Silent Risk of Tick-borne Diseases in Georgia, USA

Background: Vector-borne diseases, including tick-borne diseases (TBD) are on the rise in the USA and worldwide, possibly due in part to changes in climate and meteorological conditions. There have been few studies in the state of Georgia addressing the prevalence of TBD. The purpose of this study was to assess the contemporary risk of TBD exposure in a rural population in South-Eastern Georgia. Methods: A self-assessment survey of symptoms of recent exposure and knowledge of TBD was administered to 258 healthy individuals visiting a university health center. Blood was drawn and serological testing was performed using the indirect microimmunofluorescence (IFA) test and Rickettsia rickettsii antigen (RR-AG). Results: Of the 258 responders, 244 reported their participation in regular recreational activities potentially associated with tick exposure; however, only 11 individuals (4%) experienced a self-reported tick bite during the previous summer or fall. Most participants acknowledged their ability to recognize ticks, but only 48% (n=169) were able to correctly identify them when provided with pictures of a variety of arthropods. Similarly, only 38% and 18% of participants (n=257) were knowledgeable about proper practices of tick avoidance and prevention of tick bites, respectively. Fifty-six percent of the participants tested positive for IgG antibody reacting with RR-AG (titer of \u3e128, 64 as the positive cutoff). Conclusions: The assessment survey identified a significant knowledge gap regarding TBD among adults in Georgia. The significant level of TBD exposure we detected may affect the serological diagnosis of clinical rickettsial diseases in Georgia, USA because preexisting antibody may be interpreted as false positives. Continuous education about TBD is needed to improve awareness of the risks of exposure to ticks, to promote proper methods of tick protection and removal, and to disseminate current knowledge about these commonplace arthropods. Progra