Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 3150 Rampart Road, Fort Collins, CO 80522, USA.
J Med Entomol. 2012 Jan;49(1):11-22. doi: 10.1603/me11138.
Lyme disease is the most commonly reported vector-borne disease in the United States, with the majority of cases occurring in the Northeast. It has now been three decades since the etiological agent of the disease in North America, the spirochete Borrelia burgdorferi, and its primary North American vectors, the ticks Ixodes scapularis Say and I. pacificus Cooley & Kohls, were identified. Great strides have been made in our understanding of the ecology of the vectors and disease agent, and this knowledge has been used to design a wide range of prevention and control strategies. However, despite these advances, the number of Lyme disease cases have steadily increased. In this article, we assess potential reasons for the continued lack of success in prevention and control of Lyme disease in the northeastern United States, and identify conceptual areas where additional knowledge could be used to improve Lyme disease prevention and control strategies. Some of these areas include: 1) identifying critical host infestation rates required to maintain enzootic transmission of B. burgdorferi, 2) understanding how habitat diversity and forest fragmentation impacts acarological risk of exposure to B. burgdorferi and the ability of interventions to reduce risk, 3) quantifying the epidemiological outcomes of interventions focusing on ticks or vertebrate reservoirs, and 4) refining knowledge of how human behavior influences Lyme disease risk and identifying barriers to the adoption of personal protective measures and environmental tick management.
莱姆病是美国报告最多的虫媒传染病，大多数病例发生在东北部。自北美莱姆病的病原体——螺旋体伯氏疏螺旋体，以及其主要的北美传播媒介——肩突硬蜱（Ixodes scapularis Say）和太平洋硬蜱（Ixodes pacificus Cooley & Kohls）被发现以来，已经过去了三十年。我们在了解传播媒介和病原体的生态学方面取得了重大进展，这些知识已被用于设计各种预防和控制策略。然而，尽管取得了这些进展，莱姆病的病例数量仍在稳步增加。在本文中，我们评估了在美国东北部继续缺乏成功预防和控制莱姆病的潜在原因，并确定了可以利用额外知识来改进莱姆病预防和控制策略的概念领域。其中一些领域包括：1）确定维持伯氏疏螺旋体地方性传播所需的关键宿主侵染率，2）了解生境多样性和森林破碎化如何影响暴露于伯氏疏螺旋体的节肢动物风险以及干预措施降低风险的能力，3）量化针对蜱或脊椎动物宿主的干预措施的流行病学结果，4）完善人类行为如何影响莱姆病风险的知识，并确定个人防护措施和环境蜱管理措施的采用障碍。
