Tickborne disease surveillance: An adaptive approach

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Zoonotic pathogens are moving targets. Most originate in wildlife¹ as likely evidenced by the latest global threat, COVID-19. Shifts in associated disease patterns result from increased human contact with wildlife, globalization of human travel and trade, broad ecologic changes and vector/pathogen evolution.^2,3

Lyme disease, or borreliosis, is the most common vector-borne illness in temperate areas of the northern hemisphere.⁴ Long established in southern and central Europe, northern Asia and the northeastern United States,^5-7 it likely penetrated Canada over the past two decades in concert with the northward spread of its tick vector, Ixodes scapularis, and its causative agent, the bacterium Borrelia burgdorferi.⁸

To better understand the current approaches and major challenges associated with surveillance of emerging tickborne zoonoses, investigators from the University of Guelph’s Ontario Veterinary College used the incursion of Lyme disease into Canada as an archetype for study.⁹

Study design

A review of the available literature describing different disease surveillance programs honed in on the emergence of Lyme disease in Canada.¹⁰ Using two databases, PubMed and Web of Science, the investigators searched publications dating from 1990 through 2016. A total of 339 titles and abstracts were reviewed, of which 107 were determined to be relevant.

Survey results

Public health surveillance—the continuous collection and analysis of health data for evaluating and planning public health programs—can flag emerging epidemics and assess interventions.¹¹

Two surveillance styles exist: passive and active. Through passive surveillance, health data are submitted voluntarily by the public and the medical community, among others.¹² For Lyme and other tickborne zoonoses, passive surveillance might involve collection of ticks from people or pets, or human disease reporting. This type of disease oversight is generally inexpensive and lean on time and labor investment.^13,14

Active surveillance, on the other hand, is more costly and labor intensive because it involves coordinated efforts by public health officials to gather medical data.^12-15 For tickborne diseases, this might mean collecting both free-living ticks from the environment and ticks from small hosts, and testing them for pathogens in the laboratory.

Passive and active tickborne disease surveillance programs can be coupled as follows: Passive tick surveillance might be employed broadly, for collection of ecologic data, for instance, and then active surveillance can be applied in areas where elevated risk was identified through passive study.

Table 1 outlines the variety of specific approaches for surveillance of I. scapularis, B. burgdorferi and Lyme disease that were tagged and analyzed.

Tickborne zoonoses surveillance programs have many challenges. During the early stages of emergence, low awareness can hinder reporting efforts by the public and the medical community.^29-32 Furthermore, as growing awareness boosts reporting, the true incidence can falsely appear to be surging.^33,34

Surveillance programs are further hampered by arbitrary geographical borders,³⁵ nonstandardized data,³² communication issues impacting data collection and analysis,^36,37 and insufficient resources for extending studies longitudinally.³⁵

Finally, ticks themselves are tough to track. Their questing behavior and spot densities are variable and inconsistent.^38,39 Plus, their bites can go undetected, and a delay exists between bite and symptom onset.³¹

Shortly after I. scapularis reared its ugly head and announced its spread through Canada in the early 1990s, public health officials and researchers met to address risks.⁴⁰ Multi-province active and passive tick surveillance programs mapped tick densities, and public education programs were initiated.^41-45 In some regions, passive tick surveillance programs gave way to targeted active surveillance aimed at detecting changes in ticks’ ranges.^29,44-49

In 2009, Lyme disease was declared a reportable disease in Canada,⁵⁰ and in 2014, the Canadian Parliament passed legislation mandating a national framework for Lyme disease surveillance.^51,52

Novel surveillance approach

This comprehensive review of surveillance systems for emerging tick-borne diseases highlights the need to make them adaptive as vectors, hosts, pathogens and ecologic factors evolve.^{29,31,36,53-56} An adaptive approach that incorporates necessary experts,^2,3,37,57 comprehensive data points,^35,58 standardized measurements⁵⁹ and resources sufficient for maintaining long-term research protocols³³ can enhance surveillance data across all phases of disease emergence, from pre-emergence to endemicity.

Though this framework was created for tickborne zoonoses, it can be applied to a variety of other vector-borne and zoonotic diseases.^60-62

Dr. Capuzzi is a small animal veterinarian and journalist based in the Philadelphia area.

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