June 3, 2016
Dear Colleague:
Officially summer is just around the corner, however, judging by weather alone, summer is here now. As Virginians eagerly participate in long anticipated outdoor activities, I am writing today to raise awareness about tickborne illness this season. Enclosed are important practice support resources including Virginia-specific information on tickborne illness.
Key components of this correspondence include:
- Background information on tickborne illnesses
- Laboratory testing information
- Actions for healthcare providers
Lyme disease activity continues to expand its geographic range in Virginia. In 2014, public health identified 1,347 confirmed and probable cases of Lyme disease, more than in any previous year. While Lyme disease is the most commonly reported tickborne illness in Virginia, and the disease the public often inquires about, other tickborne illnesses also warrant our attention. Ehrlichiosis is the second most commonly confirmed tickborne illness in Virginia, and tick surveys show that ehrlichiosis agents are relatively common in ticks. While less common, the spotted fever rickettsiosis, Rocky Mountain spotted fever, does remain a concern. Many suspected cases of spotted fever rickettsiosis are identified in Virginia, but few are confirmed for surveillance purposes, partly because of insufficient laboratory evidence.
As you know, laboratory testing for tickborne illnesses is complex but critical for accurate diagnosis, treatment and surveillance purposes. Commercial laboratories offer a wide array of assays, but some are much more specific and reliable than others. To assist you in choosing the most useful assays, please review the following document/link entitled, “Recommended Laboratory Assays for Select Tickborne Diseases.” Additional information on Lyme disease lab testing is available on the CDC webpage: http://www.cdc.gov/lyme/diagnosistesting/LabTest/TwoStep/
Please consider the following actions this tick season:
- Familiarize yourself with the best laboratory assays available to diagnose tickborne illness.
- Ask about tick exposure when evaluating patients with febrile illness with or without rash.
- Remind your patients to take preventive steps including recognizing and avoiding tick habitats, using insect repellent when in likely tick habitats, removing attached ticks promptly, and creating tick-safe zones in the yard.
- Report cases of these tickborne illnesses to your local health department promptly (https://www.vdh.virginia.gov/LHD/index.htm).
Should you have any further questions about this topic, please feel free to contact David Gaines, PhD, State Public Health Entomologist in the VDH Office of Epidemiology. He can be reached by telephone at (804) 864-8192 or by email at david.gaines@vdh.virginia.gov.
Please have a safe and “tick free summer.” View VDH’s recently released video on tick bite prevention at http://www.tickfreesummer.com.
Sincerely,
Marissa J. Levine, MD, MPH, FAAFP
State Health Commissioner