LYME DISEASE RISK ASSESSMENT, FORT MCCLELLAN, ALABAMA, 28 NOV-1 DEC 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. 16-62-0508-92 FORT MCCLELLAN, ALABAMA 28 NOVEMBER - 1 DECEMBER 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, 7 August 1991. 3. PURPOSE. Lyme disease is one of several severe tick-borne diseases which pose health threats at military installations. These diseases can reduce the efficiency of affected military personnel and diminish the overall quality of life at installations. The purpose of this risk assessment was 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 McClellan. 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. Data collection for this risk assessment was conducted by Mr. Dennis D. Kuhr, Survey Officer, Entomologist, Entomological Sciences Division (ESD), U.S. Army Environmental Hygiene Activity-South (USAEHA-S). The survey officer was assisted by staff from the installation U.S. Army Medical Department Activity (MEDDAC), Preventive Medicine Service (PVNTMED Svc), Veterinary Service and the Directorate of Engineering and Housing (DEH) Wildlife Biologist. c. Personnel Contacted. A list of the personnel contacted is in Appendix B. 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 stations. Work was performed at the Main Post deer check station (Builing 698) on 28 and 29 November and at the deer check station at Pelham Range on 30 November and 1 December. 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 for analysis. (2) Tick Collection. The ears, nape and other regions were examined for the presence of ticks. Only 6 ticks were collected from 5 of the 133 deer examined. The ticks were transported to Fort McPherson and processed by direct immunofluorescent assay using antibody conjugate from Kirkegaard and Perry Laboratories, Inc. 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 113 serum samples were obtained from white-tailed deer. Because of contamination, 130 sera were tested for Borrelia burgdorferi, the causative agent for Lyme disease. All of the test results were negative. b. Tick Processing. Ticks were collected from less than 5 percent of the deer examined at the hunter check-in stations. The species collected, their life stages and the laboratory results for spirochetes are shown on Appendix C. None of the 5 ticks tested positive for either the spirochete, Borrelia burgdorferi or a spirochete species similar to burgdorferi. 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 Lyme disease of the northeast is the same as that in the more southern regions. c. Tick-borne Disease Incidence in Alabama. According to the "Morbidity and Mortality Weekly Report" (3 Jan 92/Vol.40/Nos. 51 & 52), published by the Centers for Disease Control, there were 18 reported cases of Lyme disease and 16 reported cases of Rocky Mountain spotted fever in Alabama during the 1991 calendar year. The Alabama Department of Public Health stated that one case of Lyme disease and two cases of Rocky Mountain spotted fever were reported in 1991 from the county (Calhoun) in which Fort McClellan is located. 6. RECOMMENDATIONS. Recommendations are made from the general findings of this survey to ensure good PVNTMED practices which will reduce Lyme and other tick-borne disease risks to military and civilian personnel at Fort McClellan. General Lyme disease reduction measures can be found at Appendix D. a. Fort McClellan - TRADOC. (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 E). It is recommended 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 which occur on the installation. (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 where applicable as good forestry and wildlife pracitces. Care must be exercised not to threaten habitats used by endangered or threatened species if they exist on the installation. (3) Follow the 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. Effectively managing the deer population will reduce the associated tick population. b. PVNTMED Svc, Fort McClellan - HSC. (1) 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) and TG 174, "Personal Protective Techniques Against Insects and Other Arthropods of Military Significance" by activities to educate their personnel. This education about Lyme disease, other tick-borne diseases, and tick prevention/control should be provided to soldiers (especially field sanitation teams), DEH, Range Control, Recreation Services, and other personnel who may work in tick habitats. Additional information about performing Lyme disease risk assessments is available in the Armed Forces Pest Management Board Technical Information Memorandum No. 26, "Lyme Disease - Vector Surveillance and Control." The survey officer provided copies of this TIM to the MEDDAC and DEH personnel. A "Fact Sheet, Protection from Ticks and Lyme Disease" is provided at Appendix F. (2) Conduct annual summer tick surveys by using dry ice traps, tick drags, and sampling mammal populations. 7. TECHNICAL ASSISTANCE. Support to assist the installation in conducting additional Lyme disease risk assessments and tick surveys can be requested from the USAEHA-S by submitting an AEHA Form 250-R. The survey officer provided an AEHA Directory of Services, USAEHA Pam 40-2, with these forms to the installation PVNTMED Svc, Veterinary and DEH personnel. The USAEHA-S will continue to identify and test any ticks sent to this Activity for the presence or absence of spirochetes. [signature of Kelley M. Loftier] for DENNIS D. KUHR Entomologist 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 DEH Directorate of Enginnering and Housing DGSC Defense General Supply Center DSN Defense Switched Network ESD Entomological Sciences Division MEDDAC U.S. Army Medical Department Activity PVNTMED Svc Preventive Medicine Service TG Technical Guide TIM Technical Information Memorandum USAEHA-S U.S. Army Environmental Hygiene Activity-South APPENDIX B PERSONNEL CONTACTED Maj Jeffery Record, Chief, Veterinary Services, MEDDAC.* CPT Heidi McNeil, Environmental Science Officer, PVNTMED SVC, MEDDAC. SFC Jose Rodriquez, NCOIC, Food Inspector, Veterinary Services, MEDDAC.* PFC Corey Murphy, on Medical Hold, Attached to the Veterinary Services, MEDDAC.* PFC Cathy Boggs, Food Inspector, Veterinary Services, MEDDAC.* SPC Jeffrey Lauer, Food Inspector, Veterinary Services, MEDDAC.* SGT Anthony Watson, Animal Care Specialist, Veterinary Services, MEDDAC.* SGT Miguel Caceres, Food Inspector, Veterinary Services, MEDDAC.* SSG Nancy Williams, Food Inspector, Veterinary Services, MEDDAC.* CPT James Sheets, Veterinarian, Veterinary Services, MEDDAC.* SPC William Johnson, PVNTMED Specialist, PVNTMED Svc, MEDDAC.* SPC Robert McNeil, PVNTMED Specialist, PVNTMED Svc, MEDDAC.* SSG Hyacinth James, PVNTMED Specialist, PVNTMED Svc, MEDDAC.* Dr. Charles Woernle, Alabama Department of Public Health. ------- * Indicates individuals who assisted the survey officer at the deer check stations. APPENDIX C DIRECT IMMUNOFLUORESCENT ASSAY ANALYSIS OF TICKS COLLECTED USAEHA-S HUNTING SPECIES LIFE STAGE SEX SEROLOGICAL SAMPLE NO. AREA NO. OF TICK L,N, or A (QTY) RESULTS *************************************************************************** 70 15C A. americanum * A Male(1) negative 71 17C A. americanum A Male(2) negative 108 14C A. americanum A Male(1) negative 146 2A A. maculatum A Female(1) negative 154 2A A. maculatum** A Female(1) negative ------------ * Amblyomma americanum (Linnaeus), lone star tick. ** Amblyomma maculatum (Koch), Gulf coast tick. APPENDIX D 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 E 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 F 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