In the United States, there are ten recognized tick-associated human illnesses: Lyme disease (LD), Rocky Mountain spotted fever (RMSF), human granulocytic anaplasmosis (HGA), human monocytic ehrlichiosis (HME), tularemia, Southern tick-associated rash illness (STARI), tick-borne relapsing fever (TBRF), Colorado tick fever, Powassan encephalitis, and babesiosis. These tick-borne diseases (TBDs) account for the majority of vector-borne infections reported in the United States . Each year approximately 30,000 cases of Lyme disease are reported to the CDC, ranking it among the ten most common infectious diseases in the nation. Several TBDs can cause severe morbidity and even death.
National reporting for TBDs varies by state, and monitoring TBDs has been limited somewhat by diverse epidemiologic, laboratory, and clinical issues. Changes in reporting requirements over time and in various states result in an inability to evaluate changes in TBD incidence temporally (especially for Lyme disease). Little is known about standard laboratory practices related to some of the TBDs, including types of assays used, diagnostic criteria, and testing volume.
TickNet is a network created in 2007 to foster collaboration on surveillance, research, education, and prevention for tickborne diseases. Collaborators include various divisions within CDC and key state and local health departments. CDC provides extramural funding to participating health departments and partners through the Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) cooperative agreement, to sustain and enhance surveillance for Lyme disease, and through the Emerging Infections Program (EIP), to promote applied research.
The ultimate goals of TickNET are to foster greater collaboration among CDC programs working on tickborne diseases, to enhance and integrate surveillance for tickborne diseases in partnership with states, and to facilitate applied research projects that address key public health questions regarding tickborne diseases. Through these efforts, CDC aims to better understand the burden of tickborne diseases and to develop tools to control their increasing incidence.
Connecticut has collaborated with CDC and other TickNET sites in Maryland, Minnesota, and New York on various projects including:
Evaluating national and state-specific (CT, MD, MN, NY) laboratory testing practices for Lyme and other tickborne diseases. The CT EIP staff took the lead on developing and implementing the survey. Results for this project were published in 2014 and 2016.
Lyme and other Tickborne Diseases Prevention Study (LTDPS): This was a randomized, blinded, placebo-controlled acaricide trial which took place in CT, MD, and NY in order to evaluate the efficacy of single springtime applications of acaricide on residential properties to prevent tickborne diseases. Results for this project were published in 2016.
Bait Box Intervention Study (BBI): The goal of this study was to investigate whether tickborne diseases can be prevented with the use of commercially available, SELECT TCS Tick Control System bait boxes, a rodent-targeted method of tick control. Data collection for this project was completed in 2016 and the results are expected soon.
Cost of Lyme Disease Study (COLD): This was a prospective, descriptive, cost of illness study related to Lyme disease. The CT EIP worked with the EIPs of MD, MN, and NY to assess the total societal and individual level costs of Lyme disease. Data collection has been completed for this study.
Knowledge, Attitudes, and Behavior Study (KAB): The goal of this study was to evaluate knowledge of tickborne diseases and risk perception, along with knowledge, attitudes, and behaviors regarding tick bite and tickborne disease prevention among persons living in selected areas of CT and MD. This study was conducted along with CDC and the Maryland EIP site. Data collection has been completed for this study.
Understanding Tickborne Diseases in Connecticut Study (UTiCS): The goals of this study are to identify and characterize genetic differences in Borrelia species identified in clinical specimens from patients presenting with acute symptoms of tickborne illness to primary care providers in CT, and evaluate for differences in patient characteristics among patients infected with Borrelia species and B. burgdorferi strains.
EH Jones, AF Hinckley, SA Hook, JI Meek, B Backenson, KJ Kugeler, KA Feldman. Pet ownership increases human risk of encountering ticks. Zoonoses and Public Health 2017 Jun 19. doi: 10.1111/zph. 12369 [Epub ahead of print].
AF Hinckley, JI Meek, JA Ray, SA Niesobecki, NP Connally, KA Feldman, EH Jones, PB Backenson, JL White, G Lukacik, AB Kay, WP Miranda, PS Mead. Effectiveness of residential acaricides to prevent Lyme and other tickborne diseases in humans. Journal of Infectious Diseases 2016 July 15;214(2):182-8.
NP Connally, AF Hinckley, KA Feldman, M Kemperman, D Neitzel, SB Wee, JL White, PS Mead, and JI Meek. Testing practices and volume of non-Lyme tickborne diseases in the United States. Ticks and Tick-borne Diseases 2016;7(1):193-198.
KA Feldman, NP Connally, A Hojgaard, EH Jones, JL White, and AF Hinckley. Abundance and infection rates of Ixodes scapularis nymphs collected from residential properties in Lyme disease-endemic areas of Connecticut, Maryland, and New York. Journal of Vector Ecology 2015 June;40(1):198-201.
AF Hinckley, NP Connally, JI Meek, BJ Johnson, MM Kemperman, KA Feldman, JL White, PS Mead. Lyme disease testing by large commercial laboratories in the United States. Clinical Infectious Diseases 2014 Sep 1;59(5):676-81.
JM Garnett, NP Connally, KC Stafford, 3rd, ML Cartter. Evaluation of deer-targeted interventions on Lyme disease incidence in Connecticut. Public Health Reports 2011;126(3):446-54.
NP Connally, AJ Durante, K Yousey-Hindes, JI Meek, RS Nelson, and R Heimer. Peridomestic Lyme disease prevention: Results of a population-based case-control study. American Journal of Preventive Medicine. 2009;37(3):201-6.
JW IJdo, JI Meek, ML Cartter, LA Magnarelli, C Wu, SW Tenuta, et al. The emergence of another tickborne infection in the 12-town area around Lyme, Connecticut: human granulocytic ehrlichiosis. Journal of Infectious Diseases 2000;181(4):1388-93.
CDC Ticknet: http://www.cdc.gov/ticknet/research/
Project Contact PersonSara Niesobecki, MPH, MS
Project Coordinator, TickNET
Connecticut Emerging Infections Program
One Church Street, 7th floor
New Haven, CT 06510