Systematic review and meta-analysis of tick-borne disease risk factors in residential yards, neighborhoods, and beyond

Fischhoff, I. R. and Bowden, S. E. and Keesing, F. and Ostfeld, R. S.

BMC Infect Dis (2019) 19: 861

DOI: 10.1186/s12879-019-4484-3

Abstract

BACKGROUND: Exposure to blacklegged ticks Ixodes scapularis that transmit pathogens is thought to occur peri-domestically. However, the locations where people most frequently encounter infected ticks are not well characterized, leading to mixed messages from public health officials about where risk is highest. METHODS: We conducted a systematic review and meta-analysis on spatial risk factors for tick-borne disease and tick bites in eastern North America. We examined three scales: the residential yard, the neighborhood surrounding (but not including) the yard, and outside the neighborhood. Nineteen eligible studies represented 2741 cases of tick-borne illness and 1447 tick bites. Using random effects models, we derived pooled odds ratio (OR) estimates. RESULTS: The meta-analysis revealed significant disease risk factors at the scale of the yard (OR 2.60 95% CI 1.96 - 3.46), the neighborhood (OR 4.08 95% CI 2.49 - 6.68), and outside the neighborhood (OR 2.03 95% CI 1.59 - 2.59). Although significant risk exists at each scale, neighborhood scale risk factors best explained disease exposure. Analysis of variance revealed risk at the neighborhood scale was 57% greater than risk at the yard scale and 101% greater than risk outside the neighborhood. CONCLUSIONS: This analysis emphasizes the importance of understanding and reducing tick-borne disease risk at the neighborhood scale. Risk-reducing interventions applied at each scale could be effective, but interventions applied at the neighborhood scale are most likely to protect human health. TRIAL REGISTRATION: The study was registered with PROSPERO: CRD42017079169 .

Citation

Fischhoff, I. R., Bowden, S. E., Keesing, F., & Ostfeld, R. S. (2019). Systematic review and meta-analysis of tick-borne disease risk factors in residential yards, neighborhoods, and beyond. BMC Infect Dis, 19(1), 861. https://doi.org/10.1186/s12879-019-4484-3 Animals, Humans, Risk Factors, Odds Ratio, Babesiosis, North America/epidemiology, Anaplasmosis, Ixodes scapularis, Ixodes/physiology, Lyme disease, Lyme Disease/diagnosis/epidemiology, Peri-domestic, Residence Characteristics/statistics & numerical data, Spatial scale, Tick bites, Tick Bites/*diagnosis/epidemiology, Tick-Borne Diseases/*diagnosis/epidemiology

Keywords

• Animals
• Humans
• Risk Factors
• Odds Ratio
• Babesiosis
• North America/epidemiology
• Anaplasmosis
• Ixodes scapularis
• Ixodes/physiology
• Lyme disease
• Lyme Disease/diagnosis/epidemiology
• Peri-domestic
• Residence Characteristics/statistics & numerical data
• Spatial scale
• Tick bites
• Tick Bites/*diagnosis/epidemiology
• Tick-Borne Diseases/*diagnosis/epidemiology