Tina J. Garcia
544 South Solomon
Mesa, Arizona 85204
480-570-5178
April 7, 2006
Victorio Vaz, Ph.D., Office Chief
Office of Infectious Disease Services
Arizona Department of Health Services
150 North 18th Avenue, Suite 140
Phoenix, Arizona 85007
Re: Tick and Rodent Testing for Borrelia Burgdorferi in Arizona
Dear Dr. Vaz:
I have a couple more questions regarding the tick and rodent studies that have and have not been conducted for Borrelia burgdorferi in Arizona.
In your letter to me dated February 8, 2006, you wrote that, “During the 1980’s and 1990’s, ticks were collected/submitted and identified from around the state. No potential Lyme disease vectors were identified until after 1990. Western blacklegged ticks (Ixodes pacificus) – the western Lyme disease vector – were identified in one mountain range in northwestern Arizona. Specifically, Ix. pacificus ticks were found in the highest elevations (above 6,000 feet) of the Hualapai Mountains which lie south of Kingman. Joint efforts by ADHS and the Centers for Disease Control and Prevention (CDC) to collect and test more than 200 Ix. pacificus ticks did not reveal evidence of B burgdorferi to date. Additional efforts were made in 1992 to collect blood and tissues from potential rodent reservoirs (Peromyscus mice and woodrats) in the Hualapai Mountains. Twenty-six rodents were tested and results were negative. To date, vector ticks for Lyme disease have not been found anywhere else in the state, which is likely due to our drier climate. Our data does not rule out the presence of Borrelia burgdorferi in the state; however, we have no evidence to support risk of endemic Lyme disease at this time.”
I would like to make several points that I think are relevant to the problems that Arizona is encountering with regard to Borrelia burgdorferi.
1. You stated that the most recent testing for Borrelia burgdorferi in ticks was in 1990.
That was sixteen (16) years ago.
2. You stated that the most recent testing for Borrelia burgdorferi in rodents was in
1992. That was fourteen (14) years ago.
Victorio Vaz, Ph.D.
April 7, 2006
Page Two
3. The Hualapai Mountains lie directly east of two (2) endemic areas, one being
California and the other Nevada. Please see enclosed CDC Map: Reported Cases
of Lyme Disease, United States, 2000.
4. I have been informed by the leader of the Arizona Lyme Disease Association, who
runs a support group in Arizona for more than 140 Lyme disease patients, that a
couple of patients have reported contracting Lyme disease in the Grand Canyon
and Cottonwood areas. As I told you during our February 6, 2006 conversation,
I was bitten by a tick at Sunset Point rest area south of Cordes Junction, Arizona
and subsequently contracted a Borrelia burgdorferi infection. In addition, I have also
heard of a report of a patient who contracted the disease from a tick bite while
gardening in her backyard in Fountain Hills, Arizona. Another report was given
directly to me by a dentist who installed a sprinkler system on his property in the
Phoenix area, which resulted in numerous tick bites and erythema migrans rashes
up and down his forearms. He was treated immediately with antibiotics, and
fortunately, he suffered no further infection.
5. Estimated mileage between Kingman and
Grand Canyon -- 175 miles
Cottonwood -- 177 miles
Phoenix -- 200 miles
6. I am concerned about the spread of ticks and vectors from the Hualapai Mountains
to other areas of the state, via birds and vector wildlife.
Do you consider this a possibility?
7. Enclosed is a quote from the Infectious Diseases Society of America (IDSA) in which
modes of transportation of tick vectors is clearly stated:
“Moreover, the tick vector can be transported long distances by clothing,
equipment/gear, and even automobiles to bite persons in other locales.”
Doesn’t the possibility exist that infected ticks have been brought into Arizona
by the numerous tourists who visit our state each year from other endemic
areas of the United States and Canada?
8. You stated that, “To date, vector ticks for Lyme disease have not been found
anywhere else in the state, which is likely due to our drier climate.”
(emphasis added)
If no additional tests have been conducted for fourteen and sixteen years, since
1992 and 1990, I would caution the ADHS in proposing that its studies are current.
9. You also informed me in our February 6, 2006 telephone conversation that there are
summaries of the testing, but the ADHS did not save the test results from any testing
conducted. In my letter to you dated March 1, 2006, I again requested copies of
summaries and test results.
Victorio Vaz, Ph.D.
April 7, 2006
Page Three
10. I spoke with Craig Levy via telephone on April 5, 2006. He informed me that he provided the tick and rodent specimens to the CDC for testing, and he received the test results from the CDC verbally. He also informed me that test results are “shredded” after ten (10 years.
All of these statements are very confusing. If the tests were conducted, do you still have the summaries and test results? Were they provided on paper or provided verbally? Have they been discarded because they were negative or shredded because they were more than ten (10) years old? Again, I am requesting copies of the following:
-All test reports and summaries conducted for Borrelia burgdorferi in all vectors
and ticks throughout the State of Arizona from 1980 to the present.
Given all of the points above and the information I have provided with regard to the number of patients currently residing in this state and experiencing difficulty in obtaining diagnosis and treatment, I strongly encourage the ADHS to acknowledge the problems that are facing Lyme disease patients in Arizona. I would like to work with the ADHS in helping the residents of this state who have either contracted Lyme disease here or elsewhere. I would also like to work with the ADHS in providing clarification of its data to physicians.
That is, there are no cases of Lyme disease having originated in Arizona that have met the epidemiological criteria. This does not mean that one cannot contract Lyme disease in Arizona.
Thank you in advance for your prompt response to this request.
Sincerely,
Tina J. Garcia
TJG
Enclosures
cc: Craig Levy