NEW YORK CITY
NASSAU
Per 100,000 population
20
Annual Proportion of Lyme Disease Cases by
Region in New York State (Excluding New York
City) 1986-2001
Elsewhere
Dutchess

Westchester,
Percent of Cases
Columbia
Putnam

Rockland
Nassau Suffolk
21
Lyme Disease Incidence (per 100,000 population)
12 Selected Counties in New York State 1990 vs.
2000
Rensselaer 0.6 / 44.6
Albany 1.4 / 23.4
Columbia 6.3 / 936.7
Greene 26.7 / 207.5
Ulster 4.8 / 112.0
Dutchess 53.1 / 376.2
Putnam 79.5 / 283.0
Orange 11.0 / 166.1
Westchester 45.1 / 28.4
Rockland 0.4 / 20.2
Suffolk 40.2 / 43.2
Nassau 6.4 / 6.4
22
Babesiosis

• Causative Agent Babesia microti, a protozoan
  parasite
• Reservoir White footed mouse
• Vector Deer tick - Ixodes scapularis
• Host White tailed deer

23

• Babesiosis Disease Characteristics
• Malaria-like illness
• Occasionally transmitted through blood
  transfusion
• Symptoms Fever, chills, headache, muscle aches,
  fatigue. Can be severe and require
  hospitalization. Potentially fatal.
• Incubation period typically 1-8 weeks.

24
Babesiosis Cases by Sex and Age Group
New York State (excluding New York City)
1993 - 2001
Number of Cases
25
NYS Babesiosis Cases by month of onset,
1996-2001n 37 (96), 26 (97), 107 (98), 61
(99), 72 (00), 78 (01)
1996 1997 1998 1999
2000 2001
26
Geographic Distribution of Babesiosis Cases in
New York State by County of Residence 1986 -
2001
CLINTON
FRANKLIN
ST LAWRENCE
Reported Babesiosis Case in County
ESSEX
JEFFERSON
LEWIS
WARREN
HAMILTON
1
No Reported Babesiosis Case in County
OSWEGO
ORLEANS
WASHINGTON
1
HERKIMER

• NIAGARA

WAYNE
ONEIDA
MONROE
ONONDAGA
FULTON
2
1
SARATOGA
GENESEE
ERIE
2
MONTGOMERY
ONTARIO
MADISON
SCHENECTADY
RENSSELAER
CAYUGA
1
WYOMING
1
CORTLAND
OTSEGO
ALBANY
LIVINGSTON
YATES
CHENANGO
SENECA
SCHOHARIE
TOMPKINS
1
SCHUYLER
ALLEGANY
STEUBEN
CATTARAUGUS
GREENE
3
COLUMBIA
CHAUTAUQUA
DELAWARE
TIOGA
CHEMUNG
BROOME
1
ULSTER
Excluding New York City
DUTCHESS
6
SULLIVAN
2
BRONX
1
PUTNAM
NEW YORK
ORANGE
1
12
WESTCHESTER
QUEENS
ROCKLAND
464

SUFFOLK
28
NEW YORK CITY
KINGS
RICHMOND
NASSAU
N528
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Human Granulocytic Ehrlichiosis (HGE)

• Causative Agent Anaplasma phagocytophila, a
  rickettsia
• Reservoir Unknown, probably white- footed mouse
  or other small mammal
• Vector Deer tick - Ixodes scapularis
• Host Unknown, probably white-tailed deer or
  other mammal

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Human Monocytic Ehrlichiosis (HME)

• Causative Agent Ehrlichia chaffeensis, an
  ehrlichia
• Reservoir Unknown, probably small mammal
• Vector Lone Star tick Amblyomma americanum
• Host Unknown, probably medium-large mammal

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• Ehrlichiosis Disease Characteristics
• Symptoms Fever, chills, headache, muscle
  aches, fatigue. Can be severe and require
  hospitalization.
• Sometimes confused with RMSF, but ehrlichiosis
  typically lacks a prominent rash.
• Incubation period typically 1-3 weeks.

31
Human Granulocytic Ehrlichiosis (HGE)
by Sex and Age Group in New York State
1996 - 2001
Number of Cases
Excluding New York City
32
Geographic Distribution of Human Granulocytic
Ehrlichiosis (HGE) Cases in New York State by
County of Residence 1996 - 2001
CLINTON
FRANKLIN
ST LAWRENCE
ESSEX
Reported Ehrlichiosis (HGE) Case in County
JEFFERSON
LEWIS
WARREN
HAMILTON
OSWEGO
ORLEANS
WASHINGTON
HERKIMER
WAYNE
ONEIDA

• NIAGARA

MONROE
No Reported Ehrlichiosis (HGE) Case in County
ONONDAGA
FULTON
SARATOGA
GENESEE
ERIE
MONTGOMERY
ONTARIO
MADISON
SCHENECTADY
RENSSELAER
CAYUGA
WYOMING
CORTLAND
OTSEGO
ALBANY
LIVINGSTON
YATES
CHENANGO
SENECA
SCHOHARIE
7
TOMPKINS
SCHUYLER
ALLEGANY
STEUBEN
CATTARAUGUS
GREENE
CHAUTAUQUA
DELAWARE
TIOGA
1
COLUMBIA
CHEMUNG
BROOME
107
Excluding New York City
ULSTER
SULLIVAN
5
DUTCHESS
BRONX
39
PUTNAM
NEW YORK
214
ORANGE
QUEENS
WESTCHESTER
ROCKLAND
85

3
SUFFOLK
NEW YORK CITY
KINGS
RICHMOND
NASSAU
N461
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Human Monocytic Ehrlichiosis (HME)
by Sex and Age Group in New York State
1996 - 2001
Number of Cases
Excluding New York City
35
Geographic Distribution of Human Monocytic
Ehrlichiosis (HME) Cases in New York State by
County of Residence 1996 - 2001
CLINTON
FRANKLIN
ST LAWRENCE
ESSEX
1
Reported Ehrlichiosis (HME) Case in County
JEFFERSON
LEWIS
1
WARREN
HAMILTON
OSWEGO
ORLEANS
WASHINGTON
1
HERKIMER
WAYNE
ONEIDA

• NIAGARA

MONROE
No Reported Ehrlichiosis (HME) Case in County
ONONDAGA
FULTON
SARATOGA
GENESEE
ERIE
MONTGOMERY
ONTARIO
MADISON
SCHENECTADY
1
RENSSELAER
CAYUGA
WYOMING
ALBANY
CORTLAND
OTSEGO
LIVINGSTON
YATES
CHENANGO
SENECA
SCHOHARIE
2
TOMPKINS
SCHUYLER
ALLEGANY
STEUBEN
CATTARAUGUS
GREENE
CHAUTAUQUA
DELAWARE
TIOGA
COLUMBIA
CHEMUNG
BROOME
30
Excluding New York City
ULSTER
SULLIVAN
DUTCHESS
BRONX
13
PUTNAM
NEW YORK
19
ORANGE
QUEENS
WESTCHESTER
ROCKLAND
15

SUFFOLK
NEW YORK CITY
KINGS
RICHMOND
NASSAU
N83
36
NYS Ehrlichiosis Cases by month of onset,
1996-2001n 51 (96), 81 (97), 117 (98), 76
(99), 103 (00), 17 (01)
1996 1997 1998 1999 2000
2001
37
Rocky Mountain Spotted Fever

• Causative Agent Rickettsia rickettsii, a
  rickettsia
• Reservoir typically maintained through
  tick-tick passage
• Vector American dog tick Dermacentor
  variabilis

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• Rocky Mountain Spotted Fever Disease
  Characteristics
• Rash for which it is named occurs only in 40-60
  of cases. Rash spreads from palms and soles.
• Symptoms Fever, nausea, vomiting, muscle pain,
  lack of appetite, headache. Majority of cases
  require hospitalization. Potentially fatal.
• Incubation period typically 3-14 days.

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Geographic Distribution and Exposure History of
New York State Residents with Rocky Mountain
Spotted Fever 1977 - 2001
CLINTON
1
FRANKLIN
ST LAWRENCE
1
3
ESSEX
Local exposure
JEFFERSON
1
Travel history to endemic area
LEWIS
WARREN
HAMILTON
1
2
1
OSWEGO
1
1
ORLEANS
2
WASHINGTON
1
1
1
2
1
2
HERKIMER
1
1
ONEIDA

• NIAGARA

ONONDAGA
WAYNE
FULTON
1
SARATOGA
GENESEE
1
2
1
MONROE
ERIE
1
1
MONTGOMERY
No travel history available
3
ONTARIO
MADISON
RENSSELAER
SCHENECTADY
CAYUGA
ALBANY
Residence in endemic area
1
WYOMING
1
1
CORTLAND
OTSEGO
LIVINGSTON
YATES
CHENANGO
SENECA
SCHOHARIE
1
1
1
TOMPKINS
1
1
1
CATTARAUGUS
ALLEGANY
GREENE
SCHUYLER
1
STEUBEN
BROOME
DELAWARE
2
1
1
CHEMUNG
2
1
COLUMBIA
1
1
2
CHAUTAUQUA
TIOGA
1
2
Excluding New York City
DUTCHESS
2
ULSTER
3
2
SULLIVAN
2
BRONX
2
4
6
PUTNAM
NEW YORK
ORANGE
11
1
WESTCHESTER
QUEENS
ROCKLAND
2
199
3
SUFFOLK
KINGS
NASSAU
1
RICHMOND
NEW YORK CITY
47
N353
10
41
NYS Rocky Mountain Spotted Fever Cases by month
of onset, 1996-2001n 34 (96), 14 (97), 13
(98), 14 (99), 9 (00), 3 (01)
1996 1997 1998 1999 2000
2001
42
Powassan Encephalitis

• Causative Agent Powassan virus, a flavivirus
• Reservoir Rodents, possibly other small
  mammals, birds
• Vector woodchuck tick - Ixodes cookei

43

• Powassan Disease Characteristics
• Symptoms Fever, chills, headache, muscle
  aches, fatigue, epilepsy, flaccid paralysis. Can
  be severemeningitis and encephalitis--and
  require hospitalization. Potentially fatal.
• Incubation period typically 1-2 weeks.

44
Tularemia

• Causative Agent Francisella tularensis, a
  bacteria
• Reservoir numerous animals, particularly
  rabbits, voles, muskrats, beavers. Can also be
  maintained in tick population.
• Vector American dog tick Dermacentor
  variabilis, Lone Star tick Amblyomma americanum

45

• Tularemia Disease Characteristics
• Variety of presentations, depending on route of
  inoculation. Symptoms will vary. Potentially
  fatalcase fatality rate also varies with route
  of inoculation.
• Potential bioterrorism agent, when aerosolized.
• Incubation period typically 1-14 days.

46
NYS Tularemia Cases by month of onset,
1996-2001n 2 (96), 0 (97), 5 (98), 1 (99),
0 (00), 1 (01)
1996 1997 1998 1999 2000
2001
47
Mosquitoes and Mosquito-Borne Diseases
48
Public Health Importance of West Nile Virus

• Transmitted by mosquitoes
• May cause serious, sometimes fatal, illnesses in
  humans
• Outbreaks in Israel (50s),Algeria (94), Romania
  (96-97), Czech Republic (97), Congo (98),
  Russia (99), Israel (00) , NYC (99-00) 1st in
  Western Hemisphere

49

• West Nile Virus Symptoms
• Occur from 5-15 days after exposure
• Mild- slight fever and/or headache
• Severe - high fever, head and body aches,
  disorientation, convulsions, rash
• Most severe - paralysis or death
• Persons most at risk - over 50 years of age
• 1/150 persons infected becomes seriously ill

50
West Nile Virus Transmission Cycle
Mosquito vector
Incidental infections
West Nile Virus
Incidental infections
Bird reservoir hosts
51
Laboratory ConfirmedWNV Infections, NYS,
1999-2001
1999 2000 2001
Humans (Deaths) 62 (7) 14 (1) 15 (2)
Mosquito Pools 15 400 300
Birds 142 1263 731 dead, 71 live
Mammals 20 Horses 28 Horses, 5 others 22 Horses
52
NYS WNV Encephalitis Cases by month of onset,
1996-2001n 0 (96), 0 (97), 0 (98), 59
(99), 14 (00), 15 (01)
1996 1997 1998 1999 2000
2001
53
No Confirmed Activity Birds /or
Mosquitoes Humans (and Birds /or Mosquitoes)

West Nile Virus Positive Specimens, 1999
CLINTON
FRANKLIN
ST LAWRENCE
ESSEX
JEFFERSON
LEWIS
WARREN
HAMILTON
OSWEGO
ORLEANS
WASHINGTON
NIAGARA
HERKIMER
WAYNE
ONEIDA
MONROE
ONONDAGA
FULTON
SARATOGA
GENESEE
ERIE
MONTGOMERY
ONTARIO
MADISON
SCHENECTADY
RENSSELAER
CAYUGA
WYOMING
CORTLAND
OTSEGO
ALBANY
LIVINGSTON
YATES
CHENANGO
SENECA
SCHOHARIE
TOMPKINS
SCHUYLER
ALLEGANY
STEUBEN
CATTARAUGUS
GREENE
COLUMBIA
CHAUTAUQUA
DELAWARE
TIOGA
CHEMUNG
BROOME
ULSTER
DUTCHESS
SULLIVAN
BRONX
PUTNAM
NEW YORK
ORANGE
WESTCHESTER
QUEENS
ROCKLAND
SUFFOLK
NEW YORK CITY
KINGS
NASSAU
RICHMOND
54
No Confirmed Activity Birds /or
Mosquitoes Humans (and Birds /or Mosquitoes)

West Nile Virus Positive Specimens, 2000
CLINTON
FRANKLIN
ST LAWRENCE
ESSEX
JEFFERSON
LEWIS
WARREN
HAMILTON
OSWEGO
ORLEANS
WASHINGTON
NIAGARA
HERKIMER
WAYNE
ONEIDA
MONROE
ONONDAGA
FULTON
SARATOGA
GENESEE
ERIE
MONTGOMERY
ONTARIO
MADISON
SCHENECTADY
RENSSELAER
CAYUGA
WYOMING
CORTLAND
OTSEGO
ALBANY
LIVINGSTON
YATES
CHENANGO
SENECA
SCHOHARIE
TOMPKINS
SCHUYLER
ALLEGANY
STEUBEN
CATTARAUGUS
GREENE
COLUMBIA
CHAUTAUQUA
DELAWARE
TIOGA
CHEMUNG
BROOME
ULSTER
DUTCHESS
SULLIVAN
BRONX
PUTNAM
NEW YORK
ORANGE
WESTCHESTER
QUEENS
ROCKLAND
SUFFOLK
NEW YORK CITY
KINGS
NASSAU
RICHMOND
55
West Nile Virus Positive Specimens 2001
No Confirmed Activity Birds /or
Mosquitoes Humans (and Birds /or Mosquitoes)

CLINTON
FRANKLIN
ST LAWRENCE
ESSEX
JEFFERSON
LEWIS
WARREN
HAMILTON
OSWEGO
ORLEANS
WASHINGTON
NIAGARA
HERKIMER
WAYNE
ONEIDA
MONROE
ONONDAGA
FULTON
SARATOGA
GENESEE
ERIE
MONTGOMERY
ONTARIO
MADISON
SCHENECTADY
RENSSELAER
CAYUGA
WYOMING
CORTLAND
OTSEGO
ALBANY
LIVINGSTON
YATES
CHENANGO
SENECA
SCHOHARIE
TOMPKINS
SCHUYLER
ALLEGANY
STEUBEN
CATTARAUGUS
GREENE
COLUMBIA
CHAUTAUQUA
DELAWARE
TIOGA
CHEMUNG
BROOME
ULSTER
DUTCHESS
SULLIVAN
BRONX
PUTNAM
NEW YORK
ORANGE
WESTCHESTER
QUEENS
ROCKLAND
SUFFOLK
NEW YORK CITY
KINGS
NASSAU
RICHMOND
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Constructing human risk maps for West Nile Virus
in New York
Human populationInfected bird risk
population-weighted WNV Risk Map
58
West Nile Virus Mapping Projects CONSIDERATIONS

1. METHODOLOGICAL Will more precise lat/long
   geolocations change the maps? Initial analyses
   for tested birds were done with ZIP5 data.
2. METHODOLOGICAL Can we combine this analysis with
   others, such as dead crow sightings, to make a
   better predictive model? Can other
   anthropomorphic features, such as infrastructure,
   be included?
3. INSTITUTIONAL What is the best way to translate
   these data for end users? Will it support their
   decision making?
4. BOTH What obstacles will be faced in making
   this a real-time system? To make this completely
   real-time, the following is needed on a real-time
   basis ? Satellite images ? Lab results, and
   geocoded locations on birds, mammals, and
   mosquitoes. ? Final risk maps

59
WNV Take-Home Messages

• At least 27 states
• Over 75 species of bird
• Over 25 species of mosquito
• 149 human cases
• Report viral encephalitis
• Report dead bird sightings
• Reduce mosquito breeding habitats
• Educate about how to reduce risk of WNV infection

60
Other Notable Mosquito-borne Viral Encephalitides
in NYS

• Eastern Equine Encephalitis
• Virus transmitted to horses and humans by
  infected mosquitoes.
• Symptoms - sudden onset of fever, muscle aches,
  headache. Severe - seizures, coma, encephalitis.
• Fatality rate - 33
• Sporadic isolations from Long Island, around
  Oneida Lake

61
Other Notable Mosquito-borne Viral Encephalitides
in NYS

• St Louis Encephalitis
• LaCrosse Encephalitis
• Jamestown Canyon Encephalitis
• Virus transmitted to horses and humans by
  infected mosquitoes.
• Symptoms typical symptoms leading to
  encephalitis
• All potentially fatal
• Historic isolations

62
Malaria

• Causative Agent Plasmodium spp., a protozoan
  parasite
• 4 different Plasmodia cause malaria
• Reservoir Humans
• Vector mosquitoes of the genus Anopheles

63

• Malaria Disease Characteristics
• Most cases in New York are associated with
  travel to endemic areas.
• Potential transmission through transfusion.
• Millions of infections yearly worldwide.
• Symptoms Fever, chills, cough, sweats,
  diarrhea, respiratory distress. Can be severe and
  require hospitalization. Potentially fatal.
  Severity will vary with species of plasmodium.
• Incubation period typically 7-30 days, can be up
  to 8 months.

64
NYS Malaria Cases by month of onset, 1996-2001n
365 (96), 393 (97), 333 (98), 329 (99), 308
(00), 75 (01)
1996 1997 1998 1999 2000
2001
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66
For More Information
P. Bryon Backenson Geraldine Johnson Arthropod-Bor
ne Disease Program New York State Department of
Health 518-474-4568 bpb01_at_health.state.ny.us