LYME DISEASE RISK ASSESSMENT, FORT CAMPBELL, KENTUCKY, 11-14 OCT 1991 DEPARTMENT OF THE ARMY U.S. Army Environmental Hygiene Activity - South Fort McPherson, Georgia 30330-5000 [Seal of Department of Defense, United States of America] REPLY TO ATTENTION OF: HSHB-AS-P LYME DISEASE RISK ASSESSMENT NO. 16-62-0552-92 FORT CAMPBELL, KENTUCKY 11-14 OCTOBER 1991 1. REFERENCES. a. TIM No. 26, March 1990, Lyme Disease-Vector Surveillance and Control. b. TG No. 174, June 1991, Personal Protective Techniques Against Insects and Other Arthropods of Military Significance. c. USAEHA, 8 October 1991, Standard Operating Procedure for Collection of Specimens at Deer Check Stations. 2. AUTHORITY. The scheduling of this assessment was based on AEHA Form 250, Request for USAEHA Field Services, 2 October 1991. 3. PURPOSE. Lyme disease is one of several severe tick-borne diseases which pose health threats at military installations. These diseases, while seldom life-threatening, reduce the efficiency of affected military personnel and diminish the overall quality of life at installations. The purpose of this initial risk assessment was to obtain deer serum and parasitic ticks to provide a portion of the baseline data needed in the preparation of a definitive Lyme Disease Risk Assessment for Fort Campbell. The completed assessment can be used by field commanders to minimize risks of Lyme disease to military and civilian personnel. A "Fact Sheet, Protection from Ticks and Lyme Disease" is provided at Appendix E. 4. GENERAL. a. Abbreviations and Terms. A listing of abbreviations and terms is included in Appendix A. b. Survey Personnel. This risk assessment was conducted by Mr. Jack H. Chandler, Survey Officer, Entomologist, Entomological Sciences Division (ESD), U.S. Army Environmental Hygiene Activity-South (USAEHA-S). c. Personnel Contacted. A list of the personnel contacted is in Appendix B. d. Data Collection. (1) Blood Serum Samples. Whole blood was obtained from the body cavity of field-dressed white-tailed deer (Odocoileus virginianus) as they were brought to the hunter check-in station (Building 6645A). Processing of the blood was done IAW TIM 26 and the USAEHA Standing Operating Procedure for specimen collection at deer check stations. Serum samples were sent overpacked in dry ice to the Regional Veterinary Laboratory at Fort George G. Meade, Maryland for analysis. (2) Tick Collection. The ears, nape and other regions were examined for the presence of ticks. Collected ticks were transported to Fort McPherson and processed by direct immunofluorescent assay (DIFA) to determine if they harbored spirochetes similar or identical to those causing Lyme disease. 5. FINDINGS AND DISCUSSION. a. Blood Serum Samples. A total of 27 serum samples were obtained from white-tailed deer. These samples were sent to the Regional Veterinary Laboratory for analysis. The results of these analyses will be furnished under separate cover to Fort Campbell personnel as soon as they are received by USAEHA-S. b. Tick Processing. Lone star ticks, Amblyomma americanum, were obtained from about 48 percent of the deer examined. About 98 percent of these were larvae. The species collected, their life stages and the number testing positive for spirochetes are shown on Appendix C. Approximately 49 percent of the ticks tested positive for either the spirochete, Borrelia burgdorferi or a species similar to burgdorferi. The species of Borrelia inhabiting tick midguts in the southeastern United States has not been identified and there is some doubt among researchers that the classic Lyme disease of the northeast is the same as that in the more southern regions. Therefore, the high percentage of Borrelia spirochetes reported for Fort Campbell should not be regarded as indicative of high risks for Lyme disease. 6. RECOMMENDATIONS. Recommendations are not keyed to specific report findings. They are made to reduce Lyme disease risks to military, civilian and visiting/recreating personnel at Fort Campbell. a. Fort Campbell - FORSCOM. The Lyme disease threat to installation personnel can be minimized through the use of repellents and the proper wearing of clothing and the use of repellents (see Appendix D). When possible avoid utilizing those areas identified as having exceptionally high tick populations or with ticks heavily infected with spirochetes. b. Preventive Medicine Service (PVNTMED Svc), Fort Campbell - HSC. Emphasize public awareness programs to educate installation personnel and visitors to behavioral and personal protective measures available to reduce their exposure to Lyme disease. Encourage the use of a VHS .5-inch audio- visual tape entitled "Lyme Disease - A growing threat" (PIN 504494) by activities to educate their personnel. Continue with the fine surveillance program already in place at Fort Campbell. The USAEHA-S will continue to identify and test any ticks sent to this Activity for the presence/absence of spirochetes. [signature] JACK H. CHANDLER Entomologist Entomological Sciences Division APPROVED: [signature] MICHAEL R. COLLYER MAJ, MS Chief, Entomological Sciences Division APPENDIX A ABBREVIATIONS AND TERMS DGSC Defense General Supply Center DIFA Direct Immunofluorescent Assay DSN Defense Switched Network ESD Entomological Sciences Division FORSCOM Forces Command HSC U.S. Army Health Services Command PVNTMED Svc Preventive Medicine Service TG Technical Guide TIM Technical Information Memorandum USAEHA-S U.S. Army Environmental Hygiene Activity-South APPENDIX B PERSONNEL CONTACTED Mr. Pat Brandon, Wildlife Biologist, Kentucky Department of Fish and Wildlife Resources, (502) 354-9171. Mr. George Buttrey, Wildlife Biologist, Tennessee Wildlife Resources Agency, (615) 781-6622. MAJ Frank Grubbs, Environmental Science Officer, PVNTMED Svc, HSC, DSN 635-3431. Mr. Charles Kingins, Pest Control Operator, Entomology Section, DSN 635-3110. Ms. Virginia Solyer, Outdoor Recreation, DSN 635-2175. LT White, Environmental Science Officer, PVNTMED Svc, HSC, DSN 635-3431. Mr. George Wright, Turkey Program Coordinator/Wildlife Biologist, Kentucky Department of Fish and Wildlife Resources, (502) 365-7278. APPENDIX C DIFA ANALYSIS OF LONE STAR TICKS * USAEHA-S PERMIT TICK DEVELOPMENTAL STAGE (% POSITIVE): SAMPLE NO. **: NUMBER: LARVAL NYMPHAL ADULT **************************************************************** C-12-10-91-02 00761 12 (33) 0 0 C-12-10-91-04 00371 4 (0) 0 0 C-12-10-91-05 12153 1 (0) 0 0 C-12-10-91-06 01329 46 (70) 0 0 C-12-10-91-08 00203 5 (40) 1 (0) 1 (0) C-12-10-91-12 12071 3 (67) 0 0 C-13-10-91-18 01578 1 (0) 0 0 C-13-10-91-20 60341 8 (38) 0 0 C-13-10-91-22 00277 3 (0) 0 0 C-13-10-91-23 11342 1 (0) 0 0 C-13-10-91-24 00245 1 (0) 0 0 C-13-10-91-27 00025 1 (0) 0 0 ------- * Amblyomma americanum ** Tick collection number corresponds to host deer blood serum collection number. APPENDIX D REPELLENTS 1. Several repellent products are available through the Defense General Supply Center (DGSC) or Self Service Supply System. When used in accordance with label directions and in conjunction with the proper wearing of the uniform, they provide personal protection against a wide variety of medically important insect/arthropod pests. Availability and current pricing can be obtained by calling the DGSC at DSN 695-4865: a. Insect/Arthropod Repellent Lotion (cream, 2 fluid ounces). The lotion, NSN 6840-01-284-3982, is not labeled for ticks, but will repel chigger mites and many biting flies. b. Permethrin Arthropod Repellent, Insect Repellent, Clothing Application (aerosol, 6 ounces) NSN 6840-01-278-1336. Seventy-five percent of the can is used to apply to the field uniform and the remainder is used to treat mosquito netting. The product provides protection from ticks and mosquitoes through six normal launderings. c. Insect Repellent Fabric Treatment (liquid, 5.1 fluid ounces) NSN 6840-01-334-2666. The contents are added to 2 gallons of water and applied with the 2-gallon sprayer from a field sanitation kit at a pressure of 50 pounds per square inch to field uniforms, mosquito netting, and tent fabric to provide protection from ticks and biting flies and other insects. Since most sprayers are not equipped with the required pressure gauge (NSN 3740- 01-332-8746), it will be necessary to obtain a pressure gauge and filter (NSN 4330-01-332-1639), in order to complete the retrofitting. Proper application can provide protection for the normal life of the uniform, six launderings of mosquito netting, and 6-9 months of treatment for tent fabric, depending on climate. 2. Detailed directions for the use of these and other repellents can be found in the U.S. Army Environmental Hygiene Agency Technical Guide (TG) 174, Personal Protective Techniques Against Insects and Other Arthropods of Military Significance. 3. The U.S. Army Medical Department Tick-Borne Disease Card (7189) is available from the USAEHA-S, ESD. APPENDIX E U.S. Army Environmental Hygiene Agency Entomological Sciences Division [picture of tick] Aberdeen Proving Ground, MD 21010-5422 FACT SHEET - PROTECTION FROM TICKS AND LYME DISEASE WHAT IT'S ALL ABOUT Soldiers and other personnel and dependents who live, train, work, or play in the field, share their environment with many forms of animal and insect life. Ticks may be abundant in both wooded and grassy areas. Several tick species are vectors or "transmitters" of Lyme disease. They include the deer tick, Ixodes dammini, in the Northeast and Midwest, and the western black-legged tick, Ixodes pacificus, in the West. Two other species, the Lone Star tick, Amblyomma americanum, and the black-legged tick, Ixodes scapularis, are prevalent across the South, and are potential vectors of Lyme disease. BE CONCERNED - BUT NOT ALARMED. Not all ticks carry Lyme disease, so a tick bite does not necessarily mean that disease will follow. In addition, prompt removal of a tick will lessen the chance of disease transmission. BUDDY UP When in the field, buddy up and routinely check for ticks every few hours or as frequently as possible. After returning indoors, remove your clothing and check your body carefully. Pay special attention to the hairy and/or warm, moist parts of the body. You can greatly reduce your chance of tick bite by following the DOD REPELLENT SYSTEM of wearing proper clothing and using both skin and clothing repellents: WEAR CLOTHING PROPERLY Blouse or tuck your uniform legs into your boots and wear your sleeves down. Civilians should tuck their pant legs into their socks, and their shirt into their pants. Light colored clothing makes it easier to spot ticks. USE REPELLENTS Apply deet repellent, NSN 6840-01-284-3982, to any exposed skin surfaces, and apply permethrin repellent spray, NSN 6840-01-278-1336, to your uniform or field clothing. Remember that permethrin is only for use on clothing, NEVER on skin. This combined use of repellents and proper wearing of clothing will provide nearly complete protection from tick bites. IF YOU ARE BITTEN If you find a tick embedded in your skin, DO NOT SQUASH OR BURN IT. Report to medical personnel to have the tick removed, or follow these guidelines: Use tweezers to grasp the tick's mouthparts as close to the skin as possible, and pull it straight outward. Pull slowly, firmly, and steadily. Be patient. The ticks central mouthpart called the hypostome is long and covered with barbs. This can make it difficult to remove. Wash the wound site and apply an antiseptic. Save the tick either in alcohol or frozen in a pill vial or plastic bag in case symptoms arise and identification of the tick becomes necessary. BE AWARE Be aware of the symptoms of Lyme disease. IF YOU HAVE BEEN IN AN AREA WHERE TICKS ARE FOUND AND YOU DEVELOP A RASH AROUND THE SITE OF THE TICK BITE OR FLU-LIKE SYMPTOMS (ACHES AND PAINS, HEADACHE, FEVER, EXTREME FATIGUE), ESPECIALLY DURING THE PERIOD FROM MAY THROUGH EARLY FALL, PROMPTLY SEE A PHYSICIAN FOR EVALUATION. REMEMBER... Wear trousers inside boots and sleeves down; use skin (deet) and clothing (permethrin) repellents; check your clothing and body as frequently as possible; remove attached ticks as soon as they are discovered; seek medical attention if symptoms develop. FOR FURTHER INFORMATION CALL DSN 572-2564 ADDENDUM DEPARTMENT OF THE ARMY U.S. Army Environmental Hygiene Activity - South Fort McPherson, Georgia 30330-5000 [Seal of Department of Defense, United States of America] REPLY TO ATTENTION OF: ADDENDUM LYME DISEASE RISK ASSESSMENT NO. 16-62-0552-92 FORT CAMPBELL FORT CAMPBELL, KENTUCKY 11-14 OCTOBER 1991 1. REFERENCES. a. Conference Report on the National Defense Authorization Act for Fiscal Years 92 and 93, House Report 102-311, 102nd Congress, 1st Session, November 1991, p.422. b. TIM No. 26, March 1990, Lyme Disease-Vector Surveillance and Control. c. TG No. 174, June 1991, Personal Protective Techniques Against Insects and Other Arthropods of Military Significance. d. USAEHA, 8 October 1991, Standard Operating Procedures for Collection of Specimens at Deer Check Stations. e. Memorandum, USAEHA, HSHB-AS-P, 19 November 1991, subject: Lyme Disease Risk Assessment No. 16-62-0552-92. 2. AUTHORITY. The scheduling of this assessment was based on AEHA Form 250, Request for USAEHA Field Services, 2 October 1991. 3. PURPOSE. The purpose of this initial risk assessment was to obtain deer serum and parasitic ticks to provide a portion of the baseline data needed in the preparation of a definitive Lyme Disease Risk Assessment for Fort Campbell, Kentucky. 4. GENERAL. Parasitic ticks and blood samples were obtained from hunter- killed white-tailed deer. Ticks were processed at Fort McPherson and the above mentioned report was submitted. Whole blood was processed to obtain serum which was then sent to the Regional Veterinary Laboratory at Fort George G. Meade, Maryland for analysis. The results of these tests have been received. 5. FINDINGS AND DISCUSSION. One of the 27 serological tests was positive for the spirochete, Borrelia burgdorferi, which is the causal organism for Lyme disease (see Appendix F, serological results). 6. CONCLUSION. Since one of the deer was serologically positive for exposure to Lyme disease and 48 percent of the ticks tested positive for the Lyme spirochete, installation personnel should continue to practice personal protective measures to reduce the possible disease threat. Additional tick-borne disease risk reduction measures can be found in Appendix G. 7. TECHNICAL ASSISTANCE. Questions concerning these test results should be directed to MAJ Michael R. Collyer, Chief, Entomological Sciences Division at DSN 572-2564 or 572-2578. [signature] MICHAEL R. COLLYER MAJ, MS Chief, Entomological Sciences Division APPENDIX F RESULTS OF SEROLOGICAL TESTS ON WHITE-TAILED DEER FORT CAMPBELL, KENTUCKY SAMPLE USAEHA-SOUTH HUNTING AREA TESTED FOR NUMBER SAMPLE NO.: NO: LYME AT 1:280 TITER ------------------------------------------------- 1 C-12-10-91-1 48 Negative 2 C-12-10-91-2 34 Negative 3 C-12-10-91-3 AB3 Negative 4 C-12-10-91-4 33 Negative 5 C-12-10-91-5 46 Negative 6 C-12-10-91-6 46 Negative 7 C-12-10-91-7 CB Negative 8 C-12-10-91-8 CB Negative 9 C-12-10-91-9 30 Negative 10 C-12-10-91-10 30 Negative 11 C-12-10-91-11 30 Negative 12 C-12-10-91-12 AB3 Negative 13 C-13-10-91-13 30 Negative 14 C-13-10-91-14 30 Negative 15 C-13-10-91-15 48 Negative 16 C-13-10-91-16 AB3 Negative 17 C-13-10-91-17 23 Negative 18 C-13-10-91-18 33 Negative 19 C-13-10-91-19 30 Negative 20 C-13-10-91-20 AB3 Negative 21 C-13-10-91-21 AB3 Negative 22 C-13-10-91-22 33 POSITIVE 23 C-13-10-91-23 AB3 Negative 24 C-13-10-91-24 46 Negative 25 C-13-10-91-25 49 Negative 26 C-13-10-91-26 49 Negative 27 C-13-10-91-27 48 Negative APPENDIX G TICK-BORNE DISEASE RISK REDUCTION MEASURES 1. Emphasize public awareness programs to educate installation personnel and visitors on the potential for contracting tick-borne diseases such as Lyme disease and Rocky Mountain spotted fever and on personal protective measures which can be employed to minimize these risks. The USAEHA-S can provide brochures and other display materials. An informative VHS 0.5-inch audio-visual tape entitled "Lyme Disease - A growing threat" (PIN 504494) is available from the supporting Training and Audiovisual Support Activity. Copies of a small card entitled "Tick-Borne Diseases" (U.S. Army Medical Department, 7819) make excellent handouts. Additional cards are available from USAEHA-S. 2. Submit any collected tick specimens (both field collected or ticks that have been removed from individuals) alive for identification and DFA testing to USAEHA-S, Building 180, Fort McPherson, GA 30330-5000. The USAEHA-S can provide directions and supplies for shipments of ticks. 3. Encourage individuals displaying Lyme disease symptoms such as febrile illness and rashes, to obtain prompt medical attention. 4. Stock Permethrin Arthropod Repellent (NSN 6840-01-278-1336, box of 12 cans), Insect Repellent Fabric Treatment (NSN 6840-01-334-2666, box of 12 bottles) and 3M Trademark Insect Repellent (NSN 6840-01-284-3982, box of 12 tubes) for distribution. Emphasize tick habitat avoidance and the proper wearing of clothing and use of repellents. 5. Identify high risk foci in cantonment areas via tick dragging/flagging, small mammal trapping, deer checks and the assaying of collected ticks for B. burgdorferi. Sampling should be performed in early summer when the ticks are active. Post DA Poster 40-5, and thereby identify high risk areas. 6. Avoid high tick population areas for troop training or recreation. Such areas can be identified by tick dragging or flagging prior to use. 7. Eliminate tick habitat in heavily used, infested areas (e.g., wooded recreation areas) by removing leaf litter and keeping grass mowed. Clearing should be performed during low-risk months (January/February) when the ticks are the least active. These measures will also discourage small mammals which may serve as hosts for the ticks. Thinning of trees and removal of brush will allow more sun penetration which will reduce the humidity level necessary for optimum tick survival. Prepare, as a contingency, to employ chemical control (use only approved pesticides) in the event that non-chemical control measures fail to reduce the tick population. 8. Follow installation professional wildlife biologist's recommendations to achieve annual deer harvest quotas in all training areas to ensure that the deer population is kept in check. Effective management of the deer population will reduce the associated tick population. --- Trademark 3M is a registered trademark of Minnesota Mining and Manufacturing Co., St. Paul, MN 55133. Use of trademarked name does not imply endorsement by the U.S. Army but is intended only to assist in identification of a specific product.