GREATER DANBURY
CONNECTICUT'S

TICK BORNE ILLNESS

PREVENTION CENTER

Reported cases of Lyme Disease in 2007; its our problem

See "Total Cases Reported by CDC 1990-2007" Map

1. WHAT'S NEW
In case you have not heard, Governor Rell has proclaimed May of 2010 as "BLAST Tick-Borne Illnesses Out of Connecticut Month." BLAST is an educational campaign to limit the disease, is briefly explained in her proclamation, and then more fully in Section 6 below.

Excerpt from Governor's BLAST Proclamation above.
See full text of Governor's BLAST Proclamation.

Photo above courtesy of Russell Cornelius.
Access photo above at larger file size.

To coordinate with the Governor's BLAST tick-borne illnesses
out of Connecticut proclamation, the ten local governments in the
Housatonic Region each adopted its own identically worded proclamation.

Shown above from left to right are HVCEO Members New Fairfield First Selectman John Hodge; Danbury Planning Director Dennis Elpern; Bethel First Selectman Matthew Knickerbocker; Medical Advisor to the Town of Newtown Dr. Thomas Draper; Newtown's Director of Health Donna McCarthy Culbert; Ridgefield First Selectman and HVCEO Vice-Chair Rudy Marconi; Brookfield First Selectman Bill Davidson; Mayor of New Milford and HVCEO Chair Patricia Murphy; Redding First Selectman Natalie Ketcham; Bridgewater Selectman Curtis Read; and Sherman First Selectman and HVCEO Secretary-Treasurer Andrea O'Connor.

Also of interest, HVCEO recently acted on a recommendation from the Tick Born Illness Prevention Task Force to pursue with state officials the creation of a long term coordinated plan to address this devastating illness. This initiative is reflected in the correspondence below:

April 15, 2010

Governor M. Jodi Rell
State Capitol
210 Capitol Avenue
Hartford, Connecticut 06106

Dear Governor Rell:

In 2009 area agencies completed a report entitled “Community Report Card for Western Connecticut.” Its purpose was to establish a comprehensive baseline profile of Greater Danbury health issues by assessing key quality-of-life factors in the region.

It stated that “Our community has an unusually high rate of tick borne illness as compared to nearly any other community in the nation” and that “in light of how difficult accurate statistics for tick borne diseases are to compile, it is still accurate to say that our community has one of the highest rates of infection.”

Western Connecticut has long been plagued with high infection rates of tick borne disease. The Community Report Card for our area reflects that fact.

It is fair to say that most everyone here either has someone in their family or knows someone who has been impacted by a tick borne disease. Furthermore, it is insufficient to only examine the established tick borne disease data, knowing that it is estimated that a majority of tick borne disease cases (some say 90%) are not reported, causing the statistics to be neither consistent nor valid.

Additionally, cases of other tick borne diseases, such as ehrlichiosis and babesiosis, are on the rise. Some health experts fear that babesiosis is the next tick borne epidemic.

As the impacted area’s mayors and first selectmen, we therefore request that the State of Connecticut develop a long term coordinated plan to address this devastating illness. And as a result increase its efforts concerning the tick borne disease problem.

A coordinated effort would have the CT Department of Public Health (DPH), the CT Department of Environmental Protection (DEP) and the Connecticut

Agricultural Experiment Station (CAES) work together as they do now with West Nile Virus and Eastern Equine Encephalitis.

It is obvious to health officials in our area that the human impact of tick borne diseases far outweighs that of West Nile Virus and Eastern Equine Encephalitis.

As part of the new plan we request that DPH increase its development and distribution of educational materials and raise the visibility of successful existing educational programs such as “BLAST” and “Time for Lyme”.

DPH partnering with the CT Department of Education would be an effective approach for introducing such tick borne disease related prevention programs into school curriculums.

We also request that the DEP provide advice to towns that ask for help in improving local deer control efforts. And that it assist in monitoring the progress of such efforts by coordinating data associated with deer/car accidents and determining deer population correlation with disease infection rates.

Finally we recommend that the CAES take on the role of monitoring tick abundance and tick infection rates of all tick borne diseases in communities that are making the effort to lower their infection rates. We suggest all three agencies take advantage of Center for Disease Control programs, studies and grants available to address this subject.

Tick borne illnesses hit Connecticut hard and deserve more attention. A DPH/DEP/CAES coordinated approach to prevention will go a long way towards improving public health in Connecticut.

We trust that this request will merit your action.

Sincerely yours,
Patricia Murphy, HVCEO Chairman
and Mayor of New Milford

BLAST ON
FACEBOOK!

2. INTRODUCTION
The Housatonic Region's major tick borne illness, Lyme Disease, was first recognized as a distinct clinical entity from a group of arthritis patients in the area of Lyme, Connecticut in 1975. It also became evident that this disease had an extensive history in Europe throughout the twentieth century.

Lyme Disease is caused by bacteria transmitted to humans by the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue and a characteristic skin rash. If left untreated the infection can spread to the joints, heart and nervous system.

To enhance municipal efforts, in 2008 HVCEO created a regional Tick Borne Illness Prevention Task Force. While local groups are already addressing this complex public health issue, mayors and first selectmen saw that regional coordination and communication could assist and help to more efficiently address this health problem.

The Council designated Andrea O'Connor of Sherman along with Jerry Murphy of Brookfield as Task Force Co-Chairs. All ten HVCEO municipalities then appointed representatives to the Task Force, resulting in the Task Force Membership List as of 3/2010.

The greatly increasing incidence of Lyme Disease in Connecticut is a public health crisis. Municipalities in the Housatonic Valley Region have their individual efforts to fight the disease and are jointly sponsoring this regional web page.

Tick borne illness prevention web resources in the Greater Danbury Area include:

--- Town of Bethel, CT Health Department Lyme Disease Page.

--- Town of Brookfield, CT Lyme Disease Task Force, an all volunteer group whose mission is to "provide education and information for the prevention and understanding of Lyme and other tick-borne diseases such as ehrlichiosis, babesiosis and bartonella."

--- Rotary Club of Brookfield Tick Removal Kit.

Signing ceremony on 7/16/2009 at Brookfield Town Hall as
Governor Rell endorses legislation validating treatment of
chronic Lyme Disease. This act offers physicians in Connecticut
additional legal protections when treating long term sufferers.

--- New Milford Hospital Tick Borne Disease Brochure.

--- Town of Ridgefield, CT Lyme Disease Task Force, a "non-profit organization of volunteers focused on decreasing the prevalence of Lyme Disease and other tick-borne illnesses in our community through awareness-building and education, tick remediation, and public policy advocacy."

--- Town of Ridgefield, CT Deer Committee and Report.

--- Town of Ridgefield, CT Health Department BLAST Program.

--- Ridgefield, CT VNA's Lyme, Chronic Fatigue and Fibromyalgia Support Group. A professionally facilitated group that meets the second Thursday of each month from noon to 1pm at the Ridgefield VNA office. Call Jennifer Reid at 431-0462 for more information.

--- Town of Redding, CT Health Department Lyme Disease Page.

--- Fairfield County Municipal Deer Management Alliance, a group of 18 municipalities formed "to foster a collaborative multi-town approach to managing the region's abundant deer population and reducing its impact on ecological integrity, public health (tick borne diseases) and safety (deer-vehicle accidents)."

Actions to prevent Lyme Disease range from simple to quite complex. These include using insect repellent, removing ticks promptly, defensive property landscaping, and integrated deer and pest management.

Yet tick-borne diseases are still spreading and much more needs to be done.

Blacklegged tick is the correct common name
for the tick popularly known as the “deer” tick.
Size relative to a dime is shown above.

Prevention focus is on the Region's extensive low density residential environment, as an estimated three quarters of all Lyme Disease cases are acquired from ticks picked up during outdoor activities around the home. Tick abundance is closely related to suburban residential landscapes that support the ticks' animal hosts, particularly white tailed deer and white footed mice.

3. ABOUT TICKS
An introduction as to what ticks look like is available in the Brookfield Lyme Disease Task Force's Tick Identification Guide.

See also the Tick Identification Card by the Lyme Disease Association. This card was produced with the input of Greater Danbury's Dave Shugarts of Newtown and Russell Cornelius of Brookfield.

Anyone interested in addressing tick-related illnesses needs to first understand the tick's life cycle. That cycle has a surprising complexity, as shown below:

Complex tick life cycle. Tick larvae feed on one animal, drop to the
ground and molt to a nymph. The nymphs then find and attach to
other animals, engorge, drop to ground and molt to adults.

The adult tick then feeds on a third animal, which in order for the
female tick to become fertile and complete the cycle effectively,
must be a deer. A blood filled female tick produces a single large
batch of eggs and dies. The humans and dogs depicted above are not
themselves effective hosts in tick breeding, they are accidental hosts.
They cannot alone sustain the tick population when deer are scarce.

Ticks are essentially mites that require a host animal for food and development. As shown above, ticks have distinct stages in their life cycle, including egg, six-legged larva stage, eight-legged nymph and then adult. Larvae and nymphs change to the next stage after digesting a blood meal on their host.

When approached by a potential host, a tick becomes excited, waving its front legs in order to grab the passing animal. Ticks cannot fly or jump; they must make direct contact with a host. Ticks do not bite and depart but attach and feed gradually over several to many days.

Dr. Georgina Scholl of the Fairfield County Municipal Deer Management Alliance emphasizes the following critical point on the role of deer:

Other hosts simply will not allow the ticks to succeed and breed and spread diseases. Only densely populated deer can fulfill this role. This is the OPPORTUNITY FOR PREVENTION that is afforded by the tick's dependence on deer.

All other phases of the tick life cycle have multiple alternate hosts, but this one phase, the fertility of the adult female tick, depends on just one species, the white tailed deer.

It is precisely because of this dependence on a single key animal host that Lyme Disease can be so easily prevented just by controlling the population density of one animal.

In sum we could leave the complex tick life cycle alone, except for the fact that there are at least eleven recognized human diseases associated with ticks in the United States, seven or eight of which occur in the mid-Atlantic or northeastern states.

Most prevalent in Connecticut are Lyme Disease and the bacterial diseases Ehrlichiosis and Babesiosis. See "Ehrlichiosis: The Newer Tick-Borne Disease in Town", by Doug Hartline of the Redding Health Department.

The bottom line: Humans and ticks don't mix.

4. TICKS IN THE REGIONAL LANDSCAPE
In Connecticut and elsewhere in the Northeast the emergence of Lyme Disease can be linked to changing landscape patterns.

In the mid-1700s ticks were abundant. But then by the later 1800s ticks were nearly extinct. Between those times the land had been cleared for agriculture and white-tailed deer in many areas were drastically reduced or virtually eliminated due to habitat loss and unregulated hunting.

With the reestablishment of forested habitat and animal hosts through the latter half of the 1900s, ticks that survived were able to spread. The risk of human infection increased through the 1960s and 1970s yielding today's out of control situation.

Today, the Region's explosive population growth had yielded a vast pattern of residential homes in re-wooded areas, as amply demonstrated on this Map of Greater Danbury Land Use.

Excerpt from the Map of Greater Danbury Land Use,
documenting extensive development (red) located in wooded areas.

A key inducement to this low density suburban pattern of residential housing "in or near the woods" is the Region's prevalence of low density residential zoning, as documented by this 2008 Zoning Patterns Overview Map.

While the resulting low intensity suburban environment is in most ways very pleasant, there is an unintended consequence: it supports mammals such as mice and deer that enable the tick life cycle to thrive.

Our plight is well reflected in the key conclusion in the 2007 CT Tick Management Handbook, where the incidence of Lyme Disease is attributed to five main factors:

--- Increased tick abundance
--- Overabundant deer population
--- Increased recognition of the disease
--- Establishment of more residences in wooded areas
--- Increased potential for contact with ticks

5. DEFENSIVE LANDSCAPE MANAGEMENT
Our Region's residential landscapes were designed for a variety of aesthetic and environmental reasons. Fortunately, low cost “tickscape” practices can be introduced to landscape and backyard management.

Thoughtful yard modifications can create an environment unattractive to primary tick hosts and may decrease the abundance of ticks that are present in parts of the yard.

Fewer ticks have been found on well-maintained lawns, except on areas adjacent to woodlands, stonewalls, or heavy groundcover and ornamental vegetation.

At left are woods blending into the backyard. At right is the preferred
sharper definition between areas after "tickscape" intervention.
Source: CT 2007 Tick Management Handbook

While there is a lot of variation in tick numbers between homes, larger properties are more likely to harbor ticks because they are more likely to have woodlots. The blacklegged tick is found mainly in densely wooded areas, 67% of total sampled, and ecotone, 22% (defined as the unmaintained transitional edge habitat between woodlands and open areas).

Fewer ticks are found in ornamental vegetation, 9%, and lawn, 2%. Within the lawn, most of the ticks, 82%, are located within 3 yards of the lawn perimeter particularly along woodlands, stonewalls, or ornamental plantings.

Tick abundance in manicured lawns is also influenced by the amount of canopy vegetation and shade. Groundcover vegetation can harbor ticks. Woodland paths also may have a high number of ticks, especially adults, along the adjacent grass and bushes.

Make use of these "tickscape" improvement guides:

--- Brookfield Lyme Disease Task Force's Tick Safe Zone.

--- CT Agricultural Experiment Station's Managing Ticks on Your Property.

6. "BLAST" PROGRAM
AND PERSONAL PROTECTION
During 2008 Ridgefield received a grant from the CT Department of Public Health for a program of Lyme Disease prevention and education. The resulting BLAST Program, led by Jennifer Reid, was designed to be shared with other communities.

"B" stands for bathing soon after spending time outdoors. A recent study showed that people who did not contract Lyme disease were more likely to shower or bathe within two hours after spending time in their yards.

"L"reminds everyone to look their bodies over for ticks daily and remove them properly. Speedy removal helps avoid disease transmission.

Remove ticks carefully by their mouthparts with tweezers and save them in a plastic bag for identification. Contact your local health department for tick-testing policies and notify your physician if you have any concerns.

Expanding rashes should be reported to your physician in a timely manner. The painless erythema migrans (EM) rash can often go unnoticed and will eventually disappear while the infection remains. Other early symptoms include fatigue, headache, fever and achy muscles and joints.

"A" encourages you to become educated about repellents and apply them appropriately. Studies have shown that applying 30-40% DEET-based repellant to skin is effective at repelling blacklegged (deer) ticks.

Application of 0.5% permethrin-based insecticide to clothing is highly effective at repelling ticks. Clothing treated with permethrin can be washed several times and still retains its repellant properties.

"S" stands for spraying the yard to reduce tick abundance. Homeowners should consider the benefits of applying pesticide to the perimeter of their yards.

Studies have shown that even one application of pesticide at the right time of year and in the best location can reduce blacklegged tick populations by 85 – 90%.

Complete information on tick management is available in electronic format through the Connecticut Agricultural Experiment Station's CT 2007 Tick Management Handbook (8.52 mb) .

"T" reminds everyone to treat your pets. Local veterinarians offer a variety of methods for protecting animals from tick-borne diseases. Dogs and cats increase one’s chances of exposure to Lyme disease.

Pets can carry ticks in to the home on their fur. Pet owners should be cautious about sleeping with their pets. Make everyone in your family a Lyme fighter this year.

Additional introduction is on the BLAST Program page at the Ridgefield Health Department.

BLAST banner on Brookfield's Route 133 in 2008.

BLAST dissemination activities have included presentations with health educators, manned displays, outreach to medical personnel, municipal involvement, advertising and publicity.

Valuable web ready resources were produced by this innovative program for free use by all parties. They are available for download below:

BLAST BROCHURES: English.doc -- Spanish.doc

BLAST FLYERS: General Flyer.doc -- Grade School-young girl art.doc -- Middle School-young man art.doc -- Spanish Lyme Prevention.doc

BLAST GRAPHICS: BLAST Logo.doc -- Checkers the Dog.jpg -- Dash Lyme Figher.jpg -- Green BLAST Word.doc -- Lyme Fighter Lacy.jpg -- Lyme Fighter Dad.jpg -- Lyme Fighter Logo.jpg -- Lyme Fighter Mom.jpg -- Lyme Fighter Nana.jpg -- Lyme Fighter Tiny.jpg

BLAST POWERPOINTS: Alternative to Spraying.ppt -- For Adults.ppt -- For Grades 3 to 5.ppt -- For Grades K to 2.ppt

BLAST PROMOTIONAL: Business Card.doc -- Lyme Awareness Certificate.doc -- Display Photo.jpg -- Ridgefield Health Business Card Magnet.pdf -- Ridgefield Health Pencils.pdf --

BLAST PUBLIC RELATIONS: Contact Request Letter to Churches.doc -- Basic Message.doc -- Newsletter Article.doc

BLAST SOURCES: Banner, Yard Signs.doc -- Brochure.doc -- Magnet, Pencil.doc -- CDC Info Card.doc -- Public Info Guide.doc -- CT DPH Lyme Disease Prevention Handbook.doc -- DEET Brochure.doc -- Lyme in Rhyme Children's Book.doc -- Pesticide Brochure.doc --Tick Check Stickers.doc -- Tick ID Card.doc -- Tick Management Handbook.doc -- T Shirts.doc -- Weston Westport Brochures.doc

7. STATISTICAL INDICATORS
A good data base is important for prevention efforts. People want to be both convinced of the scope of the problem and have baseline data for assessing effectiveness of prevention strategies.

Below are some data resources on Lymes Disease, tick prevalence and deer population:

--- 12/2008 CT labs no longer required to report Lyme Disease.

--- Statistics at the National Centers for Disease Control and
Prevention, including reported cases by state 2003-2007.

--- Tick census conducted in Newtown 11/2008 and in Redding 11/2008.

--- CT Department of Public Health's Lyme Disease Statistics Page.

--- Lyme Disease Prevention Among Connecticut Residents, 1999-2004.

---Results of Lyme Prevention Focus Group, Ridgefield, CT July 2008.

The above chart is an excerpt from the
2009 Community Health Report Card for Western CT

8. DEER MANAGEMENT
Southwestern Connecticut is fortunate to have had in place since 2004 the Fairfield County Municipal Deer Management Alliance. Visit the Alliance web site for much valuable information on deer management.

The purpose of this group is "to foster a collaborative approach to managing the region's abundant deer population and reducing its impact on ecological integrity, public health and safety."

Note that the Alliance does not itself manage deer populations. Rather, it aims to study, educate, inform and raise awareness of the benefits of a balanced deer population and to share the current state of the art with those towns or institutions that want to use this method of preventing tick borne diseases.

HVCEO volunteers as the financial manager for and auditor of Alliance funds.

Source: 2007 CT Tick Management Handbook

The Alliance includes 18 municipalities located in three of Connecticut's state defined planning regions (see map of planning regions), as follows:

GREATER BRIDGEPORT REGION: Bridgeport, Easton and Fairfield.

HOUSATONIC VALLEY REGION: Bethel, Brookfield, Danbury, Newtown, Redding, Ridgefield and Sherman.

SOUTH WESTERN REGION: Darien, Greenwich, New Canaan, Norwalk, Stamford, Weston, Westport and Wilton.

As shown below the Alliance offers Nine Short Statements on the Role of Deer in the Lyme Epidemic. These were authored by Dr. Kirby Stafford, State Entomologist and Vice Director of the Connecticut Agricultural Experiment Station and who wrote the 2007 CT Tick Management Handbook.

Dr. Peter Rand, Co-Director of the Maine Medical Center's Vector-borne Disease Laboratory, also contributed. Both are scientific advisors to the Deer Management Alliance.

1) Deer are the single most important, key animal host in the tick's life cycle. Without deer there would be few if any ticks. (From page 52 of the CT Tick Management Handbook and from Dr. Anderson's studies on Narragansett Bay islands and Dr. Rand's study on Monhegan Island).

2) Reducing deer densities to below 10 to 12 per square mile has been shown to prevent ticks from perpetuating their species successfully. (From Dr. Stafford’s Testimony to the CT General Assembly on March 10, 2008).

3) Reducing deer densities to below 10 to 12 per square mile has been shown to substantially reduce tick numbers and human Lyme Disease. (Stafford Testimony 3/10/08).

4) There is more than enough scientific evidence already demonstrating the dramatic effect of sufficient deer reduction on tick populations. (Personal communication- referring to the 6 studies described in detail on page 56 of the CT Tick Management Handbook, and more described by Dr. Rand from mainland Maine in his testimony: “deer reduction was highly positively correlated with tick abundance").

Plus, two studies described and graphed in the DEP booklet: Managing Urban Deer in Connecticut, on pages 3 and 4. More deer reduction studies are described in the Cornell guidebook on Community Based Deer Management: A Practitioners' Guide: http://www.cce.cornell.edu/store).

5) Deer are key to the reproductive success of deer ticks (Page 52 of the Tick Management Handbook 2007). Dr. Rand has “demonstrated the quintessential role of the deer host in the maintenance of deer tick populations.” (Testimony to the CT General Assembly April 2008).

6) Lethal management options for deer are effective at reducing tick populations. (This is on page 56 of the revised edition CT Tick Management Handbook 2007).

7 ) In the absence of deer there are few if any ticks. This is because while adult ticks may occasionally feed on opossums, raccoons, dogs, coyotes, etc., these animals play only a minor role in the ecology of the tick and will support few ticks. (From page 52 and page 55 of CT Tick Handbook).

Ticks latched on to head of deer

8) Areas without deer have been shown to harbor few ticks and little or no infection by Lyme Disease spirochetes [a category of corkscrew-shaped bacteria]. (From pages 52 and 56 of CT Tick Management Handbook).

9) An Integrated Tick Management approach combines several methods, including managing host animal populations, to provide least toxic control of ticks for the prevention of tick-associated disease. (Table 3 page 45 of CT Tick Management Handbook).

Links of interest:

YouTube - Dr. Kirby Stafford of the CT Agricultural
Experiment Station: Deer herd reduction and lyme disease

DeerFacts.org

Ridgefield, CT Deer Committee and 2005 Report

Greenwich, CT 2004 Report on Managing Deer Population

9. STATE AND NATIONAL RESOURCES

--- CT Department of Public Health Lyme Disease Info Page.

--- CT Department of Public Health Lyme Disease
Prevention Knowledge, Attitudes and Behavior Study 2008.

--- CT 2007 Tick Management Handbook (8.52 mb) .

--- Torrington, CT Area Health District Lyme Disease Page.

--- Time for Lyme in Greenwich, CT; Time for Lyme Support Group.

--- CT Coalition to Eradicate Lyme Disease.

--- Lyme Disease Foundation in Tolland, CT.

--- Spanish text: Grupo Hispano Americano de la Enfermedad de Lyme.

--- Lyme Disease Digital Library.

--- Tick Encounter Resource Center at the University of Rhode Island.

--- Lyme Disease Association.

--- Lyme Disease Research Center at Columbia University.

--- Cary Institute of Ecosystem Studies in Millbrook, NY.

--- CDC Effectiveness of Personal Protective Measures.

--- American Lyme Disease Foundation.

--- Health Line page concerning Lyme Disease.

--- International Lyme and Associated Diseases Society.