Report to Maine Legislature
Lyme and other Tickborne Illnesses
January 31, 2018

Prepared by:
Sara Robinson, MPH, Epidemiologist, Division of Disease Control
Lindsay McFarren, Public Health Corps, Division of Disease Control

Submitted by
Maine Department of Health and Human Services, Maine Center for
Disease Control and Prevention (Maine CDC), Division of Disease Control,
Infectious Disease Program

Maine CDC Report to Maine Legislature on Lyme Disease – January 2018

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 Report to Maine Legislature – Lyme Disease
During the first special session of the 123rd Legislature in 2008, hearings and discussion over
proposed legislation regarding the reporting of Lyme disease led to Chapter 561 of the Session Laws.
This law, An Act to Implement the Recommendations of the Joint Standing Committee on Insurance
and Financial Services Regarding Reporting on Lyme Disease and Other Tickborne Illnesses,
directed Maine Center for Disease Control and Prevention to submit an annual report to the joint
standing committee of the Legislature having jurisdiction over health and human services matters and
the joint standing committee of the Legislature having jurisdiction over health insurance matters. This
report was to include recommendations for legislation to address public health programs for the
prevention and treatment of Lyme disease and other tickborne illnesses in the state, as well as to
address a review and evaluation of Lyme disease and other tickborne illnesses in Maine.
A bill in the second session of the 124th Legislature in 2010 amended these laws to include
information on diagnosis of Lyme disease.
Title 22, Chapter 266-B, Subsection 1645 in Maine statutes, directs Maine CDC to report on:
I. The incidence of Lyme disease and other tickborne illness in Maine
II. The Diagnosis and Treatment Guidelines for Lyme disease recommended by Maine Center for
Disease Control and Prevention and the United States Department of Health and Human
Services, Centers for Disease Control and Prevention
III. A summary or bibliography of peer-reviewed medical literature and studies related to the
diagnosis, medical management, and treatment of Lyme disease and other tickborne illnesses,
including, but not limited to, the recognition of chronic Lyme disease and the use of long-term
antibiotic treatment
IV. The education, training, and guidance provided by Maine Center for Disease Control and
Prevention to health care professionals on the current methods of diagnosing and treating
Lyme disease and other tickborne illnesses
V. The education and public awareness activities conducted by Maine Center for Disease Control
and Prevention for the prevention of Lyme disease and other tickborne illnesses; and
VI. A summary of the laws of other states enacted during the last year related to the diagnosis,
treatment, and insurance coverage for Lyme disease and other tickborne illnesses based on
resources made available by the federal Centers for Disease Control and Prevention or other
organizations.
This is the tenth annual report to the Legislature and includes an update on activities conducted
during 2017.

Maine CDC Report to Maine Legislature on Lyme Disease – January 2018

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 Executive Summary
Lyme disease is a notifiable condition in the State of Maine. The goal of Lyme disease surveillance is
to help define demographic, geographic, and seasonal distribution; monitor disease trends; identify
risk factors for transmission; and promote prevention and education efforts among the public and
medical communities. Reported cases are classified as confirmed, probable, and suspect based on
clinical symptoms and laboratory testing interpreted using criteria established by the Council of State
and Territorial Epidemiologists. The surveillance case definition is not intended to be used in clinical
diagnosis. Lyme disease surveillance is passive, dependent upon reporting, and therefore likely to be
an under-representation of the true burden of Lyme disease in Maine. Federal CDC released a
statement in 2013 that the true burden of Lyme disease may be up to ten times the number of
reported cases.
Maine Lyme Disease Summary, 2017 (Preliminary data as of January 16, 2018)
•

1,769 confirmed and probable cases

•

Most common symptoms of reported cases* of Lyme disease in Maine included:
o Erythema Migrans (characteristic expanding rash):
872 cases (49%)
o Arthritis (joint swelling):
513 cases (29%)
o Neurological (Bells Palsy or other cranial neuritis):
202 cases (11%)
* Cases could report more than one symptom

•

Hospitalization occurred in 58 cases (3%).

•

Among case patients with a reported date of symptom onset, 68% began experiencing
symptoms during June, July, or August. Date of symptom onset is missing for 17% of cases.
Confirmed and Probable Cases of Lyme Disease – Maine 2017*

Lyme Disease Cases per 100,000 persons (Rate) – Maine 2017*

* 2017 data are preliminary as of 01/18/2018

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 I. The Incidence of Lyme disease and other tickborne illness in Maine
A. Lyme disease
Lyme disease is caused by the bacteria Borrelia burgdorferi which is transmitted to a person through
the bite of an infected deer tick (Ixodes scapularis). Symptoms of Lyme disease include the formation
of a characteristic expanding rash (erythema migrans) at the site of a tick bite 3-30 days after
exposure. Fever, headache, joint and muscle pains, and fatigue are also common during the first
several weeks. Later features of Lyme disease can include arthritis in one or more joints (often the
knee), Bell’s palsy and other cranial nerve palsies, meningitis, and carditis (AV block). Lyme disease
is rarely fatal. The great majority of Lyme disease cases can be treated very effectively with oral
antibiotics for ten days to a few weeks. IV antibiotics for up to 28 days may be needed for some
cases of Lyme disease which affect the nervous system, joints, or heart.
In the United States, the highest rates of Lyme disease occur across the eastern seaboard (Maryland
to Maine) and in the upper Midwest (northern Wisconsin and southern Minnesota), with the onset of
most cases occurring during the summer months. In endemic areas, deer ticks are most abundant in
wooded, grassy, and brushy areas (“tick habitat”), especially where deer populations are large.
Many endemic states are no longer counting cases of Lyme disease as the burden is too high on the
health department. This affects the national and regional rates as the number of cases appears to
drop, but in reality, it is because these health departments are using a system to estimate the number
of cases, rather than trying to count each individual case. As of 2017, Maine is still counting
individual cases but as the burden continues to increase, and funding is limited, Maine will likely
transition to an estimation system in the future.

Source: federal CDC (https://www.cdc.gov/lyme/resources/reportedcasesoflymedisease_2016.pdf)

Maine CDC Report to Maine Legislature on Lyme Disease – January 2018

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 The first documented case of Maine-acquired Lyme disease was diagnosed in 1986. The current
2017 numbers are an increase from previous years and will continue to rise as more reports are
returned to Maine CDC. In the 1990’s the great majority of Lyme disease cases occurred among
residents of south coastal Maine, principally in York County. Disease incidence remains high in the
southern and the Mid-Coast areas but is starting to increase in the northern and western counties as
well, making the problem statewide. Androscoggin, Aroostook, Franklin, Hancock, Kennebec, Knox,
Oxford, Penobscot, Piscataquis, Somerset, Waldo, and Washington counties rates increased from
2016 to 2017. Seven counties have rates of Lyme disease higher than the State rate (Hancock,
Kennebec, Knox, Lincoln, Sagadahoc, Somerset, and Waldo).
In 2017 (preliminary data as of January 16, 2017) providers reported 1,769 confirmed and probable
cases of Lyme disease among Maine residents, which is a rate of 132.4 cases of Lyme disease per
100,000 persons in Maine. Twenty-eight percent (28%) of reported cases were from the southern
counties (Cumberland and York), and 23% of reported cases were from the Midcoast counties (Knox,
Lincoln, Sagadahoc, and Waldo).
Forty-one percent (41%) of cases were female and fifty-nine percent (59%) of cases were male. The
median age of cases in 2017 was 53 years of age (average age of 46 years). The age at diagnosis
ranged from 1-99 years. Sixty-eight percent (68%) of the cases with a known onset date had onset
during June, July, or August (date of onset is missing for 17% of cases). Providers reported 58
persons (3% of all cases) were hospitalized with Lyme disease. For further Lyme disease statistics in
Maine please see Appendix 1.
B. Other Tickborne Diseases in Maine
Anaplasmosis:
Anaplasmosis is a disease caused by the bacteria Anaplasma phagocytophilum which infects white
blood cells (neutrophils). Anaplasma was previously known as human granulocytic ehrlichiosis (HGE)
or human granulocytic anaplasmosis (HGA) but was renamed in 2003 to differentiate between two
different organisms that cause similar diseases (Anaplasmosis and Ehrlichiosis). Signs and
symptoms of anaplasmosis include: fever, headache, malaise, and body aches. Encephalitis/
meningitis may occur but is rare. Anaplasmosis is transmitted to a person through the bite of an
infected deer tick (Ixodes scapularis). Preliminary data as of January 16, 2017 showed 662 cases of
anaplasmosis reported in 2017, a 78% increase from the 372 cases in 2016. Cases occurred in
Androscoggin, Cumberland, Franklin, Hancock, Kennebec, Knox, Lincoln, Oxford, Penobscot,
Sagadahoc, Somerset, Waldo, Washington, and York counties. For further anaplasmosis disease
statistics in Maine please see Appendix 2.
Babesiosis:
Babesiosis is a potentially severe tickborne disease transmitted through the bite of an infected deer
tick (Ixodes scapularis). Signs of babesiosis usually range from no symptoms (asymptomatic) to
serious disease. Common symptoms include extreme fatigue, aches, fever, chills, sweating, dark
urine, and possibly anemia. People who are infected generally make a full recovery as long as they
have a healthy spleen and do not have other diseases that prevent them from fighting off infections.
Preliminary data as of January 16, 2017 showed 117 cases of babesiosis reported in 2017, which is
an increase from the 82 cases in 2016. Cases occurred in Androscoggin, Cumberland, Hancock,
Kennebec, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Sagadahoc, Somerset, Waldo, and York
counties. For further babesiosis disease statistics in Maine please see Appendix 2.
Maine CDC Report to Maine Legislature on Lyme Disease – January 2018

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 Borrelia miyamotoi:
Borrelia miyamotoi is a species of spiral-shaped bacteria that is closely related to the bacteria that
causes tickborne relapsing fever (TBRF). It is more distantly related to the bacteria that causes Lyme
disease. First identified in 1995 in ticks from Japan, B. miyamotoi has now been detected in two
species of North American ticks, the black-legged or “deer” tick (Ixodes scapularis) and the western
black-legged tick (Ixodes pacificus). Individuals with this infection are likely to have fever, chills, and
headache. Other common symptoms include joint pain and fatigue. Unlike Lyme disease, rash is
uncommon. Although Borrelia miyamotoi is not nationally notifiable, federal CDC in association with
endemic states developed a standardized case classification to help standardize reporting and
understand the prevalence in the United States. Preliminary data as of January 16, 2017 showed six
cases with Borrelia miyamotoi infections in Maine. Cases occurred in Androscoggin, Cumberland,
Knox, Lincoln, and Sagadahoc counties.
Ehrlichiosis:
Ehrlichiosis is a disease caused by the bacteria Ehrlichia chaffeensis which infects white blood cells
(monocytes). Ehrlichia was previously known as human monocytic ehrlichiosis (HME). Signs and
symptoms of ehrlichiosis include: fever, headache, nausea, and body aches. Encephalitis/ meningitis
may occur. Ehrlichiosis is transmitted to a person through the bite of an infected lone star tick
(Amblyomma americanum). Ehrlichiosis is uncommon in Maine as the tick is not commonly found
here. However, this may be a disease to watch for as the tick appears to be moving north.
Preliminary data as of January 16, 2017 showed ten probable cases of Ehrlichia chaffensis reported
in 2017 from Androscoggin, Cumberland, Kennebec, Somerset, and York counties. Maine had ten
probable cases of Ehrlichia/Anaplasma Undetermined in 2017, which occurs when serologies are
done, but titers are the same for both Ehrlichia and Anaplasma so we cannot tell which organism was
present. For further ehrlichiosis disease statistics in Maine please see Appendix 2.
Powassan:
Powassan is a virus transmitted to humans through the bite of an infected woodchuck tick (Ixodes
cookei) or deer tick (Ixodes scapularis). It is the only tickborne arbovirus occurring in the United
States and Canada. Approximately 100 cases of Powassan were reported in the United States in the
last decade, and cases appear to be increasing. Signs and symptoms of Powassan include fever,
headache, vomiting, weakness, confusion, seizures, and memory loss. Long-term neurologic
problems may occur. There were three reported cases of Powassan in Maine in 2017. One case was
reported in Cumberland county and two cases were reported in Knox county. With the two cases
reported in late spring, Maine CDC put together a Powassan fact sheet to inform the public about
their risk. This is included as Appendix 3.
Spotted Fever Rickettsiosis:
Spotted Fever Rickettsioses (SFR) are a group of bacterial illnesses, the most common of which is
Rocky Mountain Spotted Fever (RMSF). Signs and symptoms of RMSF include fever, chills,
headache, gastrointestinal symptoms, and a maculopapular rash often on the palms and the soles.
RMSF is transmitted to a person through the bite of an infected dog tick (Dermacentor variabilis).
RMSF is not known to be endemic in Maine, but could become an emerging disease. Preliminary
data as of January 16, 2017 showed three probable cases of SFR reported in 2017. These cases
were reported in Androscoggin and York counties. For further SFR disease statistics in Maine please
see Appendix 2.

Maine CDC Report to Maine Legislature on Lyme Disease – January 2018

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 Other Emerging Tickborne Diseases:
Federal CDC and other researchers are continually on the watch for new or emerging tickborne
disease. Pathogens identified in the last few years include Heartland virus, and Bourbon virus.
Maine has no documented cases of any of these diseases, but there is serological evidence (from
either humans or wild animals) of Heartland virus in Maine, so these are diseases to watch.
II. The Diagnosis and Treatment Guidelines for Lyme disease recommended by Maine Center
for Disease Control and Prevention and the United States Department of Health and Human
Services, Centers for Disease Control and Prevention
Maine Center for Disease Control and Prevention continues to adhere to the strongest science-based
source of information for the diagnosis and treatment of any infectious disease of public health
significance. Nationally, the Infectious Disease Society of America (IDSA) is the leader in setting the
standard for clinical practice guidelines on Lyme disease and other tickborne illnesses:
https://www.idsociety.org/uploadedfiles/idsa/guidelines-patient_care/pdf_library/lyme%20disease.pdf .
Lyme disease is diagnosed clinically with the aid of laboratory testing. An erythema migrans in an
endemic area is sufficiently distinctive to allow clinical diagnosis in the absence of laboratory
confirmation. Patients should be treated on the basis of clinical findings. A two tier testing algorithm
is recommended for laboratory testing. First-tier testing is most often an enzyme-linked
immunosorbent assay (ELISA) test which, if positive or equivocal, should be followed by an IgM and
IgG Immunoblot. IgM is only considered reliable if tested within the first 30 days after symptom onset.
Acute and convalescent testing is useful to determine final diagnosis. Untreated patients who remain
seronegative despite having symptoms for 6-8 weeks are unlikely to have Lyme disease, and other
potential diagnoses should be actively pursued. A diagnosis of Lyme disease made by a clinician
may or may not meet the federal surveillance case definition, and therefore may not always be
counted as a case. Maine CDC refers physicians with questions about diagnosis to the IDSA
guidelines https://www.idsociety.org/uploadedfiles/idsa/guidelinespatient_care/pdf_library/lyme%20disease.pdf
During 2009 and 2010, IDSA convened a special review of the clinical practice guidelines on Lyme
disease to determine whether the 2006 guidelines should be revised and updated. A central question
explored at the Review Panel hearing held during July 2009 was whether Lyme disease can persist
as a chronic infection that can be successfully treated with an extended course of antibiotics.
The special panel reviewed the medical and scientific literature as well as material submitted by the
18 individuals who testified at the hearing and about 150 other comments submitted by the public.
The panel also heard from several representatives of the International Lyme and Associated
Diseases Society (ILADS), who argued for more extensive treatment for what ILADS identifies as
chronic Lyme disease. The panel met 16 times and the review took more than a year to complete.
On April 22, 2010 the special Review Panel “unanimously agreed that no changes need be made to
the 2006 Lyme disease treatment guidelines developed by the Infectious Diseases Society of
America (IDSA)” (https://www.idsociety.org/uploadedfiles/idsa/guidelinespatient_care/pdf_library/lyme%20disease.pdf).
“The Review Panel concurred that all of the recommendations from the 2006 guidelines are medically
and scientifically justified in light of the evidence and information provided, including the
recommendations that are most contentious: that there is no convincing evidence for the existence of

Maine CDC Report to Maine Legislature on Lyme Disease – January 2018

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 chronic Lyme infection; and that long-term antibiotic treatment of “chronic Lyme disease” is unproven
and unwarranted. This recommendation is also supported by federal CDC. Inappropriate use of
antibiotics (especially given intravenously) has been shown to lead to deadly blood infections, serious
drug reactions and C. difficile diarrhea, as well as the creation of antibiotic-resistant bacteria or
‘superbugs.’” (https://www.idsociety.org/uploadedfiles/idsa/guidelinespatient_care/pdf_library/lyme%20disease.pdf).

III. A Summary or bibliography of peer reviewed medical literature and studies related to the
diagnosis, medical management and the treatment of Lyme disease and other tickborne
illnesses, including, but not limited to, the recognition of chronic Lyme disease and the use of
long term antibiotic treatment.
The Infectious Disease Society of America (IDSA) continues to provide leadership in setting the
standard for clinical practice guidelines on Lyme disease.
https://www.idsociety.org/uploadedfiles/idsa/guidelines-patient_care/pdf_library/lyme%20disease.pdf.
A bibliography of peer reviewed journal articles published in 2017, as related to these clinical
guidelines and other topics of interest, is included in Appendix 4. Maine CDC reviews these journal
articles to maintain an understanding of the current research and literature available on Lyme disease
clinical management and treatment.

IV. The education, training, and guidance provided by Maine Center for Disease Control and
Prevention to health care professionals on the current methods of diagnosing and treating
Lyme disease and other tickborne illnesses
Maine CDC continues to emphasize prevention and control of Lyme disease. Surveillance for
tickborne diseases, including Lyme disease, is performed by the Division of Disease Control,
Infectious Disease Program, as Lyme disease is a notifiable disease entity by both medical
practitioners and clinical laboratories. Reporting clinicians must submit subsequent clinical and
laboratory information following the initial report. Maine CDC also monitors tickborne diseases
through syndromic surveillance. By querying of participating hospital emergency department (ED)
patient visit data, patients that complain of a tick bite are identified. An increase in ED visits for tick
bites is usually a precursor for the typical seasonal increase in Lyme disease incidence. A
comparison of 2016 and 2017 data is included as Appendix 5. Maine CDC partners with the
University of Maine Cooperative Extension Office to monitor the identification of deer ticks in Maine
through a passive submission system.
A spatial analysis of 2017 Lyme disease surveillance data was performed at the county level,
showing the continual disease progression (Appendix 6). Outreach and education to clinicians and
other healthcare providers to increase provider response to required supplemental clinical and
laboratory information is ongoing.
Maine CDC epidemiologists provide consultation to the medical community on tickborne diseases,
offering educational and preventive information as needed. Maine CDC epidemiologists present
educational outreach activities and seminars on tickborne disease prevention targeting the medical
community at statewide meetings of school nurses and others. Ongoing educational initiatives are
featured on the Maine CDC web site: http://www.maine.gov/lyme

Maine CDC Report to Maine Legislature on Lyme Disease – January 2018

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 During 2017, a clinical management guide, “Physician’s Reference Manual: Tickborne Diseases in
Maine” was mailed to hospitals, urgent care providers, and geriatric practices. This guide includes
information on ticks found in Maine and signs/symptoms, laboratory services, diagnosis, and
treatment of six tickborne diseases, including Lyme disease.
• 101 copies of this guide were distributed in 2017
Maine CDC continues to contribute to national surveillance and prevention activities. During
2017, Maine CDC epidemiologists represented the State at both local and national meetings
including:
• Northeastern Tickborne Disease meeting for High Incidence States held in Manchester, NH in
March 2017
• Council of State and Territorial Epidemiologist (CSTE) annual conference held Boise, ID in
June 2017
• Northeast Epidemiology annual conference held in Northampton, Massachusetts in October
2017
• Council of State and Territorial Epidemiologists (CSTE) Vectorborne Regional Meeting held in
Arlington, VA in November 2017
V. The education and public awareness activities conducted by Maine Center for Disease
Control and Prevention for the prevention of Lyme disease and other tickborne illnesses
Maine CDC promotes ongoing educational outreach activities targeting the public and Maine
municipalities. During 2017, Maine CDC epidemiologists provided consultation to the public on
tickborne diseases, offering educational and preventive information as needed. Maine CDC
epidemiologists present educational outreach activities and seminars on tickborne disease prevention
to the general public including:
• 36 presentations or displays held for: students in 3rd-8th grade, Boy Scouts of America, public
works employees, forestry department summer workers, health and physical education
teachers, mill workers, health care providers, Department of Transportation staff, seniors, and
the general public.
• Numerous media interviews given by Maine CDC employees (vectorborne epidemiologist,
state health officer, and state epidemiologist).
Maine CDC’s Vectorborne Epidemiologist chairs the State Vectorborne Disease Work Group; a
group comprised of both State agencies and private entities, which meets on a bimonthly basis to
proactively address surveillance, prevention and control strategies. Members of this group include:
Maine Department of Health and Human Services, Maine Department of Agriculture, Conservation,
and Forestry, Maine Department of Inland Fisheries and Wildlife, Maine Department of Education,
Maine Department of Environmental Protection, Maine Forest Service, University of Maine
Cooperative Extension Services, and the United States Department of Agriculture. A full list of
members can be found in Appendix 7. Educational efforts by the Vectorborne Work Group
included:
• Presentations given on ticks and Lyme disease
• Presence at vendor shows, television and radio interviews
• Distribution of educational materials including Lyme brochures, tick spoons, fact sheets, etc.

Maine CDC Report to Maine Legislature on Lyme Disease – January 2018

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 In 2014, Maine CDC began a project with students in 3rd to 5th grade to teach them about tick
biology and ecology, as well as present information on tickborne diseases and prevention. In 2017
Maine CDC expanded the program to include curriculum and activities developed for middle schools.
The program consists of a pre-test to gauge knowledge prior to the intervention; a twenty minute
PowerPoint presentation on tick biology and ecology, as well as disease information; four ten-minute
interactive activities; a take-home packet with games, activities, and information for parents; and a
post-test to determine changes in knowledge and practices. This was undertaken with the Maine
Public Health Corps (PHC) students who designed the curriculum and assisted with the activities. An
epidemiologist or PHC member presented the disease and biology/ecology information. Participants
evaluated the program highly in all schools. This endeavor is being undertaken in close partnership
with the Maine Department of Education. An example of one of the newly developed middle school
activities can be found in Appendix 8.
Educational materials for the 3rd-5th and 6th-8th graders are available online, including our educator’s
guide, group activities, and activity book for both ticks and mosquitoes. PHC continues to review and
update the education materials. Educational materials are available online at:
http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/school-curriculum/index.shtml.
•

The web resource for educators was visited 1,481 times in 2017

In 2017, Maine CDC and PHC expanded the Tick Free ME program which educates adults ages 45
years and older about ticks and tick prevention practices. In 2017 Maine CDC conducted the
Tick Free ME program entirely online. The program consisted of a questionnaire administered prior
to participation to gauge prior knowledge and tick prevention behaviors and to gather contact
information. During the challenge month participants received fact sheets on tickborne diseases in
Maine (Lyme disease, Anaplasma, Babesia, and Powassan), repellent, and other tick prevention
methods, and videos about tick habitats, diseases, and prevention. PHC members used weekly
surveys to measure participant’s prevention behaviors each week.
Maine CDC and PHC maintains a series of instructional short videos to educate the Maine
community in tick prevention and tickborne diseases. These videos include:
• How to Perform a Tick Check – viewed 753 times in 2017
• Tickborne Diseases in Maine: Anaplasmosis – viewed 442 times in 2017
• Tickborne Diseases: Powassan Encephalitis– viewed 411 times in 2017
• Tickborne Diseases in Maine: Lyme Disease-viewed 137 times in 2017
• Reducing Tick Habitat Around Your Home- viewed 259 times in 2017
• Tickborne Diseases in Maine : Babesiosis – viewed 135 times in 2017
• How to Choose a Residential Pesticide Applicator – viewed 45 times in 2017
• Tick Identification – viewed 6,421 times in 2017
• Choosing and Applying Personal Repellents – viewed 79 times in 2017
Maine’s PHC team conducts Tick and Mosquito “Train the Trainer” events to help educate
individuals on these topics and empower them to be a resource in their local community. During
2017 PHC held six workshops in Portland, Lisbon Falls, Ellsworth, Rockland, Falmouth, and Wells
and provided training and materials to 126 participants.

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 Maine CDC’s Lyme disease website is continually updated to provide information to the public and
to health professionals about Lyme disease in Maine. In 2017:
• The Lyme disease homepage was visited 3,046 times
• The tick identification page was visited 7,143 times
• The FAQ section was visited 35,416 times
Ongoing educational initiatives featured on the Maine CDC website include:
• Lyme disease fact sheets
• Tick Identification
• Prevention of Tickborne Diseases
• Lyme Disease Surveillance Reports from 2008-2016
• Lyme disease awareness and prevention movie
Links are also provided for the educational materials for educators and the 3rd-5th and 6th-8th grade
curriculum, and for other tickborne diseases including: anaplasmosis, babesiosis, ehrlichiosis,
Powassan, and RMSF.
During 2017, Lyme disease educational materials were distributed to partners and members of the
public. Approximate numbers of materials distributed include:
• ~14,926 Wallet-sized laminated tick identification cards
• ~10,973 Tick remover spoons
• ~3,415 Lyme disease brochures
• ~3,169 Tick ID posters
• ~745 Tick Bite Follow Up posters (Appendix 9)
• ~612 Lyme Disease Awareness Month 2017 posters
Members of the Vectorborne Disease Working Group assist Maine CDC in distributing educational
materials as widely as possible throughout the State.
Maine CDC releases Health Alerts, press releases, and other information on disease concerns of
public health significance, including tickborne diseases. Maine CDC also responds to numerous
press inquiries and releases press statements as appropriate (www.mainepublichealth.gov). Official
releases in 2017 included:
• 2017 Lyme and other Tickborne Disease Information (Health Alert) – May 2nd
• Two Cases of Powassan Encephalitis Identified in Maine Residents (Press Release) –
released June 1st
• Be Tick Smart: Maine CDC Names the Winners of the 2017 Lyme Disease Awareness Poster
Contest (Press Release) – released June 13th
• Adults Over 65 Years Old Had the Highest Rates of Lyme Disease in 2016 (Press Release) –
released June 15th
• Tick Bite Recommendations (Health Alert) – June 15th
Pursuant to Legislation enacted in the second regular session of the 126th Legislature, May 2017 was
declared to be Lyme Disease Awareness Month (PL 494). Educational activities took place the
entire month including:
• Press release/Health Alert
• Governor’s Proclamation of Lyme Disease Awareness Month (Appendix 10)
• Information distributed through social media (Facebook, Twitter, Blog)
Maine CDC Report to Maine Legislature on Lyme Disease – January 2018

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 •
•
•
•

Information distributed through multiple newsletters throughout the state
Lyme Disease Public Awareness Events held in Augusta, Freeport, Fryeburg, Kennebunkport,
and Wiscasset
Presentations throughout the state
Maine CDC presence at multiple health fairs and conferences

Another major Lyme Disease Awareness month activity was the statewide poster contest for
students in grades K-8. Students were asked to create a poster with the theme “Be Tick Smart”
demonstrating at least one of the four Lyme disease prevention methods (wear protective clothing,
use repellent, use caution in tick infested areas, and perform daily tick checks). The four winning
posters and two honorable mentions are available for viewing at the Lyme disease website
www.maine.gov/lyme. Maine CDC used one of the winning posters for our 2017 statewide
educational campaign (Appendix 11). Maine CDC distributed this poster to schools, state parks, the
board of tourism, and historical sites.
In 2011 Maine CDC launched Lyme disease data on the Maine Tracking Network Portal. The data
portal allows users to customize their data inquiries and includes data from 2001-2016, including town
level data. The Lyme portion of the portal was accessed 3,159 times during 2017. The Maine
Tracking Network Lyme Data are available on Maine CDC’s website at www.maine.gov/idepi. Please
see Appendix 12 for a sample table and map. Data can be broken down by:
• Public Health District
• County
• Town
• Gender
• Age group
Maine CDC’s main prevention message is encouraging Maine residents and visitors to use personal
protective measures to prevent tick exposures. Personal protective measures include avoiding tick
habitat, use of EPA approved repellents, wearing long sleeves and pants, and daily tick checks and
tick removal after being in tick habitats (ticks must be attached >24 hours to transmit Lyme disease).
Persons who have been in tick habitats should consult a medical provider if they have unexplained
rashes, fever, or other unusual illnesses during the first several months after exposure. Possible
community approaches to prevent Lyme disease include landscape management and control of deer
herd populations.

VI. A summary of laws of other states enacted during the past year related to the diagnosis,
treatment, and insurance coverage for Lyme disease and other tickborne illnesses based on
resources made available by federal Centers for Disease Control and Prevention or Other
Organizations
Maine CDC performed a search of state and federal legislation. A state by state listing of legislation
relating to Lyme disease can be found in Appendix 13.

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 Appendix 1
Maine Lyme disease statistics
Number and Rate per 100,000 persons of Lyme Disease Cases by County of Residence – Maine, 2013-2017*

County
Androscoggin
Aroostook
Cumberland
Franklin
Hancock
Kennebec
Knox
Lincoln
Oxford
Penobscot
Piscataquis
Sagadahoc
Somerset
Waldo
Washington
York
State

2013
Count
72
3
351
11
100
183
95
71
50
38
0
55
32
89
13
221
1384

2013
Rate
66.9
4.3
123
36.1
182.3
151
240.2
208.3
87
24.8
0
157.1
61.9
228.6
40.4
110.8
104.2

2014
Count
95
5
339
10
121
139
106
83
43
50
2
65
17
49
14
272
1410

2014
Rate
88.4
7.2
117.8
33
221.2
114.8
267.2
242.9
75.1
32.6
11.7
185.5
33.2
125.5
44
135.5
106

2015
Count
51
2
258
10
121
154
119
74
26
51
1
48
28
63
20
184
1210

2015
Rate
47.6
2.9
89.0
33.3
221.4
128.4
298.6
217.8
45.5
33.4
5.9
136.6
54.8
160.9
63.2
91.5
91.0

2016
Count
92
1
311
3
152
204
107
99
43
90
3
91
21
71
20
188
1496

2016
Rate
85.8
1.5
107.2
10.0
278.1
170.0
268.5
291.4
75.2
58.9
17.7
258.9
41.1
181.3
63.2
93.5
112.5

All data includes both confirmed and probable cases

Lyme Disease Cases - Maine, 2008-2017*
1769

1800

Number of Cases

1496

1384 1411

1500
1200
909
900

1013

976

1113

1215

752

600
300
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

* 2017 data are preliminary as of 01/16/2018

Maine CDC Report to Maine Legislature on Lyme Disease – January 2018

Page 13

2017*
Count
95
7
303
22
202
260
139
71
57
111
3
60
91
135
29
184
1769

2017*
Rate
88.5
10.3
103.8
73.3
371.2
215.6
349.7
207.5
99.6
73.1
17.8
170.1
178.7
343.0
92.2
90.9
132.4

 Rate per 100,000

Lyme Disease Incidence - Maine and US, 2008-2017*
140.0
130.0
120.0
110.0
100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
2008

2009

2010

2011

2012

Maine

2013

2014

2015

2016

2017

US

* 2017 data are preliminary as of 01/16/2018

200

Lyme disease rates by age group, Maine 2008-17*

180

Rate per 100,000 persons

160
140
120
100
80
60
40
20
0
2008

2009
<5

2010
5-14

2011
15-24

2012

2013
25-44

2014
45-64

2015

2016
65+

* 2017 data are preliminary as of 01/16/2018

Maine CDC Report to Maine Legislature on Lyme Disease – January 2018

Page 14

2017*

 * 2017 data are preliminary as of 01/16/2018

Maine CDC Report to Maine Legislature on Lyme Disease – January 2018

Page 15

 Appendix 2
Maine tickborne disease statistics (excluding Lyme disease)

Ehrlichiosis

Ehrlichiosis/
Anaplasmosis
Undetermined

42
0
102
1
24
71
110
95
14
6
0
46
4
38
2
107
662

6
0
20
0
3
15
25
10
3
2
1
7
2
1
0
22
117

2
0
3
0
0
2
0
0
0
0
0
0
1
0
0
2
10

6
0
1
0
0
3
0
0
0
0
0
0
0
0
0
0
10

Spotted Fever
Rickettsiosis

Babesiosis

Androscoggin
Aroostook
Cumberland
Franklin
Hancock
Kennebec
Knox
Lincoln
Oxford
Penobscot
Piscataquis
Sagadahoc
Somerset
Waldo
Washington
York
Total

Powassan

County

Anaplasmosis

Number of Selected Tickborne Disease Cases by County of Residence – Maine, 2017*

0
0
1
0
0
0
2
0
0
0
0
0
0
0
0
0
3

0
0
1
0
0
0
0
0
1
0
0
0
0
0
0
1
3

Number of Selected Tickborne Disease Cases– Maine, 2008 - 2017*
Anaplasmosis
Babesiosis
Ehrlichia chaffeensis
Ehr/Ana undetermined
RMSF
Powassan

2008
17
11
1
0
1
0

2009
15
3
1
0
5
0

2010
17
5
4
0
2
0

2011
26
9
1
0
1
0

2012
52
10
3
0
3
0

2013
94
36
3
2
2
1

2014
191
42
8
6
3
0

2015
186
55
5
1
1
0

* 2017 data are preliminary as of 01/16/2018

Maine CDC Report to Maine Legislature on Lyme Disease – January 2018

Page 16

2016
372
82
7
4
4
1

2017*
662
117
10
10
3
3

 Anaplasmosis and Babesiosis, Maine 2008-2017*
700
600

Number of Cases

500
400
300
200
100
0
2008

2009

2010

2011

2012

Anaplasmosis

2013

2014

2015

2016

Babesiosis

* 2017 data are preliminary as of 01/16/2018

Maine CDC Report to Maine Legislature on Lyme Disease – January 2018

Page 17

2017

 Appendix 3

Powassan Virus
Fact Sheet
What is Powassan virus?
Powassan (POW) virus disease is a rare, but often
serious disease that is spread by infected ticks.
POW virus is one of a group of arthropod-borne
viruses (arboviruses) that can cause swelling of the
brain (encephalitis).

include hospitalization, respiratory support, and
fluids.

How is it spread?
POW virus is spread by the bite of an infected tick.
POW virus is not passed from person-to-person.

How can I reduce the chance of getting
infected?
The best way to prevent POW virus disease is by
protecting yourself from tick bites.
• Avoid contact with ticks by avoiding wooded
and bushy areas with high grass.
• Apply repellents to bare skin, according to label
instructions.
o Repellents containing DEET can be applied
to exposed skin, but only last a few hours.
o Clothing and gear can be treated with
permethrin, which remains protective
through several washings.
• Find and remove ticks before they have a
chance to bite and attach.
o Bathe or shower (preferably within 2 hours
after being outdoors) to wash off and find
ticks on your body.
o Conduct a full-body tick check. Parents
should thoroughly check children,
especially in their hair.
o Also examine clothing, gear and pets.

What are the symptoms?
Many people who become infected do not develop
any symptoms. POW virus can cause swelling of
the brain and meninges (the membranes that
surround the brain and spinal cord). Symptoms can
include fever, headache, vomiting, weakness,
confusion, loss of coordination, speech difficulties,
and seizures.
Who is at risk for infection?
Anyone bitten by a tick in an area where the virus is
found can get infected with POW virus. The risk is
highest for people who live, work or play in brushy
or wooded areas, because of greater exposure to
potentially infected ticks.
How soon do people infected get sick?
The time from tick bite to onset of illness ranges
from one week to one month.
How is it diagnosed?
Diagnosis is based on a combination of signs and
symptoms and laboratory tests of blood or spinal
fluid.
What is the treatment?
There is no specific medicine to cure or treat POW
virus disease. Treatment for severe illnesses may

Is there a vaccine?
No, currently there is no vaccine available to
prevent POW.

Where can I get more information?
For more information contact your healthcare
provider or local health center. You can also
contact the Maine Center for Disease Control and
Prevention by calling 1-800-821-5821 or visiting the
website http://www.maine.gov/idepi. The federal
Centers for Disease Control and Prevention
website http://www.cdc.gov/powassan is another
excellent source of health information.

 Appendix 4
Peer-reviewed medical literature related to medical management and treatment of Lyme
disease – bibliography: 2017
•

Akel, T., & Mobarakai, N. (2017). Hematologic manifestations of babesiosis. Annals of Clinical
Microbiology and Antimicrobials,16(1). doi:10.1186/s12941-017-0179-z

•

Badawi, A., Shering, M., Rahman, S., & Lindsay, L.R. (2017). A systematic review and metaanalysis for the adverse effects, immunogenicity and efficacy of Lyme disease vaccines:
Guiding novel vaccine development. Can J Public Health,108(1), 62.
doi:10.17269/cjph.108.5728

•

Bechtold, K. T., Rebman, A.W., Crowder, L A., Johnson-Greene, D., & Aucott, J.N. (2017).
Standardized Symptom Measurement of Individuals with Early Lyme Disease Over
Time. Archives of Clinical Neuropsychology,32(2), 129-141. doi:10.1093/arclin/acw098

•

Butler, A. D., Carlson, M.L., & Nelson, C.A. (2017). Use of a tick-borne disease manual
increases accuracy of tick identification among primary care providers in Lyme disease
endemic areas. Ticks and Tick-borne Diseases,8(2), 262-265. doi:10.1016/j.ttbdis.2016.11.010

•

Chang, C., Feemster, K.A., Coffin, S., & Handy, L.K. (2017). Treatment-Related Complications
in Children Hospitalized With Disseminated Lyme Disease. Journal of the Pediatric Infectious
Diseases Society,6(3). doi:10.1093/jpids/pix060

•

Feng, J., Zhang, S., Shi, W., & Zhang, Y. (2017). Activity of Sulfa Drugs and Their
Combinations against Stationary Phase B. burgdorferi In Vitro. Antibiotics,6(1), 10.
doi:10.3390/antibiotics6010010

•

Gasmi, S., Ogden, N.H., Leighton, P.A., Adam-Poupart, A., Milord, F., Lindsay, L.R.,…
Thivierge, K. (2017). Practices of Lyme disease diagnosis and treatment by general
practitioners in Quebec, 2008–2015. BMC Family Practice,18(1). doi:10.1186/s12875-0170636-y

•

Halperin, J.J. (2017). Diagnosis and management of Lyme neuroborreliosis. Expert Review of
Anti-infective Therapy,16(1), 5-11. doi:10.1080/14787210.2018.1417836

•

Hermance, M.E., & Thangamani, S. (2017). Powassan Virus: An Emerging Arbovirus of Public
Health Concern in North America. Vector-Borne and Zoonotic Diseases,17(7), 453-462.
doi:10.1089/vbz.2017.2110

•

Ismail, N., & Mcbride, J.W. (2017). Tick-Borne Emerging Infections. Clinics in Laboratory
Medicine,37(2), 317-340. doi:10.1016/j.cll.2017.01.006

 •

Jowett, N., Gaudin, R.A., Banks, C.A., & Hadlock, T.A. (2017). Steroid use in Lyme diseaseassociated facial palsy is associated with worse long-term outcomes. The
Laryngoscope,127(6), 1451-1458. doi:10.1002/lary.26273

•

Kletsova, E.A., Spitzer, E.D., Fries, B.C., & Marcos, L.A. (2017). Babesiosis in Long Island:
review of 62 cases focusing on treatment with azithromycin and atovaquone. Annals of Clinical
Microbiology and Antimicrobials,16(1). doi:10.1186/s12941-017-0198-9

•

Lebel, D.P., Moritz, E.D., Obrien, J.J., Lazarchick, J., Tormos, L.M., Duong, A.,… Stramer, S.L.
(2017). Cases of transfusion-transmitted babesiosis occurring in nonendemic areas: a
diagnostic dilemma. Transfusion,57(10), 2348-2354. doi:10.1111/trf.14246

•

Mareedu, N., Tompkins, J., Schotthoefer, A., Hall, M.C., Fritsche, T., & Frost, H. (2017). Risk
Factors for Hospitalization, Severe Infection, and Prolonged Disease in Patients With
Babesiosis in the Upper Midwest.American Society of Tropical Medicine and Hygiene,97(4).
doi:10.4269/ajtmh.17-0146

•

Molins, C.R., Ashton, L.V., Wormser, G.P., Andre, B.G., Hess, A.M., Delorey, M.J.,… Belisle,
J.T. (2017). Metabolic differentiation of early Lyme disease from southern tick-associated rash
illness (STARI). Science Translational Medicine,9(403). doi: 10.1126/scitranslmed.aal2717.

•

Nigrovic, L.E., Bennett, J.E., Balamuth, F., Levas, M.N., Chenard, R.L., Maulden, A.B., &
Garro, A.C. (2017). Accuracy of Clinician Suspicion of Lyme Disease in the Emergency
Department. Pediatrics,140(6). doi:10.1542/peds.2017-1975

•

Primus, S., Akoolo, L., Schlachter, S., & Parveen, N. (2017). Screening of patient blood
samples for babesiosis using enzymatic assays. Ticks and Tick-borne Diseases.
doi:10.1016/j.ttbdis.2017.11.003

•

Schotthoefer, A.M., Schrodi, S.J., Meece, J.K., Fritsche, T.R., & Shukla, S.K. (2017). Proinflammatory immune responses are associated with clinical signs and symptoms of human
anaplasmosis. PloS One,12(6). doi:10.1371/journal.pone.0179655

•

Socarras, K.M., Theophilus, P.A.S., Torres, J.P., Gupta, K., & Sapi, E. (2017). Antimicrobial
Activity of Bee Venom and Melittin against Borrelia burgdorferi. Antibiotics,6(4), 31.
doi:10.3390/antibiotics6040031

•

Tseng, Y., Demaria, A., Goldmann, D.A., & Mandl, K.D. (2017). Claims-Based Diagnostic
Patterns of Patients Evaluated for Lyme Disease and Given Extended Antibiotic
Therapy. Vector-Borne and Zoonotic Diseases,17(2), 116-122. doi:10.1089/vbz.2016.1991

•

Verhaegh, D., Joosten, L.A.B., & Oosting, M. (2017). The role of host immune cells and
Borrelia burgdorferi antigens in the etiology of Lyme disease. European Cytokine
Network,28(2). doi:10.1684/ecn.2017.0396.

 Appendix 5

Maine CDC Surveillance Report

Report run: Liza-"2018 11321541?!r AM

Daily Suspected Tick Exposures ys. Past Two Years

2016 2111? 21318
120?
Hit}?
so?



4o?
2'3' mp? ?de lfrimij?'Month of?fear

 

oy Dec

Data Notes:

The number of suspected tick exposures is based on automated processing ofchiefcomplaint text
from patient encounters at Maine emergency departments and af?liated urgent care facilities- New
hospitals are added to the suryeillance system every year. increasing the universe of
patient encounters and confounding year?over-year comparisons. For more information about l'u'laine's
surveillance data and methods. please contact 

Appendix 6
Lyme Disease Cases per 100,000 people (Rate) – Maine, Selected years 2010-2017*

* 2017 data are preliminary as of 01/16/2018

 Appendix 7
2017 Maine Vectorborne Disease Work Group
Chair: Sara Robinson, Maine Center for Disease Control and Prevention (Maine CDC)
Adams, Justin
Beausang, Beth
Bennett, Siiri
Bergeron, Justin
Bonthius, Jessica
Camuso, Judy
Chamberlain, Anne
Dill, Griffin
Dill, Jim
Donahue, Charlene
Dyer, Robin
Elias, Susan
Fish, Gary
Fiske, Rachael
Gardner, Allison
Groden, Ellie
Hicks, Lebelle
Hinkel, Bill
Jackson Jones, Paula
Jennings, Henry
Kantar, Lee
Kavanah, Brian W
Keenan, Patrick
Lacombe, Eleanor
Lay, Cam
Lichtenwalner, Anne
Lubelczyk, Charles
Matluk, Nicholas
Morris, Jesse W
Morrison, Mike
Murray, Kathy
Patterson, Megan L
Peranzi, Catie
Poland, Emily
Rand, Peter
Ravana, Kyle
Robich, Rebecca
Robinson, Sara
Smith, Rob
Staples, Joe
Storch, Dick
Struble, Dave
Szantyr, Beatrice
Tomlinson, Mary
Walsh, Michele

Municipal Pest Management
Chellie Pingree’s Staff
Maine CDC
Maine Department of Agriculture, Conservation, and Forestry
Maine CDC
Maine Department of Inland Fisheries and Wildlife
Maine Board of Pesticide Control
Maine Cooperative Extension
Maine Cooperative Extension
Maine Forest Service
US Department of Agriculture
Maine Medical Center Research Institute, UMaine Orono
Maine Board of Pesticides Control
Maine Department of Agriculture, Conservation, and Forestry
University of Maine Orono
University of Maine Orono
Maine Board of Pesticides Control
Maine Department of Environmental Protection
Midcoast Lyme Disease Support Group
Maine Board of Pesticides Control
Maine Department of Inland Fisheries and Wildlife
Maine Department of Environmental Protection
Biodiversity Research Institute
Maine Medical Center Research Institute
Maine Board of Pesticides Control
University of Maine, Animal Health Laboratory
Maine Medical Center Research Institute
Maine Health and Environmental Testing Laboratory
US Department of Agriculture
Municipal Pest Management
Maine Board of Pesticides Control
Maine Board of Pesticides Control
Maine CDC
Maine Department of Education
Maine Medical Center Research Institute
Maine Department of Inland Fisheries and Wildlife
Maine Medical Center Research Institute
Maine CDC
Maine Medical Center Research Institute
University of Southern Maine
University of Maine Cooperative Extension
Maine Forest Service
Physician, Lincoln Maine
Maine Board of Pesticides Control
Maine Department of Agriculture, Conservation, and Forestry

 Webber, Lori
Welch, Margaret
Wood, Greg

Maine CDC
Maine Medical Center Research Institute
Maine Department of Environmental Protection

 Appendix 8
Sample 6th-8th Grade Activity

Tick Tag

Activity A

Group size is suggested to be ten
students or less.
Having parent volunteers or
teaching aides may be helpful in
the small group setting.
This activity is designed to take
approximately ten minutes so
students can rotate through each
activity.
This game is designed to be played
in a large open space.
*This activity was created by 7th
grade students from King Middle
School in Portland, ME.

a. Directions:
Choose 1 student to be the disease (tagger),
and 1 student to be the antibodies
(unfreezers); the rest of the students will be
cells. The taggers will run around to tag the
cells, and if a cell is tagged, then they sit down
and wait for an antibody (unfreezer) to come
rescue them. The antibodies carry around a list
of questions to ask the tagged cells. If the
infected cells answer correctly, then they join
the antibodies in a conga line to help the other
cells. If they answer incorrectly, then they join
the disease (taggers) and try to tag other cells.
In the end, when there are no more cells,
whichever team (disease or antibody) has the
most people, wins. Multiple rounds can be
played as time allows. Select new students to
be the tagger and unfreezer. Make sure the
new unfreezer starts where the last one left off
in the question list to avoid repeating.
b. Supplies:
Questions
c. Learning Objective:
Knowledge of diseases ticks can transmit
Knowledge of the transmission cycle
Maine Learning Results in Health
Education: A3, A4
d. Estimated time: 10 minutes

 Appendix 9
Tick Bite Poster

 

 

WHAT I DO AFTER A TICK 

FULLDW THESE TIPS IF vou A OH TDUHEELF DR SDMEDHE ELE E:
- . EDEN 

 

I Use tweezers or a ticlc spoon to remcnre ticks quickly.r and safeiy. Iiit straight up

- Don't if the head nen'iains in the skin after removal. the abdomen is the part of
the tick that CUTIE disease

- Clean the area around the bite 1with soap and 1water or rubbing alcohol

11.1": may. IFWLE
I Dog ticks in Maine are not known to carry human disease
- The University of Maine Cooperative Extension o?ers a free ticlc identi?caljon service

Phone: IDISBIJBED or {in Maine}
E-mail: chlcidi?maineedu

 

 

 

 

 

 

 

 

Deer Tiolt {Blaoldegged tick] Dog Ticlc
- Epotheiindheadishlacir. - Spotbelindheadtuswhiteon'u
{Please note 'd'iaJt ticks are not pictured to scale}

 
   

. ironiu om 

I Swiptoms to monitor.
Lyme [L'Jiseaser truils rash. headache. fever. chills. joint pahL
A?c?asmosi: iesrer. headache. lack. of appe?te. nausea muscle pain. 1Iromiting.
BalJ-esiosis: iatigue. sweating. dark urine. chills. fever. anemia.
F'owassan: headache. body ache. leser. vomiting.
i Antihioti? are not ruclutirieljir recommended without 
I Nitibio-ijcs are not effective for premting or healing Pom-asap-

For more information visit: or scan this QR. code

 

 

 

Appendix 10
2017 Governor?s Proclamation

gift: E: in:

?(6.336% GE





  

WI IEHEAE the Maine Fin-Ila Fur Iii?wad: Cnnm? and vacntiun mm HHS cute: nl'

Lyme dim i=1 Fr; 

WHEREAS. It": wild] incidtmu LII- Lynn: dim ih much lJou rupurtmL mL?uJing
afl'unuu: :hihkcu haw-ten Inc aml ?nd-m pvt?m and minus: adultsuru Elnly-
liar:- 

WW. public mama-Jan alumna. ILT Imam? fut-div Lu In: [ink mum-lb?
pwmnung mum at Lyme dine-33c Ertli-u?l?' Ink?hum: Mm; ?nd

WHERE-IS. IJJI: 124" Main: anislmlu: mauled J?uhli-z "Law {?Elnp1cr Jill-1. U. J.
air: At: EJn'tn-an' Alarm-a; writ-um madam.

Nil-W1 I. lilruerl'xu'ni Hu- 55m: nt'hjmlu. do [mutu-
[hE [1.5

DISEASE AWARENESS MUNTH

IJ1n1ugl nu1Ihc Elna-I: l'lfMlilJnL?. nr? urge thl: pu'l'rl'ic1n Ital-111cm ni'1lh: nuns 1ha:l he
Him Ln mdLu: at lick-hum: ?Inert-3:5.

In In?mmy Mm], I Im'rr.? mam-mi].
tin-ht:
mm nl?xud Iii-[11W 
luu'ui .l'l hugLuu 1mn?r iru

dug: 'l'wn 'I'I'I'Iunaml 

$19. Li?
Pull. may
Gun-ram

 



.-


-.
?nd 3.: 

Sutnim?y af?x}:
1111'}: 

 

Appendix 11
Maine CDC Lyme Disease Awareness Month Poster 2017

 
 
   
  

 


L.
2

BE TICK


  
 

 

 

Wear protective Use an EPA Use caution in Perform daily
clothing. approved tick infested tick checks.
repellent. areas.

Maine Center for Disease

2017 BE TICK SMART ConfrolandPreven?m For more information
Poster Contest Winner visit 

 

Appendix 12
Maine Tracking Network: Lyme Disease Data Portal

Hal! IJI Lyn-ma That: Sum
by Town. Halna 31-13 by Town. Malna 21151-313
Iii-pi mm 

r/%1 ti

 

 

 

 

 

 

 

 

 

 



?Mann-trim?:

Mlhual'?ma

Flmrahatmma Haldane [.ma?par manna Inlla papulattuL 


3?me 
mum and nthar heallmra partners-

Fl-gAraB mam mmbarald-aar?dua?mtla Banner amen 1m From
1933-21113. mama 'u'adar?huma Erma-a: ?n Stale-[If Malna}uflalladfraatia:lt Rati?cation Inh'htna


Dl'l'farant "taped-mama an: base-dun Wim?m?maa.

lnatda't: an par?ah'ta maynaua 


Baum-?nancial

thnakThadata?aram?adadmd Hugram?apt?bndah?mnlha??-
Banana Euraauwara uaatlha?wlataalala. publlc: mannand (minty:I ?Miran!
minimal-511m [?DEUEI-twara maul: mlmlannuw?avalrataacrf Lyn-ma dlaamaJ'h-adatatiaptay'waa praparadhyha
Halna Envitnrrantd Putt: Haatth Trackhg Program. Data [Malay updahad: 

Flguta Ell-15m pmhdad the-dam lulu! may. The datawarau?yzadhf the Halna Enviulmanml PalfrHaatm framing F'mgrarn.
Data updated: M21115. [uptay updatad: M16.

Appendix 13
2017 Tickborne Disease Legislation
Connecticut
Title: An Act Designation May as Lyme disease Awareness Month (HB 5102)
Status: Failed
Title: An Act Concerning Standards for Lyme disease Testing (SB 329)
Status: Failed
Delaware
Title: Designating the Month of May 2017 as “Lyme Disease Awareness Month” in the State of
Delaware (HCR 24)
Status: Passed
Illinois
Title: Lyme Disease Awareness Month (HR 0350)
Status: Passed
Iowa
Title: Lyme Disease Treatment (HF577)
Status: Passed
Maine
Title: An Act to Require Insurance Coverage for the Diagnosis and Treatment of Lyme disease (H.P.
975)
Status: Failed
Title: Resolve, To Expand Research to Fight Lyme Disease (H.P.0737)
Status: Failed
Massachusetts
Title: An Act Establishing a Special Commission to Find the Best Practices to Promote Education,
Awareness, and Prevention of Lyme Disease (S.1255)
Status: Failed
Title: An Act Relative to the Control of Tick-Borne Illness (H.2120)
Status: Passed
New York
Title: Requires health insurers to provide coverage for long term medical care for Lyme disease and
other tick borne related pathogens (AB 114; S670)
Status: Failed
Title: An Act directing the department of financial services, in consultation with the commissioner of
health, to study and report upon insurance coverage for the treatment of Lyme disease (AB 04863A)
Status: Failed

 Title: Relates to grants for graduate medical education in Lyme and tick-borne disease (AB 5501; SB
2621)
Status: Failed
Title: Relates to directing the study and report on providing coverage for lyme disease treatment (AB
6927)
Status: Failed
Title: Requires the New York state health care quality and cost containment commission to issue a
report on coverage for chronic Lyme disease (SB 2168)
Status: Failed
Title: Directs the commissioner of health to establish protocols for the diagnosis and treatment of
Lyme disease and other tick borne diseases (SB 6926)
Status: Failed
Pennsylvania
Title: Insurance Coverage for Lyme Disease and Related Tick-Borne Illness (SB 100 P.N. 74)
Status: Failed
Title: A Resolution designating the month of May 2017 as "Lyme Disease Awareness Month" in
Pennsylvania (HR 316 P.N. 814)
Status: Passed
Virginia
Title: Lyme disease; treatment of a patient (SB 671)
Status: Passed
Wisconsin
Title: Proclaiming May 2017 as Lyme Disease Awareness Month (SJR45)
Status: Passed
Federal Legislation
Title: Lyme Disease Research Stamp Act (H.R. 4333)
Status: Failed
Title: Tick Identification Pilot Program Act of 2017 (H.R. 3484)
Status: Failed
Title: Tick-Borne Diseases Prevention Act (H.R. 2894)
Status: Failed