In Canada, tick-borne diseases are becoming more common. This presents a growing risk to public health and begs the question of whether the country’s current surveillance and public awareness initiatives are adequate to handle this expanding issue. In addition to the more well-known Lyme disease, other illnesses including anaplasmosis, babesiosis, and Powassan virus are also becoming more prevalent. These illnesses are spread by tick bites.

MaryAnn Harris noticed an unexpected increase in tiredness one morning in September 2021. Soon after telling her husband Charles de Lint that she needed to lie down, further concerning symptoms, such as nausea and double vision, started to manifest. The pair, who live in Ottawa, went straight to a nearby hospital’s emergency room. The emergency care doctors conducted a number of tests, but they were unable to determine what was causing Harris’s symptoms. Not too long after, her husband was sent home due to visitor restrictions connected to the pandemic.

Harris was unconscious and in the intensive care unit on life support when de Lint arrived the next day. De Lint felt helpless and terrified at the abrupt and drastic deterioration. Medical professionals tried a plethora of tests and procedures over the course of the following three years to try to save Harris. She was paralyzed despite finally regaining consciousness due to severe inflammation in her brain stem. Harris was in the hospital until she passed away at the age of 71 in early June 2024. The cause of her sickness was eventually identified as an uncommon virus spread by tick bites.

Medical professionals have been warning about the growing number of Canadians being exposed to ticks that transmit a variety of harmful infections for years. Although Lyme disease is the most well-known and widespread sickness spread by ticks, less well-known dangers such as the rare Powassan virus, which ultimately led to Harris’s terrible demise, and the bacterial illnesses anaplasmosis and babesiosis are also causing concern.

Data on illnesses carried by ticks are still scarce, even with the increase in case counts. The situation is becoming worse due to climate change, which is enabling tick populations to spread further north and expose more people to these infections. Experts are now debating whether awareness campaigns and surveillance initiatives will be enough to keep up with the growing threat.

Underdiagnosis is likely, according to Dr. Isaac Bogoch, an infectious diseases specialist with Toronto’s University Health Network. He points out that incomplete knowledge of these newly developing infections by the general population and medical professionals may result in missing or postponed diagnoses. Saying, “The more you look, the more you find,” he emphasized the importance of being more watchful.

A disjointed surveillance system in Canada makes tracking diseases carried by ticks more difficult. Since 2009, Lyme disease has been a nationally reportable disease, which is concerning given its potential severity. A few hundred instances of Lyme disease were documented in the early years, but in recent years, over 2,500 cases have been reported annually, a rise in both awareness and the quantity of ticks carrying bacterium.

Data for other tick-borne infections, such as babesiosis, anaplasmosis, and Powassan virus, are still hard to come by. These illnesses are still not well documented from the provinces, and it was only recently decided that they needed to be reported nationwide. For instance, in 2009, Alberta reported the country’s first incidence of anaplasmosis. It took more than ten years for Manitoba to track its spread before Ontario and Nova Scotia, among other provinces, increased their surveillance.

Ontario reported 15 instances of babesiosis and 40 confirmed or suspected cases of anaplasmosis in 2023; the majority of the incidents occurred between June and August. Both illnesses have the potential to result in more serious illness as well as flu-like symptoms. In the meantime, the Powassan virus, which in approximately 10% of cases can result in severe neurological symptoms and brain inflammation, is still uncommon but alarming because of its serious effects on human health and ease of transmission through tick bites.

Prominent expert on ticks at the Public Health Agency of Canada (PHAC), Heather Coatsworth, drew attention to the rising incidence of these diseases, especially in high-tick regions like Ontario, Quebec, and Nova Scotia. Anaplasmosis infections number in the “hundreds and hundreds” in Canada each year, according to Coatsworth, with occasional cases of babesiosis. Powassan virus infections are still uncommon and limited in scope, but because of their severe symptoms and quick spread, they represent a serious risk.
The spread of black-legged ticks, which carry both Powassan and Lyme disease, has contributed to a four-fold increase in Powassan cases, according to recent U.S. data published in Clinical Microbiology and Infection. From 2004 to 2013, there were 64 documented Powassan cases in the U.S., but this number rose to about 300 in the next decade. This trend could also occur in Canada due to climate change, which expands the range of ticks and increases human exposure to these diseases.

For infections carried by ticks, prompt treatment is essential; yet, a lack of knowledge among medical professionals might cause a delay in diagnosis and treatment. Due to a lack of knowledge among many healthcare professionals, little diagnostic testing is conducted. While Powassan virus infections do not have a specific therapy, supportive care is necessary to manage symptoms, time-sensitive bacterial infections require immediate antibiotic treatment to prevent serious development.

Ottawa local Mary Raths counts herself lucky to have been diagnosed with anaplasmosis in 2021 and treated promptly. Raths sought medical attention after going on a camping vacation and developing a fever, headache, and nausea. She also tested negative for COVID-19. Raths’ attending physician, who was knowledgeable about anaplasmosis, started antibiotic therapy on the basis of suspicion, and she recovered completely in five days. Subsequent blood testing verified the bacterial infection, most likely acquired from a tick bite she sustained while camping.

Many patients remain exposed since there is still a lack of awareness despite the rising number of cases. In order to enhance the identification and treatment of illnesses carried by ticks, Dr. Bogoch stressed the importance of raising awareness and educating healthcare professionals. He said that in order to keep up with the expanding threat, a lot of work needs to be done.

A nationwide tick-borne disease surveillance dashboard is being developed by PHAC and is anticipated to go live in the fall of 2024. With a particular focus on Lyme disease, this service attempts to give Canadians comprehensive case counts that are split down by geographic, demographic, and seasonal aspects. By the summer of 2025, information on anaplasmosis, babesiosis, and Powassan virus will be accessible. Coatsworth conveyed the hope that greater data sharing will assist Canadians in identifying their tick bite risk and implementing preventative actions.

Charles de Lint hopes that greater knowledge and instruction may spare others from going through what his wife went through because of the Powassan virus. Harris underlined the significance of teaching medical professionals, particularly emergency department physicians, to identify tick-borne infections even if he was unsure of the location of the bite.

De Lint reminisced about their 40 years of marriage to Harris, narrating special moments from their first encounter in a record store to their artistic and musical partnerships. He emphasized the terrible effects of diseases spread by ticks and the necessity of averting such catastrophes, particularly for younger people whose lives could be severely impacted.

It is advised to take the following safety measures to prevent tick bites:

Avoid being bitten:

Put on long sleeve shirts and pants in light colors.
Put your socks inside your pants and your shirt inside your pants.
Put on closed-toe footwear.
Apply insect repellent with DEET or icaridin.
Stroll down designated pathways or trails.
Wear garments treated with permethrin, which is currently available in Canada.

Look for ticks.

As soon as you can after being outside, take a shower or bathe.
Every day, give yourself, your kids, your pets, and your equipment a thorough body tick inspection.
For at least ten minutes, place your clothing in a dryer set on high heat.
React if you get bitten:

As soon as possible, remove the tick from your skin with clean, fine-point tweezers.
Bring the tick with you to your healthcare provider and keep it in a tight container.
If you feel ill or are worried after being bitten by a tick, get in touch with your doctor.
In order to safeguard the public’s health, more surveillance, education, and preventive measures are needed as tick-borne illnesses pose an increasing hazard in Canada.