Published in:
Open Access
01-12-2019 | Tick | Research article
Systematic review and meta-analysis of tick-borne disease risk factors in residential yards, neighborhoods, and beyond
Authors:
Ilya R. Fischhoff, Sarah E. Bowden, Felicia Keesing, Richard S. Ostfeld
Published in:
BMC Infectious Diseases
|
Issue 1/2019
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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.