Lyme Disease Profile, Fort Dix, NJ, 5-6 December 1988 DEPARTMENT OF THE ARMY U.S. Army Environmental Hygiene Activity - North Fort George G. Meade, Maryland 20755-5225 [Seal of Department of Defense, United States of America] REPLY TO ATTENTION OF: HSHB-AN-P (40) 09 MAY 1989 MEMORANDUM FOR Commander, U.S. Army Training and Doctrine Command, ATTN: ATMD, Fort Monroe, VA 23651-5451 Commander, U.S. Army Health Services Command, ATTN: HSCL-P, Fort Sam Houston, TX 78234-6000 SUBJECT: Lyme Disease Profile No. 16-61-0584-89, Fort Dix, NJ, 5-6 December 1988 1. REFERENCES. a. AR 40-5, Preventive Medicine, 30 August 1986. b. FONECON between Dr. Terry Schulze, New Jersey Department of Health, and Mr. Ben Pagac, this Activity, 19 April 1989, subject: Tick Infectivity Rates in New Jersey. 2. AUTHORITY. a. AEHA Form 250-R, TRADOC, 14 November 1988. b. USAEHA FY 89 mission services schedule as coordinated with U.S. Army Health Services Command, Project No. 16-61-0584-89. 3. PURPOSE. To assess the risk of Lyme disease to Fort Dix personnel by examining deer for the tick vector, Ixodes dammini and to assay ticks for the Lyme disease etiologic agent, Borrelia burgdorferi, IAW para 1-4.i.(1), AR 40-5. 4. GENERAL. a. Personnel Contacted. LTC Mary Vaeth, Chief, Preventive Medicine Service (PVNTMED Svc), Medical Department Activity (MEDDAC), Fort Dix and Mr. Roger Smith, Chief, Natural Resources Branch (NRB), Directorate of Engineering and Housing (DEH), Fort Dix, were briefed during the course of this survey. b. Survey Conduct. The survey was conducted by Mr. Benedict Pagac, Entomologist, U.S. Army Environmental Hygiene Activity - North (USAEHA-N), Fort Meade, MD, during the period of 5-6 December 1988. Assistance was provided by Mr. Roger Smith, Chief, NRB, DEH, Fort Dix; Mr. Roger Meyers, Wildlife Management Specialist, NRB, DEH, Fort Dix; and SP4 Heather Carrasco, PVNTMED Svc, MEDDAC, Fort Dix. 5. METHODS. a. Tick Collection. The heads, ears, and necks of 26 white-tailed deer (Odocoileus virginianus), shot by hunters, were examined immediately before or after the weighing and tagging process. The hair was stroked contrary to the natural lay, with the hand edge, and ticks were removed from the exposed skin using fine-point (# 5) jeweler's forceps. Examination time-per-carcass varied from three to ten minutes, with an average time of five minutes per deer. Collected ticks were placed in labeled, 20 ml humidified vials and kept cool (1.5 - 4.5 degrees C). Ticks were returned to this Activity for identification and testing. b. Tick testing. Ticks were assayed via Fluorescent Antibody (FA) testing to determine infection rates of the Lyme disease causing spirochete, B. burgdorferi. c. Blood Samples. Blood pooled within the body cavities of 22 shot deer was collected using clean plastic (4.0 ml) disposable pipettes. Blood samples were not taken from carcasses that had been rinsed with water or otherwise treated in a manner which might contaminate the sample. Samples were placed in 7.0 ml labeled tubes, spun, and sera were separated, placed in 1.5 ml micro centrifuge tubes, and frozen (-8.5 degrees C) until FA testing could be performed. 6. RESULTS. a. Laboratory Results. Tick collection and testing results are presented in enclosure. Serum test results are pending and will be reported at a later date. b. Deer Distribution. Of the 26 deer examined for ticks, 16 were shot off-post, 10 on-post. Off-post locations with corresponding number (#) of deer from that area included; Cookstown (6), Springfield (1), Chesterfield (2), Pemberton (1), New Jersey Deer Management Zone (NJDMZ) 52 (1), and NJDMZ 48 (5). On-post locations included; Fort Dix Deer Management Area (FDDMA)-2 (1), FDDMA-6B (2), FDDMA-13 (5), and FDDMA-16A (1). Of the 26 deer examined, 23 (88.5%) had I. dammini. Three of the 26 deer had ticks infected with B. burgdorferi. All three of the deer which yielded infected ticks were shot off-post; 1 near Chesterfield, 2 in NJDMZ-48 (near Juliustown). 7. DISCUSSION. a. Epidemiology. From late April 1988 to 31 March 1989, at least 17 human cases of Lyme disease were reported from Walson Army Hospital, Fort Dix. These cases included military and eligible civilian personnel. At least 5 of these Lyme disease patients lived on Fort Dix (3 in Garden Terrace, 2 in Grove Park), 2 were from McGuire Air Force Base, at least 4 came from nearby off-post communities (e.g., Browns Mills), and 3 from more distant locations (e.g., Philadelphia, northern New Jersey). This information, along with the survey results, suggests that not only areas within Fort Dix, but nearby communities as well, should be considered in any efforts to reduce the risk of Lyme disease (see para 9.). b. Tick Infectivity. On 25 November 1986, Schulze (reference 1.b.), using dark field microscopy, derived an infectivity rate of 42.1% from free ranging ticks (n=133) collected at Fort Dix. The 1.8% infectivity rate of ticks collected from deer during this survey would, in comparison, appear low. Whether this is due to natural fluctuations in spirochetal infection rates, seasonal trends, sampling method, or other factors, is yet to be determined. 8. CONCLUSIONS. Of 26 deer examined for Ixodes dammini, 23 (88.5%) harbored this species. Of 170 Ixodes dammini tested, 3 (1.8%) were positive using FA assay. Sampling done in 1986 showed a higher infectivity rate (42.1%). Continued surveillance and preventive measures are warranted at Fort Dix and surrounding areas. 9. RECOMMENDATIONS. a. Emphasize public awareness programs to educate troops, dependents, civilian employees, and visitors on personal protective measures and Lyme disease. Because it is impossible to perform a comprehensive treatment of any type that will eliminate Lyme disease, and because the threat of contracting the disease from off-post locations would still exist despite any vector control attempts performed on-post, public awareness is essential and will provide the best measure of protection (para 2-4., 2-5., 2-6., and 3-2., AR 420-76; para 10-7.b., AR 40-5). b. Report all confirmed and suspected cases (e.g., suspicious febrile illnesses, arthralgias, and Erythema Migrans) of Lyme disease by special telegraphic report to [RCS MED-16(R4)] for all soldiers and civilian beneficiaries (para 4., reference 1.c.). c. Identify high risk foci in cantonment areas via tick dragging and tick assay for B. burgdorferi. Surveillance would be appropriate at the west end of post, focusing on wooded margins near Garden Terrace. Dragging should be performed in spring or early summer when I. dammini nymphs (the life stage responsible for most human Lyme disease infections) are active. Post, and thereby identify, high risk areas [paras 2-4.f. and 2-6.a.(1), AR 420-76; para 10-7., AR 40-5]. d. 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 [para 2-4.f. and 3-2., AR 420-76; para 14-2.c., AR 40-5). e. Eliminate tick habitat in heavily used, infested areas (e.g., wood edges along recreation areas) by removing low brush and leaf litter. Tick infestations should be verified via tick flagging or dragging prior to habitat modification (paras 2-5.k. and 3-2.c., and 3-5., AR 420-76; para 10-7. and 14-3, AR 40-5). f. 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 (paras 3-2.c. and 4-1.a., AR 420-76). g. Submit collected tick specimens alive for identification and FA testing to USAEHA-N, ATTN: ESD, Fort Meade, MD 20755-5225 (para 10-7.f., AR 40-5). 10. TECHNICAL ASSISTANCE. Technical advice or consultation may be obtained from your Major Command Pest Management Consultant. Informal technical advice or consultation concerning the findings and recommendations of this report may be obtained by telephone from this Activity, Fort George G. Meade, MD 20755-5225 at AUTOVON 923-5281/6502. Questions regarding the use and disposition of pesticides that are unrelated to this report may be addressed to the USAEHA "Pesticide Hotline" at AUTOVON 584-3773. Requests for service should be sent through appropriate command channels of the requesting activity to the Commander U.S. Army Environmental Hygiene Agency, ATTN: HSHB-MR-E, Aberdeen Proving Ground, MD 21010-5422, with an information copy furnished to the Commander, U.S. Army Health Services Command, ATTN: HSCL-P, Fort Sam Houston, TX 78234-6000. [signature] JAMES R. WILES LTC, MS Commanding Encl LYME DISEASE/TICK SURVEY RESULTS FORT DIX, NEW JERSEY 5 DECEMBER 1988 NUMBER (PERCENT) --------------------------------------------------------------------------- Deer examined: 26 Deer having ticks: 26 (100) Deer having Ixodes dammini: 23 (88.5) Ixodes dammini collected: 343 Female Ixodes dammini tested: 50 Male Ixodes dammini tested: 120 Total Ixodes dammini tested: 170 Ixodes dammini positive: 3* (1.8) Deer having Dermacentor albipictus: 17 (65.4) Dermacentor albipictus collected: 81 Dermacentor albipictus tested: 4 Dermacentor albipictus positive: 0 (00.0) Deer having both Ixodes dammini and Dermacentor albipictus: 14 (53.8) --------------------------------------------------------------------------- * all partially engorged females --------------------------------------------------------------------------- Collection Site: Fort Dix Deer Checking Station Collector: Benedict B. Pagac, Jr. Deer sex/age: All males, at least 1.5 years old ---------------------------------------------------------------------------