Assessment of Physician Knowledge, Attitudes, and Practice for Lyme Disease in a Low-Incidence State.

Lyme disease (LD), caused by the bacterium Borrelia burgdorferi, is transmitted to humans in California through the bite of infected blacklegged ticks (Ixodes pacificus). Overall, the incidence of LD in California is low: approximately 0.2 confirmed cases per 100,000 population. However, California's unique ecological diversity results in wide variation in local risk, including regions with local foci at elevated risk of human disease. The diagnosis of LD can be challenging in California because the prior probability of infection for individual patients is generally low. Combined with nonspecific symptoms and complicated laboratory testing, California physicians need a high level of awareness of LD in California to recognize and diagnose LD efficiently. This research addresses an under-studied area of physicians' knowledge and practice of the testing and treatment of LD in a low-incidence state. We assessed knowledge and practices related to LD diagnosis using an electronic survey distributed to physicians practicing in California through mixed sampling methods. Overall, responding physicians in California had a general awareness of Lyme disease and were knowledgeable regarding diagnosis and treatment. However, we found that physicians in California could benefit from further education to improve test-ordering practices, test interpretation, and awareness of California's disease ecology with elevated levels of focal endemicity, to improve recognition, diagnosis, and treatment of LD in California patients.

Borrelia burgdorferi and Borrelia miyamotoi seroprevalence in California blood donors.

The western blacklegged tick, Ixodes pacificus, an important vector in the western United States of two zoonotic spirochetes: Borrelia burgdorferi (also called Borreliella burgdorferi), causing Lyme disease, and Borrelia miyamotoi, causing a relapsing fever-type illness. Human cases of Lyme disease are well-documented in California, with increased risk in the north coastal areas and western slopes of the Sierra Nevada range. Despite the established presence of B. miyamotoi in the human-biting I. pacificus tick in California, clinical cases with this spirochete have not been well studied. To assess exposure to B. burgdorferi and B. miyamotoi in California, and to address the hypothesis that B. miyamotoi exposure in humans is similar in geographic range to B. burgdorferi, 1,700 blood donor sera from California were tested for antibodies to both pathogens. Sampling was from high endemic and low endemic counties for Lyme disease in California. All sera were screened using the C6 ELISA. All C6 positive and equivocal samples and nine randomly chosen C6 negative samples were further analyzed for B. burgdorferi antibody using IgG western blot and a modified two ELISA test system and for B. miyamotoi antibody using the GlpQ ELISA and B. miyamotoi whole cell sonicate western blot. Of the 1,700 samples tested in series, eight tested positive for antibodies to B. burgdorferi (0.47%, Exact 95% CI: 0.20, 0.93) and two tested positive for antibodies to B. miyamotoi (0.12%, Exact 95% CI: 0.01, 0.42). There was no statistically significant difference in seroprevalence for either pathogen between high and low Lyme disease endemic counties. Our results confirm a low frequency of Lyme disease and an even lower frequency of B. miyamotoi exposure among adult blood donors in California; however, our findings reinforce public health messaging that there is risk of infection by these emerging diseases in the state.

A newly recognized occupational hazard for US electronic recycling facility workers: polybrominated diphenyl ethers.

OBJECTIVE: To describe a newly recognized US occupational health hazard, polybrominated diphenyl ether (PBDE) flame retardant exposure, to US workers at electronics recycling facilities to communicate this information to occupational medicine physicians and related health workers. METHODS: Using PBDE air values reported from a California electronic recycling facility and estimates of US food, air and dust intake, electronic recycling facility workers' PBDE exposure at this facility was estimated using multiple possible scenarios. We compared these estimates to intake estimates for the US general population. Occupational PBDE study findings from China, Sweden, and Norway where elevated environmental or blood PBDE levels were detected in similar workers are reviewed. RESULTS: An approximate 6-fold to 33-fold increase in the electronic recycling facility workers' PBDE exposure was estimated compared with the US general population. CONCLUSION: PBDE exposure in US electronic recycling facilities is a largely unrecognized occupational health hazard. The extent of worker exposure in the US should be better characterized and steps taken to lower levels of PBDEs in the workplace where exposure exists. Health care providers, plant safety professionals, and government agencies can play a role in recognizing the problem and in decreasing worker exposure.

PBDEs in US and German clothes dryer lint: a potential source of indoor contamination and exposure.

Polybrominated diphenyl ethers (PBDEs) are emerging persistent organic pollutants (POPs). Since the 1970s, PBDEs have been widely used as additive flame retardants in furniture and electronic equipment. Due to their wide use and persistent nature, these chemicals are found in the environment, human blood, breast milk and other tissues in increasing levels in recent decades. PBDEs are similar to polychlorinated biphenyls (PCBs) in structure and toxicity. However, unlike PCBs and PCDDs/PCDFs, the route of PBDE exposure is not almost exclusively through food. PBDE levels in US food are not markedly higher than in Europe, although US human blood and milk levels are an order of magnitude higher. For these reasons, other possible routes of PBDE exposure have been investigated to understand PBDE intake into humans. PBDE contaminated clothes dryer lint and household dust are indicators of indoor contamination and may be sources of human exposure through hand-to-mouth contact or dermal absorption. There are very few publications about PBDEs in US or European lint. Household dryer lint from 12 US and seven German homes were analyzed for PBDEs by gas chromatography coupled to high-resolution mass spectrometry. We found the median US total PBDE levels were more than 10 times higher than median German levels and the mean US levels were two times higher than mean German levels. The US levels ranged from 321 to 3073ngg(-1) (median: 803ngg(-1), mean: 1138ngg(-1)) and the German levels were from 330 to 2069ngg(-1) (median: 71ngg(-1), mean: 361ngg(-1)). PBDE contamination of lint was found in all samples; the source of the PBDEs may be from dryer electrical components and/or dust deposition onto clothing.