www.borelioza-forum.pl

Lyme disease and tick attachment duration

http://www.geocities.com/HotSprings/Oas ... chment.txt


*************************************************************
as of 4 July 2000
The issue:
---------

How long must a tick that is infected with the Lyme disease bacteria be
attached to a person before the bacteria is transmitted to the person?

Summary of "answers" from the references below:
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"as soon as they bite"
three hours
a few hours
several hours
after only 6 hours
after 8 hours
many hours
12-24 hours
16-24 hours
18-49 hours
less than 24 hours
as early as 24 hours
at least 24 hours
24 hours
more than 24 hours
24-48 hours
36 hours
36-24 hours
36-48 hours
42 hours
48 hours/2 days
after 48 hours
72 hours
greater than or equal to 72 hours
some days


Medical Abstracts:
-------------------------------------------------------------------------

[several hours]
TITLE: [The principal arthropod vectors of disease. What are the risks
of travellers' to be bitten? To be infected?]
VERNACULAR TITLE:
Les principaux arthropodes vecteurs de maladies. Quels risques pour le
voyageur d'etre pique? D'etre contamine?
AUTHOR: Coosemans M; Van Gompel A
AUTHOR AFFILIATION:
Institut de medecine tropicale Prince Leopold, Anvers, Belgique.
ABSTRACT:
Many blood-sucking arthropods are potential vectors of disease. To
become a vector, the arthropod must be susceptible to the infective
agent and must survive the incubation period so as to transmit the
pathogens to a host. While some arthropod associated diseases affect
only man (e.g. malaria) most of these diseases are (anthropo-)
zoonoses with man often an accidental host. The risk of contamination
depends on the one hand on the biting behaviour of the vector, its
biology and distribution, and on the other hand on the sites visited
by the traveller, the length of his stay, his activities, the
conditions of sleeping accommodation. The risk of contracting malaria
is very high in tropical Africa, in the forest area of South America
and South East Asia, in Papua New Guinea. Malaria can be prevented if
measures (e.g. pyrethroid impregnated bed nets, repellents) are taken
to avoid bites of Anopheline mosquitoes between sunset and sunrise,
but appropriate chemoprophylaxis must not be neglected. Lethal cases
of yellow fever among unvaccinated travellers still occur despite a
strict international regulation on vaccination requirements. Dengue
is a major health problem in intertropical areas. As no vaccine is
available, personal protection measures are recommended against
daytime-biting mosquitoes, including the use of protective clothing,
repellents. Other arthropod borne diseases among travellers are less
common but the risks increase during adventure trips (e.g. zoonotic
leishmaniasis, tick-borne relapsing fever) and humanitarian actions
(e.g. risk of louse-borne typhus during visits of overcrowded
prisons). Tick-borne diseases receive nowadays more attention. These
diseases are not only restricted to some occupations (farmers,
veterinarians) but also ramblers and campers are at risk. Attached
ticks should be removed rapidly and carefully, since several hours of
attachment are needed for transmission of spirochetes of LYME
disease.
NLM PUBMED CIT. ID: 10078389 NLM CIT. ID: 99178115
SOURCE: Bull Soc Pathol Exot 1998;91(5 Pt 1-2):467-73

http://www.ncbi.nlm.nih.gov:80/entrez/q ... t=Abstract

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[72 hours]
TITLE: Duration of tick attachment as a predictor of the risk of Lyme
disease in an area in which Lyme disease is endemic.
AUTHOR: Sood SK; Salzman MB; Johnson BJ; Happ CM; Feig K
Carmody L; Rubin LG; Hilton E; Piesman J
AUTHOR AFFILIATION:
Department of Medicine, Long Island Jewish Medical Center and Albert
Einstein College of Medicine, New Hyde Park, New York, USA.
ABSTRACT:
Animal studies have shown an exponential increase in the risk of
Borrelia burgdorferi infection after 48-72 h of deer tick attachment.
Persons with tick bites were prospectively studied to determine if
those with prolonged tick attachment constitute a high-risk group for
infection. Ticks were identified, measured for engorgement, and
assayed by polymerase chain reaction (PCR) for B. burgdorferi DNA.
Duration of attachment was determined from the scutal index of
engorgement. Of 316 submissions, 229 were deer ticks; 14% were
positive by PCR. Paired sera and an intact tick for determination of
duration of attachment were available for 105 subjects (109 bites).
There were 4 human cases (3.7% of bites) of B. burgdorferi infection.
The incidence was significantly higher for duration of attachment
> or =72 h than for <72 h: 3 (20%) of 15 vs. 1 (1.1%) of 94 (P
= .008; odds ratio, 23.3; 95% confidence interval, 2.2-242). PCR was
an unreliable predictor of infection. Tick identification and
measurement of engorgement can be used to identify a small, high-risk
subset of persons who may benefit from antibiotic prophylaxis.
NLM PUBMED CIT. ID: 9086168 NLM CIT. ID: 97240708
SOURCE: J Infect Dis 1997 Apr;175(4):996-9

http://www.ncbi.nlm.nih.gov:80/entrez/q ... t=Abstract

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[less than 24 hours]
TITLE: Unusual features in the epidemiology of Lyme borreliosis.
AUTHOR: Angelov L
AUTHOR AFFILIATION:
Medical University, Plovdiv, Bulgaria.
ABSTRACT:
In this study two cases of Lyme borreliosis are presented. First, the
author describes how he contracted Lyme borreliosis 24 hours after he
visited an endemic area. The second case described is that of a woman
who developed Lyme borreliosis symptoms, when intestinal content of
an infected tick came into contact with her conjunctiva. In both
cases the diagnosis is based on clinical picture and positive
serological tests. The first case shows the probability of
contracting Lyme borreliosis when the duration of the tick's
attachment to the skin is less than 24 hours. The second case,
described demonstrates transmission of B. burgdorferi by contact.
NLM PUBMED CIT. ID: 8817171 NLM CIT. ID: 96414111
SOURCE: Eur J Epidemiol 1996 Feb;12(1):9-11

http://www.ncbi.nlm.nih.gov:80/entrez/q ... t=Abstract

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[after 48 hours]
TITLE: Duration of tick bites in a Lyme disease-endemic area.
AUTHOR: Falco RC; Fish D; Piesman J
AUTHOR AFFILIATION:
Vector Ecology Laboratory, Calder Ecology Center, Fordham University,
Armonk, NY 10504, USA.
ABSTRACT:
Regression equations, based on scutal index (body length/scutal
width), were developed to determine the duration of attachment for
nymphal and adult female lxodes scapularis ticks. Feeding times were
calculated for 444 nymphal and 300 female ticks submitted by bite
victims between 1985 and 1989 in Westchester County, New York, an
area where Lyme disease is highly endemic. Nymphs were attached for a
mean of 34.7 hours, with 26.8% removed after 48 hours, the critical
time for transmission of Borrelia burgdorferi. Attachment times
increased with victim age class (Kruskal-Wallis test, p < 0.05).
Mean duration of attachment for female ticks (28.7 hours) was
significantly less (Kruskal-Wallis test, p < 0.05) than that for
nymphs, with 23.3% attached for more than 48 hours. The 0- to 9-year
age class had the highest proportion (37.1%) of females attached for
more than 48 hours. Nymphs remain attached to adult tick-bite victims
longer than they remain attached to children. However, children have
a high risk of acquiring Lyme disease because they receive more
nymphal bites and also because they are less likely to have female
ticks removed in time to prevent transmission.
NLM PUBMED CIT. ID: 8546120 NLM CIT. ID: 96138331
SOURCE: Am J Epidemiol 1996 Jan 15;143(2):187-92

http://www.ncbi.nlm.nih.gov:80/entrez/q ... t=Abstract

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[8 hours after attachment]
TITLE: Differential spirochetal infectivities to vector ticks of mice
chronically infected by the agent of Lyme disease.
AUTHOR: Shih CM; Liu LP; Spielman A
AUTHOR AFFILIATION:
Department of Parasitology and Tropical Medicine, National Defense
Medical Center, Taipei, Taiwan, Republic of China.
ABSTRACT:
We determined whether the infectivity of the Lyme disease spirochete
(Borrelia burgdorferi) to vector ticks varies with the duration of
infection in laboratory mice. Thus, noninfected nymphal deer ticks
were permitted to feed on two strains of early (2 months after
infection) and late (8 months after infection) spirochete-infected
mice. The attached ticks were removed from their hosts at specified
time intervals and were thereafter examined for spirochetes by direct
immunofluorescence microscopy. Spirochetes can be acquired by nymphal
ticks as fast as 8 h after attachment. More than 80% of the attached
ticks acquired spirochetal infection within 48 h after feeding on
early spirochete-infected mice. In contrast, spirochetal infectivity
to ticks was less than 50% after feeding on late spirochete-infected
mice. The overall infectivity of spirochete-infected mice to ticks
correlated with the duration of tick attachment. In addition, there
was no adverse effect on the spirochetal infectivity to ticks by high
levels of host antibody against spirochetes, and no obvious
differences in infectivity to ticks was observed by the site of tick
feeding. We conclude that the span of spirochetal infectivity to
ticks varies with the duration of infection in mice and suggest that
spirochetes may persist and may be evenly distributed in the skin of
infected hosts, regardless of prominent host immunity.
NLM PUBMED CIT. ID: 8586694 NLM CIT. ID: 96156120
SOURCE: J Clin Microbiol 1995 Dec;33(12):3164-8

http://www.ncbi.nlm.nih.gov:80/entrez/q ... t=Abstract

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[24 hours]
TITLE: Cultivation of Borrelia burgdorferi from human tick bite sites:
a guide to the risk of infection.
AUTHOR: Berger BW; Johnson RC; Kodner C; Coleman L
AUTHOR AFFILIATION:
Department of Dermatology, State University of New York at Stony Brook.
ABSTRACT:
BACKGROUND: The risk of acquiring Lyme disease has been evaluated by
xenodiagnostic procedures with laboratory strains of Borrelia
burgdorferi and laboratory-reared Ixodes ticks, or by clinical trials
in which diagnosis was based on clinical findings, culture, or
serologic tests. OBJECTIVE: Our purpose was to determine the risk of
infection from tick bites in a natural setting in which wild strains
of B. burgdorferi were involved, by a biopsy culture technique.
METHODS: Skin biopsy specimens were obtained from Ixodes scapularis
tick bite sites, processed, and examined for the presence of B.
burgdorferi. RESULTS: B. burgdorferi was cultivated from only 2 of 48
skin biopsy specimens. In both instances duration of tick attachment
was approximately 24 hours. CONCLUSION: In a hyperendemic region for
Lyme disease the risk of infection after a deer tick bite appears to
be low, particularly if the tick has been attached for less than 24
hours.
NLM PUBMED CIT. ID: 7829700 NLM CIT. ID: 95130771
SOURCE: J Am Acad Dermatol 1995 Feb;32(2 Pt 1):184-7

http://www.ncbi.nlm.nih.gov:80/entrez/q ... t=Abstract

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[more than 24 hours]
TITLE: Prevention of Lyme disease.
AUTHOR: Couch P; Johnson CE
AUTHOR AFFILIATION:
College of Pharmacy, University of Michigan (UM), Ann Arbor.
ABSTRACT:
Lyme disease and the use of tick repellents and physical protective
measures to prevent the disease are discussed. Lyme disease is a
multiple-organ-system, immune-mediated inflammatory disorder
transmitted by the bites of ixodid ticks infected with Borrelia
burgdorferi. An individual is at greatest risk for infection when a
tick has been attached to the skin for more than 24 hours. Lyme
disease occurs in three stages and may affect the skin, nervous
system, cardiac system, and joints. Antimicrobials used in management
consist primarily of penicillins, cephalosporins, tetracyclines, and
erythromycin. Tick repellents are divided into those applied to the
skin and those applied to clothing. Skin repellents include
N,N-diethyl-meta-toluamide (DEET), 2-ethyl-1,3-hexanediol, and
dimethyl phthalate. Permethrin is by far the most effective clothing
repellent. DEET plus a permethrin-containing clothing repellent
offers the best overall protection. The adverse effects of repellents
are minimal, but cases of hypersensitivity have been reported,
especially in children. Physical measures to prevent tick bites
include avoiding tick-infested areas, wearing light-colored clothing
for easy identification of crawling ticks, regularly checking the
body and pets for ticks, wearing protective garments and closed-toed
shoes, and removing attached ticks promptly by using tweezers or
forceps to apply a steady upward pull. A vaccine for the active
immunization of humans against Lyme disease remains to be developed.
Although antimicrobial therapy is available for persons with Lyme
disease, the best approach for those who may be exposed to infected
ticks is to apply topical skin or clothing repellents and to practice
common-sense measures of physical protection.
NLM PUBMED CIT. ID: 1595748 NLM CIT. ID: 92280866
SOURCE: Am J Hosp Pharm 1992 May;49(5):1164-73

http://www.ncbi.nlm.nih.gov:80/entrez/q ... t=Abstract

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[48 hours]
TITLE: Duration of adult female Ixodes dammini attachment and
transmission of Borrelia burgdorferi, with description of a needle
aspiration isolation method.
AUTHOR: Piesman J; Maupin GO; Campos EG; Happ CM
AUTHOR AFFILIATION:
Division of Vector-Borne Infectious Diseases, Centers for Disease
Control, Ft. Collins, CO 80522.
ABSTRACT:
The relationship between the attachment duration of adult female
Ixodes dammini and the transmission of Borrelia burgdorferi was
studied. Sixteen rabbits were exposed to spirochete-infected female
ticks for specified intervals. All five rabbits exposed to ticks that
fed to repletion (greater than 120 h) became infected, as did two of
three exposed for 48 h. In contrast, five rabbits exposed to a
cumulative total of 53 infected female I. dammini for 36 h failed to
become infected, as did three rabbits exposed for 24 h. A needle
aspirate method facilitated the isolation of spirochetes from host
skin.
NLM PUBMED CIT. ID: 2010643 NLM CIT. ID: 91185898
SOURCE: J Infect Dis 1991 Apr;163(4):895-7

http://www.ncbi.nlm.nih.gov:80/entrez/q ... t=Abstract

-----
[must attach for 2 days...]
TITLE: Prospects for suppressing transmission of Lyme disease.
AUTHOR: Spielman A
AUTHOR AFFILIATION:
Department of Tropical Public Health, Harvard School of Public Health,
Boston, Massachusetts 02115.
ABSTRACT:
A variety of methods have been developed to prevent human infection by
the Lyme disease spirochete in the northeastern United States, mainly
based on the observations that nymphal Ixodes dammini serve as
vector, that deer serve as hosts for the reproductive stage of this
tick, that white-footed mice serve as the reservoir of infection, and
that nymphs are most abundant in early summer and must attach for 2
days before infection is transmitted. Methods for personal protection
included seasonal avoidance of infested sites, the use of repellants,
and prompt removal of attached ticks. Destruction of mouse habitat,
but not of mice, was locally effective. Nondestructive acaricidal
treatment of deer proved ineffective, but the elimination of these
hosts resulted in reduced transmission after several years. Treatment
of mice by means of acaricide-impregnated bedding material
effectively reduced transmission.
NLM PUBMED CIT. ID: 3190093 NLM CIT. ID: 89048794
SOURCE: Ann N Y Acad Sci 1988;539:212-20

http://www.ncbi.nlm.nih.gov:80/entrez/q ... t=Abstract

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[as early as 24 hours]
TITLE: Duration of tick attachment and Borrelia burgdorferi transmission.
AUTHOR: Piesman J; Mather TN; Sinsky RJ; Spielman A
ABSTRACT:
Nymphal Ixodes dammini transmitted Borrelia burgdorferi to 1 of 14
rodents exposed for 24 h, 5 of 14 rodents exposed for 48 h, and 13 of
14 rodents exposed for greater than or equal to 72 h. Prompt removal
of attached ticks is a prudent public health measure, especially in
regions where Lyme disease is endemic.
NLM PUBMED CIT. ID: 3571459 NLM CIT. ID: 87195350
SOURCE: J Clin Microbiol 1987 Mar;25(3):557-8

http://www.ncbi.nlm.nih.gov:80/entrez/q ... t=Abstract


-------------------------------------
Other medical or scientific information:

Title:Disseminated Lyme disease after short-duration tick bite
Authors:Patmas MA, Remorca C
Source:JSTD 1994; 1:77-78

Abstract:
Lyme disease, an Ixodes tick-borne spirochetal infection, has been the
subject of much controversy. One problematic area has been the
prophylactic treatment of deer-tick bites in endemic areas. Some have
argued against routine antimicrobial prophylaxis based upon the belief
that transmission of Borrelia burgdorferi is unlikely before 24-48 hours
of tick attachment. Others have suggested that it is cost effective to
administer prophylactic antibiotics against Lyme disease when embedded
deer-tick bites occur in endemic areas. Herein, a case of disseminated
Lyme disease after only 6 hours of tick attachment is presented. The
current recommendation against treatment of short-duration tick bites
may need reconsideration, particularly in hyperendemic areas. Color
pictures.

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While it is true that it takes the spirochete some time to travel to the
salivary glands from the tick's midgut where it resides, at the Lyme
Conference, Willy Burgdorfer described a study in which they found 5 to
10 percent of ticks already have the spirochete in their salivary
glands. That means they transmit the disease as soon as they bite..

"written by an attendee at Lyme Conference at Bard College, Fall 1999."

-----

======================================
Other considerations:

Cutting away the skin within two days:

TITLE: Delayed dissemination of Lyme disease spirochetes from the site
of deposition in the skin of mice.
AUTHOR: Shih CM; Pollack RJ; Telford SR 3d; Spielman A
AUTHOR AFFILIATION:
Department of Tropical Public Health, Harvard School of Public Health,
Boston, Massachusetts 02115.
ABSTRACT:
To determine whether the agent of Lyme disease disseminates in
vertebrate hosts directly after deposition by an infecting tick, a
6-mm disk of skin was excised from the sites where nymphal Ixodes
dammini ticks infected by Lyme disease spirochetes, Borrelia
burgdorferi, had fed. Infection in each mouse was tested by examining
xenodiagnostic ticks that had engorged on these mice 4 weeks later
and by serologic testing. Generalized infection was aborted when the
site of inoculation was excised within 2 days after the infecting
tick detached but not after 2 weeks. In contrast, all mice became
infected when the bite site remained intact. Spirochetes could be
cultured from the tissues around the site of attachment solely when
the sample was ablated within a week after infecting ticks detached.
These observations suggest that infecting ticks deliver the agent of
Lyme disease directly into the skin and that such spirochetes
multiply locally for some days before disseminating to remote sites.
NLM PUBMED CIT. ID: 1527418 NLM CIT. ID: 92407384
SOURCE: J Infect Dis 1992 Oct;166(4):827-31

http://www.ncbi.nlm.nih.gov:80/entrez/q ... t=Abstract

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Cement plug issue:

TITLE: Preliminary studies on virus and spirochete accumulation in the
cement plug of ixodid ticks.
AUTHOR: Alekseev AN; Burenkova LA; Vasilieva IS; Dubinina HV
Chunikhin SP
AUTHOR AFFILIATION:
Zoological Institute, Russian Academy of Sciences, St Petersburg,
Russia. ana@21sp.spb.su
ABSTRACT:
We provide evidence that tick-borne encephalitis virus and Borrelia
burgdorferi s.l. are accumulated in the cement plug in the host skin
within the first few hours after tick attachment. Extirpation of the
tick without the cement plug, even very soon after the attachment,
did not prevent the transmission by Ixodes ricinus, Ixodes
persulcatus or Dermacentor reticulatus to mice. This was within 1
hour in the case of the TBE virus and after 20-22 h of attachment, in
the case of Borrelia and I. persulcatus. The epidemiological
significance of these findings is discussed.
NLM PUBMED CIT. ID: 9004495 NLM CIT. ID: 97158223
SOURCE: Exp Appl Acarol 1996 Dec;20(12):713-23

http://www.ncbi.nlm.nih.gov:80/entrez/q ... t=Abstract

----------------------

Government Fact Sheets

Federal government web sites:
-------------------------------------------------------------------------
National Institutes of Health
National Institute of Allergy and Infectious Diseases

TICK- BORNE DISEASES: AN OVERVIEW FOR PHYSICIANS

"The Lyme disease bacterium is transmitted primarily by the tiny deer
tick, after it has been attached to the host for more than 24 hours."

NIAID, a component of the National Institutes of Health, supports
research on AIDS, tuberculosis and other infectious diseases as well as
allergies and immunology.

Prepared by:
Office of Communications
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892

Public Health Service
U.S. Department of Health and Human Services
June 1996

See entire fact sheet at:
http://www.niaid.nih.gov/factsheets/tickborn.htm

-----
Lyme Disease
The Facts, The Challenge

"NIH supported researchers suggest that a tick must be attached for many
hours to transmit the Lyme disease bacterium, so prompt tick removal
could prevent the disease."

U.S. Department of Health and Human Services
Public Health Service
National Institutes of Health

NIH Publication No. 92-3193
April 1992

See entire fact sheet at:
http://www.nih.gov/niams/healthinfo/lyme/

-----
Division of Vector-Borne Infectious Diseases
National Center for Infectious Diseases
Centers for Disease Control and Prevention

"Early removal of attached ticks is especially important as transmission
is inefficient before 36 hours of tick attachment."

Centers for Disease Control and Prevention, Division of Vector-Borne
Infectious Diseases, Rampart Road, Colorado State University Foothills
Research Campus, P.O. Box 2087, Fort Collins, Colorado 80522, USA;
telephone: (970)221-6400; fax: (970)221-6476

Maintained by jxh7
Latest update: August 1996

See front page at:
http://www.cdc.gov/ncidod/dvbid/dvbid.htm
See complete article at:
http://www.cdc.gov/ncidod/diseases/lyme/lymegen.htm

-----
US ARMY CENTER FOR HEALTH PROMOTION AND PREVENTIVE MEDICINE

USACHPPM ENTOMOLOGY

"Animal studies suggest that Ixodes ticks may not efficiently transmit
infection until after 48 hours and that prompt removal of attached ticks
may limit transmission. It is not precisely known how long a tick must
remain attached to humans before infection occurs, but it is believed to
probably be a similar time period."

See entire article at:
http://chppm-www.apgea.army.mil/ento/TICKS.HTM

-----
Navy Health Book

Lyme Disease Warning

HM2 James Grubb, USN, NAVHOSP Charleston, May 23, 1996
Peer Review Status: Not Peer Reviewed

In order to transmit the disease, the tick needs to be attached for at
least several hours.

http://www.vnh.org/NHB/HW9620Lyme.html


----------------------

State government web sites:
-------------------------------------------------------------------------
California Department of Health Services
Centers for Disease Control and Prevention
Disease Fact Sheets J through L

Lyme Disease
(tick-borne borreliosis, Lyme arthritis)

If removal occurs within three hours of attachment, the risk of tick-
borne infection is reduced.

See entire fact sheet at:
http://www.dhs.cahwnet.gov/disease/disease5.htm

-----
Public Health Fact Sheet
Lyme Disease

The tick must be attached for at least 24 hours to pass on the bacteria,
so removing the tick promptly will cut down your chances of being
infected.

Massachusetts Department of Public Health
Updated May 1996

http://www.magnet.state.ma.us/dph/lymefact.htm

-----
From the Marin/Sonoma [California] Mosquito & Vector Control District
web page:

Featured Diseases
3. LYME DISEASE

Infected ticks usually do not transmit the Lyme organism during the
first 24 hours, and the risk of infection increases the longer the tick
remains attached.

Updated October 27, 1997

See entire web page at:
http://www.sonic.net/~msmvcd/lymedis.html

-----
Minnesota Department of Health

Disease Prevention and Control
Acute Disease Prevention Services (ADPS)
Lyme Disease Slide Script

If the deer tick is infected, it must be attached for 24-48 hours before
it transmits the bacteria.

http://www.health.state.mn.us/divs/dpc/ ... slides.htm

Disease Prevention and Control
Acute Disease Prevention Services (ADPS)
FACT SHEET: TICK-BORNE DISEASES

"...if a deer tick is infected, it must be attached for at least 24
hours before it can transmit the bacteria."

http://www.health.state.mn.us/divs/dpc/adps/fctstly.htm

Disease Prevention and Control
Acute Disease Prevention Services (ADPS)
Lyme Disease Guidelines for Minnesota Clinicians: Epidemiology,
Microbiology, Diagnosis, Treatment and Prevention
September 1995

Animal studies indicate that the deer tick needs to be attached for 24
hours or more before transmission of B. burgdorferi occurs.

http://www.health.state.mn.us/divs/dpc/ ... idline.htm

Office of the Governor Press Releases 1997
June 6, 1997
Governor Pataki Encourages New Yorkers to Guard Against Lyme Disease

An infected tick usually must be attached for at least 24 hours to
cause illness.

See entire news release at:
http://www.state.ny.us/governor/press/june6_97.html

----------------------

Other government web sites:
-------------------------------------------------------------------------

Berkeley Lab Currents

February 21, 1997

Currents is Berkeley Lab's biweekly employee newspaper published by the
Lab's Public Information Department,

The risk to people is relatively low as long as you are aware of the
proper methods to avoid tick bites, and promptly remove any ticks that
may have attached. Research shows that it usually takes 12 to 24 hours
for the bacteria that cause Lyme disease to be transmitted.

http://www.lbl.gov/Publications/Current ... -1997.html

----------------------

Health maintenance organization web sites:
-------------------------------------------------------------------------
From the MultiPlan web site:

"MultiPlan is also affiliated with several organizations — CareAway USA,
HNDI, Preferred Plan and Olympus — that complement and strengthen
MultiPlan's portfolio of services."

See the entire "about MultiPlan" web page at:
http://www.multiplan.com/about/

General Facts About Lyme Disease and its Transmission

If you remove a tick before it has been attached for more
than 24 hours, you greatly reduce your risk of infection.
SOURCE: Centers for Disease Control
1998

See entire fact sheet at
http://www.multiplan.com/healthwell/wellness/lyme.html

-----
From the Harvard Pilgrim Health Care [Massachusetts] web site:

Health Information

What You Should Know About Lyme Disease
Caution - not panic- is the right prescription

Lyme disease is not transmitted immediately upon being bitten.
In fact, new studies indicate that, generally, the tick needs
to feed- be attached to the skin- for between 24 and 48 hours
before a person becomes infected.

http://www.harvardpilgrim.org/html/your ... 6/lyme.htm

-----
From the Physicians Plus Medical Group, Madison, Wisconsin:

Common Health Concern - First Aid and Home Care

Insect Bites

Physicians Plus Health Education

To prevent Lyme disease, remove ticks promptly. A "grace period" of 24
hours exists between the attachment of the tick and its injection of
disease into your body.

http://www.pplusmeriter.com/living/libr ... insect.htm

----------------------

University web sites:
-------------------------------------------------------------------------
The University of Iowa Department of Family Practice
2141 Steindler Building
Iowa City, Iowa 52242
(319)-335-8466, Fax (319)-338-8302

How long must a tick be attached before I am at risk for a tick related
illness such as Lyme disease?

The tick generally has to be attached for more than 24 hours before
there is a risk of spreading Lyme disease or other illness.

mgraber@blue.weeg.uiowa.edu/last update February 16th, 1996

See entire article at:
http://www.uiowa.edu/~famprac/lyme.htm

-----
Urban Integrated Pest Management
North Carolina Cooperative Service
College of Agriculture and Life Sciences
North Carolina Sate University

Ticks

"The minimum attachment time required for transmission of Lyme disease
spirochete is not yet known."

Last Modified: 07/10/96

See the entire web page at:
http://ipmwww.ncsu.edu/urban/cropsci/c1 ... ticks.html

-----
University of Maine Cooperative Extension

"...a tick must remain attached to the host for at least 24 hours in
order to infect the host."

http://pmo.umext.maine.edu/factsht/ticks95.htm

-----
From Mercer University Biology website:

TICKS and TICK-BORNE DISEASES
Last revised: 04/08/97

"Both infections can be treated with antibiotics if detected in their
early stages. Lyme disease is the more manageable of the two since only
about 1% of tick bites typically result in infection. An article in the
September 1994 Scientific American also says the tick must be attached
for 36 to 48 hours in order to transmit an infecting dose of the
microbe. Much less is known about ehrlichiosis."

See entire page at:
http://bio-oak.mercer.peachnet.edu/tick.html

-----
Epizootiology of Lyme Disease

"Apparently, a minimum of 24 hours of tick attachment is required for
spirochete transmission."

This site maintained by The Rhode Island Tick Pickers. The Tick Research
Laboratory is located within the Biological Sciences Department,
University of Rhode Island,100 Flagg Road, Kingston, RI 02881-0816. We
can be reached via telephone (401-874-2650), Fax (401-874-4256), or
E-mail (ticklab@uriacc.uri.edu).

See entire page at:
http://www.uri.edu/artsci/zool/ticklab/Lyme4.html

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From the University of Wisconsin Cooperative Extension web site

INFOSOURCE 864
HEADING: GARDEN & LANDSCAPE
SUBHEADING: CONTROLLING NUISANCE INSECTS

TITLE: LYME DISEASE & DEER TICKS
SPECIALIST OR AUTHOR: PELLITTERI
AREA: AGRICULTURE (horticulture)
INTRO TO INFOSOURCE: 1990
LAST REVIEWED: 1996, PELLITTERI
REVISED: 1993

"...it will take between 18 and 49 hours after it attaches to its host
for the tick to transmit the disease."

See entire article at:
http://www.uwex.edu/disted/infosrce/864.htm

----------------------

Lyme disease organizations web sites:
-------------------------------------------------------------------------
From American Lyme Disease Foundation (ALDF) Inc. web page:

A Homeowner's Guide to the Ecology and Environmental Management of
Lyme Disease

"Because it takes 24-48 hours for a feeding tick to transmit the Lyme
disease bacteria, examine yourself and your children while outdoors,
when you get home, and again at night."

The World Square is a trademark of: World Square Corp.
copyright &copy; 1995 World Square Corp.
Most recent update: 7/28/95

See entire guide at:
http://www.w2.com/docs2/d5/lyme1.html

-----
From the Lyme Disease Center For South Jersey web site:

MODERN MEDICINE

There is no standard approach to Lyme disease:
Your management must be individualized

PHILIP W. PAPARONE. DO

Until the treatment of asymp somatic patients is better understood. The
common practice of antibiotic prophylaxis should be discouraged.

Infection is not necessarily a consequence of either an ixodid tick bite
or an embedded ixodid tick Ticks promptly removed within a few hours of
attachment usually do not effect transmission of the disease. The
findings of one animal study suggest that ticks ma not effectively
transmit infection until after 24 to 48 hours of attachment to the
host.13 This time frame however can be variable and may be limited to 16
to 24 hours.

There is a consensus among physicians who practice in Lyme disease
territories that although nymphs need to be embedded for at least 1 to 2
days in order to transmit infection. adult ticks can transmit infection
in muchless time. Minimizing need for antibiotic prophylaxis. the point
has been made that to treat all people with suspicious bites makes no
better sense than to treat all children all winter in an attempt to
prevent acute rheumatic fever.14

13.Piesman J. Mather TN, Sinsky RJ, Spiel man A. Duration of tick
attachment and Borrelia burgorferi transmission. J Clin Micrbiol
1987:25:557-8.

14.Buebendorf DP. Goff CW. Burke KR. Practicing in Lyme disease
territory (letter). Conn Med 1989:53:375.

See entrie page at:
http://www.njlyme.com/mmld.htm

-----
LYME DISEASE CENTER OF SOUTH JERSEY

Philip Paparone. D.O.
Recommended Procedure for Tick Removal
County Service

Hunterdon County Health Department officials had considered offering a
tick-testing service to county residents but decided against the idea
because testing ticks "is not as straightforward as it might initially
seem," said John Beckley, MPH, the department's director.

Even ticks carrying the Lyme bacterium transmit infection in only a
fraction of cases, he said. The period of attachment is really a very
important factor in determining your relative risk of infection
from known tick exposure, Beckley said. Studies show that infected ticks
must be attached for 24 hours or more. Therefore, prompt detection
can prevent transmission even when the tick is infected.

See entire article:
http://www.njlyme.com/tickr1.htm

----------------------

Miscellaneous health web sites:
-------------------------------------------------------------------------
Lyme Disease

LYME DISEASE FACT SHEET

Prepared by
Elise Taylor
and
Allen C. Steere

[Image]
Deer Tick magnified X75

Lyme Disease Research Center
New England Medical Center

750 Washington Street, NEMC 406 Boston, MA 02111
Telephone: (617)636-7772
Revised January 1995

Do you recommend treatment for tick bite?
The risk of Lyme disease following a recognized tick bite is small if
the tick is promptly removed. In animal studies, the tick must usually
be attached for at least 24 hours before the spirochete is transmitted.
We normally advise a watchful "wait and see" rather than immediate
treatment for tick bites. However, if the tick has been attached long
enough to become engorged or if the patient is quite anxious, the
physician may decide to treat. If symptoms of Lyme disease develop,
antibiotic therapy should be given immediately.

http://oldlymect.com/Lymedis.htm

-----
THIS ARTICLE IS PROVIDED ONLY FOR INFORMATIONAL PURPOSES AND SHOULD NOT
BE CONSTRUED AS MEDICAL ADVICE. CONSULT YOUR HEALTH PROFESSIONAL FOR
ADVICE RELATING TO A MEDICAL PROBLEM OR CONDITION.

EARLY TREATMENT IS CRUCIAL FOR LYME DISEASE by Kenneth Miller, MD

Doctors are now determining that a tick must be attached to a person for
24 to 48 hours in order to transmit disease.

Kenneth Miller, MD, an attending physician in Danbury Hospital's
Department of Rheumatology, is in private practice at Arthritis
Associates of Connecticut in Danbury, which also runs the Lyme Disease
Center.

See entire paper at:
http://www.danbury.lib.ct.us/org/hospital/well626.htm

-----
Parkhurst Exchange
Questions & Answers in Infection

3 2-19 It might be Lyme disease

"When individuals travel to areas endemic for Lyme disease, is
prophylactic antibiotic recommended for suspected deer tick bites?"
inquires MIKE MONAGHAN, MD, of Trenton, Ont.

Undoubtedly this is a common practice in many areas. However there are
no clinical studies that adequately adress whether this is an
appropriate approach or not. Nevertheless, a recent hypothetical study
employing decision analysis has suggested that prophylactic doxycycline
is cost-effective in areas where the probability of Lyme disease after a
tick bite is highest. As a result, many authorities recommend
doxycycline after tick bites that occur in areas known to be endemic
for Lyme disease when one is reasonably confident that the bite was due
to an Ixodes tick and when the duration of the tick's attachment is
prolonged (especially longer than 24 hours). Magid D.

Prevention of Lyme disease after tick bite. N Engl J Med 1992;
327:534-41.

http://www.bestmdsite.com/exchange/qa/qa-infection.html

-----
"Information from Your Family Doctor"
from the American Academy of Family Physicians "You aren't likely to get
Lyme disease if the tick has been attached to your skin for less than 48
hours. This handout is provided to you by your family doctor and the
American Academy of Family Physicians. Other health-related information
is available from the AAFP on the World Wide Web
(http://www.aafp.org/healthinfo). Information may also be
obtained from HealthAnswers&reg; (http://www.healthanswers.com). 8/97

This Web page was last modified on January 22, 1998.
American Academy of Family Physicians

See entire handout at:
http://www.aafp.org/patientinfo/lymedis.html

-----
From the Virginia Mason Medical Center, Seattle, WA web site:

Summer Safety for Kids

"The tick must be attached to the child for 24 hours to spread the
disease, Dr. Richter [Virginia Mason pediatrician Dr. Monica Richter]
points out, so when children have been in a tick environment check them
every day - particularly the scalp, armpits and groin."

http://www.vmmc.org/healthinfo/magazine ... afety.html

-----
Brought to you by Mayo Clinic, January 24, 1998

Watch out for tick bites!
A Lyme disease report
March 27 1997

If you are bitten, and the tick stays attached to your skin for 36 to 48
hours (the exact time may vary), bacteria called Borrelia (B.)
burgdorferi can travel from the tick's gut to your bloodstream.

http://www.mayohealth.org/ivi/mayo/9703/htm/lyme.htm

-----
THIS PAMPHLET IS PROVIDED FOR INFORMATIONAL PURPOSES AND SHOULD
NOT BE CONSTRUED AS MEDICAL ADVICE OR INSTRUCTION. CONSULT YOUR
HEALTH PROFESSIONAL OR ADVICE RELATING TO A MEDICAL PROBLEM OR
CONDITION.

LYME DISEASE

Lyme disease: the facts, the challenge. (Pamphlet) Pamphlet by: U.S.
Department of Health and Human Services.

Studies by NIH-supported researchers suggest that a tick must be
attached for many hours to transmit the Lyme disease bacterium, so
prompt tick removal could prevent the disease.

See entire pamphlet at:
http://www.danbury.lib.ct.us/org/hospital/p5.htm

-----
Health News
Last Updated: Thursday, August 28 [1997]

Lyme Disease Risk Does Not Mean Lyme Disease Prevention

(3) How long does an infected tick have to be attached to your body to
cause Lyme disease?

1-2 hours
2-10 hours
10-24 hours;
more than 24 hours

Answer: more than 24 hours.
Most Vineyard [Martha's] respondents guessed less than 10 hours.

Knowledge of ticks and Lyme disease does not always translate
into protective behavior to prevent Lyme disease.
(American Journal of Preventive Medicine, August, v 13, pg. 265)

Summarized by Diane Cooper, MSLS/Optum Medical Library Services

See entire article and questionaire (very interesting!) at:
http://www.optumcare.com/whats.new/news/0897.html

-----
From the Net Medicine™ web site:
The Smart Source for Health & Medical Information

"The disease can be spread when a tick infected with the bacteria bites
a person and stays attached for a period of time."

Source: NY State Department of Health

See entire article at:
http://www.netmedicine.com/pt/PTINFO/lyme.htm

----------------------

Other miscellaneous web sites:
-------------------------------------------------------------------------
Martha's Vineyard Chamber of Commerce

Health and Human Services

FACTS ABOUT TICKS

The following material was provided by the Martha's Vineyard Lyme Action
Committee, P.O Box 1696, Oak Bluffs 02557.

Not all ticks carry disease. Prompt removal is advisable, but infection
will not occur for several hours.

http://www.vineyard.net/org/mvcc/health.html

-----
Lyme Disease: "The Great Imitator".
By: Brie A. Upton and Barry S. Lewis

Research results indicate "...that B. burgdorferi spirochetes are
transmitted by infected saliva injected during feeding, but that the
spirochetes are not present in the salivary glands until many hours
after tick attachment" (Sonenshine, 1991) [sic - should be 1993]. It has
been suggested that transmission may also occur through regurgitation
(Sonenshine, 1991) [sic - should be 1993].

http://137.142.42.104/StudentArea/lewis/termpaper.html

Sonenshine, D.E. (1993) Biology of Ticks: Volume 2. New York: Oxford
University Press.

http://137.142.42.104/StudentArea/lewis/references.html

----------------------

Media references:
-------------------------------------------------------------------------

From Long Island Jewish Medical Center News Releases web site:

June 1997

Long Island Jewish Medical Center Study Shows Lyme Disease Risk Linked
to Length of Time Tick is Attached to Skin

*Patients 20 times more likely to get Lyme disease if tick on skin for
72 hours

New Hyde Park, NY... A study at Schneider Children's Hospital (SCH) of
Long Island Jewish Medical Center (LIJ) shows that people bitten by a
deer tick are 20 times more likely to contract Lyme disease if the tick
remains undetected on their skin for 72 hours or more. The findings,
published in The Journal of Infectious Diseases, April edition, showed
that the incidence of infection following a tick bite is one to three
percent. However, if the tick has been on the skin for 72 hours, the
risk of contracting Lyme Disease jumps to 20 percent.

"The study illustrates the importance of checking yourself and your
children for ticks if you're in an area where Lyme disease is
prevalent," said Sunil Sood, MD, the pediatric Lyme disease specialist
who conducted the research. "Removing a tick correctly, that is, using
tweezers and getting as close to the skin as possible when pulling it
off, can mean the difference between contracting Lyme disease and
avoiding it."

How do you know how long a tick has been on your skin? The laboratory at
the Children's Hospital is available to analyze ticks brought in by the
public. "If the lab finds that it is indeed a deer tick and that it was
attached for 72 hours, patients will be advised on whether they should
receive antibiotics as a precautionary measure," said Dr. Sood.

See entire article at:
http://www.lij.edu/news/lyme_disease.html

-----
Friday, July 18, 1997

Lyme disease cases proving prevalent in Southeastern Pa. Suburban
development and an abundance of ticks are part of the problem, health
experts say.

By Mary Blakinger
INQUIRER CORRESPONDENT

"Tick expert Jan G. Humphreys doesn't mince words. ``You've got a heck
of a tick population down there,'' said the biology professor at Indiana
University of Pennsylvania."

"Studies done on guinea pigs suggest that the optimum time for host
infection is 42 hours after tick attachment, according to Humphreys.
Promptly spotting and carefully removing the tick is an effective way to
avoid infection, Humphreys said."

See entire article at:
http://www.phillynews.com/inquirer/97/J ... LYME18.htm

-----
From the The Parenting Resource Center on the Web:
Last Update: May 10, 1996

A QUICK GUIDE TO LYME DISEASE

Reprinted with permission of the American Lyme Disease Foundation. Inc.
in association with the Centers for Disease Control.

Remember also that if you remove a tick before it is attached for more
than 24 hours, you can greatly reduce your chances of getting Lyme
disease.

Produced by the:
American Lyme Disease Foundation. Inc.
in association with the Centers for Disease Control.
This brochure was funded by Grant # U50/CCU206603-04 from the CDC.

See entire brochure at:
http://www.parentsplace.com/genobject.c ... equik.html

-----
September 20, 1991
***PEDS NEWS***

LYME DISEASE

"Note: Animal studies suggest that prolonged attachment of tick for at
least 24 hours is required for transmission of the Lyme Disease
organism."

AJ/da [probably Archna Jain, M.D.]

Archna Jain, M.D. (Dr.Jain@vpeds.com) Arnold Solof, M.D., Judith Hunt,
M.D., Archna Jain, M.D., Olabode Ogidan, M.D.

1138 East Chestnut Avenue, Vineland, New Jersey 08360
Tel (609) 692-1108 , Fax (609) 692-2077, Office@vpeds.com
Web site maintained by Arnold Solof, M.D
Last updated 03/08/97

See entire paper at:
http://www.vpeds.com/lyme_pi.htm

-----
From the Go, girl! Magazine web site:.

Health News
by Rebecca Boger

"According to the Center for Disease Control, in order for a tick to
transmit a disease, it must be attached to you for at least 24 hours."

See entire article at:
http://www.gogirlmag.com/backiss/backis ... health.htm

----------------------

other miscellaneous:

European Union Concerted Action on Lyme Borreliosis

These findings show that borrelia can be transmitted by ticks when they
start to feed. An explanation for this may be that a proportion of ticks
carry borreliae in their salivary glands. Furthermore, a study on
gerbils and I. ricinus by other EUCALB participants (Kahl, Gray) has
shown that transmission can sometimes occur in less than 24 hours.

http://www.dis.strath.ac.uk/vie/LymeEU/pactin2.htm

-----
For more information on Lyme disease, see:

Antibiotic Prophylaxis After Tick Bite For Prevention Of Lyme Disease -
An Annotated Bibliography
http://www.geocities.com/HotSprings/Oas ... iblio.html

Lots Of Links On Lyme Disease
http://www.geocities.com/HotSprings/Oas ... links.html

-----
Originally prepared on 22 January 1998, updated 4 July 2000 by
Art Doherty
Lompoc, California
doherty@utech.net