LYME DISEASE RISK ASSESSMENT, COLUMBUS AIR FORCE BASE, COLUMBUS, MISSISSIPPI, 23-24 NOVEMBER 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. 16-62-0533-92 COLUMBUS AIR FORCE BASE COLUMBUS, MISSISSIPPI 23-24 NOVEMBER 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, 16 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 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 for Columbus Air Force Base (AFB). The completed assessment can be used by field commanders to minimize risks of Lyme disease to military and civilian personnel. 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 Ms. Deanna Harrison, Biological Technician, Entomological Sciences Division (ESD), U.S. Army Environmental Hygiene Activity-South (USAEHA-S). c. Personnel Contacted. (1) SSG Levingston, Military Public Health Services, Columbus AFB, DSN 742-2144. (2) 2LT Dean, Civil Engineer Squadron, Columbus AFB, DSN 742-7942. 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 Sportman's Lodge (Bldg 1816). Processing of the blood was done IAW TIM 26 and the USAEHA Standing Operating Procedure for specimens 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 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 three 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 Columbus AFB personnel as soon as they are received by USAEHA-S. Additional blood collection supplies were shipped to Columbus AFB in the event that any additional deer will be killed for the remainder of the hunting season. If any more blood samples are received, these samples will be tested and the results supplied to Columbus AFB personnel. b. Tick Processing. Black-legged tick, Ixodes scapularis, were obtained from 33 percent of the deer examined. All of the 30 ticks collected were adults. The species collected, their life stages and the number testing positive for spirochetes are shown on Appendix C. Approximately three percent of the ticks tested were 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 percentage of ticks infected with Borrelia spirochetes reported for Columbus AFB 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 Columbus AFB. a. Columbus AFB. 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 C). When possible avoid utilizing those areas identified as having exceptionally high tick populations or with ticks heavily infested with spirochetes. b. Military Public Health Service-Columbus AFB. 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 with the Columbus AFB Veterinary Service. The USAEHA-S will continue to identify and test any ticks sent to this Activity for the presence/absence of spirochetes. 7. TECHNICAL ASSISTANCE. A "Fact Sheet, Protection from Ticks and Lyme Disease" is provided at Appendix D. [signature of Jack H. Chandler] for DEANNA D. HARRISON Biological Technician Entomological Sciences Division REVIEWED BY: [signature] JACK H. CHANDLER Entomologist USAEHA-South Lyme Disease Program Manager APPROVED: [signature] MICHAEL R. COLLYER MAJ, MS Chief, Entomological Sciences Division APPENDIX A ABBREVIATIONS AND TERMS AFB Air Force Base DGSC Defense General Supply Center DSN Defense Switched Network ESD Entomological Sciences Division HSC U.S. Army Health Services Command TG Technical Guide TIM Technical Information Memorandum USAEHA-S U.S. Army Environmental Hygiene Activity-South APPENDIX B IMMUNOFLUORESCENT ASSAYS ANALYSIS OF THE TICKS COLLECTED AT COLUMBUS AFB USAEHA-S NUMBER TICKS* COLLECTED: PERCENT POSITIVE: SAMPLE NO. **: *************************************************************************** CAFB-11-23-91-02 19 0 CAFB-11-23-91-03 11 9 ------------ * Ixodes scapularis ** Tick collection number corresponds to host deer blood serum collection number APPENDIX C 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 D 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. 16-62-0533-92 COLUMBUS AIR FORCE BASE COLUMBUS, MISSISSIPPI 23-24 NOVEMBER 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, 31 December 1991, subject: Lyme Disease Risk Assessment No. 16-62-0533-92. 2. AUTHORITY. The scheduling of this assessment was based on AEHA Form 250, Request for USAEHA Field Services, 16 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 Columbus Air Force Base, Mississippi. 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. All of the serological tests were negative for the spirochete, Borrelia burgdorferi, which is the causal organism for Lyme disease (see Appendix E, serological results). 6. CONCLUSION. Although only one of the ticks tested positive for the Lyme spirochete and none of the deer were serologically positive for exposure to Lyme disease, Lyme and other tick-borne diseases are known to exist in the state of Mississippi. Installation personnel should continue to practice personal protective measures to reduce the possible disease threat. 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 E RESULTS OF SEROLOGICAL TESTS ON WHITE-TAILED DEER COLUMBUS AIR FORCE BASE, MISSISSIPPI SAMPLE USAEHA-SOUTH TESTED FOR NUMBER SAMPLE NO.: LYME AT 1:280 [sic] TITER ------------------------------------------------- 1 CAFB-23-11-91-1 Negative 2 CAFB-23-11-91-2 Negative 3 CAFB-23-11-91-3 Negative