2014 Letter to Doctors
COMMONWEALTH of VIRGINIA
Department of Health
MARISSA J. LEVINE, MD, MPH, FAAFP PO BOX 2448 TTY 7-1-1 OR
STATE HEALTH COMMISSIONER RICHMOND, VA 23218 1-800-828-1120
Tick-borne Diseases in Virginia
June 20, 2014
Dear Colleague,
Summer weather has arrived in Virginia and with it the significant increase in tick-borne disease transmission. I am writing today to provide critical Virginia-specific epidemiologic, diagnostic and disease control information for your use in practice.
While Lyme disease is most familiar to us and the general public, other tick-borne illnesses present in Virginia also warrant our attention. Ehrlichiosis is the second-most commonly confirmed tick-borne illness in the Commonwealth. Tick surveys across Virginia and the eastern United States show that the agents of ehrlichiosis are far more common in ticks than those that cause spotted fever rickettsiosis. However, Rocky Mountain spotted fever, or the milder spotted fever rickettsiosis (also known as Tidewater spotted fever) do remain a concern.
Lyme disease activity continues to expand its geographic range in Virginia. In 2013, public health surveillance counted 1,307 confirmed and probable cases of Lyme disease, more than in any previous year.
Given the growing impact of these diseases on the people of Virginia, please consider the following actions:
• Ask about tick exposure when evaluating patients with febrile illness with or without rash.
• Learn more about the identification of tick-borne illness, including ehrlichiosis, anaplasmosis, and spotted fever rickettsiosis (http://www.vdh.virginia.gov/epidemiology/DEE/Vectorborne/).
• Familiarize yourself with the different laboratory assays available to diagnose tick-borne illness.
• Remind your patients to take proper prevention steps including using insect repellent, removing ticks promptly, applying pesticides and reducing tick habitat.
• Report suspect, probable and confirmed cases of these tick-borne illnesses to your local health department promptly (http://www.vdh.virginia.gov/LHD/index.htm).
As you know, laboratory testing for tick-borne illnesses is complex but critical for accurate diagnosis, treatment and surveillance purposes. Different laboratory assays have varying levels of specificity and reliability. To assist you in your decision-making concerning the different assays, please review the document entitled, “Recommended Laboratory Assays for Select Tick-borne Diseases.”
Information including Lyme disease lab testing, clinical features and epidemiology of other tick-borne diseases in Virginia can also be found on the VDH webpage:
http://www.vdh.virginia.gov/clinicians/LymeDiseaseForum/index.htm .
Additional information on Lyme disease lab testing is available on the CDC webpage:
http://www.cdc.gov/lyme/diagnosistesting/LabTest/TwoStep/ .
Should you have any further questions about this topic please feel free to contact David Gaines, PhD, state public health entomologist in the VDH Office of Epidemiology. He can be reached by telephone at (804) 864-8192 or by email at david.gaines@vdh.virginia.gov. Please have a safe and tick free summer.
Sincerely,
Marissa J. Levine, MD, MPH, FAAFP State Health Commissioner