LYME DISEASE RISK ASSESSMENT, FORT STEWART, GEORGIA, 31 OCT-19 DEC 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-AW56-93 FORT STEWART, GEORGIA 31 OCTOBER - 19 DECEMBER 1992 1. REFERENCES. See Appendix A for a listing of references. 2. AUTHORITY. Memorandum, U.S. Army Environmental Hygiene Agency (USAEHA), HSHB-M, 21 September 1992, subject: USAEHA Schedule 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 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 and feral hog serum and parasitic ticks to provide a portion of the baseline data needed to develop a definitive Lyme Disease Risk Assessment for Fort Stewart. 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 B for other assistance that the U.S. Army Environmental Hygiene Activity-South (USAEHA-S) can provide. 4. GENERAL. a. Abbreviations and Terms. See Appendix C for a list of abbreviations and terms. b. Survey Personnel. Mr. Dennis Kuhr, Entomologist, Entomological Sciences Division (ESD), USAEHA-S coordinated this risk assessment from 31 October - 1 November 1992 with assistance from personnel at the Preventive Medicine Service (PCNTMED Svc), Medical Department Activity. Individuals from the local PVNTMED Svc assisted the project officer during the initial two days of this project and they collected additional samples after the project officer's departure. Their sampling continued through 19 December 1992. c. Data Collection. (1) Blood Serum Samples. Whole blood was obtained from the body cavity of field-dressed white-tailed deer (Odocoileus virginianus) and feral hogs (Sus scrofa) as they were brought to the hunter check-in station. Processing of the blood was done IAW TIM 26 and the USAEHA Standing Operating Procedure for specimen collection at deer check stations. The blood samples collected 31 October - 1 November 1992 were centrifuged to obtain the needed sera which was refrigerated until it was transported to Fort McPherson on wet-ice. Sera collected after the project officers departure on 1 November - 19 December 1992 were frozen after centrifuging and sent to USAEHA-S overpacked on dry ice. Each sample was divided into three equal volumes. Serum samples were sent overpacked in dry ice to the Regional Veterinary Laboratory at Fort George G. Meade, Maryland for LD analysis, to the Regional Veterinary Laboratory at Fort Sam Houston, Texas for Rocky Mountain spotted fever (RMSF) anaylsis, and to USAEHA-S, Fort McPherson, Georgia for Human ehrlichiosis analysis. (2) Tick Collection. The ears, nape and other regions of the deer 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 from Kirkegaard and Perry Laboratories, Inc. to determine if they harbored the spirochete that causes LD. 5. FINDINGS AND DISCUSSION. a. Blood Serum Samples. A total of 61 serum samples were obtained from white-tailed deer (54) and feral hogs (7). These samples were sent to the Regional Veterinary Laboratories for analysis. The results of these analyses will be furnished in the format presented at Appendix D, under separate cover to Fort Stewart personnel as soon as they are received by USAEHA-S. b. Tick Processing. Ticks were collected from 112 deer and 6 feral hogs (total 118) examined at the hunter check-in station. The species collected, their life stages and the number testing positive for spirochetes are shown on Appendix E. Five species of ticks were collected; lone star tick (Amblyomma americanum), black-legged tick (Ixodes scapularis), Gulf Coast tick (Amblyomma maculatum), winter tick (Dermacentor albipictus), and the American dog tick (Dermacentor variabilis). Although none of the ticks tested positive for the spirochete Borrelia burgdorferi, Lyme and other tick-borne diseases may occur in the Fort Stewart area. The species of Borrelia inhabiting tick midguts in the southern United States has not been identified and there is some doubt among researchers that the classic LD of the northeast is the same as that in the more southern regions. c. Georgia Department of Health. Personnel at the Georgia Department of Health reported 22, 38, and 2 human cases of LD, RMSF, and Human ehrlichiosis, respectively, for 1992. A breakdown of these diseases per county is not yet available. 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 Stewart. General LD reduction measures can be found at Appendix F. a. Fort Stewart - Forces Command. (1) The Lyme and other tick-borne disease threats to installation personnel can be minimized through the proper wearing of clothing and the use of repellents (see Appendix G). It is recommeded that commanders at all levels emphasize the use of the 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 (DA Poster 40-5) at entrances to training areas to inform training area users that the threat of LD exists. b. PVNTMED Svc, Fort Stewart - 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 and other tick-borne diseases. Encourage the use of a video home system VHS 0.5-inch audio-visual tape entitled "Lyme Disease - A growing threat" [personal identification number (PIN) 504494] by activities to educate their personnel. A "Fact Sheet, Protection from Ticks and Lyme Disease" is provided at Appendix H. 7. LABORATORY ASSISTANCE. The USAEHA-S will continue to identify and test any ticks sent to this Activity for the presence or absence of spirochetes. [signature] DENNIS D. KUHR Entomologist Entomological Sciences Division REVIEWED BY: [signature] JACK H. CHANDLER Entomologist USAEHA-S Lyme Disease Program Manager APPROVED BY: [signature] MICHAEL R. COLLYER MAJ, MS Chief, Entomological Sciences Division APPENDIX A REFERENCES 1. 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. 2. Technical Information Memorandum (TIM) No. 26, March 1990, Lyme Disease-Vector Surveillance and Control. 3. Technical Guide (TG) No. 174, June 1991, Personal Protective Techniques Against Insects and Other Arthropods of Military Significance. 4. USAEHA, 8 October 1991, Standard Operating Procedure for Collection of Specimens at Deer Check Stations. 5. Technical Bulletin Medicine 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 DGSC Defense General Supply Center DIFA Direct Immunofluorescent Assay DSN Defense Switched Network ESD Entomological Sciences Division GTA General Training Aid LD Lyme disease NSN National Stock Number PIN personal identification number PVNTMED Svc Preventive Medicine Service RMSF Rocky Mountain spotted fever TG Technical Guide TIM Technical Information Memorandum USAEHA U.S. Army Environmental Hygiene Agency USAEHA-S U.S. Army Environmental Hygiene Activity-South VHS video home system APPENDIX D WHITE-TAILED DEER AND FERAL HOG SERA COLLECTED AT FORT STEWART, GEORGIA [data omitted by this typist - data summarized in above report] APPENDIX E DIFA ANALYSIS OF TICKS COLLECTED AT FORT STEWART, GEORGIA [data omitted by this typist - data summarized in above report] APPENDIX F 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 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 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-AW56-93 FORT STEWART, GEORGIA 31 OCTOBER - 19 DECEMBER 1992 1. REFERENCES. Memorandum, USAEHA-S, HSHB-AS-P, 29 March 1993, Lyme Disease Risk Assessment No. 16-62-AW56-93, Fort Stewart, Georgia, 31 October - 19 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 serum and parasitic ticks to provide a portion of the baseline data needed to develop a definitive Lyme Disease Risk Assessment for Fort Stewart. 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 D, serological results). 5. FINDINGS AND DISCUSSION. Four of the 51 serological tests were positive for the spirochete, Borrelia burgdorferi, which is the causal organism for Lyme disease. Forty-five of 52 serological tests were positive for the rickettsia, Ehrlichia chaffeensis, which is the causal organism for human ehrlichiosis. Fourteen of 51 serological tests were positive for the riskettsia, rickettsia rickettsii, the causal organism for Rocky Mountain spotted fever. 6. CONCLUSION. Since 7 percent of the deer tested were seropositive for exposure to Lyme disease, 87 percent were seropositive for exposure to human ehrlichiosis and 27 percent were seropositive 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] DENNIS D. KUHR Entomologist USAEHA-S Pest Management Program Manager APPROVED BY: [signature] MICHAEL R. COLLYER MAJ, MS Chief, Entomological Sciences Division APPENDIX D WHITE-TAILED DEER AND FERAL HOG SERA COLLECTED AT FORT STEWART, GEORGIA [Data omitted - data summarized in above report.]