The tick population in Pennsylvania is plentiful and particularly poor this summer thanks to a mild winter and early spring.
Now there is concern among medical professionals that Lyme disease, which is transmitted by these black-legged ticks, is exploding in southwestern Pennsylvania.
Doctors diagnose thousands of Lyme disease cases in the state every year, and doctors at UPMC Children’s Hospital in Pittsburgh noted an alarming trend.
“In the mid-2000s, our department saw a dramatic increase in both the number of children with Lyme disease and questions about Lyme disease in children from local doctors,” said Dr. Andrew Nowalk, Associate Professor of Pediatrics and Clinical Director of Infectious Diseases at UPMC Children’s Hospital, Pittsburgh. “Our cases grew rapidly from single digits to hundreds of cases per year. We realized that we were in the middle of an epidemic. “
Nowalk said these cases were discovered at the children’s hospital because patients from across the western half of Pennsylvania were treated there, as opposed to adult patients who may have sought care closer to home.
“Our biggest learning point was that due to the unusual concentration of cases, a children’s hospital is more likely to discover an epidemic than a state health department or an adult hospital,” said Nowalk.
The case research of the children’s hospital from 2003-2013 revealed another interesting trend. As the cases started in more rural areas, they steadily spread to more urban zip codes, the research found.
“As doctors in the community got better at diagnosing early and mild cases, our cases got sicker and more complex over time,” Nowalk said. “We were surprised at the development over time from a rural epidemic to an epidemic concentrated in the Pittsburgh area.”
Lyme disease is caused by black-legged tick bites. A tick needs 36 to 48 hours to be attached to the disease, caused by a bacterium called Borrelia burgdorferi. Lyme disease can cause fever, fatigue, joint and muscle pain, inflammation, arthritis, and even facial paralysis if not treated with antibiotics.
The children’s hospital study looked at more than 700 patients with Lyme disease and found that doctors diagnosed 262 cases from the tell-tale rash that spreads over time. Blood tests confirmed the rest of the cases. Almost half of the patients were between 5 and 9 years old, with only a third reporting a history of a tick bite. The majority of cases were diagnosed in the spring and summer, and hospital admissions increased with the number of cases.
Analysis of patient zip codes showed a shift from rural to non-rural areas, including Allegheny Counties and Pittsburgh. Study results show that Lyme disease in the pediatric population of western Pennsylvania has increased exponentially over the past decade, with cases migrating southwest.
All patients studied were treated with antibiotics, which can be effective in fighting the disease when given within a reasonable time.
“Fortunately, children respond extremely well to antibiotics and the treatment clears the infection completely,” Nowalk said. “However, especially in older children and those who have been infected for a long time prior to diagnosis, symptoms may persist due to damage from infection – and these symptoms do not require further antibiotic administration, but can be very difficult to treat in many patients be.”
This means that most children treated with antibiotics shouldn’t have lasting effects into adulthood. All stages of Lyme disease in children and adults are similar, but doctors say there are some differences.
“Children are more likely to tolerate an infection without symptoms over a longer period of time,” said Nowalk. “Infections with neurological symptoms – weakness of the facial muscles, meningitis – are more common in children than in adults. We also see a number of children who have a fever with Lyme disease alone, which is less common than adults. It is important that the Lyme disease test is equally effective in children and adults. “
The easiest way to avoid Lyme disease is to avoid ticks.
“Late spring and early summer are the most risky seasons, although Lyme disease and tick bites can occur year-round when the weather is warm and people are in tick-infested areas,” Nowalk said.
Common sense measures make a world of difference. Parents should use DEET or permethrin-based insect repellant on clothing and be careful around tall grass and other places where ticks like to hop on hosts. Children should also wear long sleeves and pants if they are at risk from outdoor activities such as hiking, fishing, and playing in parks. Parents should also do a thorough visual inspection for ticks after being outdoors.