Quoc Nguyen, M.D., has professional and personal motivations for his diligence in tracking local trends in the spread of mosquito and tick-borne illnesses. As Onondaga County medical director, he fields questions about and advises local physicians on preventing exposure to, and treatment of those illnesses—which become more common during the warm weather months. An avid outdoorsman and father of five grown children, Nguyen also wants to make sure he does what he can to protect his own health.
With Eastern equine encephalitis, Lyme disease, the Zika virus, and other insect-borne illnesses so frequently in the local and national news, Family Times recently checked in with Nguyen to find out what Onondaga County residents should know and how they can minimize their risks for exposure.
Central New Yorkers have become increasingly aware of tick-borne illnesses in recent years. But has there been an actual rise in cases of Lyme disease?
Quoc Nguyen: The official number we have for reported cases in Onondaga County last year is 130. It was an increase from 2011-2012, when there were 86 reported cases. We do keep moving up a bit, but the real answer is we don’t know. It seems incremental, but it definitely depends on location. Our county is averaging 15 cases per 100,000 residents, while in Tompkins County, it’s 100 per 100,000.
Since we had a relatively mild winter, should we be more vigilant about checking ourselves, and our children, for ticks?
QN: The tick cycle is actually two years. It’s during that second year of their lives—in the spring and summer—when they are nymphs, that’s when they feed and can transmit the bacteria that can cause Lyme disease. They are also small, and can be hard to detect. The mild weather may contribute a little bit, but it’s more just the fact that we, and our pets, are outside more. That’s the risk.
What about mosquitoes? Does a mild, damp winter lead to more in the spring?
QN: Every year we put out traps in May. We keep a close eye on them during the spring. The Environmental Protection Agency provides clear guidelines on removing potential breeding sites, and preventing exposure. When we get the data from those traps, we develop a plan. Puddles and other standing water sites are treated, and mosquitoes are tested for disease. The treatments we use are good for up to three months. All the larvicides and treatments we use are approved by the EPA.
What is the proper way to check for ticks after spending time outdoors?
QN: We have to be careful to check the scalp and the skin folds. Also, the ticks that bite us are not the adults: They are the nymphs, which are the size of a sesame seed. You need to check young children every day, and you need to check as soon as you come in. An extra pair of eyes helps!
What is the best way to teach children to check themselves, without alarming them?
QN: You can mitigate some of that by encouraging children to stay in the middle of the trails when they are hiking, or in parks. Don’t go off the trails into tall grass. Long pants and light-colored fabrics are good ideas, and tick repellants are more widely available now. Those cannot be used on very young infants.
If we do find a tick on ourselves, or our children, what should we do?
QN: The first thing you should do is think about how long it may have been attached. If you’ve just come in and it’s lying flat, just flick it off. If it’s engorged, the time limit before treatment is recommended is usually 36 hours. You can still remove it, but if more than a day elapses, or you know it’s been more than 36 hours since it attached, be on the safe side and see your doctor. They may want to prescribe antibiotics. It is not necessary to save the ticks. If you are not sure how long the tick may have been attached, it’s better to be safe than sorry.
Is the appearance of rings around the bite site a good indicator of Lyme exposure?
QN: The rings occur in about 60 percent of cases, so it is a good sign, but it is not the most reliable indicator of Lyme. If the bite is on your scalp, you wouldn’t even see the rings. Fever and a generalized achiness, those are common symptoms.
The blood test will tell you if you’ve been exposed to Lyme. The problem is, if you have 100 people bitten by ticks carrying Lyme disease, only five of them would have any obvious symptoms. All 100 would test positive for exposure. For example, I’m an outdoorsy person, so I would probably test positive. I’d have the antibodies, but I don’t have Lyme disease.
Many of the diseases we are exposed to pass us by. Probably 95 percent of us have already been exposed to Lyme. West Nile, probably 80 of those exposed have not had the disease. Now with Zika, 85 percent of those exposed do not get it. We all deal with diseases differently, and none of them have a 100 percent attach rate. The (Centers for Disease Control and Prevention) continuously monitors the links between exposure and illness.
West Nile is something we commonly find in Central New York when we test mosquitoes. Most people get West Nile without knowing it. They have fevers, headaches and joint pain. Only a very small percentage develops signs of meningitis. The majority of people have no symptoms at all.
Are there other tick-borne illnesses that we should be mindful of?
QN: We follow them all. Babesiosis, the Powassan virus, we are always looking out for those. And we always test ticks for these viruses. The numbers for these, nationally, have been very low and there have been no spikes locally.
Mosquitoes carrying the EEE virus were found in both Onondaga and Madison counties last summer. What symptoms should parents be aware of if they think their children have been exposed?
QN: It is a serious disease. For the past few years, we’ve always had mosquitoes with EEE. For humans, there is no vaccine. We do know that the virus is carried by night-flying mosquitoes. We know how to avoid it, but even when we conduct the aerial spraying, it is hard to control. It looks like the environment in certain areas of the county is conducive for harboring EEE. The best thing you can do is to be vigilant about exposure and use repellant judiciously.
For the last two to three years, we have had a few very ill people; it’s a bad disease. We always issue press releases when mosquitoes test positive for it. Being proactive is the best thing we can do.
The Zika virus has been in the news, internationally, for months. Southern states are preparing for possible outbreaks, as well as illnesses such dengue and chikungunya. Could these illnesses eventually be spread here?
QN: We are tracking them because of the people who travel south and are exposed. But we do not have the mosquito that carries Zika here in Central New York. We do worry about the cases of sexually transmitted Zika—the exchange of infection.
Are local family physicians and general practitioners becoming better at addressing patient concerns about these illnesses and picking up on early symptoms? It wasn’t long ago that local patients with Lyme disease had trouble finding effective treatment.
QN: There has been a lot of attention on Lyme disease, locally. It is not easy to diagnose. The blood test is not much help beyond determining exposure. The symptoms are the important thing. The more information you can give your health care provider, the better. With EEE, you become very, very sick and physicians are getting better at addressing the early symptoms.
