Lyme borreliosis in Europe: influences of climate and climate ...
Lyme borreliosis in Europe: influences of climate and climate ...
Lyme borreliosis in Europe: influences of climate and climate ...
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<strong>Lyme</strong> <strong>borreliosis</strong> <strong>in</strong> <strong>Europe</strong><br />
Page 23<br />
<strong>in</strong> endemic areas compared to non-endemic ones – a difference ma<strong>in</strong>ly due to differences <strong>in</strong><br />
media coverage (Gray et al., 1998b). Swedish media, for example, broadcast or pr<strong>in</strong>t <strong>in</strong>formation<br />
about risk areas, risk periods <strong>and</strong> personal preventive measures at the beg<strong>in</strong>n<strong>in</strong>g <strong>of</strong> the tick<br />
activity period <strong>in</strong> spr<strong>in</strong>g each year. With <strong>in</strong>creas<strong>in</strong>g tourism with<strong>in</strong> the <strong>Europe</strong>an Region it is<br />
important to target visitors to tick endemic areas as well. Several <strong>in</strong>formative web sites about LB<br />
risk <strong>and</strong> prevention are now available for the general public, for example the National Public<br />
Health Service for Wales (http://www.phls.wales.nhs.uk/lyme.htm), <strong>and</strong> the <strong>Lyme</strong> Disease<br />
Network, <strong>Lyme</strong>net, <strong>in</strong> the United States (http://www.lymenet.org).<br />
There are several effective methods available for personal protection aga<strong>in</strong>st tick bites <strong>in</strong><br />
addition to knowledge about risk areas, risk periods <strong>and</strong> the use <strong>of</strong> adequate garden<strong>in</strong>g practices.<br />
• Proper cloth<strong>in</strong>g, such as boots, should be worn when visit<strong>in</strong>g tick-<strong>in</strong>fested locations.<br />
Trousers <strong>and</strong> sweaters should be tightened or tucked <strong>in</strong> at ankles, wrists <strong>and</strong> waist<br />
(Tällekl<strong>in</strong>t & Jaenson, 1995).<br />
• Chemical repellents can be applied on the clothes. N-diethyl-toulamide (DEET), the<br />
agent used <strong>in</strong> mosquito-repellents, has been shown to be effective <strong>in</strong> prevent<strong>in</strong>g I. ric<strong>in</strong>us<br />
from adher<strong>in</strong>g to cloth<strong>in</strong>g (Jaenson et al., 2003).<br />
• Rout<strong>in</strong>e control <strong>of</strong> body <strong>and</strong> clothes directly after activities <strong>in</strong> tick-<strong>in</strong>fested vegetation can<br />
reduce tick attachment. Daily self-<strong>in</strong>spection <strong>and</strong> prompt tick removal is protective<br />
aga<strong>in</strong>st LB.<br />
• The fur <strong>of</strong> pet animals that are kept <strong>in</strong> tick-<strong>in</strong>fested areas should be <strong>in</strong>spected regularly<br />
for ticks, particularly for attached female adults. Otherwise, such pets could contribute<br />
considerably to an <strong>in</strong>creas<strong>in</strong>g density <strong>of</strong> ticks <strong>in</strong> adjacent gardens <strong>and</strong> surround<strong>in</strong>gs<br />
(Thomas GT Jaenson, unpublished observations).<br />
In addition, <strong>in</strong>-depth education about cl<strong>in</strong>ical symptoms, diagnosis, treatment, risk factors,<br />
surveillance, etc. should be provided to health personnel not only <strong>in</strong> endemic areas but also <strong>in</strong><br />
potential new risk regions.<br />
7.6. Surveillance <strong>and</strong> monitor<strong>in</strong>g<br />
Several <strong>in</strong>itiatives have been taken lately to address LB <strong>in</strong> <strong>Europe</strong> <strong>and</strong> to promote monitor<strong>in</strong>g<br />
<strong>and</strong> the shar<strong>in</strong>g <strong>of</strong> <strong>in</strong>formation. The <strong>Europe</strong>an Union concerted action on <strong>Lyme</strong> <strong>borreliosis</strong><br />
(EUCALB) targets pr<strong>of</strong>essional groups, rang<strong>in</strong>g from scientific researchers to public health<br />
workers. Their web site provides up-to-date <strong>in</strong>formation about scientific publications <strong>and</strong> other<br />
LB activities around <strong>Europe</strong>. The Network for Communicable Disease Control <strong>in</strong> Northern<br />
<strong>Europe</strong> (Ep<strong>in</strong>orth) consists <strong>of</strong> <strong>in</strong>fectious disease control <strong>in</strong>stitutes <strong>in</strong> Denmark, Norway, Icel<strong>and</strong>,<br />
Sweden, F<strong>in</strong>l<strong>and</strong>, the Russian Federation, Estonia, Latvia <strong>and</strong> Lithuania. The aim <strong>of</strong> this network<br />
is to share <strong>in</strong>formation <strong>and</strong> register data on major <strong>in</strong>fectious diseases, <strong>in</strong>clud<strong>in</strong>g LB, <strong>in</strong> this<br />
region.<br />
There is a need for the establishment <strong>and</strong> fund<strong>in</strong>g <strong>of</strong> several surveillance centres throughout<br />
<strong>Europe</strong>. These should be set up with<strong>in</strong> a pan-<strong>Europe</strong>an network to record changes <strong>in</strong> the reported<br />
number <strong>of</strong> human cases <strong>and</strong> <strong>in</strong> tick <strong>and</strong> pathogen prevalence <strong>in</strong> nature, <strong>in</strong>clud<strong>in</strong>g areas that have<br />
previously not been <strong>in</strong>vestigated. The follow<strong>in</strong>g recommendations should be considered when<br />
data is collected.<br />
• St<strong>and</strong>ardized methods for tick collection should be employed. The methods should – if<br />
possible – not be changed over time to allow future comparisons. Sampl<strong>in</strong>g should be<br />
sufficiently frequent <strong>in</strong> time <strong>and</strong> space.