NEHA July/August 2024 Journal of Environmental Health

The July/August 2024 issue of the Journal of Environmental Health (Volume 87, Number 1), published by the National Environmental Health Association.

JOURNAL OF Environmental Health Dedicated to the advancement of the environmental health professional Volume 87, No. 1 July/August 2024


Published by the National Environmental Health Association

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A Survey of Tick Species in Missouri: 2019 and 2021 ................................................................ 8

Ešective and consistent train- ing approaches are necessary for capacity building. The retail food reg- ulatory workforce can, however, lack standardized train- ing, promotion,

International Perspectives: Exposure to Contaminants During Active Transport in Uruguay and the Eect on Health Parameters ......................................................................... 16


Decoding Training Needs: Using Relevance and Exposure to Identify Training Needs in the Retail Food Regulatory Workforce......................................................... 24 Building Capacity: A Call for More Participatory Science in Environmental Health Research: Background and Resources to Build Capacity ............................................................... 34 Direct From CDC/Environmental Health Services: Statewide Water System Maps: An Important Public Health Eort to Improve Drinking Water Justice .......................................... 38

and retention practices. This month’s cover article analyzed data from a training needs assessment to better understand the training needs of the retail food regulatory workforce overall and by job level. Using a 4-quadrant approach to plot the relevance of and exposure to validated retail food safety knowledge areas, the authors show the knowledge areas that need priority focus for training. The article demonstrates the importance of this approach and suggests that it can be applied to further assessment of training needs in the retail food regulatory workforce and beyond. See page 24. Cover images © iStockphoto: Tim UR

The Practitioner’s Tool Kit: Estimating Microbial Bioloads ......................................................... 42


Environmental Health Calendar ...............................................................................................44

Resource Corner........................................................................................................................ 45


JEH Quiz #1............................................................................................................................... 46

JEH Author, Title, and Subject Index: Volume 86 ..................................................................... 48

EHAC-Accredited Programs ................................. 41 EHLR Certificate Program.............................. 23, 47 Glo Germ.............................................................. 63 Hedgerow Software ................................................2 HS GovTech.......................................................... 64 JEH Advertising ....................................................47 NEHA CP-FS Credential ......................................43 NEHA Credentials .................................................. 7 NEHA Endowment Foundation Donors .............. 33 NEHA Job Board................................................... 32 NEHA Membership .......................................... 4, 14 NEHA REHS/RS Study Guide............................... 23 NEHA/AAS Scholarship Fund Donors ................. 15 NSF......................................................................... 5 Private Water Network .........................................37


President’s Message: Building Hopeful Communities ............................................................................... 6

Special Listing ........................................................................................................................... 52

Spotlight on NEHA Activities....................................................................................................54

NEHA 2024 and 2025 AEC....................................................................................................... 56

NEHA News .............................................................................................................................. 58

NEHA Member Spotlight .......................................................................................................... 62


July/August 2024 • our:-l o2 :A5ro:me:?-l e-l?4

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An open access journal published monthly (except bimonthly in January/ February and July/August) by the National Environmental Health Association (NEHA), 720 S. Colorado Blvd., Suite 105A, Denver, CO 80246-1910. Phone: (303) 802-2200; Internet: E-mail: Volume 87, Number 1. Yearly print subscription rates: $160 (U.S.) and $200 (international). Single print copies: $15, if available. Claims must be filed within 30 days domestic, 90 days foreign, © Copyright 2024, NEHA (no refunds). Opinions and conclusions expressed in articles, columns, and other contributions are those of the authors only and do not reflect the policies or views of NEHA. NEHA and the Journal of Environmental Health are not liable or responsible for the accuracy of, or actions taken on the basis of, any information stated herein. NEHA and the Journal of Environmental Health reserve the right to reject any advertising copy. Advertisers and their agencies will assume liability for the content of all advertisements printed and also assume responsibility for any claims arising therefrom against the publisher. Advertising rates available at The Journal of Environmental Health is indexed by Clarivate, EBSCO (Applied Science & Technology Index), Elsevier (Current Awareness in Biological Sciences), Gale Cengage, and ProQuest. The Journal of Environmental Health is archived by JSTOR ( jenviheal). Full electronic issues from present to 2012 available at All technical manuscripts submitted for publication are subject to peer review. Visit for submission guidelines and instructions for authors. To submit a manuscript, visit Direct all questions to Periodicals postage paid at Denver, Colorado, and additional mailing offices. POSTMASTER: Send address changes to Journal of Environmental Health , 720 S. Colorado Blvd., Suite 105A, Denver, CO 80246-1910.

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Volume 87 • Number 1

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Building Hopeful Communities

CDR Anna Khan, MA, REHS/RS

I discovered environmental health by ac- cident. At Eastern Kentucky University (EKU), I added an elective—Intro to En- vironmental Health—to fill my schedule. To the professors out there, that was a terrible title for the class. It would have been more accurate, not to mention more memorable, if the class was titled: The Good, the Bad, and the Ugly: Intro to Environmental Health. Let me tell you why. On the very first day, I was blown away by the diversity of the en- vironmental health practice. I felt as if I was launched into outer space! I learned about the good (prevention and mitigation), the bad (outbreaks and incidents), and the ugly (emergencies and disasters that result in morbidity and mortal- ity). I listened to a panel of career environ- mental health professionals, which included commissioned o cers from the U.S. Public Health Service (USPHS). The proverbial light bulb went oˆ! That is what I wanted to be, an environmental health o cer with USPHS. I was going to practice the good, tackle the bad, and prevent the ugly. As I drove home that evening, I thought to myself, “Is it pos- sible for someone like me to do this? A shy, dyslexic, slow reader from a small town and a single mother of two?” The next day, I gathered up the courage to go into the environmental health building at EKU to find someone to talk to about envi- ronmental health. Along the way, I was telling myself that if they told me it was not possible, I would still be okay. I met a woman, not any woman, but Dr. Carolyn Harvey, a beacon of strength and guidance, who understood the challenges

tor for communication for the Division of Environmental Health, Science, and Practice within the Centers for Disease Control and Prevention (CDC). Along the way, I have led over 30 emergency responses involving natu- ral disasters, infectious disease outbreaks, industrial incidents, and humanitarian crises, and I have worked in over 17 countries on global health security. Academia sets students on the right track and changes lives. I am extremely grateful for the professors at EKU who gave me the support I needed to start a rewarding and impactful career. Others along my journey have taught me valuable lessons. When I was supporting the 2014–2015 Ebola outbreak in Africa, I spoke with a community leader and shared my frustration and confusion about why a particular area within the community that was designated as quarantined was not able to keep people quarantined despite provid- ing food, water, and other necessities. He explained that people want to be with family and want to worship when they are afraid. At that time, I was ignorant and I had trou- ble relating to what he was saying. I could only see the sickness and how to prevent the sickness. I was only thinking from the sci- ence side and not from a place of empathy. I will never forget what he said next, “If you take away hope, you take away everything from a community.” This memory is one I share often and use as a teachable moment. It is something that I discuss when I present about listening to the community and empathizing with what a community is going through during risk communication courses. The point I always

We may often be regulators who enforce compliance, mandate protocols, and create guidance, but we also change perspectives

for the better of our communities.

that I would face and was there to support me throughout my journey. Like me, her family came from the same small town in east Ten- nessee. She knew my uncle who was the local pharmacist. She understood my trouble with dyslexia. She overcame her struggles in life and shared them with me openly. She gave me hope. I realized hope was not a strategy, but it was the first step in finding my way. Dr. Harvey and other professors at EKU, such as Worley Johnson, Joe Beck, and Dr. Gary Brown, believed in me, supported me, and empowered me to go on this journey. And what a journey it has been! I have had more than 17 years in federal service serving in many diˆerent roles—a certified investiga- tor with the Food and Drug Administration conducting complex food, drug, and medical device facility inspections; a compliance o - cer with the Strategic National Stockpile; and a public health advisor, public health scien- tist, program manager, and an associate direc-


Volume 87 • Number 1

try to stress is that I thought I understood what this community leader was saying, but in 2020, during the COVID-19 pan- demic, I lived through what he had lived. My mother—despite all the science and all the data that I could share—needed to be with family and friends, just like the people in his community. She needed hope. I thought about this community leader and I thought if I take away hope, I take everything from her. So, I practiced at home what I preach at work. Using the same risk communication principles that I present around the world for CDC and the National Environmental Health Association (NEHA), I approached my mother with messages of hope and empow- erment through preventive methods. Sharing this message with her is what got us through the next steps of the pandemic. It was through these moments of self- awareness and personal impact that I realized that being an environmental public health practitioner does not only come with great power but also great responsibilities. We may often be regulators who enforce compliance, mandate protocols, and create guidance, but we also change perspectives for the better of our communities.

I realize my story is not unique and some of my environmental health colleagues lost parents, grandparents, and friends during the pandemic. They also continued to work in diŽcult environments and sometimes the choices they had to make for the communities they served were not easy. Hope is, however, what environmental health professionals give to our communities. Every time you go into an outbreak and search for the cause—the why behind the outbreak—you provide hope. Every time you worked in a community and provided guidance during the pandemic, you gave hope. Every time you did an inspection and found something that needed to be cor- rected, you gave hope that someone would not get sick and that the prevention (the good) prevailed. You handled the good, the bad, and the ugly in stride and with grace. It is an honor and privilege to serve as your NEHA president. I take this responsibility with pride. I am the first female USPHS com- missioned oŽcer to hold this position as well as one of only nine other women to hold this position. My goal is to make a di”erence to the generations that follow and to give them hope for the future through better strategies. I also want to take on diŽcult issues such as climate

change and its impact on health, water, food safety, and lead poisoning prevention. One of my colleagues, Dr. Bryan Brooks, said to me, “The world needs what NEHA provides.” The environmental health prac- titioners that make up our organization are world leaders in environmental health. We have more than 3,000 Registered Environ- mental Health Specialist/Registered Sani- tarian (REHS/RS) and approximately 2,600 Certified Professional–Food Safety (CP-FS) credential holders. NEHA is focused on the present while forging a path for our future. Our commitment to empowering future leaders in environmental health is evident in the National Environmental Pub- lic Health Internship Program (NEPHIP). which has amassed over 40 participants in 3 years. I look forward to serving with you. Of course, none of this work and progress is pos- sible unless I listen to you, the experts.

Did You Know?

We support your continuing education (CE) needs by providing educational opportunities to complement your credentials and life-long learning. We have improved and expanded our virtual CE oerings, which are available in a variety of formats and free to members. Learn more at continuing-education.

Stand out in the crowd. Show the world you are the environmental health expert you know you are with a credential. You might even earn more or get promoted.


July/August 2024 • our:-l o2 :A5ro:me:?-l e-l?4


Open Access

A Survey of Tick Species in Missouri: 2019 and 2021

Henry O. Agbonpolo, MBBS, MPH Department of Housing and Neighborhood Health, Marion County Public Health Department

spreading in animals (Gettings et al., 2020). Some researchers have speculated that, due to climate change, the population of ticks is shifting from the East Coast, where there is a higher population density, to the Midwest, where there is a lower population density (Alkishe et al., 2021; Gettings et al., 2020). Additionally, the tick population is increas- ing quickly in Missouri (Hudman & Sargen- tini, 2016) and surrounding areas, including Arkansas, Illinois, Kansas, Nebraska, Okla- homa, and Tennessee. In Oklahoma (Small et al., 2019), the dominant species are the American dog tick ( Dermacentor variabilis ), black-legged deer tick ( Ixodes scapularis ), lone star tick ( Amblyomma americanum ), and Gulf Coast tick ( Amblyomma macula- tum ). Additionally, the winter tick ( Derma- centor albipictus ) has been reported to be among frequently occurring species (Mit- cham et al., 2017). In Missouri, the most frequently occurring species, however, is A . americanum , which is responsible for the transmission of the Bourbon virus (Savage et al., 2017). Further, a study conducted in Illi- nois indicated the endemicity of tickborne disease based on reports of multiple cases across human and animal populations (Her- rmann et al., 2014). Several circumstances have been implicated as risk factors for transmitting ticks and tick- borne diseases. One risk factor is the increasing number of animals as pets, with the increased prevalence of E. canis , which is commonly transferred via Rhipicephalus sanguineus , the brown dog tick (Gettings et al., 2020). Land practices can also a”ect the tick population. For example, a study conducted in Missouri on land management indicated that ticks are more likely to be found in unmanaged land compared with managed land. Hence, land practices such as mowing and burning are

b>?r-/? The population of ticks within North America has been increasing and expanding geographically due to climate change, reforestation, resurging deer populations, and other factors. A study was conducted to determine which species of ticks occur in Missouri during the summer season (June, July, and August). We initiated an expanded statewide surveillance using environmental samples and ticks collected by veterinary oces across the state in 2021. This work was a continuation of 2019 surveillance that involved 34 conservation areas from 22 counties. The survey was funded by the Missouri Department of Health and Senior Services, in part to determine if the invasive Haemaphysalis longicornis was present in Missouri. Among all the species detected, only four species of medical importance were identified in 2019: Amblyomma americanum, Amblyomma maculatum, Dermacentor variabilis, and Ixodes scapularis . In 2021 following an expanded surveillance, however, sampling did detect the invasive species H. longicornis in Missouri. Our study is intended to inform environmental health professionals of the prevalence of tick species of importance in Missouri, the pathogens these species harbor, and human health risks. This information can increase awareness of tick species—including new novel species—to educate the public about safety and preventive practices, as well as possibly inform the development of diagnostic and treatment protocols. Keywords: Amblyomma americanum , Amblyomma maculatum , Dermacentor variabilis , Haemaphysalis longicornis , Ixodes scapularis , tickborne diseases, vector control

Introduction The presence of ticks has been established in North America and its population is fast increasing due to reforestation, resurging deer populations, and other factors (Alk- ishe et al., 2021). Also, climate change and

increasing temperatures have been identified as contributors to the increasing tick popula- tion (Alkishe et al., 2021). Among the vari- ous tickborne diseases, ehrlichiosis (caused by Ehrlichia canis ) has been reported to be endemic in the U.S. and its prevalence is fast


Volume 87 • Number 1

essential in controlling the tick population (Hudman & Sargentini, 2018). Other considerations include sociologi- cal factors. For example, Bayles & Allan (2014), in their work determining the human incidence of tickborne disease, found that coniferous forests, increasing relative humidity during June, and the increased number of abandoned houses are risk factors in Missouri for an increasing tick population They also determined the risk factors for contracting ehrlichiosis and showed that ehrlichiosis is strongly associ- ated with living in poverty, hunting, and doing other outdoor activities. Moreover, Sempertegui-Sosa et al. (2020) detected pathogenic ticks in Missouri and concluded that favorable hosts—such as the white-tailed deer—are vital to the increas- ing population of ticks in the state. Simi- larly, birds have been shown to be favorable hosts for some species of ticks. Roselli et al. (2022) conducted a study on tick infestation in birds across urban settings that indicated birds harbor ticks and play an active role in the transmission of tickborne disease. This conclusion is aligned with the results from a study by Loss et al. (2016) that found birds harbor and carry tickborne pathogens across vast regions. As a result of the complexity associated with tickborne diseases, researchers have increased their focus on identifying ticks and tickborne diseases via laboratory analysis and clinical presentation to improve medical pro- fessionals’ knowledge of clinical presentation, diagnosis, and treatment (Lester Rothfeldt et al., 2017; Luedtke et al., 2020; Mattoon et al., 2021). Studies have revealed that A . ameri- canum is an aggressive biting tick species that is dominant in Oklahoma (Mitcham et al., 2017). It is responsible for the transmis- sion of the Bourbon virus and is diagnosed via laboratory detection of Bourbon virus- specific antibodies in human serum (Savage et al., 2017). Savage et al. (2017) isolated A . americanum from several ticks from six sites in northwest Missouri. Further, Aziati et al. (2023) reported cases of human Heartland virus from A . americanum . Another study conducted in St. Louis, Missouri, revealed that A . americanum is the predominant species in St. Louis (Aziati et al., 2023), and A . maculatum is the predomi- nant species in western Tennessee (Mays et

al., 2016), while in Kentucky, I . scpaularis and A . maculatum are the predominant spe- cies (Lockwood et al., 2018). Furthermore, a study in Arkansas indicated that the Bor- relia species—which are di•cult to confirm and are the causative species of Lyme dis- ease—are endemic in Kentucky (Pasternak & Palli, 2022) and northeast Missouri (Hud- man & Sargentini, 2016). Similarly, reports of a study conducted in Illinois indicated that the tick species of medical importance are I . scpaularis , A . americanum , and D . variabilis . Gilliam et al. (2020) have shown that the D . variabilis tick, however, is the most dominant species in Illinois. Due to a poor understanding of the mecha- nism of pathogenicity and emerging virulent pathogens, controversy surrounds the diag- nosis of tickborne diseases. A study con- ducted in Missouri indicated a disparity in the diagnosis of Lyme disease and ehrlichio- sis due to the inability to isolate the agent of these diseases, thus resulting in misdiagno- sis of both diseases (Hudman & Sargentini, 2016). Lester Rothfeldt et al. (2017) con- ducted a study in Arkansas that indicated a misinterpretation of the clinical presenta- tion of tularemia, as evidenced by increased reports of misidentification of symptoms. Discrepancies in the diagnosis of Rocky Mountain Spotted Fever (RMSF) cases exist, with the documentation of laboratory-con- firmed cases decreasing in number despite increasing incidence (Dahlgren et al., 2016). Further, findings from Luedtke et al. (2020) indicated misdiagnosis of the spotted fever group due to the low prevalence of Rickett- sia rickettsii in Nebraska. Similarly, studies in Arkansas and Kentucky revealed that R . rickettsii might not be the primary patho- genic organism for RMSF, as shown through the inability to detect R. rickettsii due to its low prevalence in D . variabilis ticks via DNA analysis (Luedtke et al., 2020; Trout Fryxell et al., 2015). To increase awareness of tick bites and subsequently prevent tickborne diseases, researchers have increased their focus on knowledge, attitudes, and practices regarding tick prevention. For example, a study con- ducted to ascertain the level of knowledge of tick prevention among beef farmers indicated that >50% of beef farmers had a knowledge deficit in the perceived risk associated with exposure to ticks, although a few beef farm-

ers were conversant with safety practices to prevent tick bites (Noden et al., 2020). A study assessing the knowledge, attitudes, and practices of clinicians regarding ticks and tickborne diseases indicated that increased awareness of these diseases through educa- tion, training, and campaigns is essential for clinicians to identify people at risk of tick bites and educate individuals at risk about how to prevent exposure (Carson et al., 2022). Like- wise, Mattoon et al. (2021) assessed physi- cian knowledge of ticks and found there was a need to increase physician knowledge of tickborne diseases to enable them to educate patients on the possible modes of transmis- sion and preventive measures. One study provided tick surveillance train- ing to local health department employees in Illinois and evaluated the training’s impact on knowledge, attitudes, and practices. The pre- training assessment indicated a poor under- standing of surveillance, which is essential for tick identification. Although the training was not associated with increases in surveil- lance practices, a few months after this sur- veillance education, knowledge and attitudes improved (Lyons et al., 2022). Another study conducted among employ- ees in the upper Midwest region assessed knowledge, attitudes, and practices of pro- tective measures against ticks and found that employees have su•cient awareness of pre- ventive measures against ticks. There was, however, a lack of safety practices to prevent tick bites (Schotthoefer et al., 2020). Reports of e¡ective management of ticks and tickborne diseases have been docu- mented, including laboratory investigation, pharmaceutical treatment, use of pesticides in homes, land management, and surveil- lance. One study conducted in Missouri, for example, indicated that land manage- ment (e.g., mowing, burning) e¡ectively suppresses the tick population (Hudman & Sargentini, 2018). Also, McCollough (2018) found that empirical treatment with doxycycline is essential to halt the progres- sion of acute tickborne disease into a more severe phase. In addition, Hinckley et al. (2016) conducted a study to determine the e¡ectiveness of acaricides (i.e., a class of pesticide that kills ticks and mites) in the northeastern part of the U.S. and found that pesticides could be recommended to pre- vent tickborne diseases. They found, how-


July/August 2024 • our:-l o2 :A5ro:me:?-l e-l?4


ever, that the acaricide was ineective in suppressing the tick population when used following manufacturer recommendations. The reason for this insignificant reduction is unknown. Furthermore, reports of statewide sur- veillance conducted in Tennessee led to the discovery of a novel tick ( Haemaphysalis lon- gicornis , the Asian long-horned tick), which suggests that active surveillance, along with passive surveillance, is essential in identify- ing new species (Trout Fryxell et al., 2021). H . longicornis is native to Asian vegetation and has been reported to possess partheno- genic features (i.e., reproduction by devel- opment of an unfertilized usually female gamete). This feature allows the tick species to rapidly colonize and take over new geo- graphical areas and habitats. This tick is an important vector of human and animal dis- ease agents, resulting in human hemorrhagic fever and reduction in the production of dairy cattle (Beard et al., 2018). Identifying H. longicornis in new locations informs envi- ronmental public health professionals about the negative impacts of this species, as well as its characteristic pathological features and methods of diagnosis. Further, awareness about this tick can inform the development of treatment modalities and safety practices to halt its spread. Special surveillance (i.e., ongoing monitor- ing and collection in significantly important areas) is, however, more eective in identify- ing tick-prone habitats (Lyons et al., 2021). In our study, we conducted tick surveillance to determine the presence of H . longicornis , an invasive tick species in Missouri. Timely iden- tification of this species is important in report- ing new cases, developing treatment modali- ties, and reducing the incidence of disease. It is also crucial to understand the presence of H . longicornis to properly educate the public about safety and preventive practices.


Conservation Areas ( N = 34) Within Missouri Counties ( N = 22) Surveyed for Ticks, Summer 2019


# of Surveyed Sites Conservation Area


1 1 1 1 1 1 1 1 1 1 1 6 2 2 2 1 1 1 2 2 2 2

Brickyard Hill


Stubblefield Access Busiek State Forest



Heath Memorial

Gentry Green

Gentry Seat Memorial

Bois-D’Arc Grand Trace



Jameson McCormack


Rudolf Bennitt


Paris Spring Access




Flag Spring, Powell Tower Site, Huckle Berry Ridge, Buffalo Hills, Mt. Shira Access, Neosho Bicentennial

New Madrid

Seven Island, Donaldson Point


Bilby Ranch, Keever Bridge Access


Caney Mountain, Patrick Bridge Access


Little River


Mineral Hills Bee Hallow

Randolph Scotland

Memphis Lake, Indian Hills Arrow-Wood, Hunnewell Lake Weldon Spring, August A. Busch Boston Ferry, Hollister Tower Site


St. Charles


Tick Collection Techniques In 2019, flagging and carbon dioxide-baited sticky traps were used to collect ticks dur- ing the summer months of June, July, and August. In 2021, ticks were collected from veterinary oŽces throughout the state and by environmental collection using tick drags. Tick Flagging The flagging technique is an improved method of collecting questing ticks (i.e., ticks that actively seek a host by climbing high vegeta- tion, as compared with ticks that sit-and-wait for a bloodmeal) that is recommended by the Centers for Disease Control and Prevention (CDC). This method consists of a 3-ft x 3-ft cloth attached to a pole and exploits the ticks’ questing behavior. To catch ticks, the flag is used to brush the grass back and forth while moving in a forward direction. This movement

helps to trap ticks onto the flag. The ticks are eventually retrieved using forceps and stored in a container for later identification. Tick Dragging Tick dragging is one of the well-known techniques for collecting ticks. This tech- nique consists of a 1-m 2 piece of cloth that is attached to a rod and dragged over vegetation. To determine tick density, CDC advises con- ducting tick dragging along a straight tran- sect for at least 750 m (approximately 1,125– 1,500 steps). The person travels through the vegetation while pulling the cloth behind them, stopping every 10–15 min to check the cloth for ticks. If found, the collected ticks are removed from the cloth with forceps and placed in an alcohol vial for later identifica- tion. Tick dragging is an eective method of collecting I. scapularis .


Tick Collection Ticks were collected during summer 2019 and summer 2021. In 2019, ticks were col- lected from 34 conservation areas within 22 counties in Missouri (Table 1). In 2021, an additional 31 counties were surveyed for ticks (Figure 1), including Miami County in Kansas and Madison County in Illinois.


Volume 87 • Number 1



Map of Missouri Counties Surveyed for Ticks, 2019 and 2021

Tick Species and Number of Specimens Collected in Missouri, Summer 2019


# of Specimens Collected

Amblyomma americanum Amblyomma maculatum Dermacentor variabilis




Ixodes scapularis


from dogs and horses. Additionally, ticks from turkeys and deer were brought in by hunters (Table 3). The results of laboratory confirmation of tick identification using molecular tech- niques did not detect any specimens of H . longicornis in 2019. In 2021, however, the presence of H . longicornis was established in Greene County by molecular detection of nymphal specimens. The primary purpose of our study was to demonstrate the importance of tick surveil- lance and determine the prevalence of tick species of importance in Missouri. To estab- lish our objective, we focused on 34 conser- vation areas in 22 counties in summer 2019. The tick flagging technique was reinforced by the use of sticky bait traps to collect a full range of ticks. Overall, only four species of ticks were identified ( A . americanum , A . mac- ulatum , D . variabilis , and I . scapularis ), with one or more species of Ixodes spp. Due to challenges in 2019 with obtaining ticks from specific hosts (e.g., rabbits, birds, cattle, deer) that could harbor H . longicornis , we further expanded our survey in 2021 to include an additional 31 counties (Figure 1) and a variety of hosts. As a result of the expanded surveillance involving a variety of hosts, specimens of H . longicornis were iden- tified in Greene County. The main limitation of our study is that specimens from Miami County (Kansas) and Madison County (Illinois) were included in our study. Because animals migrate season- ally, it seems plausible that specimens that were identified as H . longicornis might have been collected from a host that migrated from Kansas or Illinois.

Note. Red dots indicate counties that were surveyed. Map created with

Identification of Ticks Ticks were transported to a laboratory facil- ity at Missouri State University for micro- scopic visual identification. Specimens of H . longicornis were sent to a CDC laboratory in Atlanta, Georgia, for species confirmation using molecular techniques. Results and Discussion In 2019, we employed flagging and sticky bait traps to collect ticks. Overall, 2,204 ticks were collected during the collection time frame. We also identified and retrieved 1,504 larvae from the legs of workers using masking tape. Visually, the collected larvae appeared to be A . americanum . Only four species of ticks of medical impor- tance were identified throughout the summer 2019 collection period (Table 2): A . america- num (2,049), A . maculatum (25), D . variabilis (129), and I . scpaularis (1). St. Charles and Macon counties had larger tick populations,

but most of the ticks were collected in Ozark County. St. Charles and Macon counties are relatively rural with lots of farmland and wild- life conservation areas, which provide a good habitat for ticks. Ozark County is, however, completely rural, has milder winters, and typi- cally has hot, sunny, and humid conditions during the summer months. These conditions have been reported to be tick-prone, so it could be plausible that ticks might have migrated to Ozark County during the winter months and stayed till the summer months when surveil- lance was conducted. In 2021, only the tick dragging tech- nique was used to collect ticks and a total of 799 ticks were collected using this technique. Further, 4,223 ticks were col- lected from veterinary o“ces throughout Missouri. During collection, the dragging method was more e”ective in collecting A . americanum ticks than I . scapularis ticks. The largest number of ticks was retrieved


July/August 2024 • Journal of Environmental Health



Species and Number of Ticks Identified From Different Hosts at Veterinary Offices or During Field Collection in Missouri, Summer 2021


# of Ticks Collected

Amblyomma americanum

Dermacentor variabilis

Ixodes scapularis

Amblyomma maculatum

Haemaphysalis longicornis


61 13 17

44 10

2 0 3


0 0 0 6 0 0 7 0 0 0

0 0 0 0 0 0 0 0 6 0


3 8











0 6 0 1






Turkey Human


0 8

0 1 2 0

10 67

Unknown Tick drag






Conclusion From tick surveillance conducted in Missouri in 2019, only four tick species of medical importance were identified: A . americanum , A . maculatum , D . variabilis, and I . scapularis . In 2021 following an expanded surveillance, however, sampling did detect the invasive species H. longicornis . The main finding of our study was the establishment of a novel tick, H . longicornis , through active state surveillance. Our find- ing is important and will aid in increasing

awareness of this tick among environmental health professionals and potentially a ected populations, especially beef farmers. Overall, our study can increase awareness of the tick species present in Missouri—including new novel species—to educate the public about safety and preventive practices, as well as pos- sibly inform the development of diagnostic and treatment protocols. We support and rec- ommend that continuous state surveillance is needed to identify existing, novel, and emerg- ing ticks and tickborne diseases.

Acknowledgment: The author appreciates Dr. David Claborn for his immense contribution to the success of this research. Corresponding Author: Henry O. Agbon- polo, Department of Housing and Neighbor- hood Health, Marion County Public Health Department, 3838 North Rural Street, India- napolis, IN 46205. Email:


Alkishe, A., Raghavan, R.K., & Peterson, A.T. (2021). Likely geo- graphic distributional shifts among medically important tick species and tick-associated diseases under climate change in North America: A review. Insects , 12 (3), Article 225. https://doi. org/10.3390/insects12030225 Aziati, I.D., McFarland, D., Jr., Antia, A., Joshi, A., Aviles-Gamboa, A., Lee, P., Harastani, H., Wang, D., Adalsteinsson, S.A., & Boon, A.C.M. (2023). Prevalence of Bourbon and Heartland viruses in field collected ticks at an environmental field station in St. Louis County, Missouri, USA. Ticks and Tick-borne Diseases , 14 (1), Arti- cle 102080. Bayles, B.R., & Allan, B.F. (2014). Social-ecological factors deter- mine spatial variation in human incidence of tick-borne ehrlichi- osis. Epidemiology and Infection , 142 (9), 1911–1924. https://doi. org/10.1017/S0950268813002951 Beard, C.B., Occi, J., Bonilla, D.L., Egizi, A.M., Fonseca, D.M., Mer- tins, J.W., Backenson, B.P., Bajwa, W.I., Barbarin, A.M., Berton,

M.A., Brown, J., Connally, N.P., Connell, N.D., Eisen, R.J., Falco, R.C., James, A.M., Krell, R.K., Lahmer, K., Lewis, N., . . . Halperin, W. (2018). Multistate infestation with the exotic disease–vector tick Haemaphysalis longicornis —United States, August 2017– September 2018. Morbidity and Mortality Weekly Report , 67 (47), 1310–1313. Carson, D.A., Kopsco, H., Gronemeyer, P., Mateus-Pinilla, N., Smith, G.S., Sandstrom, E.N., & Smith, R.L. (2022). Knowledge, attitudes, and practices of Illinois medical professionals related to ticks and tick-borne disease. One Health , 15 , Article 100424. Dahlgren, F.S., Paddock, C.D., Springer, Y.P., Eisen, R.J., & Beh- ravesh, C.B. (2016). Expanding range of Amblyomma america- num and simultaneous changes in the epidemiology of spotted fever group rickettsiosis in the United States. The American Jour- nal of Tropical Medicine and Hygiene , 94 (1), 35–42. https://doi. org/10.4269/ajtmh.15-0580


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Gettings, J.R., Self, S.C.W., McMahan, C.S., Brown, D.A., Nordone, S.K., & Yabsley, M.J. (2020). Local and regional temporal trends (2013–2019) of canine Ehrlichia spp. seroprevalence in the USA. Parasites & Vectors , 13 , Article 153. s13071-020-04022-4 Gilliam, B., Gronemeyer, P., Chakraborty, S., Winata, F., Lyons, L.A., Miller-Hunt, C., Tuten, H.C., Debosik, S., Freeman, D., O’Hara- Ruiz, M., & Mateus-Pinilla, N. (2020). Impact of unexplored data sources on the historical distribution of three vector tick species in Illinois. Journal of Medical Entomology , 57 (3), 872–883. https:// Herrmann, J.A., Dahm, N.M., Ruiz, M.O., & Brown, W.M. (2014). Temporal and spatial distribution of tick-borne disease cases among humans and canines in Illinois (2000–2009). Environmen- tal Health Insights , 8 (Suppl. 2), 15–27. EHI.S16017 Hinckley, A.F., Meek, J.I., Ray, J.A.E., Niesobecki, S.A., Connally, N.P., Feldman, K.A., Jones, E.H., Backenson, P.B., White, J.L., Lukacik, G., Kay, A.B., Miranda, W.P., & Mead, P.S. (2016). E£ectiveness of residential acaricides to prevent Lyme and other tick-borne diseases in humans. The Journal of Infectious Diseases , 214 (2), 182–188. Hudman, D.A., & Sargentini, N.J. (2016). Detection of Borrelia , Ehrlichia , and Rickettsia spp. in ticks in northeast Missouri. Ticks and Tick-borne Diseases , 7 (5), 915–921. ttbdis.2016.04.010 Hudman, D.A., & Sargentini, N.J. (2018). Prevalence of tick-borne pathogens in northeast Missouri. Missouri Medicine , 115 (2), 162–168. Lester Rothfeldt, L.K., Jacobs, R.F., Wheeler, J.G., Weinstein, S., & Haselow, D.T. (2017). Variation in tularemia clinical manifesta- tions—Arkansas, 2009–2013. Open Forum Infectious Diseases , 4 (1), Article ofx027. Lockwood, B.H., Stasiak, I., Pfa£, M.A., Cleveland, C.A., & Yabsley, M.J. (2018). Widespread distribution of ticks and selected tick- borne pathogens in Kentucky (USA). Ticks and Tick-borne Dis- eases , 9 (3), 738–741. Loss, S.R., Noden, B.H., Hamer, G.L., & Hamer, S.A. (2016). A quan- titative synthesis of the role of birds in carrying ticks and tick- borne pathogens in North America. Oecologia , 182 (4), 947–959. Luedtke, B.E., Sha£er, J.J., Monrroy, E., Willicott, C.W., & Bourret, T.J. (2020). Molecular detection of spotted fever group Rickett- siae (Rickettsiales: Rickettsiaceae) in Dermacentor variabilis (Acari: Ixodidae) collected along the Platte River in South Central Nebraska. Journal of Medical Entomology , 57 (2), 519–523. https:// Lyons, L.A., Brand, M.E., Gronemeyer, P., Mateus-Pinilla, N., O’Hara Ruiz, M., Stone, C.M., Tuten, H.C., & Smith, R.L. (2021). Com- paring contributions of passive and active tick collection meth- ods to determine establishment of ticks of public health concern

within Illinois. Journal of Medical Entomology , 58 (4), 1849–1864. Lyons, L.A., Mateus-Pinilla, N., & Smith, R.L. (2022). E£ects of tick surveillance education on knowledge, attitudes, and practices of local health department employees. BMC Public Health , 22 , Article 215. Mattoon, S., Baumhart, C., Barsallo Cochez, A.C., MacQueen, D., Sne- deker, J., Yancey, C.B., Gatch, M., & Mader, E.M. (2021). Primary care clinical provider knowledge and experiences in the diagnosis and treatment of tick-borne illness: A qualitative assessment from a Lyme disease endemic community. BMC Infectious Diseases , 21 (1), Article 894. Mays, S.E., Houston, A.E., & Trout Fryxell, R.T. (2016). Specifying pathogen associations of Amblyomma maculatum (Acari: Ixodi- dae) in Western Tennessee. Journal of Medical Entomology , 53 (2), 435–440. McCollough, M. (2018). RMSF and serious tick-borne illnesses (Lyme, ehrlichiosis, babesiosis and tick paralysis). In E. Rose (Ed.), Life-threatening rashes: An illustrated, practical guide (pp. 215– 240). Springer. Mitcham, J.R., Barrett, A.W., Gruntmeir, J.M., Holland, T., Martin, J.E., Johnson, E.M., Little, S.E., & Noden, B.H. (2017). Active sur- veillance to update county scale distribution of four tick species of medical and veterinary importance in Oklahoma. Journal of Vector Ecology , 42 (1), 60–73. Noden, B.H., Garner, K.D., Lalman, D., & Talley, J.L. (2020). Knowledge, attitudes, and practices regarding ticks, tick-borne pathogens, and tick prevention among beef producers in Okla- homa. Southwestern Entomologist , 45 (2), 341–350. https://doi. org/10.3958/059.045.0202 Pasternak, A.R., & Palli, S.R. (2022). Mapping distributions of the Lyme disease vector, Ixodes scapularis , and spirochete, Borrelia burgdorferi , in Kentucky using passive and active surveillance. Ticks and Tick-borne Diseases , 13 (2), Article 101885. https://doi. org/10.1016/j.ttbdis.2021.101885 Roselli, M.A., Noden, B.H., & Loss, S.R. (2022). Tick infestation of birds across a gradient of urbanization intensity in the United States Great Plains. Urban Ecosystems , 25 , 379–391. https://doi. org/10.1007/s11252-021-01160-0 Savage, H.M., Burkhalter, K.L., Godsey, M.S., Panella, N.A., Ashley, D.C., Nicholson, W.L., & Lambert, A.J. (2017). Bourbon virus in field-collected ticks, Missouri, USA. Emerging Infectious Diseases , 23 (12), 2017–2022. Schotthoefer, A., Stinebaugh, K., Martin, M., & Munoz-Zanzi, C. (2020). Tickborne disease awareness and protective practices among U.S. Forest Service employees from the upper Midwest, USA. BMC Public Health , 20 , Article 1575. s12889-020-09629-x Sempertegui-Sosa, C.D., Schrier, J., Romine, D.J., & Connolly, M.E. (2020). Detection of pathogenic bacteria among adult ticks col-

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