Rebecca J. Eisen

Climate and Vectorborne Diseases

Climate change could significantly affect vectorborne disease in humans. Temperature, precipitation, humidity, and other climatic factors are known to affect the reproduction, development, behavior, and population dynamics of the arthropod vectors of these diseases. Climate also can affect the development of pathogens in vectors, as well as the population dynamics and ranges of the nonhuman vertebrate reservoirs of many vectorborne diseases. Whether climate changes increase or decrease the incidence of vectorborne diseases in humans will depend not only on the actual climatic conditions but also on local nonclimatic epidemiologic and ecologic factors. Predicting the relative impact of sustained climate change on vectorborne diseases is difficult and will require long-term studies that look not only at the effects of climate change but also at the contributions of other agents of global change such as increased trade and travel, demographic shifts, civil unrest, changes in land use, water availability, and other issues. Adapting to the effects of climate change will require the development of adequate response plans, enhancement of surveillance systems, and development of effective and locally appropriate strategies to control and prevent vectorborne diseases.

Early-phase transmission of Yersinia pestis by unblocked fleas as a mechanism explaining rapidly spreading plague epizootics

Plague is a highly virulent disease believed to have killed millions during three historic human pandemics. Worldwide, it remains a threat to humans and is a potential agent of bioterrorism. Dissemination of Yersinia pestis, the etiological agent of plague, by blocked fleas has been the accepted paradigm for flea-borne transmission. However, this mechanism, which requires a lengthy extrinsic incubation period before a short infectious window often followed by death of the flea, cannot sufficiently explain the rapid rate of spread that typifies plague epidemics and epizootics. Inconsistencies between the expected rate of spread by blocked rat fleas and that observed during the Black Death has even caused speculation that plague was not the cause of this medieval pandemic. We used the primary vector to humans in North America, Oropsylla montana, which rarely becomes blocked, as a model for studying alternative flea-borne transmission mechanisms. Our data revealed that, in contrast to the classical blocked flea model, O. montana is immediately infectious, transmits efficiently for at least 4 d postinfection (early phase) and may remain infectious for a long time because the fleas do not suffer block-induced mortality. These factors match the criteria required to drive plague epizootics as defined by recently published mathematical models. The scenario of efficient early-phase transmission by unblocked fleas described in our study calls for a paradigm shift in concepts of how Y. pestis is transmitted during rapidly spreading epizootics and epidemics, including, perhaps, the Black Death.

Using Geographic Information Systems and Decision Support Systems for the Prediction, Prevention, and Control of Vector-Borne Diseases

Emerging and resurging vector-borne diseases cause significant morbidity and mortality, especially in the developing world. We focus on how advances in mapping, Geographic Information System, and Decision Support System technologies, and progress in spatial and space-time modeling, can be harnessed to prevent and control these diseases. Major themes, which are addressed using examples from tick-borne Lyme borreliosis; flea-borne plague; and mosquito-borne dengue, malaria, and West Nile virus disease, include (a) selection of spatial and space-time modeling techniques, (b) importance of using high-quality and biologically or epidemiologically relevant data, (c) incorporation of new technologies into operational vector and disease control programs, (d) transfer of map-based information to stakeholders, and (e) adaptation of technology solutions for use in resource-poor environments. We see great potential for the use of new technologies and approaches to more effectively target limited surveillance, prevention, and control resources and to reduce vector-borne and other infectious diseases.

Adaptive strategies of Yersinia pestis to persist during inter-epizootic and epizootic periods.

Plague is a flea-borne zoonotic bacterial disease caused by Yersinia pestis. It has caused three historical pandemics, including the Black Death which killed nearly a third of Europes population in the 14th century. In modern times, plague epizootics can extirpate entire susceptible wildlife populations and then disappear for long time periods. Understanding how Y. pestis is maintained during inter-epizootic periods and the factors responsible for transitioning to epizootics is important for preventing and controlling pathogen transmission and ultimately reducing the burden of human disease. In this review, we focus primarily on plague in North American foci and discuss the potential adaptive strategies Y. pestis might employ to ensure not only its survival during inter-epizootic periods but also the rapid epizootic spread and invasion of new territories that are so characteristic of plague and have resulted in major pandemics and establishment of plague foci throughout much of the world.

Transmission of Flea-Borne Zoonotic Agents*

Flea-borne zoonoses such as plague (Yersinia pestis) and murine typhus (Rickettsia typhi) caused significant numbers of human cases in the past and remain a public health concern. Other flea-borne human pathogens have emerged recently (e.g., Bartonella henselae, Rickettsia felis), and their mechanisms of transmission and impact on human health are not fully understood. Our review focuses on the ecology and epidemiology of the flea-borne bacterial zoonoses mentioned above with an emphasis on recent advancements in our understanding of how these organisms are transmitted by fleas, maintained in zoonotic cycles, and transmitted to humans. Emphasis is given to plague because of the considerable number of studies generated during the first decade of the twenty-first century that arose, in part, because of renewed interest in potential agents of bioterrorism, including Y. pestis.

County-Scale Distribution of Ixodes scapularis and Ixodes pacificus (Acari: Ixodidae) in the Continental United States.

Abstract The blacklegged tick, Ixodes scapularis Say, is the primary vector to humans in the eastern United States of the Lyme disease spirochete Borrelia burgdorferi, as well as causative agents of anaplasmosis and babesiosis. Its close relative in the far western United States, the western blacklegged tick Ixodes pacificus Cooley and Kohls, is the primary vector to humans in that region of the Lyme disease and anaplasmosis agents. Since 1991, when standardized surveillance and reporting began, Lyme disease case counts have increased steadily in number and in geographical distribution in the eastern United States. Similar trends have been observed for anaplasmosis and babesiosis. To better understand the changing landscape of risk of human exposure to disease agents transmitted by I. scapularis and I. pacificus, and to document changes in their recorded distribution over the past two decades, we updated the distribution of these species from a map published in 1998. The presence of I. scapularis has now been documented from 1,420 (45.7%) of the 3,110 continental United States counties, as compared with 111 (3.6%) counties for I. pacificus. Combined, these vectors of B. burgdorferi and other disease agents now have been identified in a total of 1,531 (49.2%) counties spread across 43 states. This marks a 44.7% increase in the number of counties that have recorded the presence of these ticks since the previous map was presented in 1998, when 1,058 counties in 41 states reported the ticks to be present. Notably, the number of counties in which I. scapularis is considered established (six or more individuals or one or more life stages identified in a single year) has more than doubled since the previous national distribution map was published nearly two decades ago. The majority of county status changes occurred in the North-Central and Northeastern states, whereas the distribution in the South remained fairly stable. Two previously distinct foci for I. scapularis in the Northeast and North-Central states appear to be merging in the Ohio River Valley to form a single contiguous focus. Here we document a shifting landscape of risk for human exposure to medically important ticks and point to areas of re-emergence where enhanced vector surveillance and control may be warranted.

Environmentally Related Variability in Risk of Exposure to Lyme Disease Spirochetes in Northern California: Effect of Climatic Conditions and Habitat Type

Abstract Risk of exposure to Borrelia burgdorferi sensu lato (s.l.) spirochetes, which include the causative agents of Lyme disease, is, in part, determined by the density of questing infected vector ticks. We sought to clarify the temporal patterns of nymphal activity, and the extent of variation in peak and cumulative densities of B. burgdorferi s.l.-infected Ixodes pacificus Cooley & Kohls nymphs, at 12 sites within the ecologically diverse Mendocino County in northwestern California. Also, we assessed the impact of various environmental characteristics (e.g., climatologic variables, habitat type, deer usage) on the aforementioned tick-related traits. The average durations of total and peak (nymphal density > 75% of absolute peak) questing activity were 31% and 82% longer, respectively, in areas with conifers present than in oak woodlands, which represented the warmest and driest habitat type examined. Peak and cumulative densities of infected nymphs varied > 400-fold between sites. Both traits were positively associated with the presence of Quercus spp. oaks or deer, and lower in redwood/tanoak versus oak and oak/Douglas fir habitats. However, a prolonged duration of nymphal activity in redwood habitats, relative to oak woodlands, resulted in a shift from peak nymphal densities occurring in oak woodlands in spring to redwood/tanoak habitats in summer. In conclusion, our data clearly show significant variability in seasonal as well as spatial risk of exposure to Lyme disease spirochetes within a small but ecologically, diverse geographic area. Hence, temporally dynamic and spatially explicit models are needed to assess the risk of exposure to tick-borne pathogens at spatial scales encompassing diverse climatologic or ecological conditions.

Western Gray Squirrel (Rodentia: Sciuridae): A Primary Reservoir Host of Borrelia burgdorferi in Californian Oak Woodlands?

Abstract In California, dense woodlands have been recognized as important biotopes where humans are exposed to the nymphal stage of the western blacklegged tick, Ixodes pacificus Cooley & Kohls, the primary vector of the Lyme disease spirochete Borrelia burgdorferi sensu stricto (s.s.), in the far-western United States. To identify the principal reservoir host(s) of this spirochete, and of closely related spirochetes in the B. burgdorferi sensu lato (s.l.) complex, in dense woodlands in Mendocino County, California, ≈50 species of birds and mammals, including wood rats and kangaroo rats, were evaluated as potential hosts for vector ticks and borreliae in 2002 and 2003. Although polymerase chain reaction (PCR) and sequencing analyses revealed that many vertebrate species had been exposed to one or more members of the B. burgdorferi s.l. spirochetal complex, only the western gray squirrel, Sciurus griseus, fulfilled the major criteria for a reservoir host of B. burgdorferi s.s. Ear-punch biopsies from eight of 10 squirrels collected from five separate woodlands were PCR-positive for B. burgdorferi s.s., 47% of I. pacificus larvae (n = 64) and 31% of nymphs (n = 49) removed from squirrels contained B. burgdorferi s.l., and the engorgement status of I. pacificus larvae was associated positively with acquisition of spirochetes. Overall, 83 and 100% of the amplicons sequenced from PCR-positive I. pacificus larvae and nymphs, respectively, were identified as B. burgdorferi s.s. Among the five remaining positive I. pacificus larvae, three contained B. bissettii and two had uncharacterized B. burgdorferi s.l. Borrelia burgdorferi s.s. was detected in one of five larvae and zero of two nymphs of the Pacific Coast tick, Dermacentor occidentalis Marx, that likewise had been removed from squirrels. The rickettsial agent of human anaplasmosis, Anaplasma phagocytophilum, was detected in the blood or ear biopsies of two squirrels and in one (1.6%) of 64 I. pacificus larvae and two (4.1%) of 49 nymphs obtained from squirrels. The one rickettsial-positive larva was coinfected with B. burgdorferi s.s. The apparently high reservoir potential of S. griseus for B. burgdorferi s.s., plus the fact that the geographic distribution of this squirrel coincides well with that of most reported human cases of Lyme disease in this region, indicated that it may be essential for maintaining foci of B. burgdorferi s.s. in certain types of woodlands. The findings with respect to A. phagocytophilum, although of less certain significance, suggest that S. griseus could serve as a secondary host of this rickettsia.

Detection of a Borrelia miyamotoi Sensu Lato Relapsing-Fever Group Spirochete from Ixodes pacificus in California

Abstract We investigated whether host-seeking nymphs and adults of the western blacklegged tick, Ixodes pacificus Cooley & Kohls, the primary vector of Lyme disease spirochetes in far-western North America, are infected naturally with relapsing-fever group spirochetes in Mendocino County, California. Relapsing-fever group borreliae were detected in four (1.7%) of 234 nymphal and two (0.7%) of 282 adult host-seeking I. pacificus ticks by polymerase chain reaction and sequence analysis of the 16S rRNA and flagellin genes, respectively, exhibiting 99 and 98.5% sequence homology to Borrelia miyamotoi Fukunaga. Phylogenetic analysis based on these two genes revealed that the borreliae detected in these ticks belong to the relapsing-fever group and that these are closely related to, if not identical with, B. miyamotoi.

Geographic Variation in the Relationship between Human Lyme Disease Incidence and Density of Infected Host-Seeking Ixodes scapularis Nymphs in the Eastern United States

Prevention and control of Lyme disease is difficult because of the complex biology of the pathogens (Borrelia burgdorferi) vector (Ixodes scapularis) and multiple reservoir hosts with varying degrees of competence. Cost-effective implementation of tick- and host-targeted control methods requires an understanding of the relationship between pathogen prevalence in nymphs, nymph abundance, and incidence of human cases of Lyme disease. We quantified the relationship between estimated acarological risk and human incidence using county-level human case data and nymphal prevalence data from field-derived estimates in 36 eastern states. The estimated density of infected nymphs (mDIN) was significantly correlated with human incidence (r = 0.69). The relationship was strongest in high-prevalence areas, but it varied by region and state, partly because of the distribution of B. burgdorferi genotypes. More information is needed in several high-prevalence states before DIN can be used for cost-effectiveness analyses.