Authors: Lola Stamm, Emeritus Professor, University of North Carolina, NC, USA
Take a look behind the scenes of a recent Future Microbiology editorial, entitled ‘Tick-borne diseases on the rise: an ounce of prevention is worth a pound of cure’, as we ask the author about the increasing prevalence of these diseases and what can be done to prevent them.
What inspired you to write this piece?
My interest in tick-borne diseases (TBDs) dovetails nicely with my public health background in emerging and re-emerging infectious diseases, but it was a lone star tick bite that led me to write about the rising incidence of TBDs.
What factors are contributing to rising numbers of TBDs?
Factors contributing to the increase in TBDs are complex. Due to environmental changes, some tick species that transmit TBDs are increasing their population density and expanding or reclaiming their geographic range, which enhances the possibility of contact with humans whose behaviors place them at risk for tick bite. Ticks need a suitable habitat for survival and reproduction. This includes wildlife hosts such as mice and deer that play an important role in the tick life cycle and can act as reservoirs for TBD agents.
Although many people associate ticks with rural environments, they may not think about exposure to ticks in suburban settings. Suburbanization can increase the risk of encountering ticks that transmit TBDs by creating fragmented landscapes that support ticks and their wildlife hosts. Because habitat fragmentation continues at a rapid pace, we need to better educate the public about how such changes can put humans at greater risk for encountering ticks that transmit TBD agents.
What current diagnostics are available for identifying TBDs?
Signs and symptoms of TBDs can be nonspecific and can vary from person to person, thus diagnosis of TBDs is mostly based on serologic tests, which detect antibodies present in blood to bacterial, viral or protozoal agents of TBDs. The usefulness of the serologic tests can be compromised by a variety of factors including timing of specimen collection, suboptimal sensitivity during early infection, inability to identify coinfections with more than one TBD agent, inability to detect novel TBD agents, and difficulty distinguishing acute from past infection. Additionally, some serologic tests that are positive for TBDs may remain positive after treatment and resolution of infection. For less common TBDs agents, molecular tests, such as PCR, may be necessary to identify the TBD agent and must be performed in specialized labs.
How can we prevent tick bites and consequential disease?
Tick bites can be prevented through the consistent use of personal protection measures. It is important to check skin, hair and clothing as soon as possible after spending time outdoors to enable early detection and removal of ticks to reduce the possibility of transmission of TBD agents. As recommended by the Centers of Disease Control and Prevention (GA, USA), the best way to prevent tick bites when entering tick-infested areas is to use a two-tiered strategy that includes applying an EPA-registered topical tick repellent to exposed skin and wearing protective clothing that has been treated with permethrin, which repels and kills ticks.
What are your predictions for next 10–15 years in this field? What do you hope to see?
For the foreseeable future, TBDs are likely to continue to increase. Prevention and management of TBDs are hampered by suboptimal diagnostic tests, limited treatment options for emerging viral TBD agents, lack of vaccines, and inadequate public engagement to improve TBD literacy. It is my hope that public health and biomedical research professionals will be able to obtain the resources needed to accelerate their efforts to address these challenges.
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