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Social-behavioral/ecological risk assessment for Lyme disease in southern Québec, Canada.

Catherine Bouchard1, 2*, Cécile Aenishaenslin2, Erin E. Rees1, David Nantel2, Pierre Valois3, Denis Talbot4, Serge-Olivier Kotchi1, Yann Pelcat1, François Milord5, Robbin L. Lindsay6, Patrick A. Leighton2 and Nicholas H. Ogden1
  • 1 Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Canada
  • 2 Faculty of Veterinary Medicine, University of Montreal, Canada
  • 3 Faculty of Education Sciences, Laval University, Canada
  • 4 Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Canada
  • 5 Integrated Center for Health and Social Services Montérégie, Canada
  • 6 National Microbiology Laboratory, Canada

Lyme disease (LD) risk is emerging rapidly in Canada due to range expansion of the vector ticks and is now present from coast to coast, accelerated by the warming of the northern climate (Ogden et al. 2019; Bouchard et al. 2019; Leighton et al. 2012). There are important regional differences in terms of the risk of contracting LD due to spatial heterogeneity from social behavior (i.e. if people are informed and are adopting LD preventive measures) and ecological risk (i.e. where infected ticks are located). LD transmission risk is expected to be higher in areas where ecological characteristics favor a higher density of infected ticks and when human behavior facilitate exposure to biting ticks. To date, very few studies have accounted for human social-behavioral risk factors associated with LD in the context of adaptation to climate change and have tried to quantify their relative importance, which represents a critical gap (Kilpatrick et al. 2017; Bouchard et al. 2019). To address this gap, we are building upon our previous work in identifying regional-level differences in the knowledge and the adoption of preventive behavior toward LD in Canada (Bouchard et al. 2018; Aenishaenslin et al. 2017; Aenishaenslin et al. 2016). The objective of this ongoing project is to develop and enhance an integrated social-behavioral and ecological risk mapping approach to i) identify geographic hotspots of LD risk for geographic prioritization of public health interventions and ii) develop a spatially-explicit assessment tool to examine the relative contribution of different types of risk factors across the emerging landscapes of LD risk. The study was conducted in the regions of Montérégie and Estrie located in southern Québec. The blacklegged ticks, Ixodes scapularis, infected with the agent of LD are widespread in these regions and as a result, LD incidence is the highest in the province. LD knowledge and behaviors in the population were measured and compared during three web and phone survey studies conducted in southern Québec in 2012, 2014 and 2018. These data were used to create an index for the social-behavioral component of risk for each year and were subsequently explored to identify the underlying social risk factors that may have contributed to a higher social-behavioral risk. For the ecological risk analysis, we developed a tick abundance model by integrating data from ongoing long-term tick surveillance programs and high resolution environmental data derived from Earth Observation images from 2007 up to 2018. Socialbehavioral and ecological components of the risk measures were combined to create integrated socialbehavioral vulnerability risk maps and, with the addition of human population densities, prioritization index maps. Map predictions were validated by testing the association of high-risk areas with the current spatial distribution of human cases of LD. Our preliminary results demonstrated that social-behavioral and ecological components of LD risk have markedly different distributions within southern Québec. The occurrence of human LD cases in a municipality was positively associated with tick density and the social-behavioral/ecological vulnerability risk index (p<0.01). These findings suggest that an integrated approach should be considered, such as reinforced public health messages with preventive measures for ticks in targeted areas, for locally adapted interventions. This project is a first step towards an enhanced integrated LD risk assessment approach, identifying socialbehavioral risk factors that act in conjunction with ecological risk factors to influence the management of emerging tick-borne diseases. Social survey data is a valuable but underused source of information to understand regional LD exposure variation. Our study highlights a new research area in which integrated social-behavioral and ecological risk maps are developed and validated. The approach developed applies widely to other vector-borne and/or zoonotic diseases, and to the different epidemiological context where the geographic patterns of risk are driven by the interplay between social-behavioral and ecological factors (Bouchard et al. 2018).

Acknowledgements

This work was funded by the Public Health Agency of Canada (PHAC). Active field surveillance conducted from 2007 to 2018 was a joint effort between PHAC, Université de Montréal, and the Institut national de santé publique du Québec (INSPQ). The authors wish to thank all the field assistants and coordinators, laboratory personnel from the National Microbiology Laboratory (NML) and Laboratoire de santé publique du Québec (LSPQ) involved in the collection and analysis of field surveillance data.

References

• Ogden NH, Gachon P. Climate change and infectious diseases: What can we expect? Can Commun Dis Rep 2019;45(4):76–80. https://doi.org/10.14745/ccdr.v45i04a01 • Bouchard C, Dibernardo A, Koffi J, Wood H, Leighton PA, Lindsay LR. Increased risk of tick-borne diseases with climate and environmental changes. Can Commun Dis Rep 2019;45(4):83–9. https://doi.org/10.14745/ccdr.v45i04a02 • Leighton, P. A., Koffi, J. K., Pelcat, Y., Lindsay, L. R. & Ogden, N. H. Predicting the speed of tick invasion: an empirical model of range expansion for the Lyme disease vector Ixodes scapularis in Canada. Journal of Applied Ecology 49, 457–464 (2012). • Kilpatrick AM, Dobson AD, Levi T, Salkeld DJ, Swei A, Ginsberg HS, Kjemtrup A, Padgett KA, Jensen PM, Fish D, Ogden NH, Diuk-Wasser MA. 2017. Lyme disease ecology in a changing world: consensus, uncertainty and critical gaps for improving control. Phil. Trans. R. Soc. B 2017, 372, (1722), 201601117. DOI: 10.1098/rstb.2016.0117 • Bouchard C, Aenishaenslin C, Rees EE, Koffi JK, Pelcat Y, Ripoche M, Milord F, Lindsay LR, Ogden NH, Leighton PA. Integrated Social-Behavioral and Ecological Risk Maps to Prioritize Local Public Health Responses to Lyme Disease. Environ Health Perspect. 2018 Apr 18;126(4):047008. doi: 10.1289/EHP1943. PubMed PMID: 29671475; PubMed Central PMCID: PMC6071748. • Aenishaenslin C, Bouchard C, Koffi JK, Ogden NH. 2017. Exposure and preventive behaviours toward ticks and Lyme disease in Canada: Results from a first national survey. Ticks Tick Borne Dis 8:112- 118. • Aenishaenslin C, Bouchard C, Koffi JK, Pelcat Y, Ogden NH. 2016. Evidence of rapid changes in Lyme disease awareness in Canada. Ticks Tick Borne Dis 7:1067-1074.

Keywords: social, behavioral, ecological, Risk maps, prevention, Lyme Disease, Canada

Conference: GeoVet 2019. Novel spatio-temporal approaches in the era of Big Data, Davis, United States, 8 Oct - 10 Oct, 2019.

Presentation Type: Senior oral presentation

Topic: Spatio-temporal surveillance and modeling approaches

Citation: Bouchard C, Aenishaenslin C, Rees EE, Nantel D, Valois P, Talbot D, Kotchi S, Pelcat Y, Milord F, Lindsay RL, Leighton PA and Ogden NH (2019). Social-behavioral/ecological risk assessment for Lyme disease in southern Québec, Canada.. Front. Vet. Sci. Conference Abstract: GeoVet 2019. Novel spatio-temporal approaches in the era of Big Data. doi: 10.3389/conf.fvets.2019.05.00046

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Received: 31 May 2019; Published Online: 27 Sep 2019.

* Correspondence: Dr. Catherine Bouchard, Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Saint-Hyacinthe, Canada, catherine.bouchard@canada.ca