Abstract
Recent scholarship supports the use of tick bite encounters as a proxy for human disease risk. Extending entomological monitoring, this study was designed to provide geographically salient information on self-reported tick bite encounters by survey respondents who concomitantly reported a Lyme disease (LD) diagnosis in a state perceived as non-endemic to tick-borne illness. Focusing on Texas, a mixed-methods approach was used to compare data on tick bite encounters from self-reported LD patients with county-level confirmed cases of LD from the U.S. Centers for Disease Control and Prevention (CDC), as well as serological canine reports. A greater proportion of respondents reported not recalling a tick bite in the study population, but a binomial test indicated that this difference was not statistically significant. A secondary analysis compared neighboring county-level data and ecological regions. Using multi-layer thematic mapping, our findings indicated that tick bite reports accurately overlapped with the geographic patterns of those patients previously known to be CDC-positive for serological LD and with canine-positive tests for Borrelia burgdorferi, anaplasmosis, and ehrlichiosis, as well as within neighboring counties and ecological regions. LD patient-reported tick bite encounters, corrected for population density, also accurately aligned with official CDC county hot-spots. Given the large number of counties in Texas, these findings are notable. Overall, the study demonstrates that direct, clinically diagnosed patient reports with county-level tick bite encounter data offer important public health surveillance measures, particularly as it pertains to difficult-to-diagnose diseases where testing protocols may not be well established. Further integration of geo-ecological and socio-demographic factors with existing national epidemiological data, as well as increasingly accessible self-report methods such as online surveys, will contribute to the contextual information needed to organize and implement a coordinated public health response to LD.
Highlights
Vector-borne diseases, caused by viruses, bacteria, and parasites transmitted to humans by intermediary organisms, such as ticks and mosquitoes, have become significantly more widespread in the United States (U.S.) over this past decade [1]
This study explores how patients are diagnosed with Lyme disease (LD), via their tick bite encounters while experiencing a self-reported diagnosis of a tick-borne disease
Respondents to the online Texans and Ticks Survey who reported a diagnosis of Lyme disease provided county-level data on personal tick bite encounters
Summary
Vector-borne diseases, caused by viruses, bacteria, and parasites transmitted to humans by intermediary organisms (vectors), such as ticks and mosquitoes, have become significantly more widespread in the United States (U.S.) over this past decade [1]. The number of LD patients with lingering symptoms was projected to be as high as 1,944,189 in 2020 [5]. LD is a multi-system condition that can manifest quickly and, may produce symptoms that are often mistaken for other diseases such as influenza or various auto-immune disorders [2,7]. Late-stage LD is known to cause a host of lingering and debilitating symptoms, such as cardiac, rheumatological, or neurological manifestations [8]. “To qualify for the diagnosis of LD, patients must have Lyme-compatible symptoms and signs that are either consistently or variably present for six or more months” [9]. LD is often used as a catch-all term for a set of complex concurrent infections
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