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Alert Date: 
Friday, July 19, 2019 - 11:00am
Location: 
Windsor and Essex County

With the increase in outdoor activities related to the summer season, the Windsor-Essex County Health Unit (WECHU) would like to take this opportunity to share some new resources and information about Lyme disease to provide guidance when patients present with compatible risks and symptoms.

Lyme disease is a disease of public health significance, according to the Health Protection and Promotion Act, R.S.O., 1990.  All suspect and confirmed Lyme disease cases must be reported to the WECHU within one business day of identification.  Reporting forms are frequently updated to reflect current guidelines.  The most current version is available here.

LYME DISEASE IN WINDSOR AND ESSEX COUNTY

Public Health Ontario released an updated map for 2019 that identifies risk areas for blacklegged ticks in Ontario.  Windsor, Amherstburg, Lasalle, Harrow, and parts of Essex are included.

In 2018, there were 9 cases of Lyme disease (confirmed or probable cases) in Windsor and Essex County (WEC), corresponding to an incidence rate of 2.2 cases per 100,000 residents.  In Ontario, for the same period, there were 620 cases of Lyme disease corresponding to an incidence rate of 4.2 cases per 100,000 residents.  The incidence rate was not significantly different between Ontario and WEC.  It should be noted, however, that the three-year average incidence rate of Lyme disease in WEC increased by 25.9% from 2013-2015 to 2016-2018.  This may be due to a variety of factors including increased awareness, testing, and the expansion of the blacklegged tick population into more areas locally. 

MANAGEMENT OF TICK BITES AND INVESTIGATION OF EARLY LOCALIZED LYME DISEASE

Health Quality Ontario launched a Clinical Guidance Document to support clinicians should a client present with a tick exposure.  A copy is provided in this package for your reference. Clinicians are encouraged to refer to this clinical guidance document, which provides the most current information about testing and treatment. 

Key highlights include:

  • Advising asymptomatic clients with tick bites to monitor for signs and symptoms for 30 days.  Signs and symptoms compatible with early localized Lyme disease include erythema migrans (EM) or “bull’s eye” rash at bite site, fever, chills, malaise, headache, myalgia, neck stiffness, fatigue, lymphadenopathy, and arthralgia.
  • Considering post-exposure prophylaxis, consisting of a single dose of doxycycline, for asymptomatic clients with exposure in a risk or endemic area and had a tick attached for more than 24 hours and removed within the past 72 hours.  Continue to advise clients to monitor for signs and symptoms for 30 days.
  • When clinically warranted, treating without positive laboratory results.

PATIENT EDUCATION

  • Counsel patients regarding tick bite prevention measures, such as covering up, using insect repellents that contain DEET, and doing a full body check after potential exposure.
  • Counsel patients on how to safely remove ticks, and to remove as soon as possible.  Ticks are removed by a tick key or a pair of tweezers.
  • Inform clients that ticks removed from humans only can be submitted for testing to the Health Unit (to determine tick species and stage and if there is evidence of Borrelia burgdorferi, if applicable).  This service is available at both the Leamington and Windsor office.  The tick should be placed in a closed seal container or small plastic bag.

MORE INFORMATION

Our website (www.wechu.org) is a useful reference for health care providers.  For additional information or consultation, please call the Health Unit @ 519-258-2146 ext. 1420.

Additional Resources