LYME DISEASE RISK ASSESSMENT, CAMP FRANK D. MERRILL, DAHLONEGA, GEORGIA, 13-17 SEPTEMBER 1993 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-AW52-93 CAMP FRANK D. MERRILL DAHLONEGA, GEORGIA 13-17 SEPTEMBER 1993 1. REFERENCES. a. Army Regulation (AR) 40-5, 15 October 1990, Preventive Medicine. b. AR 420-76, 3 June 1986, Pest Management. c. Technical Bulletin Medicine (TB MED) 561, June 1992, Occupational and Environmental Health Pest Surveillance. 2. AUTHORITY. Memorandum, USAEHA, HSHB-M, 21 September 1993, subject: U.S. Army Environmental Hygiene Agency Scheduling 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, 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 parasitic ticks to provide a portion of the baseline data needed to develop a definitive Lyme Disease Risk Assessment for Camp Frank D. Merrill. The completed assessment can be used by field commanders to minimize risks of Lyme disease to military and civilian personnel. See Appendix A for other assistance that the U.S. Army Environmental Hygiene Activity-South (USAEHA-S) can provide. 4. GENERAL. a. Installation Description. Camp Frank D. Merrill is a satellite installation of Fort Benning, Georgia and serves as the Headquarters for the 5th Ranger Training Battalion. The installation is located within the boundaries of the Chattachoochee National Forest about 8.5 miles North and West of Dahlonega, Georgia. Elevations range from about 550 feet above mean sea level in the cantonment to well over 1000 feet. Steep gradient ravines drain run-off water to the Etowah River, West Fork of Montgomery Creek and Ward Creek. Hardrock substrate is overlain by soils heavy with clay. Mixed hardwood and conifers form a dense canopy over much of the installation. Understory on the uplands is rather sparse. b. Abbreviations and Terms. A listing of abbreviations and terms is included in Appendix B. c. Survey Personnel. This Lyme Disease Risk Assessemnt was conducted by Mr. Jack H. Chandler, Entomologist, Entomological Sciences Division (ESD), USAEHA-S. d. Personnel Contacted. A list of the personnel contacted is in Appendix C. 5. FINDINGS AND DISCUSSION. a. Small Mammal Trapping. Sherman, collapsible traps were used to live-trap small mammals at various sites on the installation. Ten traps were operated for two nights at each of ten sites. Captured mammals were examined for ticks and immediately released unharmed at the site of capture. Trap sites are described in Appendix D. A single female, white-footed mouse (Peromyscus leucopus) was removed on 15 September from traps at sites 2 and 3. No ticks were collected from either specimen. Both were released unharmed. A short-tailed shrew (Blarina brevicauda) was captured at site 9, near the sewage spray field. The specimen was dead and did not have any attached ticks. It was buried at the site. b. Dry Ice Trapping. Ticks are attracted to the carbon dioxide gas released from dry ice. Blocks of dry ice were placed in the center of white cloth which had been staked to the ground. These were allowed to remain in place for about 5 hours before both sides of the cloth were examined for ticks. No ticks were collected by this method at any of the sites described at Appendix E. c. Tick Dragging/Flagging. A conventional tick drag and flag was used to sample in the vicinity of all of the dry ice traps and small mammal trap sites. Numerous other habitats were sampled. No ticks were captured using either of these methods. However, two adult female American dog ticks (Dermacentor variabilis) were removed from the survey officer while flagging for ticks west of site 2 (on the East side of site of the Etowah River). The midgut contents of both ticks were prepared for direct immunofluorescent assay (DIFA) with Kirkegaard and Perry's Affinity Purified Antibody To Borrelia species (Catalog No. 02-97-92) to determine if they were infected with spirochetes similar to those responsible for Lyme disease. A minimum of 50 fluorescing spirochetes similar to the Lyme disease spirochete (Borrelia burgdorferi) were observed per field at high power (400X) with each of the specimens. The American dog tick has not been implicated in the spread of Lyme disease and the presence of large numbers of spirochetes in the mid-gut region of the ticks does not imply that this species is capable of transmitting these organisms to man. However, this tick is the most important vector of the causal organism of Rocky Mountain spotted fever in the United States. d. Other Methods. A female Eastern box turtle (Terrapene carolina) was captured by hand at sites 2 and 10. No ticks were observed on any of the specimens. A juvenile skink (Eumeces sp., probably fasciatus) was captured at site 5. No ticks were observed on this specimen. An adult black rat snake (Elaphe obsoleta) captured and released near Camp Washega did not have any nymphal or adult ticks on its body. e. No tick or other medically important surveillance has been conducted at Camp Merrill within the last five years. Consistent surveillance over several years will provide historic data necessary to identify high-risk areas on installation maps. These data can prove invaluable for contingency planning and for pest management activities designed to mitigate arthropod related health risks to personnel. This data should be included in the pest management plan for Fort Benning. 6. CONCLUSIONS. Personnel contacted were not aware of any tick infestation problems or cases of Lyme or other tick-borne human diseases at Camp Merrill. Extensive sampling during this survey substantiated the general lack of ticks during the present season. However, efficient vectors are common in the region and the potential for contracting Lyme disease, Rocky Mountain spotted fever or human Ehrlichiosis exists to anyone training or recreating in the field. Proper use of personal protective measures, including the use of repellents will serve to minimize exposure to ticks and the diseases they tranmit and to repel mosquitos and other biting arthropods. 7. RECOMMENDATIONS. Where possible, recommendations are keyed to specific report findings. The paragraph number of the associated finding is listed in brackets at the beginning of each recommendation. Recommendations identified with an asterisk (*) are not keyed to specific report findings, but were made to further reduce tick-borne and other arthropod-associated risks to civilian and military personnel at Camp Merrill. a. 5th Ranger Battalion, Camp Frank D. Merrill, Dahlonega, Georgia. (1) *Train personnel in the proper personal protective techniques, including proper removal of attached ticks. The tick-borne disease threat to installation personnel can be minimized with the proper wearing of clothing and the use of repellents (see Appendix F). (2) *Implement a comprehensive tick-borne disease risk reduction program at Camp Frank D. Merrill if surveillance indicates a large tick population; information is contained at Appendix G to assist you. b. Preventive Medicine Service (PVNTMED Svc), U.S. Army Medical Department Activity, Fort Benning - Health Services Command. (1) [5e] Initiate surveillance for ticks and other medically important arthropods at Camp Merrill. Detailed guidance for conducting surveillance can be found in TB MED 561. Additional guidance can be obtained by contacting representatives of the USAEHA-S, ESD at DSN 572-2564 or 572-2578 [AR 420-76, para 2-6 (1 & 3); AR 40-5, para 2-2i]. (2) *Send ticks and other specimens to USAEHA-S for identification and testing for the presence of causative organism of Lyme disease. (3) [5e] Furnish the Entomology Shop supervisor with records of all pest management operations, including surveillance conducted by PVNTMED Svc at Camp Merrill. Alert commanders at Camp Merrill when populations of ticks or other pests are identified [AR 420-76, para 2-6 (1 & 3); AR 40-5, para 2-2i]. 8. TECHNICAL ASSISTANCE. A fact sheet "Ticks and Tick-borne Diseases" is provided at Appendix H. [signature] JACK H. CHANDLER, JR. Entomologist Entomological Sciences Division APPROVED: [signature] MICHAEL R. COLLYER MAJ, MS Chief, Entomological Sciences Division APPENDIX A TECHNICAL ASSISTANCE Technical advice or consultation on pest management problems, to include on-site assistance, may be obtained by telephoning our Activity, DSN 572-2564. Please inform you Major Command Consultant if you desire to request on-site assistance from our Activity. 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. Waste water 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 waste water 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. 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 normal workday. 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 B ABBREVIATIONS AND TERMS AR Army Regulation Bldg Building DGSC Defense General Supply Center DIFA Direct Immunofluorescent Assay DSN Defense Switched Network ESD Entomological Sciences Division IDAA Individual Dynamic Absorption Application LD Lyme disease PVNTMED Svc Preventive Medicine Service TB MED Technical Bulletin Medical USAEHA U.S. Army Environmental Hygiene Activity USAEHA-S U.S. Army Environmental Hygiene Activity-South APPENDIX C PERSONNEL CONTACTED Mr. Douglas Cook, Construction Maintenance Foreman, Camp F. D. Merrill, Directorate of Public Works, COM (706) 864-3367, Ext 186. SFC Clayton F. Sayles, Operations SGT, HQ 5th Training Battalion, Bldg 12, Camp F. D. Merrill, DSN 797-5770, Ext 122. CPT Kemp, Operations Officer, HQ 5th Training Battalion, Bldg 12, Camp F. D. Merrill, DSN 797-5770, Ext 184. SFC Wilburn, HQ 5th Training Battalion, Bldg 12, Camp F. D. Merrill, DSN 797-5770, Ext 161. APPENDIX D SHERMAN SMALL-MAMMAL TRAP SITES SITE NO.: LOCATION(No. Traps): DESCRIPTION: 1 North Bldg 3 (10) Site identical to Dry Ice Site 1a&b, on East side road, alongside stream. 2 North Bldg 3 (10) Site identical to Dry Ice Site 1c&d, on West side of road. 3 North sites 1&2 (10) Bivouac-like ravine, on South side road, within timber. 4 North of cantonment About 2 miles along road, in on Conner's Gap Road. timber. (10) 5 North of cantonment About 1 mile from cantonment on Conner's Gap Road. entrance to road, in timber. (10) 6 South & West of Bldg Timber, base of hill near SP 42. F. 7 West food plot In timber, alongside fallen logs. 8 Near SP G, near food In blackberry bushes. plot. 9 South Bldg 42 On West Side of Sewage Spray Field, in timber. 10 South of Airfield Base of timbered bluff. APPENDIX E DRY ICE TRAP SAMPLING SITES SITE NO.: LOCATION/BLDING NO. DESCRIPTION OF SITE: (Number of traps) 1a North of Bldg 3 (1) Open area West of road. 1b,c North of Bldg 3 (2) Edge of timber, East of road. 2a,b North of Bldg 3 (2) North of Site 1, junction of road and small stream. On East side of road, within timber, near stream. 2c,d North of Bldg 3 (2) Same location only West of road, along stream in low area. 3a,b South Airfield (2) South side of road, west of stream, within timber. 3c,d South Airfield (2) Southern margin of airfield, in timber. 4a Near food plot (1) Blackberry thicket north of food plot, West of airfield. 4b,c Within food plot(2) East margin of food plot, within timber. APPENDIX F 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 battle dress uniform. Treatment lasts for repeated (30 or more) washings. 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 TG 174, Personal Protective Techniques Against Insects and Other Arthropods of Military Significance. An informative VHS 0.5-inch audio-visual tape about repellent application entitled "Application of the Arthropod Repellent System" (PIN 708575) and (TVT 8-232) is also available from the supporting TSC. 3. Do not use tick or flea collars. A toxic reaction can result. Humans have sweat glands in their skin that serve as an avenue for chemical absorption. Dogs on the other hand, respire by panting, lacking sweat glands, In addition, pets have a thicker hair barrier than most humans to protect then from direct contact with the collars. 4. The following practices enhance the effectiveness of protection when used in conjunction with repellents: - Cover as much exposed skin as possible. Consider loose fitting long- sleeved shirts in summer. - Tuck pants inside socks or boots to keep out ticks. - Wear light-colored clothing to make ticks easier to see. - Plan ahead and treat clothing with permethrin before your outdoor activity begins. Permethrin binds with fabric and is persistent through several washings. - Store treated clothing in a plastic bag to help preserve repellent effectiveness and identify treated clothing. 5. The U.S. Army Medical Department Tick-Borne Disease Card (7189) is available from the USAEHA-S, ESD. APPENDIX G 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 Support Center (TSC). General Training Aid 8-5-56, Tick-Borne Diseases makes an excellent handout. Additional cards are available from USAEHA-S. An informative VHS 0.5-inch audio-visual tape about repellent application entitled "Application of the Arthropod Repellent System" (PIN 708575) and (TVT 8-232) is also available from the supporting TSC. 2. Submit any collected tick specimens (both field collected or ticks that have been removed from individuals) alive for identification and DIFA 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 Lyme disease 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 APPENDIX H JUST THE FACTS U.S. Army Environmental Hygiene Agency Just the Facts - Ticks and Tick-borne Diseases 16-001-0593 * Identification * Geographic Location * Tick-borne Disease * Care of Tick Bites The following information will help you avoid tick-related problems as you live, train, work, or play in or around the grassy or wooded habitats where ticks are found. IDENTIFICATION Unlike insects, adult ticks have eight legs, relating them more closely with spiders and scorpions. The tick's body is also fused into a single region instead of having the head, thoracic, and abdominal regions typical of insects. There are two distinguishable families of ticks: (1) the hard ticks, which have hard smooth skin and an apparent head; and (2) the soft ticks with tough, leathery, pitted skin and no distinct head. The hard ticks are the ticks we most commonly find in the woodlands and on our pets. Soft ticks are generally less often observed and are found in caves and on birds. It is the hard ticks we associate with most of our common tick-borne diseases in the United States. For assistance in identifying ticks contact the local personnel in the pest control shop, Preventive Medicine Service, Health Clinic, or the Entomological Sciences Division, U.S. Army Environmental Hygiene Activity- South. GEOGRAPHIC LOCATION Keep in mind that not all ticks carry a tick-borne disease, so a tick bite does not necessarily mean that disease will follow. However, there are several ticks that are potential vectors of tick-borne diseases. In the Northeast and Midwest is the deer tick (Ixodes dammini), reported to be the same species as the black-legged tick (Ixodes scapularis); the western black-legged tick (Ixodes pacificus) and the Rocky Mountain wood tick (Dermacentor andersoni) in the West; the black-legged tick in the South; and the American dog tick (Dermacentor variabilis) and Lone Star tick (Amblyomma americanum), which are found throughout much of the United States. LYME DISEASE The causative agent of Lyme disease is the spirochete bacteria Borrelia burgdorferi. Frequency Lyme disease has become the most common tick-borne disease in the United States. Cases have been report in 48 states, with the greatest number of cases occuring every year in the northeastern states of Connecticut, Rhode Island, Massachusetts, New York, and New Jersey; in the upper midwest states of Wisconsin and Minnesota; and in the western states of California and Oregon. The disease is spreading rapidly, however, with an increasing number of diagnosed cases in the southeastern and southern states. Symptoms The most apparent and common symptom of Lyme disease, occuring in 50 to 65 percent of the cases, is a rash around the site of the tick bite. The rash appears within 3 days to 3 weeks after the bite and expands in a ring or bull's eye pattern, with the center area clear. Other complaints include flu-like symptoms, such as fever, chills, headache, and extreme fatigue. Although Lyme disease rarely causes death, the disease can cause a great deal of pain and discomfort if allowed to progress to later stages. If you have been in an area where ticks are found and you develop any of the symptoms mentioned above, especially during the period from May through early Fall, see a physician for evaluation immediately. ROCKY MOUNTAIN SPOTTED FEVER The causative agent of Rocky Mountain spotted fever (RMSF) is the rickettsial organism, Rickettsia rickettsii. Frequency RMSF was originally found in the Rocky Mountains, but is now much more abundant in the Southeast and South-central United States. Oklahoma, North and South Carolina, Virginia, West Virginia, Georgia, and Tennessee often lead the nation in the number of reported cases of this disease. Symptoms Usually the first symptoms of RMSF appear 3 to 14 days after the tick bite and include sudden fever, chills, muscle aches, bloodshot eyes, and headaches. There may also be nervous symptoms, such as sleeplessness, restlessnes, and delirium. In about 50 percent of the patients, a characteristic spotty rash occurs on the feet and hands within 2 to 3 days of the fever. The rash may move to the rest of the body, but does not start on the trunk of the body like the rashes caused by measles and some other disease. Although this disease can be effectively controlled with antibiotics following prompt treatment, fatalities do occur. HUMAN EHRLICHIOSIS Human ehrlichiosis is caused by the rickettsial organism Ehrlichia chaffeensis. Frequency Human ehrlichiosis was first reported from Arkansas in 1986. It has been found in at least 11 other southern states. Symptoms Symptoms of Human ehrlichiosis can be very mild to severe, requiring hospitalization, and include fever, chills, headache, aches and pains in the joints and muscles, loss of appetite, eye pain, nausea, and vomiting. There is usually no rash. PREVENTION Wear clothing properly. To greatly reduce your chance of tick bite, follow the DOD Repellent System of wearing proper clothing. 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. In addition, when in the field, "buddy up" and routinely check for ticks every few hours or as frequently as possible. After returning, remove your clothing and check your body carefully. Pay special attention to hairy or warm, moist parts of the body. Use repellants. The DOD Repellent System also recommends applying deet repellent, NSN 6840- 01-284-3982, to any exposed skin surfaces, and permethrin repellent spray, NSN 6840-01-278-1336, to your uniform or field clothing. NEVER USE PERMETHRIN ON YOUR SKIN. The permethrin repellent is best applied to clothing prior to wearing. Allow the repellent to dry before using the treated clothing. ONCE BITTEN If you find a tick embedded in your skin, do not squash or burn it. 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. Because the tick's central mouthpart is long and covered with barbs, it can be difficult to remove. Be patient. The prompt and careful removal of attached ticks greatly lessens the possibility of obtaining a tick-borne disease. Wash the bite site and apply an antiseptic. Save the tick in alcohol or freeze it in a pill vial or plastic bag in case symptoms appear and identification of the tick becomes necessary. If symptoms do appear, seek medical attention immediately. --------------------------------------- Entomological Sciences Division U.S. Army Environmental Hygiene Activity-South, Ft. McPherson, GA 30330-5000 DSN 572-2564 or Commercial 404-752-2564 Nationally Recognized as the Center of Matrixed Occupational and Environmental Health Excellence AEHA From 326, 1 Dec 92 (HSHB-CS)