What You Should Know About
Lyme Disease and Other
Tick-Borne Diseases
Minnesota Department of Health
Disease Prevention & Control
625 Robert St N
PO Box 64975
Saint Paul, MN 55164
(651) 201-5414
Revised October 2009
Goal
“Minnesota residents and visitors will take
action to prevent exposure to ticks which
may carry Borrelia burgdorferi; will know the
signs and symptoms of Lyme disease and
other tick-borne diseases; and if present, will
seek early diagnosis and treatment.”
1995 Minnesota Lyme Disease Public Education Plan
Goals of presentation
• Be aware of Lyme disease and other
tick-borne diseases
• Recognize basic signs and symptoms
• Seek early diagnosis and treatment
• Know whether you live, work or play in
endemic areas
• Practice prevention activities
• Know whom to contact for more
information
LYME DISEASE
Borrelia burgdorferi,
the bacteria that cause Lyme disease
History
1975
Juvenile cases of arthritis found in
Connecticut
Disease named Lyme disease
1985
Lyme disease became reportable in
Minnesota
Lyme Disease
Signs & Symptoms
3 to 30 days after deer tick bite
• Rash (often “bulls-eye”)
• Fever
• Chills
• Headache
• Muscle and joint pain
• Fatigue
Erythema migrans (EM)
rash characteristic of
Lyme disease
Lyme disease rash
without central clearing
Lyme Disease
Signs & Symptoms
Days to weeks after illness onset
• Multiple rashes
• Facial paralysis on one side
• Fever, stiff neck, headache
• Weakness, numbness, arm/leg pain
• Irregular heart beat
• Persistent weakness and fatigue
Multiple
Rashes
• Reaction as
bacteria move
through body
• Not caused by
multiple tick bites
Multiple
Rashes
• This is another
example of a
multiple rash.
Lyme Disease
Signs & Symptoms
Weeks to months after illness onset
• Fatigue
• Chronic arthritis
• Nervous system problems
Joint Swelling
Joint swelling and
pain may occur
weeks to months
after onset of
illness if left
untreated.
Diagnosis of Lyme Disease
• Physical examination
• History of possible exposure to
deer ticks
• Blood tests may be performed
– A screening test is done first,
followed by a confirmatory test
for antibodies to Lyme disease
bacteria
Remember
Early recognition of signs and symptoms
of Lyme disease is very important for
prompt diagnosis and treatment.
Treatment
• Lyme disease can be treated
• Antibiotics are used to treat
Lyme disease
• Talk to your doctor about
specific treatment
Questions about
Diagnosis or Treatment
of Lyme Disease?
Call your doctor
or
Minnesota Department of Health at
651-201-5414
TICKS
Blacklegged Tick
(deer tick)
American dog tick
(wood tick)
(spreads Lyme disease)
(does not spread Lyme disease)
adult male
adult female
Blacklegged Ticks (Deer Ticks)
Blacklegged ticks
have three life
stages
Nymph
Adult
(female)
Larva
Blacklegged Tick Larvae
• Size of period at end of sentence
• Initially does not have Lyme disease
bacteria, so does not transmit the
bacteria to a host
• May get the bacteria from a host who
has the bacteria
Collecting Immature
Blacklegged Ticks
Lyme disease researchers often live-trap small
mammals to collect blacklegged ticks.
Natural Host for
Immature Blacklegged Ticks
Immature blacklegged ticks can be infected by feeding
on mice that are carrying Lyme disease bacteria.
Transmission can also occur from the ticks to mice.
Blacklegged Tick
Nymph
Blacklegged Tick Nymph
• Size of a poppy seed
• Transmits most cases of disease because
they are so difficult to detect
• Seeks a blood meal from mid-May to midJuly
Blacklegged Tick Adults
Adult
female
Adult
male
Blacklegged Tick Engorgement
Male and Female Adult
Blacklegged Tick
• Feed and mate on large animals in the
fall or early spring
• After feeding, females lay eggs, then die
• Ticks that did not feed or mate go
dormant
Two-Year Life Cycle of Blacklegged Tick
EGGS
MEAL 1
• Mouse
• Bird
LARVAE
NYMPHS
Eggs laid,
adults die
MEAL 3
* For adults
that did not
feed in fall
• Person
• Deer
• Dog
MEAL 2
(peak feeding
time May-mid July)
• Person
• Mouse
• Dog
SPRING
SUMMER
WINTER
FALL
Nymphs
molt into
adults
Larvae molt
into nymph
stage
ADULTS
MEAL 3
• Person
• Deer
• Dog
Nymphs dormant
Blacklegged Tick
Habitat
Trails and
Edge Habitat
• Blacklegged ticks
live in woody, brushy
areas that provide
food and cover for
hosts such as mice
and deer
• Exposure to these
ticks can be greatest
along trails and
edges of woods
Blacklegged Tick Questing
Blacklegged ticks
search for a host
from the tips of lowgrowing vegetation,
generally climbing
onto a person or
animal near ground
level.
Blacklegged Tick Feeding
To Get Lyme Disease
• Blacklegged tick must be infected with
Lyme disease bacteria
• Only the nymphs and adult females can
transmit the Lyme disease bacteria
• Tick must be attached 24 - 48 hours before
it passes bacteria to host
Lyme Disease Cases by State,
2002 Lyme2002
Disease Cases
by State
as Reported to CDC
(nn=23,763
=
23,763)
11
37
1
0
867
12
4
4
261
1807
5535
852
4631
3989
2349
194
26
738
259
D.C.
25
137
1090
2
26
42
6
4
97
47
5
1
7
0
28
26
3
1
12
139
82
21
25
41
4
11
2
5
79
0
3
219
Kittson
Roseau
Lake
of the
Woods
Koochiching
Marshall
St. Louis
Beltrami
Pennington
Polk
Lyme Disease Areas of
Highest Risk
in Minnesota
Cook
Clear
Water
Red Lake
Lake
Itasca
Mahnomen
Norman
Hubbard
Cass
Tick-borne disease risk in
Minnesota is highest in
forested areas within the
shaded zones.
Becker
Clay
Aitkin
Wadena
Wilkin
Crow Wing
Carlton
Ottertail
Pine
Todd
Mille
Lacs
Grant
Kanabec
Douglas
Morrison
Benton
Traverse
Stevens
Pope
Stearns
Blacklegged ticks may
also be found at lower
levels in some forested
areas outside this zone.
Isanti
Big Stone
Sherburne
Swift
Chisago
Kandiyohi
Anoka
Meeker
Wright
Chippewa
Hennepin
WashingRam- ton
sey
Lac Qui Parle
McLeod
Renville
Carver
Scott
Yellow Medicine
Dakota
Sibley
Lincoln
Lyon
Redwood
Nicollet
Le
Sueur
Rice
Goodhue
Wabasha
Brown
Olmsted
Pipestone
Rock
Murray
Cottonwood
Watonwan
Nobles
Jackson
Martin
Blue Earth
Faribault
Waseca
Steele
Freeborn
Dodge
Mower
Winona
Fillmore
Houston
Minnesota Department of Health
May 2008
Reported Cases of Lyme Disease in Minnesota,
1986-2008 (n = 9,726)
1,300
1,239
1,200
1,100
1,050
1,023
1,000
900
800
700
600
500
465 463
475
400
300
252 256 261
100
202 204
196
200
283
147
94
83
83
107
67
80
0
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
Number of Cases
917 913
866
Year
Reported Cases of Lyme Disease in
Minnesota by Location of Residence, 19982007 (n=6,905)
1400
Metro Area
Greater Minnesota
Number of Cases
1200
1000
800
600
400
200
0
1998
1999
2000
2001
2002
2003
Year
2004
2005
2006
2007
Reported Cases of Lyme Disease by
County of Exposure, Twin Cities
Metropolitan Area, 1998-2007
County
Anoka
Washington
Ramsey
Dakota
Hennepin
Scott
Carver
Total
No. of Cases
187
183
38
32
18
6
5
469
Top Ten Counties of Exposure for
Reported Cases of Lyme Disease,
1998-2007
County
1. Crow Wing
2. Cass
3. Pine
4. Aitkin
5. Anoka
6. Washington
7. Houston
8. Morrison
9. Hubbard
10. Itasca
Wisconsin
Other
Total Cases with Known Exposure
No. (%) of Cases
966 (20%)
370 (8%)
302 (6%)
207 (4%)
187 (4%)
183 (4%)
125 (3%)
124 (3%)
103 (2%)
103 (2%)
940 (20%)
1,120 (24%)
4,730
Reported Cases of Lyme Disease
by Month of Onset, Minnesota,
1999-2008 (n = 6,277*)
45%
41%
40%
Percent of Cases
35%
30%
25%
22%
19%
20%
15%
9%
10%
0%
4%
4%
5%
0%
0%
0%
0%
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
1%
0%
Nov
Dec
Month
* Excluding 1,415 cases without erythema migrans or with unknown onset dates
25%
24%
Reported Cases of Lyme Disease
by Age at Onset, Minnesota,
1999-2008 (n=7,610*)
20%
16%
Percent
16%
15%
11%
10%
9%
10%
8%
6%
5%
0%
0-12
13-19
20-29
30-39
40-49
50-59
60-69
70+
Age at Time of Onset
* Excluding cases with unknown age at time of onset
Reported Cases of Lyme Disease in
Minnesota by Sex, 1999-2008
Male
Female
Total
4,732 (62%)
2,960 (38%)
7,692
Human Anaplasmosis
Signs and Symptoms
•
•
•
•
Fever (over 102 degrees)
Chills and shaking
Severe headache
Muscle aches
Reported Cases of Human Anaplasmosis
in Minnesota by Year, 1995-2008
(n = 1,602)
350
322
300
278
Number of Cases
250
200
186
176
149
150
139
93
100
79
50
30
18
6
76
36
14
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
30%
Reported Cases of Human Anaplasmosis
by Age at Onset, Minnesota, 1999-2008
(n = 1,530)
25%
25%
22%
20%
Percent
20%
16%
15%
10%
7%
5%
5%
3%
2%
0%
0-12
13-19
20-29
30-39
40-49
50-59
60-69
70+
Age at Time of Onset
* Excluding cases with unknown age
Human Anaplasmosis
Sex Distribution, 1999-2008
Male
980 (64%)
Female
554 (36%)
Total
1,534
35%
Reported Cases of Human Anaplasmosis
by Month of Onset, Minnesota,
1999-2008 (n = 1,519*)
30%
Percent of Cases
30%
27%
25%
20%
15%
10%
10%
10%
8%
6%
5%
5%
2%
0%
0%
0%
Jan
Feb
Mar
1%
0%
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Month
* Excluding 15 cases with unknown onset
Kittson
Reported Cases of Human Anaplasmosis
in Minnesota by County of Exposure,
1995-2007
(n = 1,323)
Roseau
Lake
of the
Woods
Koochiching
Marshall
St. Louis
Beltrami
1
Pennington
Polk
Red Lake
Cook
12
Clear
Water
1
Lake
Itasca
1
7
22
9
Mahnomen
Norman
Hubbard
4
155
41
Becker
Clay
Cass
Aitkin
7
Wadena
Wilkin
Crow Wing
1
Ottertail
368
1
Cases with unknown exposure = 266
Carlton
15
100
Cases with known exposure = 1,057
Pine
Todd
Grant
5
Douglas
65
Mille
Lacs
Kanabec
Morrison
2
39
Minnesota = 722
Wisconsin = 99
Other State = 7
12 6
Benton
Stevens
Traverse
Pope
1
Stearns
4
Big Stone
Swift
9
3
Kandiyohi
Meeker
1
Isanti
Sherburne
Anoka
14
Wright
3
1
Chippewa
9
Chisago
Ramsey
Hennepin
McLeod
Carver
Yellow Medicine
1
5
2
Lac Qui Parle
Renville
7
Washington
Scott
Dakota
Sibley
Lincoln
Lyon
Redwood
Brown
Rice
Le
Sueur
Nicollet
Goodhue
1
1
2
Wabasha
Olmsted
Pipestone
Murray
Cottonwood
Watonwan
Rock
Nobles
Jackson
Martin
Blue Earth
Faribault
Waseca
Steele
Freeborn
1
Dodge
Mower
Winona
1
Fillmore
2
Houston
10
* Includes confirmed and probable cases
Babesiosis Signs & Symptoms
•
•
•
•
•
•
High fever
Chills
Headache
Muscle aches
Fatigue
Loss of appetite
Summary of Tick-Borne Diseases,
Minnesota, 1999-2008
(n = 9,333)
Number of Cases
8000
7,692 (82%)
6000
4000
1534 (16%)
2000
107(1%)
0
Lyme disease
Human
anaplasmosis
Babesiosis
Prevention Actions
• Campers, hikers, hunters, people in
outdoor occupations, and people who live
near the woods may be at risk in the
counties known to have blacklegged ticks.
• Know whether you live, work or play in an
area that has blacklegged ticks
• Take precautions when in blacklegged tick
habitat, especially from May through July
• Remember, preventing exposure to
blacklegged ticks requires diligence
Lyme Disease Vaccine
• Discontinued in 2002
Prevention
Use repellents (DEET or
permethrin), according
to label directions.
Tucking pants into socks
creates a barrier to ticks.
Wearing light-colored
clothing helps to more
easily spot ticks.
Checking for Ticks
It is a good idea to check yourself and your children for
ticks after spending time in a wooded or brushy area.
Pets
Check your dog or cat
for ticks before bringing
them inside.
There is a Lyme disease
vaccine for dogs, but it
does not prevent them
from bringing ticks into
the home.
Avoid Deer Tick Bites
• Be aware of high-risk
times and places
• Walk in the center of
trails to avoid picking up
ticks from brush
• Wear long pants, lightcolored clothing, and
repellent
Avoiding Blacklegged Ticks at Home
If you live in area with ticks, they are usually located
around the fringe of your yard and a wooded area.
Removing
Attached Ticks
Ticks have barbed
mouth parts. This
means that ticks
attached to the skin
should be pulled out
slowly and steadily.
To Remove a Deer Tick
• Use tick forceps or tweezers
• Grasp the tick close to the skin
• Pull outward S-L-O-W-L-Y, gently,
and steadily
• Do not squeeze the tick
• Use an antiseptic on the bite
Important Messages
• Know whether you live, work or
play in an area that has deer ticks
• Take preventive actions
• Seek early diagnosis and treatment
Whom to Contact
Minnesota Department of Health
651-201-5414
Metropolitan Mosquito Control District
651-645-9149
Minnesota Department of Health’s
Lyme Disease Web Site
www.health.state.mn.us
Scroll down to “Diseases and
Conditions” and click on “Diseases A to
Z”
Click on “Lyme Disease”