August 215 Get Tick Smart! Lyme Disease Awareness in Durham Region Lyme disease (LD) is a serious illness caused by the bite of an infected blacklegged tick. Ticks can become infected if they feed on infected birds or animals such as deer and mice. In Ontario, blacklegged ticks are most commonly found in wooded and grassy areas along the north shores of Lake Erie, Lake Ontario and the St. Lawrence River. In the fall of 214, blacklegged ticks found in the Rouge Valley of Pickering tested positive for the bacteria that causes LD. These were the first ticks found within Durham Region to have tested positive. In recent years, Durham Region has seen an increase in human cases of LD. Between 21 and 214, a total of 2 confirmed human cases of LD were reported among Durham Region residents, with 9 of these reported in 214. The majority of cases were reported to have been associated with travel outside Durham Region. While the risk of contracting LD within Durham Region is currently low, it is likely to increase, subject to deer, small rodent and bird migration patterns across the north shore of Lake Ontario. Diagnosis of LD can be very difficult as initial symptoms vary from person to person. Typical symptoms include a circular red bulls-eye rash which spreads out from the tick bite and general flu-like symptoms such as fatigue, fever, muscle and joint pain, chills and swollen lymph nodes. Although LD can cause significant health complications, it can be treated effectively if caught early. Removal of the tick within the first 24 to 36 hours after the bite will typically limit the risk of infection. In 21, the Durham Region Health Department (DRHD) developed a communication plan to increase public awareness about the risk of LD. From 211 to 214 LD brochures were distributed to target groups such as school boards, horticultural societies, campers, hikers, garden centres and golf courses. Other communication strategies included print and online advertisements, mobile apps and displays at community events. RRFSS Data Collection In 211, 212, and, the Rapid Risk Factor Surveillance System (RRFSS) was used to survey Durham Region residents about LD. Approximately 6 Durham Region adults aged 18 and older were surveyed in the fall of each year regarding their awareness of the early symptoms of LD, their perceived risk of becoming infected with LD, and their use of personal protective measures during the past summer to reduce exposure to ticks. The survey results provide data for evaluation of Health Department initiatives to increase public awareness and encourage behaviours that reduce the risk of contracting LD. 1
Summary of Results Lyme Disease Awareness In, three quarters (74% ±4%) of adults in Durham Region had heard of LD and less than half (43% ±4%) knew that people get LD from ticks. These results are not significantly different from 211 or 212. Awareness of the early symptoms of LD varied: 22% (±4%) mentioned general flu-like symptoms including fatigue, fever or chills, muscle or joint pain, or swollen lymph nodes, 11% (±3%) mentioned a red rash and only 7% (±3%) specifically described a circular bull s-eye rash. This pattern showed no significant change from previous years. Table 1 - Awareness of Early Symptoms, Adults 18+, Durham Region Early Symptoms of Lyme Disease 211 211 212 212 Flu-like symptoms 23% 19-27 22% 19-26 22% 18-26 Red rash 1% 7-12 1% 7-12 11% 9-14 Bull's-eye/ circular rash 4%* 2-6 6%* 4-8 7% 5-1 Other 7% 4-9 6%* 4-9 7% 5-9 Don't know symptoms 38% 34-43 35% 31-39 37% 32-41 Figure 1 - Awareness of Early Symptoms, Adults 18+, Durham Region, 211-1 211 212 Percent of Residents 8 6 4 2 23 22 22 1 1 11 4* 7 6* 7 6* 7 38 35 37 flu-like symptoms red rash bull's-eye/ circular rash other don't know symptoms Early Symptoms 2
Lyme Disease Perceived Risk Most Durham Region residents did not consider themselves to be at much risk of contracting LD during the summer of. Those who had never heard of LD (26% ±4%) would not be aware of any risk and a further 44% (±4%) considered themselves at low or no risk of getting the disease. Another 18% (±4%) felt they were at medium or high risk and 12% (±3%) could not identify their level of risk. This pattern showed no significant change from previous years. Table 2 - Perceived Risk of Lyme Disease, Adults 18+, Durham Region 211 211 212 212 Risk Level No risk 17% 14-2 14% 11-17 16% 13-19 Low risk 31% 27-35 34% 3-38 28% 24-32 Medium risk 9% 7-11 9% 7-11 12% 1-15 High risk 4% 3-6 4% 3-6 6%* 4-8 Don t know risk 13% 1-16 1% 7-13 12% 1-16 Never heard of Lyme disease 27% 24-31 31% 27-35 26% 23-31 Figure 2 - Perceived Risk of Lyme Disease, Adults 18+, Durham Region, 211-1 211 212 Percent of Residents 8 6 4 2 31 34 9 9 13 1 12 28 17 4 4 6* 14 16 12 no risk low risk medium risk high risk don't know risk Perceived Risk 3
Lyme Disease Personal Protective Behaviours During the summer of, 71% (±4%) of Durham Region adults aged 18 and over spent time outdoors in grassy fields or wooded areas. Among these residents, 27% (±5%) protected themselves every time or most of the time, 23% (±4%) protected themselves only sometimes or rarely and about half (51% ±5%) never took steps to protect themselves from tick bites while in these areas. This pattern showed no significant change from previous years. The most common methods of tick protection used were wearing long pants and sleeves (25% ±5%) and/or using insect repellant (26% ±5%). Only 6%* (±4%) specifically mentioned using DEET. Closed footwear and/or socks were used by 9%* (±4%) and 6%* (±3%) said they tucked in or taped the bottom of their pants. After being outside, only 12% (±4%) checked themselves for ticks every time or most of the time, 19% (±4%) sometimes or rarely and over two thirds (7% ±4%) never checked themselves. There has been no significant increase in use of protective measures since 211. Table 3 - Personal Protective Behaviours, Adults 18+, Durham Region 211 211 212 212 Type of Protection No protection used 49% 44-55 56% 51-61 51% 46-57 Long pants/sleeves 26% 22-31 21% 17-25 25% 21-3 Insect repellant 25% 2-3 21% 17-25 26% 21-31 Closed footwear/socks 9% 7-13 5% 4-8 9% 7-13 Pants tucked in/taped 6% 4-9 4% 3-7 6% 4-9 Figure 3 Personal Protective Behaviours, Adults 18+, Durham Region, 211-1 Percent (among residents who spent time outdoors) 8 6 4 2 49 56 51 no protection used 26 21 25 25 26 21 5* 6* 4* 9 9* long pants/sleeves insect repellant 211 212 closed footwear/socks 6* pants tucked in/taped Type of Protection Used 4
Discussion In, three quarters of adults in Durham Region had heard of LD, but less than half knew that people get LD from ticks. Overall, between 211 and there was no significant change in awareness of LD or use of measures to protect against tick bites among Durham Region residents. Most Durham Region residents did not consider themselves to be at much risk of contracting LD which is consistent with the messaging to date that the risk within Durham Region is low. This may explain why half of those who spent time outdoors in grassy or wooded areas during the summer months did not take any measures to protect themselves from tick bites. In 215, the Durham Region Health Department (DRHD) will continue the development of an effective and comprehensive public communication campaign that is designed to educate the community regarding LD and the need for personal protective measures against ticks. Information about Lyme disease and DRHD initiatives and resources is available on the Lyme disease Information page on durham.ca: http://www.durham.ca/health.asp?nr=/departments/health/lymedisease/index.htm&setfooter= /includes/health/healthfooterenviro.inc. The Vector-borne Diseases Annual Report 214 can be accessed at: http://www.durham.ca/health.asp?nr=/departments/health/vbd.htm&setfooter=/includes/healt h/healthfooterenviro.inc. Data Notes The Rapid Risk Factor Surveillance System (RRFSS) is a random-digit-dialed telephone survey of adults aged 18 years and older, conducted by the Institute for Social Research at York University, on behalf of the DRHD. Since 21, a sample of at least 1 Durham Region residents has been surveyed on a monthly basis regarding health risk behaviours such as smoking, alcohol use, immunization, etc. For further information see www.rrfss.ca and www.durham.ca (health/health statistics). The information is essential for planning and evaluating programs and services, as well as for monitoring emerging health issues. 95% Confidence Interval (CI) refers to the variability around the estimate. Percentages are expressed in the form of the point estimate and the around the estimate. The true or actual percentage falls within the range of values 95 out of 1 times. A wide confidence interval reflects a large amount of variability or imprecision. Usually, the larger the sample size the narrower the confidence intervals. In bar charts, the 95% confidence interval is represented by an error bar at the top of each bar. Coefficient of Variation (CV) refers to the precision of the estimate. When a CV is between 16.6% and 33.3%, the estimate should be interpreted with caution because of high variability. An estimate with a CV over 33.3% is not releasable. Significant Difference refers to a difference between two estimated percentages that is not likely due to chance. If the 95% Confidence intervals of two estimates do not overlap there is considered to be a significant difference between the estimates. Household Weights are applied when calculating the estimates to compensate for the unequal probability of respondent selection based on the number of adults in the household. 5