Lyme Disease Risk Assessment No. 16-61-AW48-93, Picatinny Arsenal, New Jersey, 26 September 1992 - 16 January 1993 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 (40-5f) 13 AUG 1993 MEMORANDUM FOR Commander, U.S. Army Material Command, ATTN: AMXEN-U, Rock Island, IL 61299-7190 SUBJECT: Lyme Disease Risk Assessment No. 16-61-AW48-93, Picatinny Arsenal, New Jersey, 26 September 1992 - 16 January 1993 1. Two copies of the subject report are enclosed; a brief summary is provided below. Please call me at DSN 923-6200/7403 or commercial (301)677-6200/7403 if this report does not meet your needs or if you require additional information on this risk assessment or support in the areas of occupational and environmental health. 2. The Lyme disease vector, Ixodes scapularis (formerly named Ixodes dammini), was present on 51 of the 94 deer examined at Picatinny Arsenal in Morris County. Forty-three of the 338 (12%) I. scapularis tested positive for Borrelia spp.; nineteen (44%) were confirmed to carry Borrelia burgdorferi, the Lyme disease causative agent. Lyme disease antibodies were detected in 24 (26%) of the 93 deer serum samples tested. This survey, combined with the information from the New Jersey State Department for Health Service, indicates that the present risk of contracting Lyme disease at Picatinny Arsenal is HIGH. Implementation of personal protective measures for all military, civilians, and family members using Picatinny Arsenal for outdoor training or recreation is strongly recommended. [signed by] KOTU K. PHULL LTC, MS Commanding ----- 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 (40-5f) 13 AUG 1993 LYME DISEASE RISK ASSESSMENT NO. 16-61-AW48-93 PICATINNY ARSENAL, NEW JERSEY 26 SEPTEMBER 1992 - 16 JANUARY 1993 1. REFERENCES. a. AR 40-5. Preventive Medicine, 15 October 1990. b. Armed Forces Pest Management Board Technical Information Memorandum No. 26, Lyme Disease: Vector Surveillance and Control, March 1990. c. Lyme Disease Surveillance Summary, Vol. 3, No. 3, Centers for Disease Control and Prevention, September 1992. d. J. H. Oliver, Jr., et al. 1993. Conspecificity of Ticks Ixodes scapularis and Ixodes dammini (Acari: Ixodidae). J. Med Ent., 30(1), 54-63. 2. AUTHORITY. AEHA Form 250-R, HSC, 7 July 1992. 3. PURPOSE. To assess the risk of Lyme disease to Picatinny Arsenal personnel by examining deer for the tick vector, Ixodes scapularis (formerly Ixodes dammini) and to assay ticks and deer blood for the Lyme disease etiologic agent, Borrelia burgdorferi, in accordance with AR 40- 5, paragraph 10-7.f. 4. GENERAL. a. Risk Definition. The term "risk," as used in this report, is a non-statistical evaluation of qualitative and quantitative information available to determine the potential to acquire Lyme disease. To the extent available, information evaluated includes the following elements: history of Lyme disease in the area, the presence or absence of the tick vector (I. scapularis) and the mammalian host population needed to sustain a viable population of the vector, the presence of the Lyme disease-causing spirochete (B. burgdorferi) in the tick population, and the presence of antibodies to B. burgdorferi in the mammalian host population. Criteria for risk categorization follow: Low - Some elements of the Lyme disease cycle identified in nearby areas, but not on the installation Moderate - Some elements of Lyme disease cycle identified from the installation or human cases of Lyme disease reported from the local area High - All elements of the Lyme disease cycle present on the installation b. Personnel Contacted. The purpose and methodology of this assessment was discussed with Mr. Jonathan Van De Venter, Natural Resources Manager, Directorate of Engineering and Housing (DEH), Picatinny Arsenal. Ms. Shirley Payton, Division of Infectious Disease, New Jersey Department of Health (NJDH), was contacted for epidemiological data concerning human Lyme disease cases in New Jersey. c. Survey Conduct. Samples were collected by Mr. Van De Venter at deer checks between September 1992 and January 1993. Ticks were identified and assayed via Direct Fluorescent Antibody (DFA) tests by personnel of this Activity. Serum samples were assayed via Indirect Fluorescent Antibody (IFA) tests by personnel of the U.S. Army Regional Veterinary Laboratory, Fort George G. Meade, Maryland for the presence of Lyme disease antibodies. d. Technical Assistance. Technical assistance or further informal advice may be obtained by contacting Chief, Entomological Sciences Division, this Activty, commercial (301)677-5281/6502 or DSN 923- 5281/6502. 5. BACKGROUND. a. Lyme disease is a multi-systemic infectious disease caused by the spirochete, B. burgdorferi, which is transmitted to humans by the bite of an infected tick. The disease is most often referred to as Lyme disease or Lyme arthritis in the United States. Lyme disease has become the most prevalent arthropod-borne illness in North America. Its geographic range is expanding and the number of reported cases continues to rise each year. The Office of the Surgeon General reported 379 cases of Lyme disease contracted on Department of Defense (DOD) installations from 1987 through 1991. During 1990, there were 78 cases of Lyme disease treated in military hospitals from all the Armed Services of which 26 of the cases were either dependents or retired members. During 1991, there were 81 cases of Lyme disease treated in miltary hospitals of which 31 of the cases were either dependents or retired members. Three soldiers were reported to have permanent disabilities caused by Lyme disease during 1991. The need to protect soldiers and other personnel working on DOD installations has increased with the spread of Lyme disease. b. Epidemiological data for 1992 from the NJDH reveal 679 cases of human Lyme disease statewide that met the Centers for Disease Control and Prevention (CDC) guidelines, including confirmation by isolation of B. burgdorferi. There were 120 reported cases of human Lyme disease in Morris County, where Picatinny Arsenal is located. 6. METHODS. a. Tick Collection. Deer, the preferred host for the adult stage of the Lyme disease tick vector, I. scapularis, were examined at the check station at Picatinny Arsenal. Deer examined were local deer from or near Picatinny Arsenal. The heads, ears, and necks of 94 hunter-shot white-tailed deer (Odocoileus virginianus) were examined for ticks immediately before the weighing and tagging process. The hair on deer were stroked contrary to the natual lay, using the hand edge, to search for ticks. Ticks were removed using a fine-point (No. 5) jeweler's forceps and returned to this Activity for identification and testing. Total examination time per carcass was approximately 5-10 minutes. b. Tick Testing. Collected ticks were tested via a two-phase DFA assay. Ticks were first tested using a purified antibody (Kirkegaard & Perry Laboratories, Inc., Gaithersburg, Maryland), for the presence of spirochetes of the genus Borrelia. One of the Borrelia, B. burgdorferi, is the causative agent for Lyme disease. Those ticks found to be positive in the Borrelia spp. test, were further tested using a B. burgdorferi, species-specific purified antibody (Kirkegard & Perry Laboratories, Inc.). Infection rates were determined specifically for the Lyme disease-causing spirochetes. Tick assays were performed by personnel of this Activity. c. Blood Samples. Blood pooled in the deer body cavities was collected using a clean 4 ml disposable plastic pipettes. Samples were placed in 7 ml labeled tubes and spun for at least five minutes. The sera were separated and frozen (-9 degrees C) until IFA testing could be performed by personnel of the Regional Veterinary Laboratory, Fort Meads, MD. 7. RESULTS. (See also Appendices A and B) a. Three hundred thirty-eight I. scapularis ticks were collected from 51 of the 94 deer examined. Of the 338 I. scapularis, 43 (13%) tested positive for Borrelia species. Species-specific antibody tests confirmed that 19 of 38 (50%) Borrelia-positive ticks were positive for B. burgdorferi, resulting in a 6% B. burgdorferi infection rate. b. None of the 33 Dermacentor albipictus (the Winter deer tick) collected and tested was positive for Borrelia species. c. Twenty-four of the 93 deer serum samples tested (26%) were positive (greater than 1:128 titer level) for B. burgdorferi antibodies. 8. DISCUSSION. a. The significance of the presence of non-burgdorferi, Borrelia spp. in tested ticks is yet to be determined. Research institutions and the CDC are currently investigating differences in Borrelia species and strains relative to their geographic occurrence, host tick species, and the pathogenic implications. It cannot be assumed that spirochetes detected and identified as B. burgdorferi, using currently available methods, are the only Borrelia that may cause Lyme disease type symptoms. b. The incidence of Lyme disease in Morris County increased from 18 confirmed cases in 1988 to 120 in 1992. A similar increase in the incidence of Lyme disease in Morris County has been recorded during the past 5 years. Twenty-six I. scapularis ticks removed from humans on Picatinny Arsenal, were submitted to this Activity for identification and testing by the Environmental and Natural Resources Branch, DEH, during 1992. Of the 26 submissions tested, 12 (46%) were positive for Borrelia spp. 9. CONCLUSIONS. The presence of I. scapularis on examined deer and humans, the presence of the Lyme disease spirochete, and information from the NJDH on the epidemiology of Lyme disease in Morris County and Picatinny Arsenal, New Jersey, indicate that the present risk of contracting human Lyme disease at Picatinny Arsenal, is HIGH. 10. RECOMMENDATIONS. a. Implement recommendations in accordance with guidelines in Appendix C. b. Emphasize, to all residents and visitors at Picatinny Arsenal the importance of applying risk reduction measures, as detailed in Appendices C, D, and E. c. Conduct annual follow-up surveillance using the methods described in reference 1.b and paragraph 6, above. 11. ADDITIONAL ASSISTANCE. Additional direct support in the fields of pest management, pesticide risk management, water supply management, wastewater management, hazardous waste management, worksite hazards management, health care hazards management, sanitation and hygiene, and installation industrial hygiene management is available, and may be requested from U.S. Army Environmental Hygiene Activity-North at commercial (301)677-6502/5281/6205 or DSN 923-6502/5281/6205. [signed by] JAMIE A. BLOW 1LT, MS Entomological Sciences Division APPROVED BY: GEORGE J. MAGNON MAJ, MS Chief, Entomological Sciences Division ----- APPENDIX A DATA SUMMARY SHEET DOD LYME DISEASE SURVEY U.S. ARMY ENVORONMENTAL HYGIENE ACTIVITY-NORTH PICATINNY ARSENAL 26 SEPTEMBER 1992 - 16 JANUARY 1993 # DEER EXAMINED 94 # DEER WITH Ixodes scapularis[1] 51 # DEER WITH TICKS 53 # DEER SERUM SAMPLES TESTED 93 # DEER SERUM SAMPLES POSITIVE[2] 24 # HUMAN LYME DISEASE CASES, 1992 - MORRIS COUNTY 120 # HUMAN LYME DISEASE CASES, 1992 - NEW JERSEY 679 ------------------------------------------------------------------------ 1 Ixodes dammini and Ixodes scapularis have been synonymized by Oliver et al. (1993). 2 Screening titer level greater than 1:128. ----- APPENDIX B TICK TESTING[1] AND SERUM TESTING RESULTS[2] PICATINNY ARSENAL, NEW JERSEY 6 SEPTEMBER 1992 - 16 JANUARY 1993 Table B-1. Ixodes scapularis collected from 51 of 94 deer and tested via DFA for Borrelia species and Borrelia burgdorferi ======================================================================== Borrelia spp. B. burgdorferi -------------------- ---------------------- #COLLECTED #TESTED # + % + #TESTED # + % + TOTAL 338 338 43 13 38 19 50 ------------------------------------------------------------------------ Table B-2. Dermacentor albipictus collected from 12 of 94 deer and tested via DFA for Borrelia species and Borrelia burgdorferi ======================================================================== Borrelia spp. B. burgdorferi -------------------- ---------------------- #COLLECTED #TESTED # + % + #TESTED # + % + TOTAL 33 33 0 0 0 0 0 ------------------------------------------------------------------------ Table B-3. TOTAL TICKS collected from 53 of 94 deer and tested via DFA for Borrelia species and Borrelia burgdorferi ======================================================================== Borrelia spp. B. burgdorferi -------------------- ---------------------- #COLLECTED #TESTED # + % + #TESTED # + % + TOTAL 371 368 43 12 38 19 50 ------------------------------------------------------------------------ Table B-4. SERUM SAMPLES taken from 24 of 93 deer and tested via IFA for Borrelia burgdorferi ======================================================================== Borrelia burgdorferi -------------------- #COLLECTED #TESTED # + % + TOTAL 93 93 24 26 ======================================================================== 1 Direct Fluorescent Antibody (DFA) testing method 2 Indirect Fluorescent Antibody (IFA) testing method ----- APPENDIX D Lyme Disease Risk Reduction Measures 1. Emphasize public awareness programs to educate troops, family members, civilian employees and visitors on personal protective measures and Lyme disease. Methods should include, but not be 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, video "Lyme Disease: A growing threat" (FAUPIN No. 504494DA). A 35mm slide format presentation on Lyme disease is also available from 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-N, Fort Meade, Maryland, 20755-5225. 3. Stock Permethrin Arthropod Repellent (NSN 6940-01-278-1336, 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, 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 medical care 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. scapularis nymphs (the life stage responsible for most human Lyme disease infections) are active. Post DA Poster 40-5, to 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. scapularis. 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 ----- APPENDIX E REPELLENTS 1. Several arthropod repellents are available through the Defense General Supply Center (DGSC) or Self Service Supply System. When used in accordance with directions on the label and in conjunction with the proper wearing of clothing, 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 or commercial (804) 790-4865. Repellents available for use are described below: a. Insect/Arthropod Repellent Lotion (cream, 2 fluid ounces) for application to exposed skin. 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 for a maximum of five weeks or five launderings. Apply more frequently if "buddy checks" reveal attached ticks. 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 55 pounds per square inch to field uniforms, mosquito netting, and tent fabric to provide protection from ticks, 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 (up to 180 days in the field), six launderings of mosquito netting, and 6-9 months of treatment for tent fabric, depending on the 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, June 1991. 3. The U.S. Army Medical Department Tick-Borne Disease Card (7189) is available from the Entomological Sciences Division, USAEHA-North, by calling DSN 923-5281 or commercial (301) 677-5281. ----- APPENDIX F FACT SHEET - MOSQUITO AND TICK REPELLENTS * DEET (N,N-Diethyl-m-tolumide) containing repellents offer good protection against mosquitoes, and are formulated for application to exposed skin. * Permethrin containing repellents offer excellent protection against ticks, and are formulated for application to clothing. * DEET will also offer protection against ticks, keeping them from attaching to treated skin. However, ticks generally do not attach in exposed areas, the only areas DEET may be applied to. * Permethrin, on the other hand, will also offer protection against mosquitoes, but may not be applied to exposed skin where mosquitoes bite. It is useful in treating bed netting. * Combined use of DEET on exposed skin for mosquito repellency and Permethrin on clothing for tick repellency offers maximum protection against both pests. Always read and follow the label before using any compound. * Do not use tick and 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 them from direct contact with the collars. * Various lotion products have acclaimed as offering protection against mosquitoes. Professional literature both supports and refutes benefits from lotions. However, there is a consensus that mineral oil, a component of many lotions, does substantially reduce mosquito bites on treated skin. * Tests have shown that DEET products containing a high concentration (greater than 50%) of DEET do not offer greater protection than those products containing 30-50% DEET. * The following practices enhance the effectiveness of protection against mosquitoes and ticks 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 ticks out. - Wear light-colored clothing to make seeing ticks easier. - 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. -----