Parental Surveillance Guide to Lymes Disease Allison Waterbury

Parental Surveillance Guide to Lyme’s Disease Allison Waterbury, MPH student Walden University PUBH 6165 -3 Instructor: Dr. Patrick Tschida Fall, 2011 1 CONFIDENTIAL

Agenda • • Establish objectives for this seminar Define Lyme’s disease Discuss warning signs Know your options for treatment Understand test results Discuss long term affects Share prevention strategies 2 CONFIDENTIAL

Objectives • Gain awareness of disease in your area. • Know how to identify symptoms. • Identify a step wise approach in finding the diagnose. • Understand what your doctor is telling you. • Apply prevention strategies. • Learn where to get help in the state of Maryland. 3 CONFIDENTIAL

Lyme’s in your backyard? • The Center for Disease Control and Prevention (CDC, 2011) listed the top 8 states with the highest number of reported Lyme’s disease cases. • Pennsylvania • New York • New Jersey • Massachusetts • Connecticut • Wisconsin • Rhode Island • Maryland • Minnesota 4 CONFIDENTIAL

Lyme’s disease on the rise • Reports in Maryland has more than doubled in the last 10 years. • The number of reported cases in Maryland increased from 691 to 1, 235, during 2003 to 2005 (CDC, 2011 a). • The number peaked in 2007 at 2, 576 cases and the last report in 2009 revealed 1, 466 cases (CDC, 2011 a). • Most common among boys ages 5 -9 years old • The true incidence of Lyme’s disease in not. CONFIDENTIAL know. 5

What is Lyme’s Disease? • Tick borne infection • B. burgdorferi. • Transmitted by Ixodes Tick • Ixodes Scapularus: Most common East Coast • Reservoir deer, rodents • Tick cycle • Feed once during each three stages » Larvae » Nymph » Adult late summer following spring-early summer late fall 6 CONFIDENTIAL

Red Flag Warning Signs – Not having the energy to play with friends Bulls eye lesion Fatigue – Wanting to go to bed Flu-like symptoms – Continually expressing their legs are sore 7 CONFIDENTIAL

There is no one form of erythema migrams Figure 2. Classic erythema migrans. From” e. Medicine, ” 2008. Image reprinted with permission. Target Lesion Do not dismiss other lesions Figure 1. Pictures of erythema migrans. From “American Lyme’s disease foundaton, ” 1993, Journal of Science, (260), p. 1610 -1616. Reprinted with permission. 8 CONFIDENTIAL

First remove the TIC Tweezers Grab embedded body 9 Gently remove in one piece CONFIDENTIAL

What to expect Early Stage 2 -3 weeks 2 -4 months Second Stage Late disease 2 -3 years 10 CONFIDENTIAL

Lingering Lyme’s Disease Your child’s symptoms • What is normal Your child’s symptoms • What is NOT normal Legs Ache • “Growing pains” Legs Ache • Juvenile Arthritis 11 Decrease in appetite • Picky eaters Decrease in appetite • Fatigue • Temperature CONFIDENTIAL

Lab Results • Conclusive Results • Inconclusive Results • (+) ELISA • (+) Western Blot • (-) Symptoms after treatment • (-) ELISA • (-) Western Blot • (+) Symptoms after treatment • Things to consider • PCR test • Juvenile arthritis symptoms may persist • Antibiotics are not the choice of treatment. 12 CONFIDENTIAL

Where to bring your child No insurance Insurance • Try to avoid the emergency room • Go to your pediatrician • Refer to Clinical List for Maryland Doctors • Rheumatologist in Maryland • http: //www. needymeds. org/free_ clinics. taf? _function=list&state=m d 13 • http: //www. hopkinschildrens. org/ staff. Detail. aspx? id=3112 CONFIDENTIAL

Prevention Strategies • Check your children • Must check for specific rashes • Avoid tick-infected areas • High season in your area • Does bug spray help with ticks? 14 CONFIDENTIAL

Patient Education Material • • Pediatric Information – http: //www. uptodate. com/contents/patient-information-lymedisease-thebasics? source=search_result&search=lyme%27 s+disease&s elected. Title=21%7 E 150 Lyme’s Disease Specialists • Holtorf Medical Group » http: //aitrk 3. holtorfmed. com/lymedisease. html? aitrk=HM 3&teng=go&geng=lyme&aeng=ly me 3&keng=lyme%20 disease&meng=p Lyme’s Disease: Supplements and More • The Healing Arts Partnership » http: //www. treatlyme. net/ American Lyme’s Disease Foundation » http: //www. aldf. com/lyme. shtml 15 CONFIDENTIAL

Reference 1. Center for Disease Control and Prevention. Morbidity and mortality weekly report. Retrieved from http: //www. cdc. gov/mmwr/preview/mmwrhtml/mm 5623 a 1. htm 2. Mc. Phee, S. , Maxine, A. , & Radow, M. (2011). Current medical diagnosis and treatment. Retrieved from http: //www. accessmedicine. com/content. aspx? a. ID=18802&search. Str=ly me+disease 3. Shapiro, E. (2011). Lyme disease: Clinical manifestations in children. Retrieved on October 16 th 2011 from http: //www. uptodate. com/contents/lyme-disease-clinical-manifestationsinchildren? source=search_result&search=lyme%27 s+disease&selected. Title =1%7 E 150 16 CONFIDENTIAL

Questions and answers 17 CONFIDENTIAL