Abstract
Lyme disease is usually associated with forested habitats but has recently emerged on treeless islands in the Western Isles of Scotland. The environmental and human components of Lyme disease risk in open habitats remain unknown. We quantified the environmental hazard and risk factors for human tick bite exposure among treeless islands with low and high Lyme disease incidence in the Western Isles. We found a higher prevalence of Borrelia burgdorferi sensu lato–infected ticks on high-incidence than on low-incidence islands (6.4% vs. 0.7%); we also found that residents of high-incidence islands reported increased tick bite exposure. Most tick bites (72.7%) occurred <1 km from the home, including many in home gardens. Residents of high Lyme disease incidence islands reported increasing problems with ticks; many suggested changing deer distribution as a potential driver. We highlight the benefits of an integrated approach in understanding the factors that contribute to Lyme disease emergence.
Highlights
For sites sampled among different habitat types on high Lyme disease incidence islands (Appendix Figure 1), the best fit model to predict nymph density retained habitat type as a fixed effect (χ2 = 24.06; df = 4; p
Our findings show that environmental hazard and human tick bite exposure risk contribute to higher Lyme disease incidence in these settings
In contrast to previous studies in Europe, we found that the density of infected nymphs in treeless habitats can be comparable to forested sites, which are traditionally associated with higher Lyme disease hazard [34,43]
Summary
We quantified the environmental hazard and risk factors for human tick bite exposure among treeless islands with low and high Lyme disease incidence in the Western Isles. In the United Kingdom, Lyme disease surveillance is based on laboratory confirmed cases, following the best practice guidelines for serologic diagnosis published by the National Institute for Health and Care Excellence [9,10,11] This surveillance shows that some islands in the Highland region that lack woodland coverage have a Lyme disease incidence ≈40 times the national average (119 vs 3.2 cases/100,000 persons per year) [6]. In the United Kingdom, most studies have found relatively low tick densities in meadows [19], open hillside [20,21], and heather moorland [22,23]
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