LYME DISEASE RISK ASSESSMENT, FORT RUCKER, ALABAMA, 5-6 DECEMBER 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 LYME DISEASE RISK ASSESSMENT NO. 16-62-AW62-93 FORT RUCKER, ALABAMA 5-6 DECEMBER 1992 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 174, June 1991, Personal Protective Techniques Against Insects and Other Arthropods of Military Significance. d. USAEHA, 8 October 1991, Standard Operating Procedure for Collection of Specimens at Deer Check Stations. 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 is one of several severe tick-borne diseases which pose health threats at military installations. These diseases 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 sera and parasitic ticks to provide a portion of the baseline data needed to develop a definitive Lyme Disease Risk Assessment for Fort Rucker. When completed, this assessment can be used by field commanders to minimize risks of Lyme and other tick-borne diseases to military and civilian personnel. See Appendix A 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 B. b. Survey Personnel. CPT Kelley M. Loftin, Survey Officer, Entomologist, Entomological Sciences Division (ESD), USAEHA-S, and SGT Zebbie Gray, Preventive Medicine (PVNTMED) Specialist, coordinated this risk assessment. c. Personnel Contacted. (1) Mr. Charles Mayo, Wildlife Biologist, Wildlife Management, DSN 558-5714. (2) Mr. David M. Spillers, Wildlife Biologist, Wildlife Management, DSN 558-5714. (3) Mr. John N. Daves, Technician, Wildlife Management, DSN 558-5714. (4) Mr. Billy M. Goodson, Technician, Wildlife Management, DSN 558-5714. (5) Mr. Wesley B. Blake, Technician, Wildlife Management, DSN 558-5714. d. Data Collection. (1) Blood Serum Samples. Whole blood was obtained from the body cavity of hunter-killed white-tailed deer (Odocoileus virginianus) as they were brought to the hunter check-in station. The blood samples were centrifuged to obtain the needed sera which was kept on wet ice until it was transported to Fort McPherson. 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 and to the Regional Veterinary Laboratory at Fort Sam Houston, Texas for Lyme disease and Rocky Mountain spotted fever analysis, respectively. Analysis for human Ehrlichiosis will be performed at USEAHA-S. (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) using Borrelia burgdorferi antibody conjugate and Borrelia species antibody conjugate from Kirkegaard and Perry, Laboratories, Inc., to determine if they harbored the spirochete that causes Lyme disease. 5. FINDINGS AND DISCUSSION. a. Blood Serum Samples. A total of 24 serum samples were obtained from white-tailed deer. These samples were sent to Regional Veterinary Laboratories for analysis. The results from these analysis will be furnished in the format presented at Appendix C, under separate cover to Fort Rucker personnel as soon as they are received by USAEHA-S. b. Tick Processing. Ticks were collected from about 83 percent of the deer examined at the hunter check-in station. The species collected, their life stages and the number testing postitive for spirochetes are shown on Appendix D. The black-legged tick (Ixodes scapularis Say) was the only species collected. About thiry-five percent of the ticks tested positive using the polyclonal Borrelia species antibody preparation, while only four percent tested positive using the monoclonal Borrelia burgdorferi antibody preparation, thus strengthening the need for further study of Lyme disease in the South. 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. c. Alabama Department of Health. The State Epidemiologist Office reported no cases of either Lyme disease or Rocky Mountain spotted fever cases for either Coffee or Dale Counties in 1992. However, cases of both diseases were reported for Alabama during previous years and in 1992. 6. RECOMMENDATIONS. Recommendations are made from the general findings of this report to ensure good PVNTMED practices which will reduce Lyme and other tick-borne disease risks to military, civilian, and visiting/recreating personnel at Fort Rucker. General Lyme disease reduction measures can be found at Appendix E. a. Fort Rucker - U.S. Army Training and Doctrine Command. (1) The Lyme and other tick-borne disease threat to installation personnel can be minimized with the proper wearing of clothing and the use of repellents (see Appendix F). It is recommended that commanders at all levels emphasize the use of clothing repellent (NSN 6840-01-278-1336) and skin application repellent (NSN 6840-01-284-3982) to minimize potential exposure to tick-borne diseases. When possible avoid utilizing those areas identified as having exceptionally high tick populations or with ticks heavily infested with spirochetes. (2) When possible, modify tick habitats by mechanical removal of leaf litter and brush. The practice of controlled burning in training areas should be encouraged. Care must be exercised not to threaten habitats used by endangered species. (3) 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. (4) Post warning signs (PD Poster 40-5) at entrances to training areas to inform training area users that the threat of Lyme disease exists. b. PVNTMED Service, Fort Rucker - 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 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. A "Fact Sheet, Protection from Ticks and Lyme Disease" is provided at Appendix G. 7. LABORATORY ASSISTANCE. The USAEHA-S will continue to identify and test any ticks sent to this Activity for the presence/absence of spirochetes. [signature] KELLY M. LOFTIN CPT, MS Entomologist Entomological Sciences Division REVIEWED BY: [signature] JACK H. CHANDLER Entomologist USAEHA-South Lyme Disease Program Manager APPROVED BY: [signature] MICHAEL R. COLLYER MAJ, MS Chief, Entomological Sciences Division APPENDIX A 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. Please inform your Major Command Consultant if you desire to request on-site assistance from our Activity. 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 572-3052) 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 B ABBREVIATIONS AND TERMS DGSC Defense General Supply Center DIFA Direct Immunofluorescent Assay DSN Defense Switched Network ESD Entomological Sciences Division PVNTMED Preventive Medicine RMSF Rocky Mountain spotted fever TG Technical Guide TIM Technical Information Memorandum USAEHA-S U.S. Army Environmental Hygiene Activity-South APPENDIX C WHITE-TAILED DEER SERA COLLECTED AT FORT RUCKER, ALABAMA [Data omitted by this typist - data included in full in attached Addendum] APPENDIX D DIFA ANALYSIS OF TICKS COLLECTED AT FORT RUCKER, ALABAMA [Data omitted by this typist - data summarized in above report] APPENDIX E 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 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. APPENDIX F 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 TG 174, Personal Protective Techniques Against Insects and Other Arthropods of Military Significance. 3. The U.S. Army Tick-Borne Disease Card (GTA 8-5-56) is available from the USAEHA-S, ESD. APPENDIX G 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 572-2564 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 ADDENDUM LYME DISEASE RISK ASSESSMENT NO. 16-62-AW62-93 FORT RUCKER, ALABAMA 5-6 DECEMBER 1992 1. REFERENCES. Memorandum, USAEHA, HSHB-AS-P, 28 January 1993, Lyme Disease Risk Assessment No. 16-62-AW62-93, Fort Rucker, Alabama, 5-6 December 1992. 2. AUTHORITY. Memorandum, USAEHA, HSHB-M, 21 September 1992, subject: U.S. Army Environmental Hygiene Agency Schedule of Field Services, FY93. 3. PURPOSE. Lyme disease is one of several severe tick-borne diseases which pose health threats at military installations. These diseases 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 sera and parasitic ticks to provide a portion of the baseline data needed to develop a definitive Lyme Disease Risk Assessment for Fort Rucker. When completed, this assessment can be used by field commanders to minimize risks of Lyme and other tick-borne diseases to military and civilian personnel. 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 Lyme disease analysis, to the Regional Veterinary Laboratory at Fort Sam Houston, Texas for Rocky Mountain spotted fever analysis, and to the U.S. Army Environmental Hygiene Activity-South for human Ehrlichiosis analysis. The results of these tests have been received (see Appendix C, serological results). 5. FINDINGS AND DISCUSSION. None of the 24 serological tests were positive for the spirochete, Borrelia burgdorferi, which is the causal organism for Lyme disease. Twenty-two of the 24 serological tests were positive for the rickettsia, Ehrlichia chaffeensis, which is the causal organism for human Ehrlichiosis. Three of the 24 serological tests were positive for the riskettsia, Richettsia rickettsii, the causal organism for Rocky Mountain spotted fever. 6. CONCLUSION. Since 92 percent of the deer tested were serologically positive for exposure to human Ehrlichiosis and 13 percent were serologically positive for exposure to Rocky Mountain spotted fever, installation personnel should continue to practice personal protective measures to reduce the possible disease threat. 7. LABORATORY ASSISTANCE. The USAEHA-S will continue to identify and test any ticks sent to this Activity for the presence/absence of spirochetes. [signature] MICHAEL R. COLLYER MAJ, MS Chief, Entomological Sciences Division APPENDIX C WHITE-TAILED DEER SERA COLLECTED AT FORT RUCKER, ALABAMA SAMPLE USAEHA-S HUNTING TESTED FOR NUMBER SAMPLE NO. AREA NO. LYME(1) EHRLICHIOSIS(2) RMSF(3) *************************************************************************** 1 RK-05-12-92-1 29 Negative Positive Negative 2 RK-05-12-92-2 27 Negative Positive Negative 3 RK-05-12-92-3 W85 Negative Negative Negative 4 RK-05-12-92-4 W85 Negative Negative Negative 5 RK-05-12-92-5 W85 Negative Positive Negative 6 RK-05-12-92-6 W85 Negative Positive Negative 7 RK-05-12-92-7 W85 Negative Positive Negative 8 RK-05-12-92-8 W85 Negative Positive Negative 9 RK-05-12-92-9 W85 No serum No serum No serum 10 RK-05-12-92-10 W85 Negative Positive Negative 11 RK-05-12-92-11 W85 Negative Positive Negative 12 RK-05-12-92-12 W85 Negative Positive Positive 13 RK-05-12-92-13 W85 No serum No serum No serum 14 RK-05-12-92-14 W85 Negative Positive Positive 15 RK-05-12-92-15 W85 No serum No serum No serum 16 RK-05-12-92-16 W85 Negative Positive Negative 17 RK-05-12-92-17 W85 Negative Positive Negative 18 RK-05-12-92-18 35 Negative Positive Negative 19 RK-05-12-92-19 35 Negative Positive Negative 20 RK-05-12-92-20 W85 Negative Positive Negative 21 RK-05-12-92-21 W85 No serum No serum No serum 22 RK-05-12-92-22 W85 Negative Positive Negative 23 RK-05-12-92-23 W85 Negative Positive Positive 24 RK-05-12-92-24 W85 Negative Positive Negative 25 RK-05-12-92-25 W85 Negative Positive Negative 26 RK-05-12-92-26 W85 Negative Positive Negative 27 RK-05-12-92-27 9 Negative Positive Negative 28 RK-05-12-92-28 40 Negative Positive Negative ---------------------------------- (1) Sera is reported positive for Lyme disease with a titer of 1:128 or higher. (2) Sera is reported positive for Ehrlichiosis for a titer of 1:256 or higher. (3) Sera is reported positive for Rocky Mountain spotted fever for a titer of 1:256 or higher.