Lyme Disease Risk Assessment, Fort Benning, Georgia, 24 Oct-27 Nov 1992 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 (40-5f) 5 March 1993 MEMORANDUM FOR Commander, U.S. Army Training and Doctrine Command, ATTN: ATBO-L, Fort Monroe, VA 23651-5451 Commander, U.S. Army Medical Department Activity, Fort Benning, GA 31905 SUBJECT: Lyme Disease Risk Assessment No. 16-62-A11G-93, Fort Benning, Fort Benning, Georgia, 24 October - 27 November 1992 1. Tick-borne diseases can present a serious health threat to personnel in the field. This initial risk assessment was performed to gather preliminary data on possible reservoirs for the Lyme disease (LD) spirochete at Fort Benning for use in developing a definitive Risk Assessment. 2. Only one of 103 ticks tested positive for the spirochete responsible for LD. However, over 50 percent of those tested from hunter-killed, white-tailed deer in 1991 were positive. Since human cases of LD, Rocky Mountain spotted fever and Ehrlichiosis have been reported from throughout Georgia, personnel at Fort Benning should be encouraged to obtain and use repellents and other personal protective measures to reduce the threat from tick-borne diseases. 3. Copies of the initial report are enclosed. U.S. Army Environmental Hygiene Activity-South will respond to requests for additional information on this risk assessment or provide direct support in the areas of occupational and environmental enhancement. Assistance may be obtained by contacting the Survey Officer, Mr. Jack H. Chandler or the Chief, Entomological Sciences Division, MAJ Michael Collyer at DSN 572-2564 or 572-2578. [signature] JOSEPH A. JAKUBOWSKI LTC, MS Commanding 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-A11G-93 FORT BENNING, FORT BENNING, GEORGIA 24 OCTOBER - 27 NOVEMBER 1992 1. REFERENCES. See Appendix A for a listing of references. 2. AUTHORITY. Memorandum, USAEHA, HSHB-M, 21 September 1992, subject: U.S. Army Environmental Hygiene Agency Scheduling of Field Services, FY93. 3. PURPOSE. Lyme disease (LD) 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 is 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 (LDRA) for Fort Benning. The completed assessment can be used by field commanders to minimize risks of LD to military and civilian personnel. See Appendix B for other assistance that the U.S. Army Environmental Hygiene Activity-South (USAEHA-S) can provide. 4. GENERAL. a. Abbreviations and Terms. A listing of abbreviations and terms is included in Appendix C. b. Survey Personnel. Mr. Jack H. Chandler, Survey Officer, Entomologist, Entomological Sciences Division (ESD), USAEHA-S coordinated this risk assessment. c. Personnel Contacted. A list of the personnel contacted is in Appendix D. d. Data Collection. (1) Blood Serum Samples. Whole blood and tick samples from hunter- killed white-tailed deer (Odocoileus virginianus) were obtained by employees of Fort Benning's Natural Resources Division and the installation supervisory entomologist (Appendix E). These samples were transported to the installation Veterinary Medical Office where they were stored under refrigeration until they could be transported to Fort McPherson by the survey officer. Processing of the blood was done IAW TIM 26 and the USAEHA Standing Operating Procedure for specimen collection at deer check stations. The whole blood obtained from each deer was centrifuged to obtain serum. Each sample was divided into three equal volumes. One series of serum samples were sent overpacked in dry ice to the Regional Veterinary Laboratory at Fort George G. Meade, Maryland for LD analysis. A second series was sent to the Regional Veterinary Laboratory at Fort Sam Houston, Texas for testing for deer exposure to the organism causing Rocky Mountain spotted fever (RMSF). The remaining sera were retained at USAEHA-S for testing for exposure to the organism responsible for Ehrlichiosis. (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) fluorescein-labeled, affinity purified antibody to Borrelia sp. (Kirkegaard & Perry Laboratories, Catalog No. 02-97-92) to determine if they harbored spirochetes similar or identical to those responsible for causing LD. 5. FINDINGS AND DISCUSSION. a. Georgia Department of Health. Personnel at the Georgia Department of Health reported 22, 38, and 2 human cases of LD, RMSF, and Ehrlichiosis, respectively, for 1992. Breakdown by diseases/counties is not yet available. b. Blood Serum Samples. A total of 111 serum samples were obtained from white-tailed deer at Fort Benning. The sera were sent to Regional Veterinary Laboratories for analysis for tick-borne disease exposure. The table at Appendix E lists these samples and their identifying numbers will be used to report laboratory results to the installation as soon as they are received by USAEHA-S. c. Tick Processing. One hundred and thirty-four ticks, representing two species were examined. Thiry-one were dead and too dry to process. The species collected, their life stages and the number testing positive for spirochetes are shown on Appendix F. Less than 1 percent of the ticks tested positive for either the spirochete, Borrelia burgdorferi or a species similar to B. burgdorferi. The species of Borrelia inhabiting tick midguts in the southeastern United States has not been identified and therefore, is some doubt among researchers that the classic LD of the northeast is the same as that occurring in the more southern regions. Therefore, these data should not be regarded as indicative of high risks for LD. 6. RECOMMENDATIONS. Recommendations are not keyed to specific report findings. They are made to reduce tick-borne disease risks to military, civilian, and visiting/recreating personnel at Fort Benning. a. Fort Benning - U.S. Army Training and Doctrine Command. The LD threat to installation personnel can be minimized through the use of repellents and the proper wearing of clothing (see Appendix G). When possible avoid utilizing those areas identified as having exceptionally high tick populations or with ticks heavily infested with spirochetes. Additional strategies for reducing tick-borne diseases are detailed at Appendix H. b. Preventive Medicine Service, Fort Benning - U.S. Army Health Services Command. Emphasize public awareness programs to educate installation personnel and visitors to behavioral and personal protective measures available to reduce their exposure to LD. 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. A "Fact Sheet, Protection from Ticks and Lyme Disease" is provided at Appendix I. 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 REFERENCES 1. Technical Information Memorandum No. 26, March 1990, Lyme Disease- Vector Surveillance and Control. 2. Technical Guide (TG) No. 174, June 1991, Personal Protective Techniques Against Insects and Other Arthropods of Military Significance. 3. USAEHA, 8 October 1991, Standing Operating Procedure for Collection of Specimens at Deer Check Stations. 4. 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. 5. Technical Bulletin Medical 561, June 1992, Occupational and Environmental Health and Pest Surveillance. APPENDIX B TECHNICAL ASSISTANCE Technical advice and/or consultation on pest management problems, to include on-site assistance, may be obtained by telephone from our Activity, DSN 572-2564. Other services that we assist you with are as follows: 1. Entomological laboratory support 2. Pesticide equipment calibration 3. Pest management document review 4. Environmental laboratory support 5. Hazardous waste management 6. Industrial hygiene management 7. Sanitation and hygiene 8. Wastewater management 9. Water supply management 10. Worksite hazards management For assistance in any of the above listed programs, please call: Entomological Sciences Division - DSN 572-2564 Environmental Health and Engineering Division - DSN 572-2727 Potable, recreational and wastewater quality; hazardous waste management; document/design reviews. Industrial Hygiene Division - DSN 572-2827 Industrial hygiene; hazard communication; field sanitation and hygiene; protective equipment programs; document/design reviews. Environmental Laboratory Division - DSN 572-3236 Routine and emergency analysis of occupational health-related samples and environmental (water and soil) samples. During non-duty hours calls will be recorded by an answering machine (DSN 572-2564) and returned the next day. Many additional occupational and environmental health related services are available from our parent organization, the U.S. Army Environmental Hygiene Agency, and are described in AEHA Pamphlet 40-2, Directory of Services (published annually). We will gladly coordinate any additional services you request and that we cannot provide, with our parent organization. APPENDIX C ABBREVIATIONS AND TERMS DIFA Direct Immunofluorescent Assay DSN Defense Switched Network ESD Entomological Sciences Division LD Lyme disease RMSF Rocky Mountain spotted fever TG Technical Guide USAEHA-S U.S. Army Environmental Hygiene Activity-South APPENDIX D PERSONNEL CONTACTED Mr. Lonnie Daniels, Forestry Technician, Natural Resources Branch, DSN 784-6120. SG Cyree, Veterinary Service, DSN 835-6466. Mr. Charles Ford, Wildlife Biologist, Natural Resources Branch, DSN 784-6120. Mr. Gary Hollon, Forestry Technician, Natural Resources Branch, DSN 784-6120. Mr. Steve Kerlin, Forestry Technician, Natural Resources Branch, DSN 784-6120. Ms. Ruth Sponsler, Supervisory Entomologist, Range Roads and Grounds Branch, DSN 835-3224. SG Van Loon, Veterinary Service, DSN 835-6466. APPENDIX E WHITE-TAILED DEER SERA COLLECTED AT FORT BENNING, GEORGIA [data omitted by this typist - data summarized in above report] APPENDIX F IMMUNOFLUORESCENT ASSAYS OF THE MIDGUT CONTENTS OF TICKS COLLECTED FROM WHITE-TAILED DEER AT FORT BENNING, GEORGIA [data omitted by this typist - data summarized in above report] APPENDIX G 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. d. Insect Repellent, Clothing Application IDAA kit, NSN 6840-01-345- 0237. One kit treats one complete BDU uniform. Treatment lasts for repeated (30 or more) launderings. Note: Dry cleaning will remove the treatment. Mark advice code "2B" (no substitutions) when ordering this kit. 2. Detailed directions for the use of these and other repellents can be found in the U.S. Army Environmental Hygiene Agency TG 174, Personal Protective Techniques Against Insects and Other Arthropods of Military Significance. 3. GTA 8-3-56, Tick-Borne Diseases, is available from the USAEHA-S, ESD. APPENDIX H 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" (GTA 8-5-56) 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 direct immunofluorescent assay testing to USAEHA-S, Building 180, Fort McPherson, GA 30330-5000. USAEHA-S can provide directions and supplies for shipments of ticks. 3. Encourage individuals displaying LD 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. APPENDIX I 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. U.S. Army Environmental Hygiene Activity-South Entomological Sciences Division Fort McPherson, GA 30330-5000 FOR FURTHER INFORMATION CALL DSN: 572-2564/2578 or Commercial: (404)752-2564/2578