Unfortunately, despite our harsh Winter, ticks were not fazed.
2014 Lyme Disease Information from the Maine CDC
Lyme disease is the most common vector-borne disease in Maine. Ticks are already out and we expect
the number of Lyme disease cases to increase as the weather continues to get warmer. May is Lyme
Disease Awareness Month in Maine.
Provide general information regarding ticks and Lyme disease
Remind providers to report cases of Lyme disease, including those diagnosed by erythema
Provide resources on diagnosis and treatment of Lyme disease
Remind providers that Anaplasma, Babesia and other tick borne diseases are also increasing in
Lyme disease is a bacterial infection that is carried by Ixodes scapularis (the deer tick). Cases have
been increasing each year in Maine, and occur in all 16 counties. Over 1,375 cases of Lyme disease
were reported statewide in 2013, a record high for Maine. Lyme disease is most common among school
age children and mature adults over the age of 65. Most infections occur during the summer months, and
as the weather continues to warm up, more ticks will be out in the open, and we are likely to see more
cases of Lyme disease. Cases have already been reported in 2014, and the number will rise as we enter
The most common early symptom of Lyme disease is an expanding red rash (erythema migrans) that
occurs 3-30 days after being bitten. Fever, joint and muscle pains may also occur. Untreated infections
can lead to clinical findings in skeletal, cardiac, and nervous systems. Disseminated manifestations of
disease include: arthritis characterized by recurrent, brief attacks of joint swelling; lymphocytic
meningitis; cranial neuritis (such as Bell’s palsy); encephalitis; and second or third degree
atrioventricular block. Lyme disease is treatable, and the majority of patients recover after receiving
Remove the tick properly, ideally using tweezers or a tick spoon.
Identify the tick and the engorgement level, or length in time of attachment. Tick identification
for a fee is available through the University of Maine Cooperative Extension and more
information can be found at http://extension.umaine.edu/ipm/tickid/
Clean the area around the bite, and instruct the patient to watch for signs and symptoms for 30
Testing of the tick is not routinely recommended because even if the tick tests positive for Lyme,
that does not mean it was attached long enough to transmit the disease, and even if the tick tests
negative that does not mean that was a patient’s only exposure, and that does not eliminate the
possibility of Anaplasmosis or Babesiosis.
Prophylaxis after a tick bite is not routinely recommended, but can be considered under specific
o Tick has been identified as an engorged deer tick that has been attached for over 24 hours
o Exposure occurred in an area where there is a high rate of infected ticks. Areas south of
Bangor have the highest rate of infected ticks in the state. There is limited data from the
more northern counties on the rate of infection among ticks.
Maine Center for Disease Control and Prevention (Maine CDC)
o Prophylaxis can be started with 72 hours. Even if prophylaxis is used, monitoring for
symptoms for 30 days is recommended.
There is no data showing if prophylaxis is effective in preventing Anaplasmosis, and a single
dose of doxycycline will not have an effect on Babesiosis. As such, even if prophylaxis is used,
monitoring for symptoms for 30 days is recommended.
Preferred laboratory testing is a two tier method, with an EIA or IFA test followed by Western
IgM is only considered reliable in the first month after exposure
IDSA guidelines for assessment, treatment, and prevention of Lyme disease are available at
http://cid.oxfordjournals.org/content/43/9/1089.full
Lyme disease is a reportable condition in the state of Maine. Report all diagnosed erythema migrans
rashes and all positive lab diagnoses. Cases can be reported by fax at 1-800-293-7534 or by phone at 1-
Other diseases that are carried by ticks in Maine include Anaplasmosis, Babesiosis and Powassan.
Symptoms of Anaplasma include: fever, headache, malaise and body aches. Symptoms of Babesia
include: extreme fatigue, aches, fever, chills, sweating, dark urine, and possibly anemia. Symptoms of
Powassan include: fever, headache, vomiting, weakness, confusion, loss of coordination, speech
difficulties, seizures, and encephalitis and meningitis. Preferred testing for both Babesiosis and
Anaplasmosis is by PCR. Most reference labs offer a tick borne disease panel by PCR. Powassan
testing is by ELISA or MIA and samples should be sent to HETL to be forwarded to federal CDC.
In 2013, providers reported 94 cases of Anaplasmosis, 36 cases of Babesiosis, and 1 case of Powassan.
Five anaplasmosis cases and two babesiosis cases have already been reported in 2014. Anaplasmosis,
Babesiosis, Ehrlichiosis, Powassan, and Rocky Mountain Spotted Fever are all reportable in Maine.
A Physician’s Reference Guide is available and describes the most common tick borne diseases in
Maine. This guide can be found on our website at: http://www.maine.gov/dhhs/mecdc/infectious-
disease/epi/vector-borne/index.shtml under Resources. Paper copies can be requested through
Lyme disease data is available on Maine CDC’s website at www.maine.gov/idepi and then
navigating to Maine Tracking Network: Lyme disease on the left navigation pane.
For more information on tick borne diseases including Lyme:
http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/index.shtml
For IDSA Lyme disease treatment guidelines:
http://cid.oxfordjournals.org/content/43/9/1089.full
To order Lyme educational materials: http://www.maine.gov/dhhs/mecdc/infectious-
disease/epi/order-form-wn.shtmlDisease consultation and reporting available through Maine
Maine Center for Disease Control and Prevention (Maine CDC)
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