北京市郊区居民莱姆病知信行调查

目的调查北京周边林区和农区蜱暴露人群对莱姆病的知识、态度、信念和行为（KABP），摸清北京周边地区莱姆病高危人群自我防护意识和防护能力，为开展高危人群健康教育提供依据。方法采用问卷调查方式对北京市4个郊区的居民进行现况调查，问卷内容包括一般情况、莱姆病的相关知识、态度、信念、行为。结果在被调查者中3．9％的居民能正确回答所有关于莱姆病相关常识问题，39．5％的居民表示出现莱姆病特征性皮肤红斑时，才会去医院治疗。被凋查者中有89．1％的居民表示希望了解有关莱姆病的知识。结论蜱暴露人群莱姆病知识匮乏，个人防护能力较弱，而其了解莱姆病防治知识的愿望强烈，因此对暴露人群开展莱姆病健康教育工作势在必行。     

An evaluation of a Lyme disease prevention program in a working population

PURPOSE: Lyme disease vaccine was offered to New York State Department of Health employees considered at risk for Lyme disease because of their job duties. This evaluation was conducted to assess (1) attitudes that affected employees' decisions to accept or decline the vaccine, (2) preventive behaviors among employees who received the vaccine, and (3) effectiveness of the educational modalities offered in improving knowledge of Lyme disease and Lyme disease vaccine. METHODS: A total of 190 eligible employees were identified and were offered two educational modalities before deciding whether to receive the vaccine. The subsequent evaluation involved three telephone interviews, one pre-education and two posteducation-vaccination, to assess factors affecting the decision about vaccination and attitudes, behaviors, and knowledge among vaccine recipients (N=30) and nonrecipients (N=160). RESULTS: This evaluation indicated that the majority of vaccine recipients decided to receive the vaccine because of an anticipated risk of tick exposure. For employees who declined vaccination, many were concerned about the safety (64%), novelty (56%), or efficacy (48%) of the vaccine. Posteducation knowledge of Lyme disease vaccine significantly improved among those who attended an education session compared with those who did not and was retained 1 year later. DISCUSSION: The results suggest that when a vaccine-related disease-prevention program is undertaken, (1) attitudes about disease risks and vaccine risks influence decisions to accept vaccination, and (2) in-person education should be a mandatory element of the program.     

Lyme disease in France: a primary care-based prospective study

To estimate the incidence of Lyme borreliosis in France, describe its clinical presentations, and assess its potential risk factors, we conducted a nationwide prospective study in the French Sentinelles Network, consisting of 1178 general practitioners (GPs). Of these, 875 (74%), i.e. 1.6% of all French GPs, participated in the study from May 1999 to April 2000. Eighty-six cases of Lyme disease were reported and validated, of which 77 (90%) consisted of erythema migrans. At national level, the incidence was estimated at 9.4/100,000 inhabitants. Compared to the French general population, Lyme disease patients were older (P<10(-4)), more were living in rural areas (P<10(-3)), and amongst the working population, more were farmers (P<10(-3)) and fewer, salaried workers (P<0.005). Cervidae density correlated strongly with the estimated regional incidence of Lyme disease (r=0.82). Both incidence data and identified risk factors can help to target measures for its prevention and treatment.     

Emergence of Lyme Disease on Treeless Islands,Scotland, United Kingdom

Lyme disease is usually associated with forested habitats but has recently emerged on treeless islands in the Western Isles of Scotland. The environmental and human components of Lyme disease risk in open habitats remain unknown. We quantified the environmental hazard and risk factors for human tick bite exposure among treeless islands with low and high Lyme disease incidence in the Western Isles. We found a higher prevalence of Borrelia burgdorferi sensu lato–infected ticks on high-incidence than on low-incidence islands (6.4% vs. 0.7%); we also found that residents of high-incidence islands reported increased tick bite exposure. Most tick bites (72.7%) occurred <1 km from the home, including many in home gardens. Residents of high Lyme disease incidence islands reported increasing problems with ticks; many suggested changing deer distribution as a potential driver. We highlight the benefits of an integrated approach in understanding the factors that contribute to Lyme disease emergence.     

Lyme disease knowledge,beliefs, and practices of New Hampshire primary care physicians

BACKGROUND: Lyme disease is the most commonly reported vectorborne illness in the United States and is endemic in many counties in the Northeast, including counties in New Hampshire. Previous studies conducted elsewhere on Lyme disease have indicated substantial differences between physician practices and published consensus guidelines for diagnosis and treatment. METHODS: During 1999, we mailed a 21-item questionnaire to 600 randomly selected family practice physicians, internists, and pediatricians in New Hampshire. RESULTS: Respondents answered a median of 10 (76.9%) of 13 knowledge items correctly. Most physicians (73.6%) underestimated the incidence of erythema migrans among Lyme disease patients, and 41.2% would either test or offer treatment to an asymptomatic patient with deer-tick bite. When surveyed, most respondents (72.4%) planned to recommend Lyme disease vaccine to high-risk persons. Approximately one half (44.8%) reported giving empiric antibiotic treatment of Lyme disease solely because of patient concern. CONCLUSIONS: New Hampshire primary care physicians indicated good knowledge about Lyme disease. Lack of awareness about Lyme disease diagnostic criteria, however, could contribute to misdiagnosis through overreliance on laboratory testing. Lyme disease vaccine appeared to be well accepted by physicians, although the vaccine has since been withdrawn from the US market. Both inappropriate management of tick bite and empiric treatment of unsubstantiated Lyme disease diagnoses were common.     

Lyme disease: a proposed ecological index to assess areas of risk in the northeastern United States

BACKGROUND: Recent public awareness has resulted in a demand for information about ways to reduce the risk of acquiring Lyme disease. METHODS: Twenty-two school properties and recreational areas within a Lyme disease endemic area of central Monmouth County, New Jersey were evaluated for risk of transmission using an ecological index on the suitability, amount, and access to Ixodes dammini habitat by target human populations and the abundance of infected adult ticks. RESULTS: The characterization of tick habitat accurately predicted the elimination of 11 sites from concern. Of the remaining 11 sites, six were classified high risk and five as moderate risk. On-site tick surveys identified infected I. dammini adults at only four sites (three risk; one moderate risk). CONCLUSIONS: These results indicate that the use of selected ecological parameters provides a cost-effective method to rapidly identify areas at risk for Lyme disease transmission.     

Economic Burden of Reported Lyme Disease in High-Incidence Areas,United States, 2014–2016

Approximately 476,000 cases of Lyme disease are diagnosed in the United States annually, yet comprehensive economic evaluations are lacking. In a prospective study among reported cases in Lyme disease–endemic states, we estimated the total patient cost and total societal cost of the disease. In addition, we evaluated disease and demographic factors associated with total societal cost. Participants had a mean patient cost of ≈$1,200 (median $240) and a mean societal cost of ≈$2,000 (median $700). Patients with confirmed disseminated disease or probable disease had approximately double the societal cost of those with confirmed localized disease. The annual, aggregate cost of diagnosed Lyme disease could be $345–968 million (2016 US dollars) to US society. Our findings emphasize the importance of effective prevention and early diagnosis to reduce illness and associated costs. These results can be used in cost-effectiveness analyses of current and future prevention methods, such as a vaccine.     

Antibiotherapy for early localized Lyme disease

OBJECTIVE: The aim of this article is to provide clinicians with guidelines for the antibiotherapy of early-localized Lyme disease. The outcome measures are the clearance of erythema migrans and associated symptoms of early localized Lyme disease and the prevention rate of late complications, with a low risk of adverse effects. Design. The reviewed studies were selected by Medline with the keywords: "erythema migrans, treatment". Sixteen studies comparing treatment or duration of treatment were analyzed. RESULTS: Amoxicillin, doxycycline, and cefuroxim axetil are equally efficacious for early-localized Lyme disease. Azithromycin is an alternative. Most patients respond completely and less than 10% fail to respond. All antibiotics are associated with a low frequency of adverse effects, with the exception of Jarisch Herxheimer reaction which occurs in about 15% of the patients. CONCLUSIONS: We recommend treating adults with amoxicillin (50 mg/kg/day in 3 intakes) or doxycycline (100 mg bid) for 14 days (erythema migrans) to 21 days (early localized Lyme disease with associated symptoms). For children, we recommend amoxicillin (50 mg/kg/day in 3 intakes) or doxycycline (4 mg/kg/day in 2 intakes, maximum 100 mg/dose) above 8 years of age. Cefuroxim axetil (500 mg twice daily for adults or 30 mg/kg/day in 2 intakes, maximum 500 mg/dose, for children), and azithromycin (500 mg/day for adults and 20 mg/kg/day for children for 7-10 days) are second line treatment.     

Lyme Disease: An Increasing Health Risk for School-age Children

Lyme disease, a bacterial infection with noticeable short-term and serious long-term consequences, is the most common tick-borne disease. First described in 1977, Lyme disease poses a significant health threat to school-age children exposed to the tick vector primarily in three specific regions of the United States. This article describes Lyme disease and its clinical signs and symptoms, and discusses the school nurse's role in identification, management, and prevention of this new health risk.     

Perceived vulnerability for Lyme disease questionnaire: A social science tool for understanding tick-borne disease attitudes

Lyme disease has emerged as a growing epidemic across the U.S., with tick populations spreading north because of a plethora of human-induced factors. As the scope of this problem grows, there is a need to understand how vulnerable the public perceives themselves to be and how perceived vulnerability as a psychological construct influences public behavior. A growing body of literature has explored individual risk perceptions and individual preventative behaviors toward Lyme disease, but there remains a notable research gap regarding the concept of vulnerability. This empirical study establishes the first questionnaire for perceived vulnerability towards Lyme disease, modified from pre-existing infectious disease literature. This novel instrument was tested and compared with individual factors relating to preventative behaviors and source credibility of major information sources about Lyme disease in the state of Maine. Recent increases in black-legged tick (Ixodes scapularis) populations have affected the state of Maine in dramatic ways. This research specifically surveyed homeowners to explore their perceived vulnerability, source credibility, and individual protective intentions related to ticks and Lyme disease in Maine. Results from this study validate a modified perceived vulnerability scale for Lyme disease and highlight how understanding the relationships between these perceptions of vulnerability, individual behaviors, and sources of information can improve outreach and communication efforts about tick-borne diseases.     

Risk perceptions regarding ticks and Lyme disease: a national survey

BACKGROUND: Lyme disease (LD) is caused by the tickborne bacterium Borrelia burgdorferi and, in 2000, accounted for >90% of all reported cases of vectorborne illness in the United States. Aside from anecdotal and indirect evidence, little empirical evidence exists regarding what the U.S. public knows, says, or does about preventing LD. OBJECTIVES: To examine knowledge, perceptions, and practices regarding prevention of tick bites and LD. METHODS: In 1998, a random-digit-dial frame was used to collect a cross-sectional sample (n =1500) from the 48 coterminous states plus the District of Columbia, and an over-sample (n =250) from six states with the highest incidence of LD. RESULTS: Forty percent of respondents reported doing something to avoid being bitten by ticks. Less than half (41%) used insect repellent. Ninety-two percent of those who had heard about LD stated their likelihood of ever getting the disease was 相似文献   

Lyme disease in outdoor workers: risk factors, preventive measures, and tick removal methods

A statewide cross-sectional study of risk factors for seropositivity for antibody to Borrelia burgdorferi in outdoor workers in New Jersey was performed in September and October 1988. The crude odds ratio associated with exposure to ticks on the primary state job was 2.2 (95% confidence interval (CI) 0.7-9.0). After adjustment for multiple confounding variables with logistic regression, the adjusted occupational tick exposure odds ratio was 5.1 (95% CI 1.1-23.6). Additional analyses revealed that any use of insect repellent or antibiotics may have decreased the risk of Lyme disease in these workers (adjusted odds ratios for not using insect repellent or antibiotics were 2.0 (95% CI 1.0-4.0) and 2.3 (95% CI 0.8-6.7), respectively). These data suggest that Lyme disease is a hazard of outdoor work and that increased recognition of this fact will be necessary to prevent Lyme disease in these workers.     

Environmental risk factors for Lyme disease identified with geographic information systems.

OBJECTIVES. A geographic information system was used to identify and locate residential environmental risk factors for Lyme disease. METHODS. Data were obtained for 53 environmental variables at the residences of Lyme disease case patients in Baltimore County from 1989 through 1990 and compared with data for randomly selected addresses. A risk model was generated combining the geographic information system with logistic regression analysis. The model was validated by comparing the distribution of cases in 1991 with another group of randomly selected addresses. RESULTS. In crude analyses, 11 environmental variables were associated with Lyme disease. In adjusted analyses, residence in forested areas (odds ratio [OR] = 3.7, 95% confidence interval [CI] = 1.2, 11.8), on specific soils (OR = 2.1, 95% CI = 1.0, 4.4), and in two regions of the county (OR = 3.5, 95% CI = 1.6, 7.4) (OR = 2.8, 95% CI = 1.0, 7.7) was associated with elevated risk of getting Lyme disease. Residence in highly developed regions was protective (OR = 0.3, 95% CI = 0.1, 1.0). The risk of Lyme disease in 1991 increased with risk categories defined from the 1989 through 1990 data. CONCLUSIONS. Combining a geographic information system with epidemiologic methods can be used to rapidly identify risk factors of zoonotic disease over large areas.     

Lyme disease: basis for treatment strategy, primary preventive care and secondary preventive care

Lyme disease is the most common tick borne disease and is caused by Borrelia burgdorferi sensu lato. Ticks of the genus Ixodes are the vectors that transmit the infection to host mammals in endemic foci. Ixodes is infected by Borrelia at larval stage when it feeds on infected mammals. Man is an occasional host. The infection risk is linked to interaction between human and the natural environment. Strategies for prevention are closely related to the enzootic cycle of the Ixodes tick. Environmental measures to reduced tick density or host mammals are expensive, need to be repeated annually and cannot be applied to large areas. The primary prevention could be reduced to personal preventive measures such as reducing the amount of exposed skin and frequent checking for ticks. The risk of Lyme disease transmission after a tick bite is relatively low, and remains under 4%. The transmission rate depends on the duration of feeding. A rapide tick removal with fine tweezers or preferably special forceps and disinfection of the bite site appear to be the best technique. The absence of scientific evidence, and the risk of adverse events does not lead to recommending antimicrobial prophylaxis. Follow-up and educating the patients on the disease, clinical manifestation, and later primary prevention should be undertaken.     

北京郊区医生莱姆病KABP调查

目的调查北京郊区蜱暴露人群周围的基层医生对莱姆病的KABP,了解他们对莱姆病的认识,以及是否有意愿和能力为其服务的人群提供及时有效的诊断、治疗与预防。并为开展基层医生莱姆病培训提供依据。方法采用问卷调查方式进行横断面调查,问卷包括一般情况、莱姆病的相关知识、态度、信念与行为。结果只有49.7%的人听说过莱姆病,其中83.1%的人不知道或不认为自己工作的地方存在莱姆病,10.5%的人能正确回答所有关于莱姆病流行病学方面的知识,21.0%的人了解莱姆病典型临床表现,26.8%的人能够在不滥用的前提下为患者开出抗生素治疗;其中89.9%的人认为需要开展有关莱姆病的培训。讨论基层医务工作者对莱姆病的认识十分有限,不能为其周围的蜱暴露人群提供有效的帮助,进行培训是必要的。     

Making sense of unfamiliar risks in the countryside: the case of Lyme disease

The focus of this paper is on how popular representations of the countryside provide countryside users with a discursive framework to make sense of unfamiliar countryside-based risks, taking Lyme disease as an example. Sixty-six semi-structured interviews were conducted with 82 visitors in Richmond Park, New Forest, and Exmoor National Park in the UK. The data were analysed using thematic analysis and was informed by social representations theory. The analysis indicated that a lay understanding of the risk of Lyme disease was filtered by place-attachment and the social representations of the countryside. Lyme disease was not understood primarily as a risk to health, but was instead constructed as a risk to the social and restorative practices in the context of the countryside. The findings suggest that advice about zoonoses such as Lyme disease is unlikely to cause panic, and that it should focus on the least intrusive preventative measures.     

Lyme disease and preventive behaviors in residents of Nantucket Island, Massachusetts

BACKGROUND: To determine the age-specific prevalence of Lyme disease and whether preventive behaviors on Nantucket Island correlate with Lyme disease, we surveyed island residents. METHODS: A survey with questions on Lyme disease symptoms, history, and preventive behaviors was mailed to all residents. Respondents were stratified by likelihood of having had Lyme disease. A subsample was selected for examination, and then classified according to the Lyme disease national surveillance case definition. RESULTS: The overall lifetime prevalence of Lyme disease for Nantucket residents was 15% (CI, 10%-19.8%): 19% among females, and 11% among males. The prevalence was highest among age groups 0-16 and 30-49 years. Overall, 86% of the population practiced at least one behavior. The most frequently reported preventive behavior was checking oneself for ticks (80%), followed by wearing protective clothing (53%), avoiding tick areas (34%), and using tick repellent (11%). Younger individuals practiced fewer preventive behaviors than older individuals (p=0.001). Although males reported greater tick exposure than females, females uniformly practiced preventive behaviors more frequently (p=0.001). The practice of preventive behaviors was not associated with a history of Lyme disease, but finding more than 5 ticks per year on oneself was (p=0.001). CONCLUSION: Lyme disease is highly prevalent on Nantucket Island. Young people are particularly at risk and health education should emphasize preventive behaviors less frequently practiced: using tick repellent, avoiding tick areas, and wearing protective clothing.     

Neurologic and psychiatric manifestations of Lyme disease

The neurological and psychiatric manifestations of Borrelia burgdorferi sensu lato are so numerous that Borrelia is also called the "new great imitator". Thus knowing about the multiple clinical aspects of neuroborreliosis is necessary for the clinician. We reviewed literature for "classical" neuroborreliosis such as acute meningoradiculitis or chronicle encephalomyelitis, but also for encephalitis, myelitis, polyneuritis, radiculitis and more controversial disorders such as chronic neurological disorders, ischemic and hemorrhagic stroke, and motor neuron disease. We specified every time on which basis each disorder was attributed to Lyme disease, particularly if European or American criteria were met. Every part of the nervous system can be involved: from central to peripheral nervous system, and even muscles. In endemic areas, Lyme serology must be assessed in case of unexplained neurological or psychiatric disorder. In case of positive serology, CSF assessment with intrathecal anti-Borrelia antibody index will be more efficient to prove the diagnosis.     

Lyme Borreliosis, Po River Valley, Italy

We aimed to determine the presence of Ixodes ricinus ticks in heavily populated areas of the Po River Valley after report of a Lyme disease case. Eighteen percent of ticks examined from 3 locations were positive for Lyme disease borreliae. Lyme disease was diagnosed for 3 workers at risk for tick bite.