LYME DISEASE RISK ASSESSMENT, MARINE CORPS LOGISTICS BASE, ALBANY, GEORGIA, 27 NOVEMBER 1991 - 30 JANUARY 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-AK99-92 MARINE CORPS LOGISTICS BASE ALBANY, GEORGIA 27 NOVEMBER 1991 - 30 JANUARY 1992 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, 15 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 the Marine Corps Logistics Base (MCLB). When completed this 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 Mr. Jack H. Chandler, Survey Officer, Entomologist, Entomological Sciences Division (ESD), U.S. Army Environmental Hygiene Activity-South (USAEHA-S). GYSGT A.J. Christ, Game Warden, MCLB, collected the deer blood and parasites. c. Personnel Contacted. (1) GYSGT A. J. Christ, Game Warden, MCLB, DSN 567-5188. (2) CPT Susan Connelly, Veterinarian, Robbins AFB, DSN 468-6116. (3) Mr. Al Hargrove, Environmental Engineer, MCLB, DSN 567-5637. (4) SGT Manor Joseph, Game Warden, MCLB, DSN 567-5188. 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. 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 refrigerated and transported 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. Ticks and other parasites 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 two serum samples were obtained from white-tailed deer. These samples, labeled as A-30-01-92-1 and A-30-01-92-2, were sent to the Regional Veterinary Laboratory for analysis. The results of these analyses will be furnished in the format presented at Appendix C, under separate cover to MCLB personnel as soon as they are received by USAEHA-S. b. Tick Processing. One engorged, female black-legged tick (Ixodes scapularis) was collected from deer number A-30-01-92-1. It tested positive for either the spirochete, Borrelia burgdorferi or a spirochete species similar to burgdorferi. The species of Borrelia inhabiting ticks in the southern 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 presence of only one tick which tests positive should not be regarded as indicative of high risks for Lyme disease on the installation. c. Georgia Department of Health. No cases of Lyme disease were reported to the Centers for Disease Control in 1991 for Daugherty County, in which the MCLB is located. However, one case of Rocky Mountain spotted fever, another tick-borne disease was reported from the county. d. Additional Observation. Six deer keds, Lipotena sp. a wingless, parasitic fly were collected from the deer. These were also processed by the DIFA procedure used for the tick. Two keds contained spirochetes which were morphologically dissimilar to burgdorferi. This is the first installation in USAEHA-S's region in which spirochetes have been observed in keds. 6. RECOMMENDATIONS. Recommendations are not keyed to specific report findings. They are made to reduce Lyme and other tick-borne disease risks to military, civilian personnel at the MCLB. a. Based on the absence of reported cases of Lyme disease and the single case of Rocky Mountain spotted fever, the risks to installation personnel appears to be minimal. However, the reservoirs for these disease organisms exist in the area and the tick vectors are present and the incidence of tick-borne diseases will undoubtedly increase. Risks of contracting these diseases can be minimized through the proper wearing of clothing, avoiding areas known to harbor high tick populations and the use of repellents (see Appendix B). General Lyme disease reduction measures can be found at Appendix C. b. 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. 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] 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 MCLB Marine Corps Logistics Base TG Technical Guide TIM Technical Information Memorandum USAEHA-S U.S. Army Environmental Hygiene Activity-South APPENDIX B 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 C Lyme Disease Risk Reduction Measures 1. Emphasize public awareness programs to educate troops, dependents, civilian employees and visitors on personal protective measures and Lyme disease. Methods should include, but are not limited to: a. distribution of printed Lyme disease handouts, such as tick identification cards (USAMD-7/89), pamphlets, and fact sheets. b. notifications in the installation newsletter and post electronic media (e.g., closed-circuit TV), especially prior to the high-risk months (May-September). c. making available, for viewing, the video and 35mm slide format presentations on Lyme disease that have been previously provided by this Activity. 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-North, Fort George G. Meade, MD, 20755-5225. 3. Stock Permethrin Arthropod Repellent (NSN 6840-01-278-1336, box of 12 cans for $36.99), and 3M [Trademark] Insect Repellent (NSN 6840-01-284- 3982, box of 12 tubes, $29.30) for distribution. Emphasize tick habitat avoidance and the proper wearing of clothing and use of repellents. 4. Report all confirmed and suspected cases of Lyme disease [e.g., suspicious febrile illnesses, arthralgias, rashes, (Erythema Migrans)] by special telegraphic report [MED-16(R4)] for all soldiers and civilian beneficiaries. 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 I. dammini nymphs (the life stage responsible for most human Lyme disease infections) 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. Case by case surveillance is necessary due to the patchy distribution of I. dammini. 7. Eliminate tick habitat in heavily used, infested areas (e.g., wooded recreation areas) by removing low brush and leaf litter. Tick infestations should be verified via tick flagging or dragging prior to habitat modification. Clearing should be done in low risk months (i.e., January and February). 8. Prepare, as a contingency, to treat high-use areas with pesticides to decrease tick numbers if surveillance reveals high tick numbers and if nonchemical control techniques (e.g., brush removal, mowing, raking) do not provide adequate control. --- [Trademark] 3M is a registered trademark of Minnesota Mining and Manufacturing Co., St. Paul, MN 55133-3053. Use of trademarked name does not imply endorsement by the U.S. Army but is intended to assist in identification of a specific product. 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-AK99-92 MARINE CORPS LOGISTICS BASE ALBANY, GEORGIA 27 NOVEMBER 1991 - 30 JANUARY 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 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, 23 March 1992, subject: Lyme Disease Risk Assessment No. 16-62-AK99-92. 2. AUTHORITY. The scheduling of this assessment was based on AEHA Form 250, Request for USAEHA Field Services, 15 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 Marine Corps Logistics Base, Albany, Georgia. 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 tick tested positive for the Lyme spirochetes 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 Georgia. 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 MARINE CORPS LOGISTICS BASE, ALBANY, GEORGIA SAMPLE USAEHA-SOUTH TESTED FOR NUMBER SAMPLE NO.: LYME AT 1:280 TITER ------------------------------------ 1 A-30-01-92-1 Negative ------------------------------------ 2 A-30-01-92-2 Negative ------------------------------------