TickNET—A Collaborative Public Health Approach to Tickborne Disease Surveillance and Research

Paul Mead

, Alison Hinckley, Sarah Hook, and C. Ben Beard

Author affiliations: Centers for Disease Control and Prevention, Fort Collins, Colorado, USA

Abstract

TickNET, a public health network, was created in 2007 to foster greater collaboration between state health departments, academic centers, and the Centers for Disease Control and Prevention on surveillance and prevention of tickborne diseases. Research activities are conducted through the Emerging Infections Program and include laboratory surveys, high-quality prevention trials, and pathogen discovery.

Through their bites, ticks expose humans to a remarkable array of pathologic agents, including neurotoxins, allergens, bacteria, parasites, and viruses. The clinical features of tickborne illness range from mild to life-threatening, and collectively, tickborne diseases constitute a substantial and growing public health problem in the United States. New agents of tickborne disease are described regularly, and known agents are spreading to new areas.

The most common tickborne disease in the United States is Lyme disease, caused by the spirochete Borrelia burgdorferi. With >37,000 cases reported to the Centers for Disease Control and Prevention (CDC) during 2013, Lyme disease ranks fifth among all nationally notifiable conditions (1,2). Less common but potentially serious tickborne infections include anaplasmosis, babesiosis, ehrlichiosis, spotted fever group rickettsioses, and Powassan virus disease (3). Recent reports of US patients infected with Borrelia miyamotoi (4), an Ehrlichia muris–like agent (5), a novel bunyavirus (6), and a putative new genospecies of Borrelia burgdorferi (B. Pritt, pers.com.) all serve to highlight the potential for discovery of novel tickborne pathogens. In addition, several tickborne diseases of unknown etiology have also been described, most notably STARI (southern tick–associated rash illness). Easily confused with early Lyme disease, STARI is a distinct, idiopathic entity associated with bite of the lone star tick, Amblyomma americanum (7,8). This tick species has also been implicated recently as a cause of IgE-mediated hypersensitivity to red meat and certain chemotherapeutic agents (9).

Thumbnail of Geographic distribution of leading tickborne diseases among humans, United States, 2013. Each dot represents 1 case, based on patient residence; exposure location may be different.

Figure 1. Geographic distribution of leading tickborne diseases among humans, United States, 2013. Each dot represents 1 case, based on patient residence; exposure location may be different.

Thumbnail of US cases of Lyme disease, ehrlichiosis, anaplasmosis, babesiosis, and spotted-fever group rickettsioses reported to the Centers for Disease Control and Prevention, 2001–2013. Counts include confirmed and probable cases, according to the case definition in effect in each year. Anaplasmosis cases were reported as human granulocytic ehrlichiosis before 2008. Ehrlichiosis refers to infections caused by Ehrlichia chaffeensis, E. ewingii, and undetermined species. *Babesiosis was first de

Figure 2. US cases of Lyme disease, ehrlichiosis, anaplasmosis, babesiosis, and spotted-fever group rickettsioses reported to the Centers for Disease Control and Prevention, 2001–2013. Counts include confirmed and probable cases, according to the...

Tickborne diseases pose special challenges for clinicians and public health agencies alike. Although tickborne diseases occur throughout the United States, the distribution of any given disease can be highly focal (Figure 1), and this information must be known and considered by health care providers when assessing patients. In addition, laboratory testing is often limited to serologic assays that require paired samples drawn several weeks apart to confirm recent infection, which complicates the use of laboratory testing for both patient management and public health surveillance. With regard to prevention, tick checks, repellent use, and other personal protective measures, although generally benign and inexpensive, are not especially effective (10). Despite decades of education about these measures, case reports for the more common tickborne diseases continue to increase (Figure 2). Pesticide use can reduce tick abundance (11–13) but has not been proven to reduce tickborne disease in humans (14,15). Lymerix, developed to prevent Lyme disease, is the only vaccine ever licensed in the United States to prevent a tickborne disease in humans, but it was removed from the market during 2003 amidst poor sales and unsubstantiated reports of increased adverse events (16,17).

Dr. Mead is a medical epidemiologist with CDC in Fort Collins, CO. His research interests include medical and public health aspects of Lyme disease, plague, tularemia, and other vector-borne diseases.

References

Adams DA, Jajosky RA, Ajani U, Kriseman J, Sharp P, Onwen DH, Summary of notifiable diseases—United States, 2012. MMWR Morb Mortal Wkly Rep. 2014;61:1–121 .PubMed
Centers for Disease Control and Prevention. Notice to readers: final 2013 reports of nationally notifiable infectious diseases. MMWR Morb Mortal Wkly Rep. 2014;63:702 .PubMed
Chapman AS, Bakken JS, Folk SM, Paddock CD, Bloch KC, Krusell A, Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis—United States: a practical guide for physicians and other health-care and public health professionals.MMWR Recomm Rep. 2006;55:1–27 .PubMed
Gugliotta JL, Goethert HK, Berardi VP, Telford SR III. Meningoencephalitis from Borrelia miyamotoi in an immunocompromised patient. N Engl J Med. 2013;368:240–5. DOIPubMed
Pritt BS, Sloan LM, Johnson DK, Munderloh UG, Paskewitz SM, McElroy KM, Emergence of a new pathogenic Ehrlichia species, Wisconsin and Minnesota, 2009. N Engl J Med. 2011;365:422–9. DOIPubMed
McMullan LK, Folk SM, Kelly AJ, MacNeil A, Goldsmith CS, Metcalfe MG, A new phlebovirus associated with severe febrile illness in Missouri. N Engl J Med. 2012;367:834–41. DOIPubMed
Wormser GP, Masters E, Liveris D, Nowakowski J, Nadelman RB, Holmgren D, Microbiologic evaluation of patients from Missouri with erythema migrans. Clin Infect Dis. 2005;40:423–8. DOIPubMed
Wormser GP, Masters E, Nowakowski J, McKenna D, Holmgren D, Ma K, Prospective clinical evaluation of patients from Missouri and New York with erythema migrans-like skin lesions. Clin Infect Dis. 2005;41:958–65. DOIPubMed
Commins SP, Platts-Mills TA. Tick bites and red meat allergy. Curr Opin Allergy Clin Immunol. 2013;13:354–9. DOIPubMed
Vázquez M, Muehlenbein C, Cartter M, Hayes EB, Ertel S, Shapiro ED. Effectiveness of personal protective measures to prevent Lyme disease. Emerg Infect Dis. 2008;14:210–6. DOIPubMed
Hayes EB, Piesman J. How can we prevent Lyme disease? N Engl J Med. 2003;348:2424–30. DOIPubMed
Piesman J. Strategies for reducing the risk of Lyme borreliosis in North America. Int J Med Microbiol. 2006;296(Suppl 40):17–22. DOIPubMed
Gould LH, Nelson RS, Griffith KS, Hayes EB, Piesman J, Mead PS, Knowledge, attitudes, and behaviors regarding Lyme disease prevention among Connecticut residents, 1999–2004. Vector Borne Zoonotic Dis. 2008;8:769–76. DOIPubMed
Poland GA. Prevention of Lyme disease: a review of the evidence. Mayo Clin Proc. 2001;76:713–24. DOIPubMed
Wormser GP. Prevention of Lyme borreliosis. Wien Klin Wochenschr. 2005;117:385–91. DOIPubMed
Plotkin SA. Correcting a public health fiasco: the need for a new vaccine against Lyme disease. Clin Infect Dis. 2011;52(Suppl 3):s271–5. DOIPubMed
Shen AK, Mead PS, Beard CB. The Lyme disease vaccine—a public health perspective. Clin Infect Dis. 2011;52(Suppl 3):s247–52. DOIPubMed
Hinckley AF, Connally NP, Meek JI, Johnson BJ, Kemperman MM, Feldman KA, Lyme disease testing by large commercial laboratories in the United States. Clin Infect Dis. 2014;59:676–81. DOIPubMed

Figures

Suggested citation for this article: Mead P, Hinckley A, Hook S, Beard BC. TickNET—a collaborative public health approach to tickborne disease surveillance and research. Emerg Infect Dis. 2015 Sep [date cited]. http://dx.doi.org/10.3201/eid2109.150301

DOI: 10.3201/eid2109.150301