Lifestyle, habitat and farmers' risk of exposure to tick bites in an endemic area of tick-borne diseases in Hungary

Assessing knowledge gaps and empowering Extension workers in Illinois with information on ticks and tickborne diseases through KAP surveys

Tickborne diseases (TBDs) are increasingly prevalent in Illinois and the Upper Midwest region. People who work in occupations that require time outdoors in agricultural or natural settings, such as some Extension workers, are at risk of tick bites and TBDs. Additionally, Extension workers are often a primary source of information about ticks and TBDs in rural communities. However, there is limited information on the level of awareness about ticks and TBDs in the Extension community. The goals of this study were to sequentially i) determine the baseline awareness of Extension workers in Illinois about ticks and TBDs using a knowledge, attitudes, and practices (KAP) survey tool, ii) provide comprehensive training on ticks and TBDs to this demographic, and iii) measure the uptake of knowledge after the training intervention through a post-training survey. The study period was from June 2022 until May 2023. We received 233 pre-training and 93 paired post-training survey responses. Most survey respondents were Extension volunteers, identified as women, and were over 50 years old. Knowledge about ticks and TBDs varied. We identified several gaps in their current tick awareness, most importantly, in tick prevention measures, tick identification, and TBDs in general. TBD knowledge, attitude, and practice scores all significantly improved after training (p < 0.001), with a mean difference of 10.47, 1.49, and 2.64 points, respectively. Additionally, both Extension professionals (79.2 %) and Extension volunteers (66.7 %) were more likely to feel confident in engaging with their stakeholders on ticks and TBDs after participating in training. Poisson models revealed that higher attitude and practice scores and greater self-reported knowledge were the factors most significantly associated with higher TBD knowledge. We found that greater concern for ticks and TBD (attitudes) and adherence to science-based prevention and management methods (practices) were also associated with higher knowledge scores. To our knowledge, this is the first study in Illinois to capture Extension workers' awareness of ticks and TBDs. The results highlight Extension workers' interest in filling knowledge gaps through learning, and the importance of training Extension workers to disseminate reliable and updated information on ticks and TBDs to their constituents, a critical step in preventing TBDs.

Describing the experience of livestock producers from Ohio, USA with ticks and associated diseases

BACKGROUND

As tick ranges expand across North America, the risk of tick bites and tick-borne diseases (TBDs, i.e. diseases or syndromes associated with ticks) rises for humans and animals, making prevention critical. Several U.S. studies have examined knowledge, attitudes, and practices regarding ticks and TBDs for various cohorts of people. However, among occupational groups with high exposure risk from ticks and TBDs are livestock producers, of which we know little about. To help address this gap, an electronic questionnaire was distributed to livestock producers in Ohio, U.S, a state with a robust agricultural sector.

METHODS

We generated descriptive statistics and conducted a multiple correspondence analysis followed by hierarchical clustering on principal components to identify producers with similar response profiles.

RESULTS

Responses from 57 producers showed that most (52.6%) think the American dog tick (Dermacentor variabilis) is found in Ohio but are unsure about other species. Although several TBDs are present in Ohio, most (> 50%) producers were unsure or unaware of their presence. Interestingly, most (54.4%) thought ticks pose major health risks for their livestock but fewer (49.1%) thought the same for humans. Regardless, most producers did employ at least one prevention method for themselves (96.5%) and their animals (82.5%). Cluster analysis (n = 48) identified three groups: the largest (n = 21) was considered "aware and cautious" consisting primarily of farm owners. The others generally practiced less prevention and consisted primarily of farm employees.

CONCLUSIONS

Our findings indicate that producers in Ohio practice prevention for themselves and their livestock, but demonstrate gaps in knowledge (e.g., TBD occurrence) and attitudes (e.g., health risks) that could be addressed via educational formats we found producers preferred (e.g., extension materials), to encourage informed prevention. This is especially important for farm employees that may practice less prevention because of lower awareness. Our study can guide others in regions faced with similar tick and TBD risks to protect occupational and livestock health.

Farmers' Knowledge and Practices About Ticks and Tickborne Diseases in Illinois

OBJECTIVE

Tickborne diseases (TBDs) in Illinois have increased in recent years. A growing body of literature indicates that the risk of exposure to ticks and tickborne diseases is higher among outdoor workers, including farmers. However, information is lacking on awareness of ticks and tickborne diseases among this demographic. This study aimed to determine the knowledge and awareness among Illinois farmers regarding ticks and tickborne diseases.

METHODS

A Knowledge, Attitudes & Prevention practices (KAP) survey was developed and administered to capture information regarding farmers' knowledge and attitudes about ticks and TBDs. Tick drags were conducted on a subset of properties as an incentive to complete the survey and to compare farmers' knowledge or expectations of ticks on their land with ticks collected.

RESULTS

Fifty farmers participated in the survey, and 17 allowed tick drags. Only 60% of respondents had at least moderate knowledge about ticks gained through family and friends (56%), medical and healthcare personnel (48%), and the internet (44%). Responses varied by the type of commodity produced by the farmer. Fifty percent of participants reported knowledge about the blacklegged tick, 34% for the American dog tick, and 42% for the lone star tick; this knowledge also varied by farm type. Most farmers (54%) agreed that preventative behaviors could protect against tickborne diseases. Self-reported knowledge was significantly and directly associated with knowledge scores (p < .001).

CONCLUSION

Knowledge of ticks and TBDs was lower among crop farmers than beef or mixed commodity farmers, but farmers generally have moderate knowledge of tick species in Illinois. Many participants expressed low concern over contracting a TBD, but many were also dissatisfied with the level of tick prevention measures that they follow. These results can be utilized to fill in knowledge gaps and develop informational materials to help farmers protect themselves against ticks and TBDs.

Severe fever with thrombocytopenia syndrome incidence could be associated with ecotone between forest and cultivated land in rural settings of central China

Severe fever with thrombocytopenia syndrome (SFTS), an emerging tick-borne disease first reported in rural areas of central China, has become a major public health concern in endemic areas. The epidemic dynamic and ecologic factors of SFTS incidence at a village scale remain unclear. Here we analyzed the epidemiological characteristics of SFTS cases in Shangcheng County, the first reported areas of SFTS in China. A retrospective space-time cluster analysis was conducted to identify the dynamics of hotspot areas, and the negative binomial regression model was conducted to examine potential factors contributing to the incidence of SFTS at the village level. A total of 1,219 SFTS cases were reported in Shangcheng County from 2011 to 2020, with a case fatality rate of 12.0%. The median age of patients was 64 years, and 81.7% of patients were over 50 years old. Women accounted for 60.3% of all cases, and the incidence rate was significantly higher than that of men (Pearson χ² test, P<0.001). Five spatial-temporal clusters were identified, and mostly distributed in the central part of the county. Higher risk of SFTS incidence was shown in villages with higher percentage coverages of forest and tea plantation, and higher goat density. In villages where the ratio of cultivated land area to forest land area was between 0.2 and 1.2, the risk of SFTS incidence increased significantly, with an incidence rate ratio of 1.33 (95% CI: 1.04‒1.72, p = 0.024). Our findings indicated that ecotone between forest and cultivated land might be the most important risk settings for exposure and infection with SFTS virus in endemic areas of central China. Precise identification of risk factors and high-risk areas at a suitable scale is conducive to carrying out targeted measures and improving the surveillance of the disease.

Seroepidemiology of Borrelia burgdorferi s.l. among German National Cohort (NAKO) Participants, Hanover

Lyme borreliosis is the leading tick-related illness in Europe, caused by Borrelia Burgdorferi s.l. Lower Saxony, Germany, including its capital, Hanover, has a higher proportion of infected ticks than central European countries, justifying a research focus on the potential human consequences. The current knowledge gap on human incident infections, particularly in Western Germany, demands serological insights, especially regarding a potentially changing climate-related tick abundance and activity. We determined the immunoglobulin G (IgG) and immunoglobulin M (IgM) serostatuses for 8009 German National Cohort (NAKO) participants from Hanover, examined in 2014-2018. We used an enzyme-linked immunosorbent assay (ELISA) as the screening and a line immunoblot as confirmation for the Borrelia Burgdorferi s.l. antibodies. We weighted the seropositivity proportions to estimate general population seropositivity and estimated the force of infection (FOI). Using logistic regression, we investigated risk factors for seropositivity. Seropositivity was 3.0% (IgG) and 2.1% (IgM). The FOI varied with age, sharply increasing in participants aged ≥40 years. We confirmed advancing age and male sex as risk factors. We reported reduced odds for seropositivity with increasing body mass index and depressive symptomatology, respectively, pointing to an impact of lifestyle-related behaviors. The local proportion of seropositive individuals is comparable to previous estimates for northern Germany, indicating a steady seroprevalence.

Perceptions of ecosystem services, disservices and willingness-to-pay for urban green space conservation

While planning and management of urban green space (UGS) remain primarily driven by policymakers and expert knowledge, increasing attention has been paid to the general public's perception of and demand for UGS. This study was conducted to provide price-related outcomes to support UGS-related decision making and achieve an improved understanding of the causal relationships underpinning the residents' willingness-to-pay (WTP) for UGS conservation. An extensive survey with 3000 urban residents from three provincial capital cities in central China (i.e., Wuhan, Changsha and Nanchang) was conducted. We applied structural equation modelling to examine a range of hypothetical causal relationships among residents' perceptions about ecosystem services/disservices provided by UGS, frequency of UGS visits, socioeconomic status (SES) and WTP for the conservation of five different types of UGS. We found that residents had an average WTP of 202.4 CNY or 30.6 USD per year cross UGS types, with the attached green space having the greatest WTP (223.0 CNY or 33.7 USD per year), followed by park (215.4 CNY or 32.6 USD year), square (201.7 CNY or 30.5 USD year), suburban ecological (190.1 CNY or 28.7 USD year) and protective (182.0 CNY or 27.5 USD year) green spaces. Perceptions of UGS's ecosystem services had a positive causal impact on WTP, while perceptions of ecosystem disservices would have a negative impact. The frequency of UGS visits was found to amplify WTP at a limited level. It could further heighten and diminish the perceptions of ecosystem services and disservices. Participants with higher SES typically had greater perceptions of UGS's ecosystem services and WTP. Finally, we found that the structure of the causal relationships on WTP varied between cities, highlighting the importance of considering the fine-level impacts of biophysical environment jointly. Our results could help urban planners to understand better the ways urban green space was perceived and anticipate the likely effects of changing spatial patterns of UGS on the benefits and nuisances experienced by the general public.

Knowledge, habits and attitudes towards TBE and other tick-borne diseases in German forestry trainees

Tick-borne encephalitis (TBE) is an occupational hazard for forestry workers. We measured knowledge levels, misbeliefs, and vaccination rates in forestry trainees in order to tailor specific measures aimed at reducing occupational TBE incidence. A paper-based survey was performed at a central training site for forestry workers in the state of Baden-Wuerttemberg. The questionnaire contained items regarding vaccination status against tick-borne encephalitis virus (TBEV), self-reported tick-borne diseases, knowledge of and attitudes towards tick-borne disease, and practices in the context of ticks and tick bites. All trainees in the period June-December 2018 were surveyed. Statistical analyses were conducted using Mann-Whitney-Rank sum test and one-way ANOVA tests. Two-hundred-twenty-five trainees participated in the survey. Almost all (>99%) were aware of living in a TBE high-risk area. Eighty-three percent of respondents were vaccinated in line with current recommendations. Seventeen percent had no effective vaccination status. Twenty-seven percent believed that ticks can transmit only TBEV and Borrelia spp. Sixty-two percent knew that TBEV infections can be fatal. Only 8% of respondents use tick repellents and only 17% wear long sleeves and pants. Trainees who graduated from a six and (eight or) nine secondary school (Realschule and Abitur respectively) had more knowledge on ticks and tick-borne disease compared to graduates from a five year school (Hauptschule) (p = 0.002 and p = 0,037 respectively). Overall, the TBE vaccination rate is not high enough in this high-risk occupational group. We identified gaps in knowledge and practices that could have an impact on TBE incidence in this group if addressed. Further epidemiological research is needed on knowledge, attitudes, and practices in different high-risk populations.

Using volunteered observations to map human exposure to ticks

Lyme borreliosis (LB) is the most prevalent tick-borne disease in Europe and its incidence has steadily increased over the last two decades. In the Netherlands alone, more than 20,000 citizens are affected by LB each year. Because of this, two Dutch citizen science projects were started to monitor tick bites. Both projects have collected nearly 50,000 geo-located tick bite reports over the period 2006–2016. The number of tick bite reports per area unit is a proxy of tick bite risk. This risk can also be modelled as the result of the interaction of hazard (e.g. tick activity) and human exposure (e.g. outdoor recreational activities). Multiple studies have focused on quantifying tick hazard. However, quantifying human exposure is a harder task. In this work, we make a first step to map human exposure to ticks by combining tick bite reports with a tick hazard model. Our results show human exposure to tick bites in all forested areas of the Netherlands. This information could facilitate the cooperation between public health specialists and forest managers to create better mitigation campaigns for tick-borne diseases, and it could also support the design of improved plans for ecosystem management.

Progress, challenges, and the role of public engagement to improve tick-borne disease literacy

Vector-borne diseases have increased worldwide, facilitated by globalization and variations in climate. Tick and tick-borne disease researchers, veterinarians, medical practitioners, and public health specialists are working to share their expertise on tick ecology, disease transmission, diagnostics, and treatment in order to control tick-borne epidemics and potential pandemics. This review will be a brief overview of the current status of tick-borne diseases, challenges on the scientific and public fronts, and the role of public engagement in improving citizen education within the context of ticks and tick-borne disease research.