Prevention and health education regarding tick-borne diseases in the socio-economic environment in the cross-border area.
dr hab. Małgorzata Tokarska-Rodak, dr Dorota Plewik, dr Justyna Paszkiewicz, dr Anna Pańczuk, dr Marta Zarębska, dr Adam Szepeluk, mgr Patrycja Teodorowicz.
IMPACT DESCRIPTION SUMMARY
Many years of research on Lyme disease (LD) in employees of the forest industry and agriculture as well as hunting people who are at high risk of tick bites enabled them to learn their serological status and to begin the treatment. This research also focused on the analysis of parameters essential for LD treatment control and the degree of ticks’ infection with pathogens. The foundations for the process of introducing LD diagnosis in Ukraine in accordance with European recommendations were laid. The research outcomes include educational activity which increased social awareness of the prevention of tick-borne diseases and allowed this activity to be practically implemented. The recipients of these activities also include inhabitants of Lublin Province (Poland) and Ternopil Oblast (Ukraine). These activities are part of public health issues and are essentially related to health prevention in tourism, recreation and physical activity.
CHARACTERISTICS OF THE MAJOR RESEARCH CONCLUSIONS
Research on “The identification of full-blown and asymptomatic Borrelia burgdorferi infections in Lyme disease endemic areas in eastern Poland with particular emphasis on Lublin Province” (2012-2016) was conducted among people whose occupation involves exposure to tick bites; the study included the recommended LD tests. The risk of B. burgdorferi infection in the professions of a farmer and a forester is high and spirochete infections are common. The presence of specific antibodies to B. spielmanii and B. bavariensis antigen proteins enables these species also to be taken into account as factors in monoinfections and mixed infections as well as due to their influence on the clinical manifestation. In patients with simultaneous B. burgdorferi and A. phagocytophilum infections, the immune response to B. burgdorferi is stronger than in monoinfections [R1].
The seroepidemiological study on selected zoonoses and pathogens causing tick-borne diseases in hunters of Biała Podlaska County (2014-2016) showed the existence of B. burgdorferi s.l., A. phagocytophilum, Echinococcus spp. infection risk. The study in collaboration with the Military Institute of Hygiene and Epidemiology in Puławy also showed the existence of Hanta virus infection risk in this group. A significant percentage of antibodies to these pathogens was found in hunters, which indicates the problem of coinfections [R2].
Under the international collaboration with the Ternopil State Medical University (Ukraine) [R3] and the national collaboration with the Medical University of Lublin [R4] the significance of IgG anti-C6VlsE was studied for the assessment of LD treatment. The results facilitated the realistic assessment of the parameter significance in clinical settings. Additionally, it was proven that the presence of IgG antibodies for a varied number of B. burgdorferi antigens and the differences in IL-2 and MMP2 concentrations in seropositive persons and individuals with Lyme disease symptoms are indicative of the differences in the intensity of immune responses to infections.
The knowledge of the degree of tick infections is very important in the risk assessment of tick-borne diseases in a given area. This question is part of public health issues and has an impact on behaviours related to tourism, recreation, physical activity. The risk of tick-borne pathogen infections was assessed. The publication of the results allowed doctors and people whose occupation involves exposure to tick bites (foresters, farmers) both in Ukraine and in eastern Poland to learn the research data [R5].
CHARACTERISTICS OF THE ROLE OF THE ENTITY IN THE ACHIEVEMENT OF SCIENTIFIC ACTIVITY OUTCOMES
Diagnostic tests for Lyme disease in groups exposed to tick-borne diseases in eastern Poland and western Ukraine and the study of immune response in patients with LD clinical symptoms and with suspected LD were started in 2012 by Prof. M. Tokarską-Rodak and the research team consisting of D. Plewik, PhD, J. Paszkiewicz, PhD, A. Pańczuk, PhD, A. Szepeluk, PhD. The serological study and the testing of ticks as vectors of pathogens were carried out with the University’s own funds and the use of research infrastructure. The studies initiated by PSW were conducted in national and international research units, i.e. in collaboration with the Military Institute of Hygiene and Epidemiology in Puławy, the Medical University of Lublin, the Ternopil State Medical University. The unique expertise of the research team facilitated the implementation of original research which was of social importance and filled the gap in the field of tick-borne diseases.
BIBLIOGRAPHICAL REFERENCES AND SUMMARY OF UP TO 5 SCIENTIFIC ACHIEVEMENTS
[R1]. M.Tokarska-Rodak, D.Plewik, M.Kozioł-Montewka, A.Szepeluk, J.Paszkiewicz. Ryzyko zakażeń zawodowych Borrelia burgdorferi u pracowników leśnictwa i rolnictwa [Risk of occupational infections with Borrelia burgdorferi in forestry workers and farmers]. Medycyna Pracy 2014, Vol. 65, no 1, p. 109–117. Study conclusions: The exposure to B. burgdorferi infection is high for foresters and farmers, and the infection with spirochetes confirmed on the basis of positive results of the Wb test is quite common. The presence of specific antibodies to protein antigens of B. spielmanii and B. bavariensis suggests that these bacteria can cause Lyme disease both independently and in mixed infections, which might influence the clinical manifestations of infection. Med. Pr. 2014;65(1):109–117
[R2] Pańczuk A, Tokarska-Rodak M, Plewik D, Paszkiewicz J. Tick exposure and prevalence of Borrelia burgdorferi antibodies among hunters and other individuals exposed to vector ticks in eastern Poland. Roczniki Państwowego Zakładu Higieny 2019, Vol. 70, no 2, p. 161–168. The study determined the risk of B. burgdorferi infection as high among hunters and other individuals conducting activities related to the exposure to tick bites in the studied area.
[R3] Shkilna M, Tokarska-Rodak M, Pańczuk A, Smiyan S, Andreychyn M, Klishch I, Korda M. The use of anti-C6Vlse IgG in the assessment of the effectiveness of Lyme disease treatment – a preliminary report. Health Problems of Civilization 2019, Vol. 13, issue 1, p. 83–91 DOI:10.5114/hpc.2019.81106. Conclusions: IgG anti-C6VlsE may be important in the serological assessment of the effectiveness of Lyme disease treatment, particularly in people in the early stages of the disease. This, however, requires further research which would cover a greater number of patients. It is also essential that the assessment of the concentration of anti-C6VlsE antibodies should be additionally conducted in a period longer than 4 months after the end of the antibiotic therapy.
[R4] Tokarska-Rodak M, Pańczuk A, Fota-Markowska H, Matuska K. Analysis of selected serological parameters in patients with diagnosed Lyme borreliosis and in seropositive patients with no clinical symptoms. Annals of Agricultural and Environmental Medicine 2020. DOI:10.26444/aaem/124088. During the study, selected metalloproteinases, cytokines and chemokines were analysed in LD patients and healthy seropositive people. The presence of IgM/IgG antibodies to specific Borreliella antigens was analysed in the presence or absence of LD clinical symptoms.
[R5] Pańczuk A, Tokarska-Rodak M, Zarębska M, Pawłowicz-Sosnowska ET. Species diversity of ticks infesting dogs in the north-eastern part of Lublin Province (eastern Poland). Annals of Parasitology 2021, Vol. 67, no. 1, p. 79–83 DOI:10.17420/ap6701.314. The study determined the species composition of ticks infesting dogs from the north-eastern part of Lublin Province. In a three-year study (2017–2019), 501 tick specimens were collected from 122 dogs in the north-eastern part of Lublin Province (eastern Poland). The species of ticks infesting dogs and the pathogens transmitted by ticks were determined. This facilitates the assessment of the potential risk of infection while staying in the areas where infected ticks are present.
CHARACTERISTICS OF THE RESEARCH ACTIVITY IMPACT, INCLUDING THE ACTIVITY WHOSE OUTCOMES ARE THE SUBJECT OF COMMERCIALISATION, WITH AN INDICATION OF THE RELATION BETWEEN RESEARCH ACTIVITY AND THIS IMPACT AS WELL AS THE SOCIAL GROUP BENEFITTING FROM THIS IMPACT AND THE GREATEST RESEARCH ACTIVITY IMPACT AREA
Health education regarding tick-borne diseases and serological diagnosis for Lyme disease in people exposed to tick bites
In 2012-2013, the collaboration agreements were made with Forest Inspectorates within the State Forests which are located in the close vicinity of PSW in Biała Podlaska (Forest Inspectorates of Międzyrzec, Biała Podlaska, Radzyń Podlaski, Parczew with the seat in Sosnowica, Chotyłów). These agreements facilitated the activities including comprehensive research on the occupational risk of exposure to tick bites and the related prevalence of Lyme disease (LD).
Consequently, forest workers obtained the results of LD tests which allowed them to seek medical advice. During this research, an educational programme was developed and implemented. As a result, the participants acquired knowledge on the rules of removing ticks penetrating into the skin, rules of safety in repellent use, specific and non-specific prevention in tick-borne diseases. Thus, the awareness of occupational health and safety among forest industry workers was raised.
An analysis of social needs related to the exposure to tick bites made it possible to discern the existing issue of tick-borne diseases and other zoonoses in hunting people. Hunters, unlike foresters, are deprived of the possibility to be tested under the applicable provisions of the labour code since hunting is treated as a hobby. Based on the cooperation agreement with the Hunting Association of Biała Podlaska “Ponowa” Circle No. 18 in Biała Podlaska, hunters were tested for LD as recommended, and educational activities on prevention of tick-borne diseases were conducted. Due to the considerable interest of the hunting community in the cooperation with PSW in Biała Podlaska concerning the exposure to tick-borne diseases and their prevention, other cooperation agreements were made with the Military Hunting Circle no. 127 “Łoś” (2021) and the Hunting Association of Biała Podlaska “Ponowa” Circle No. 18 (2021). As a result of these activities, social attention was focused on the hunting communities as groups at high risk of Lyme disease and other zoonoses [S1].
Implementation of the recommended principles of Lyme disease diagnosis and the prevention of tick-borne diseases in Ukraine
Actions were taken to promote LD diagnosis in accordance with European standards among the medical community of western Ukraine, which was evident in the collaboration with I. Ya. Horbachevsky Ternopil State Medical University in 2012-2019. The study contributed to the promotion of good laboratory practice of LD diagnosis in Ukraine. The breakthrough research and the diagnosis implementation in accordance with EU recommendations guarantee the formation of the grounds for testing standards in Ukraine. Additionally, the awareness of prevention of tick-borne diseases was assessed among foresters from Ternopil Oblast. The study results on the prevention of tick-borne diseases among foresters from Ukraine were applied during training meetings [S2]. The results were also published as articles available for a wider audience, including doctors, employees of the sector of biological and natural sciences but also people not connected with the medical community but interested in work and leisure safety in forest areas [S3].
Health education regarding tick-borne diseases in various age groups
The conclusions drawn from seroepidemiological tests among hunters facilitated the organisation of educational workshops on tick-borne diseases for the secondary school students of the J.I. Kraszewski General Secondary School in Biała Podlaska [I LO im. J. I. Kraszewskiego w Białej Podlaskiej] (2019) and the Academic General Secondary School in Terespol [Akademickie Liceum Ogólnokształcące w Terespolu] (2021) [S4]. Informational and educational videos were made to be shown to the inhabitants of the region and to be widely propagated on the PSW website [S5].
The developed and implemented educational programme on ticks as vectors of pathogens and the prevention methods for tick-borne diseases is essential for public health. As a result of the undertaken actions, the transfer of knowledge took place from the academia to social groups varying in age, occupation and activities. The awareness of the region inhabitants was raised and, due to the acquired knowledge, they can take safe work and active recreation in green areas (city parks, forests, meadows). The increased social awareness allows individuals to take adequate actions in the prevention of tick-borne diseases by skilful use of repellents and other non-specific methods which may lower the number of tick bites. These issues are related to the area of physical activity sciences, occupational health and safety, occupational medicine and medical sciences.
SZCZEGÓŁOWA CHARAKTERYSTYKA DOWODÓW WPŁYWU DZIAŁALNOŚCI NAUKOWEJ
[S1] Cooperation agreement – Military Hunting Circle no. 127 “Łoś” (2021), Hunting Association of Biała Podlaska “Ponowa” Circle No. 18 (agreement 2021); Confirmation of cooperation with the Hunting Association of Biała Podlaska “Ponowa” Circle No. 18 (2021).
The concluded agreements confirm the cooperation in the form of educational actions regarding the rules for removing ticks, using repellents and specific and non-specific prevention of tick-borne diseases. The knowledge of the validity of two-stage LD diagnosis, the interpretation of cutaneous LD symptoms and co-infections increased among people working in non-medical professions.
[S2] Testimonial of cooperation with the Medical University of Ternopil (Ukraine) on the principles of Lyme disease diagnosis and the prevention of tick-borne diseases in occupational groups at an increased risk of tick bites in Ukraine
The testimonial confirms the conducted research which contributed to the promotion of good laboratory practice in LD diagnosis in Ukraine. The breakthrough research and the diagnosis implementation in accordance with EU recommendations guarantee the formation of the grounds for diagnostic standards in Ukraine
[S3] Testimonial of cooperation with foresters on the issue of health education regarding tick-borne diseases, directed at people exposed to tick-borne diseases in Poland and Ukraine
The testimonial confirms that the knowledge of ticks as vectors of pathogens for humans is essential for public health as the self-awareness of inhabitants of rural and urbanised areas is raised. Thus, they can consciously plan safe work and leisure combined with physical activity in green areas (city parks, forests). The beneficiaries’ knowledge on two-stage LD diagnosis and interpretation of cutaneous LD symptoms increased.
[S4] Letter of intent to undertake trilateral cooperation (2019); Thank-you letter for the cooperation with the J.I. Kraszewski General Secondary School in Biała Podlaska (2019). Health education regarding tick-borne diseases among secondary school students of eastern Poland (activities conducted in 2019-2021)
Workshops for young people allowed them to actively learn about ticks as vector organisms and about the principles of implementing appropriate specific and non-specific prevention of tick-borne diseases. The increased awareness in this regard allows individuals to take adequate actions in the prevention of tick-borne diseases by the skilful and safe use of repellents and other non-specific methods which may lower the number of tick bites.
[S5] Informational and educational video Health education of the region inhabitants regarding tick-borne diseases (below)
A wide audience was informed about the activities conducted by the employees of the Medical laboratory of the Innovation Research Centre of PSW in Biała Podlaska on Lyme disease diagnosis and prevention of tick-borne diseases. The recipients were informed about the implementation of the study for the benefit of the local community as well as groups professionally or as a hobby related to the exploitation and use of forest areas.
INFORMATION WHETHER THE IMPACT IS THE RESULT OF INTERDISCIPLINARY RESEARCH OR DEVELOPMENT ACTIVITIES, AND THE CHARACTERISTICS OF THE SIGNIFICANCE OF INTERDISCIPLINARY RESEARCH OR DEVELOPMENT ACTIVITIES FOR THE CREATION OF THIS IMPACT
The interdisciplinary research had an impact on the issues related to regional, national and cross-border public health but also on the non-medical groups related to the exploitation of natural resources (earth and environmental sciences), including the management of forest areas as well as the development and planning of the natural environment in urbanised areas (agriculture and horticulture, spatial development).
The use of inappropriate LD diagnostic schemes and the failure to obey the rules of prevention of tick-borne diseases affect individual health but also influence the economic (social sciences) aspects of health policy and the operation of forest industry enterprises due to the fact that the occurrence of an occupational disease such as LD leads to staff and economic consequences for employers. Lyme disease causes the necessity to implement rehabilitation procedures in many patients, which is an additional burden for the healthcare financial system. For this reason, the research results are of direct significance for employers providing health services and those in the sector of forest resource management and tourism and leisure organisation.