Impacts of misclassification on Lyme disease surveillance

In Maryland, Lyme disease (LD) is the most widely reported tickborne disease. All laboratories and healthcare providers are required to report LD cases to the local health department. Given the large volume of LD reports, the nuances of diagnosing and reporting LD, and the effort required for investigations by local health department staff, surveillance for LD is burdensome and subject to underreporting. To determine the degree to which misclassification occurs in Maryland, we reviewed medical records for a sample of LD reports from 2009. We characterized what proportion of suspected and “not a case” reports could be reclassified as confirmed or probable once additional information was obtained from medical record review, explored the reasons for misclassification, and determined multipliers for a more accurate number of LD cases. We reviewed medical records for reports originally classified as suspected (n = 44) and “not a case” (n = 92). Of these 136 records, 31 (23%) suspected cases and “not a case” reports were reclassified. We calculated multipliers and applied them to the case counts from 2009, and estimate an additional 269 confirmed and probable cases, a 13.3% increase. Reasons for misclassification fell into three general categories: lack of clinical or diagnostic information from the provider; surveillance process errors; and incomplete information provided on laboratory reports. These multipliers can be used to calculate a better approximation of the true number of LD cases in Maryland, but these multipliers only account for underreporting due to misclassification, and do not account for cases that are not reported at all (e.g., LD diagnoses based on erythema migrans alone that are not reported) or for cases that are not investigated. Knowing that misclassification of cases occurs during the existing LD surveillance process underscores the complexities of LD surveillance, which further reinforces the need to find alternative approaches to LD surveillance.     

锡林郭勒盟草原莱姆病疫源地调查

本项研究于2000年5月—2001年5月从内蒙古锡林郭勒盟地区，不同草原景现带牛、羊体表和草地采集草原血蝉1800只，用直接荧光抗体法检查蜱带菌情况，带菌率为7.5%(6/80)。晴视野显微镜检查蜱带菌情况，带菌率为2%（2/100）；用间接荧光法进行血清流行病学调查，结果证实，调查点的牛和野鼠均存在莱姆病螺旋体感染，其感染率分别为10%和20%，都高于当地人群平均感染率（7.09%)，上述研究证实内蒙古锡林郭勒盟地区人畜及野生动物均有莱姆病螺旋体感染。     

A suspected case of Lyme borreliosis in a hunting dog in Korea

A two-year-old male Pointer had been presented with anorexia, cachexia, and weight loss of 10-day duration. Upon physical examination, fever, lethargy, superficial lymph node enlargement, and tick infestation were noted. The only abnormality in CBC and serum chemistry analyses was mild hyperglobulinemia. Spleen was enlarged by radiography, and the lymph nodes showed neutrophilic lymphadenitis by cytological examination. A polymerase chain reaction test for babesiosis and commercial ELISA tests for Ehrlichia canis, heartworm, and Lyme disease was negative except for Lyme disease, which was verified by both an IFA-IgG test and a quantitative C₆ assay. Doxycycline was administered for 2 weeks and the recovery was uneventful. Post-treatment C₆ titer decreased to within normal limits.     

Estimating direct healthcare costs attributable to laboratory‐confirmed Lyme disease in Ontario,Canada: A population‐based matched cohort study using health administrative data

The objective of this study was to determine healthcare costs attributable to laboratory‐confirmed Lyme disease (LD) from the healthcare payer perspective in Ontario, Canada. A cost‐of‐illness study was conducted for incident LD subjects from 1 January 2006 through 31 December 2013 ascertained from provincial laboratory and reportable disease databases, linked to health administrative data. All LD subjects included were laboratory‐confirmed, according to provincial case definitions. Incident LD subjects were propensity‐score matched to uninfected subjects on age, sex, comorbidities and urban/rural status. We used phase‐of‐care methods to calculate attributable costs for two phases of illness: initial care (≤30 days following “index date”) and continuing care (>30 days after index date to the end of the follow‐up period). A total of 663 incident, confirmed LD subjects were identified from 2006 through 2013. Mean age was 44.2 ± 20.1 years; 339 (51.1%) were female; and 31 (4.7%) were hospitalized ≤30 days after index date. Six hundred fifty‐eight (99.2%) LD subjects were matched to uninfected subjects; mean follow‐up time was 3.3 years. Mean attributable costs per case during the initial care phase and continuing care were $277 (95% CI: $197, $357) and ?$5 (?$27, $17), respectively. Attributable costs per LD subject aged 5–14 years were $440 ($132, $747), greater than the costs observed for other age strata. Expected 1‐year attributable costs were $832, given continuing care costs were negligible. Limitations to our study include estimating costs using a cohort of only laboratory‐confirmed LD cases, introducing selection bias for diagnosed and treated patients who may have a lower risk of developing sequelae. In conclusion, the initial care phase of LD is associated with increased healthcare costs, but without significant costs attributable to LD infection after 30 days. Estimates of costs attributable to LD are important for healthcare resource prioritization and the evaluation of novel interventions.     

Knowledge and prevention of tickborne diseases among Hispanic and non‐Hispanic residents of Maryland and Virginia

Tickborne diseases (TBDs) such as Lyme disease (LD), babesiosis, ehrlichiosis and Rocky Mountain spotted fever cause substantial morbidity and even mortality in the USA. Data indicate that Hispanic populations may be at greater risk for occupational exposure to ticks and disseminated LD; however, information on knowledge and practices of Hispanic populations regarding TBDs is limited. We surveyed 153 Hispanic and 153 non‐Hispanic residents of Maryland and Virginia to assess awareness of TBDs, prevention practices and risk of tick encounters. Hispanic respondents were less likely than non‐Hispanics to report familiarity with LD symptoms (21% vs. 53%, p < 0.001) and correctly identify ticks as vectors of LD (40% vs. 85%, p < 0.001). Although there was no significant difference in overall proportion of respondents who routinely take one or more preventive measures to prevent tick bites (59% vs. 61%, p = 0.65), Hispanics were more likely to report showering after coming indoors (36% vs. 25%, p = 0.04) but less likely to conduct daily tick checks compared with non‐Hispanics (17% vs. 35%, p < 0.001). History of tick bite or finding a tick crawling on oneself or a household member in the past year did not significantly differ between Hispanics and non‐Hispanics (19% vs. 24%, p = 0.26). Notably, after controlling for Hispanic/non‐Hispanic ethnicity, primary language (English vs. Spanish) was a significant predictor of whether an individual had knowledge of LD symptoms, correctly identified ticks as vectors for LD and performed daily tick checks. These results provide guidance for future development of more targeted and effective TBD prevention education for both Hispanic and non‐Hispanic communities.     

雏鸡传染性法氏囊病的病因分析及综合防治

鸡传染性法氏囊病（IBD）一直是危害我国养鸡业最严重的传染病之一,能引起鸡的免疫机能障碍,形成免疫抑制,造成鸡体免疫系统瘫痪,使早期感染的雏鸡对多种疫病的敏感性增加,给养鸡业造成困扰和巨大的经济损失,因此在鸡生产中越来越受到重视。笔者介绍了IBD的发病原因,详细阐述了IBD的综合防治措施,供广大兽医工作者和养殖户提供参考。     

Epizootiologic background of dissimilar distribution of human cases of Lyme borreliosis and tick-borne encephalitis in a joint endemic area

Lyme borreliosis (LB) and tick-borne encephalitis (TBE) are co-endemic in some parts of Europe, however, their distribution differs despite a common tick vector and comparable animal hosts. A serosurvey of game and small mammals was made in a highly endemic area and compared with historical data in human cases; the epidemiologic risk and the population density of game were modelled using a geographic information system. While LB-risk corresponded with an overall population density of game (red deer, roe deer, mouflon, wild boar) regardless of mouse abundance, TBE-risk suggested a dependence on the abundance of mice on the one hand, and game, particularly roe deer, on the other. While the prevalence of TBE-antibodies generally grew with the game’s age, it was virtually constant at about 65% in LB irrespective of species. It implies a cumulation of scarce TBE-infection histories during the game’s lifetime, and thus a limited size of TBE-foci relative to the living space of these animals, as well as omnipresent LB-foci, in which the animals became continuously re-infected. More ecological prerequisites seem necessary to keep TBE circulating in nature which may be responsible for its confined distribution.     

上海地区野鸟中伯氏疏螺旋体和西尼罗病毒感染的血清学调查

于2005年从飞抵上海的12种候鸟和4种留鸟中采集208份血清样品,采用酶联荧光测定(ELFA)法和酶联免疫吸附试验(ELISA),分别对伯氏疏螺旋体和西尼罗病毒的感染状况进行了血清抗体调查,结果受检野鸟样品的检测结果均为阴性。     

Borrelia burgdorferi Infection and Lyme Disease in North American Horses: A Consensus Statement

Borrelia burgdorferi infection is common in horses living in Lyme endemic areas and the geographic range for exposure is increasing. Morbidity after B. burgdorferi infection in horses is unknown. Documented, naturally occurring syndromes attributed to B. burgdorferi infection in horses include neuroborreliosis, uveitis, and cutaneous pseudolymphoma. Although other clinical signs such as lameness and stiffness are reported in horses, these are often not well documented. Diagnosis of Lyme disease is based on exposure to B. burgdorferi, cytology or histopathology of infected fluid or tissue and antigen detection. Treatment of Lyme disease in horses is similar to treatment of humans or small animals but treatment success might not be the same because of species differences in antimicrobial bioavailability and duration of infection before initiation of treatment. There are no approved equine label Lyme vaccines but there is strong evidence that proper vaccination could prevent infection in horses.     

Epidemiological and Clinical Features of Three Clustered Cases Co‐Infected with Lyme Disease and Rickettsioses

Lyme disease and rickettsioses are two common diseases in China. However, the concomitant occurrence of both diseases in a single individual has been reported infrequently in literature. We reported three related female patients admitted at Beijing Ditan Hospital from October to December 2010. They had similar epidemiological histories. At the beginning, they only got a single diagnosis, respectively, but after specific screenings, the final diagnoses were made. Because arthropods can harbour more than one disease‐causing agent, patients can be infected with more than one pathogen at the same time, so the possibility of co‐infection could be higher than what was thought previously. These observations suggested that clinicians should enhance the complete screening of arthropod‐related infectious diseases so as to make an accurate diagnosis and to avoid diagnostic errors.     

猪口蹄疫的综合防控

口蹄疫是由口蹄疫病毒(Foot-and-mouth disease virus, FMDV)感染引起偶蹄动物共患的急性、热性、高度接触性传染病,最易感染的动物是黄牛、水牛、猪、骆驼、鹿、羊等;黄羊、麝、野猪、野牛等野生动物也易感染此病。世界动物卫生组织将其列为A类动物传染病,我国将其列为I类动物疫病。文章从口蹄疫病原的特性、流行病学、临床特征及病理变化等方面对口蹄疫的防控措施进行了总结、阐述。     

紫锥菊主要功能及其在鸡疾病防治上的研究进展

本文综述了紫锥菊的主要生物学功能及其在鸡疾病防治上的研究进展.     

莱姆病的现状及防治

莱姆病(lymedisease)亦称莱姆疏螺旋体病(lymeborreliosis),是20世纪70年代发现的以蜱作为传播媒介,由伯氏疏螺旋体(borreliaburgdorferi)感染所致的人畜共患传染病,其特征有慢性游走性红斑(ECA),同时伴随发热多汗、头疼、颈强直、肌疼、关节疼等症状。通过对该病的现状的分析,提出防治措施,开展有关疫苗的研究。     

对虾的免疫机制及其疾病预防策略的研究

在对虾的细胞免疫中血细胞是主要的作用因素,而体液免疫是血淋巴中的一些酶和调节因子,机体还可以被诱导产生特殊的免疫保护反应.应用免疫增强剂、疫苗和基因工程技术为预防对虾病害提供了有效的途径.本文根据国内外的有关资料,就对虾的免疫机制和疾病预防策略进行了综述.     

市级动物疫病防控信息化管理系统功能设计

我国动物疫病流行日趋复杂,而传统防控工作方式效率亟待提高。信息化能有效提高动物疫病防控管理工作效率,有利于对动物疫情的快速预警、反应、控制和溯源。本文介绍市级动物疫病防控信息化管理系统的功能设计,重点分析基础信息数据库、物资管理系统、动物疫病监测、疫情预警、疫情调查处置等功能模块,形成市级动物疫病防控大数据和网络化管理平台,实现动物防疫场点、人员、疫苗、物资和工作抽查等网络化管理,为动物疫病防控行政决策提供技术支持,切实提高基层防疫工作效率。     

本地山羊混合感染捻转血矛线虫病与疥癣病防治

自2017年起,怀化市麻阳县某私人羊场山羊陆续出现一种脱毛皮肤病,用了一些药物效果不佳,严重时甚至出现死亡。2018年笔者受邀进行诊治,根据病羊的临床症状和实验室检查诊断为羊捻转血矛线虫病与羊疥癣寄生虫病,通过采取综合防治措施,取得了明显疗效。     

禁抗时代规模猪场如何做好疾病预防

抗生素的发现和使用,促进了畜牧产业的发展,但是,随着养殖业发展,抗生素滥用现象普遍,养殖场动物耐药性越来越严重,同时也危害着肉食品安全,以及人类的健康。对此农业农村部宣布饲料无抗替抗,科学防控、科学保健,因此禁抗时代规模猪场如何做好疾病预防,成为禁抗后时代保障养殖禁抗的焦点。