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Dr. Mark E. Rogers has recently seen as many as four cases of Lyme disease daily at WVU Urgent Care at Suncrest Towne Centre, one indication that the tick-borne illness is on the rise in Monongalia County.
“This year, it’s really taken off,” Rogers said. “We’re seeing multiple cases every day.”
In fact, the entire county is diagnosing an average of one COVID-19 case a day, and he personally hasn’t seen one since about mid-June. So when a patient comes in complaining of a low-grade fever, malaise, fatigue and joint pain, his first thought is often Lyme disease — an illness caused by the bite of a blacklegged “deer” tick — rather than COVID-19.
“Some of the people we still test for COVID, but I’m telling my patients that the big thing to watch out for is Lyme disease right now,” Rogers said.
Cindy Graham, a Monongalia County Health Department registered nurse who helps with Lyme disease investigation, said she started seeing blood-work-confirmed reports of the illness in mid-June. “It really went crazy,” she said.
Diagnosing the illness
Lyme is a reportable disease, so medical practitioners who diagnose it via blood work or with a bull’s-eye rash at the site of the tick bite must send the report to the health department.
The bull’s-eye rash is left by the tick feasting on the host’s blood, during which disease transmission can occur. The Centers for Disease Control and Prevention estimates the tick must feed on the host’s blood for 36-48 hours before it transmits the disease.
Graham follows up with the reporting practitioner on all cases as well as patients who have positive blood work and/or the rash.
If a practitioner diagnoses Lyme based solely on symptoms minus the bull’s-eye rash, that case would not be reported to the health department, which means confirmed cases are probably low.
Growing issue
The Mountain State is one of 15 states, plus the District of Columbia, listed by the CDC as having a high incidence of Lyme disease. Nearby Pennsylvania top-ped the 2019 data, with 6,763 confirmed cases and 2,235 probable cases. West Virginia’s numbers were lower, at 703 confirmed and 182 probable.
The West Virginia Department of Health and Human Resources’ Zoonotic Disease Group provided updated numbers this week. Last year’s statewide number of 1,062 Lyme cases compared to 205 so far in 2021 is misleading, said Michael L. Abshire, a Zoonotic Disease Group research specialist.
“The 2021 numbers look small, but they also do not show all the cases that have been reported so far, only the ones that have been investigated and are confirmed,” Abshire said.
By comparison, at this same time in 2020, the state had 243 Lyme cases, Abshire said.
Dr. Diane K. Gross, MCHD’s regional epidemiologist, said the number of Lyme cases tends to increase exponentially in late summer, and the COVID pandemic has probably led to late reporting of cases.
Gross also said while the DHHR’s official Lyme number for Monongalia County is 17, she has 26 potential cases that still need to be evaluated.
Rogers and Graham said they have seen Lyme disease in patients of all ages.
Individuals can get it while hiking or camping, but Graham said she has heard a lot of accounts in which individuals reported getting it just working or playing in their yards.
What to look for
Ticks can be found anywhere on the body, but common places include skin folds such as behind the knees, under armpits, around the beltline, in the groin and behind the ears, as well as on the scalp, Rogers said.
And even though a mature deer tick has a distinguished look, with black legs and a red and black body, they might not always be so obvious.
“They can be very tiny nymphs, smaller than a poppy seed,” Rogers said. “People come in and don’t recall having a tick bite. But they have the symptoms or the rash.”
Those who want to remove it, rather than wait for a health care practitioner’s help, should do so with tweezers, making sure to get a firm grip on it in order to get the head out.
“I use the same procedure that the CDC recommends,” Rogers said. “Get as close down to the skin where the mouth meets the skin and firmly grasp them and pull them up with traction. The skin is going to tent and it will pop off.”
If the head remains embedded, Rogers uses a tiny needle to flick it out like a splinter.
Prevention
The CDC (cdc.gov/ticks) provides information on tick prevention. This includes checking yourself and your pets daily when you return from outdoors.
Prevention starts before you step out the door. Clothes and gear can be treated with products that contain 0.5% permethrin, and individuals also can use Environmental Protection Agency-registered insect repellents that contain diethyltoluamide, or DEET.
Anyone planning on spending time outdoors should also consider wearing long sleeves and/or long pants.
In some situations, such as when multiple members of a family have been diagnosed with Lyme disease contracted while spending time in their yard, Rogers also suggests treating the yard with pesticides.
Treatment
Lyme disease is treated with the antibiotic doxycycline. Rogers prescribes a one-time dose if the patient is not experiencing symptoms. Someone who does have symptoms would get a longer course of the medication, he said, maybe 10 to 21 days.
The bacteria that cause Lyme disease will clear up if treated properly, Rogers added.
Problems can occur if Lyme disease gets into a joint or nerve, where permanent damage can result.
“One misconception is that there is this chronic Lyme disease, where people might be on antibiotics for months or years,” he said. “That’s not something we have evidence for.”
Why the rise?
Lyme disease is found primarily in the mid-Atlantic and Northeast regions of the United States. CDC surveillance maps (cdc.gov/lyme/datasurveillance/maps-recent.html) show that more of the state’s instances of the illness have been found in northern West Virginia.
Neither Rogers nor Ed Abbott, a registered nurse who investigates Lyme disease for MCHD, knows why Lyme disease is on the rise, although both believe weather could be a factor.
“That’s what I would like to know,” Rogers said. “I know it seems like we’ve had milder winters, but that’s hypothetical. But my guess is that we have more surviving through milder winters.”
MCHD’s Threat Preparedness program conducts tick surveillance, and Abbott said that recently, more ticks have been found in shady areas.
Tick surveillance was suspended last summer because of the COVID-19 pandemic, said Jamie Moore, MCHD’s Threat Preparedness program director.
“However, we’ve resumed dragging for ticks this summer, although efforts have sometimes been hampered by rain,” he said.
Tick surveillance is conducted to learn what ticks are in the area and to send off specimens to the state lab to be tested for disease.
So far, surveillance has been done in Monongalia, Preston and Marion counties, with plans to also move into Harrison, Doddridge and Taylor counties. These are the members of the six county Preparedness Action Coalition Team, one of the DHHR’s West Virginia Surveillance Regions.
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