Original Article

Association of Doxycycline Prescriptions and Tick-Related Emergency Department Visits in North Carolina

Authors: Sarah Rhea, DVM, MPH, Seth Glickman, MD, MHA, Anna Waller, ScD, Carl Williams, DVM, MA, Larry Glickman, VMD, DrPH

Abstract

Objectives: To compare the seasonal frequency of doxycycline prescriptions with tick-related emergency department (ED) visits in North Carolina, and to determine if doxycycline prescriptions are associated in time with an increase in the number of ED visits for a tick-related patient complaint or a subsequent diagnosis of a tick-borne infection.


Methods: Aggregate monthly counts of total dispensed doxycycline prescriptions for each North Carolina Piedmont Metropolitan Statistical Area (MSA) were compared with the proportions of tick-related ED visits from August 2007 through July 2009.


Results: Epidemic curves of tick-related ED visits for each of the 6 MSAs were characterized by increased frequency in the spring and summer months followed by a decline in the fall. However, the pattern of doxycycline prescriptions varied by MSA. Doxycycline prescriptions in Durham-Chapel Hill and Raleigh-Cary MSAs increased in the spring and summer, while for the 4 other Piedmont MSAs there was no consistent or pronounced spring-summer increase.


Conclusion: Doxycycline prescription use did not always correlate well with suspected tick activity in North Carolina. Therefore, doxycycline prescription use cannot necessarily be used as a surrogate measure of tick activity for infectious disease surveillance until the reasons for this variability are better understood.

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References

1. Salinas LJ, Greenfield RA, Little SE, et al. Tickborne Infections in the southern United States. Am J Med Sci 2010;340:194-201.
 
2. Blanton L, Keith B, Brzezinski W. Southern tick-associated rash illness: erythema migrans is not always Lyme disease. South Med J 2008;101:759-760.
 
3. North Carolina Division of Public Health. Reported Communicable Diseases, North Carolina, January-December (by date of report). December 31, 2008. Available at: http://www.epi.state.nc.us/epi/gcdc/pdf/cdtable2008.pdf. Accessed December 15, 2010.
 
4. Rhea SK, Glickman SW, Waller A, et al. Evaluation of routinely collected veterinary and human health data for surveillance of human tick-borne diseases in North Carolina. Vector Borne Zoonotic Dis 2011;11:9-14.
 
5. Doxycycline. In: DrugPoints ® System [intranet database]. Version 5.1. Greenwood Village, CO: Thomson Healthcare; 2010.
 
6. Hansmann Y. Treatment and prevention of Lyme disease [published online ahead of print April 8, 2009]. Curr Probl Dermatol 2009;37:111-129.
 
7. Chapman AS, Bakken JS, Folk SM, et al. Diagnosis and management of tick-borne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis-United States. MMWR 2006;55:1-27.
 
8. North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) [Internet]. Chapel Hill, NC: The University of North Carolina at Chapel Hill; c2004-2010. Available at: http://www.ncdetect.org. Accessed November 22, 2010.
 
9. Skiles MP, Schinasi L, Waller AE, et al. The UNC Department of Emergency Medicine Carolina Center for Health Informatics Report NC DETECT Emergency Department Data: 2008, North Carolina Emergency Department Data, January 1, 2008-December 31, 2008. Chapel Hill, NC: Carolina Center for Health Informatics, Department of Emergency Medicine, University of North Carolina at Chapel Hill; 2010.
 
10. Travers DA, Haas SW. Evaluation of emergency medical text processor, a system for cleaning chief complaint text data. Acad Emerg Med 2004;11:1170-1176.
 
11. US Census Bureau. Annual estimates of the population for counties of North Carolina: April 1, 2000 to July 1, 2009. August 16, 2010. Available at: http://quickfacts.census.gov/qfd/states/37000lk.html. Accessed October 3, 2010.
 
12. Apperson C, Engber B, Waldvogel M. Ticks and tick-borne diseases in North Carolina. Department of Entomology, North Carolina Cooperative Extension, North Carolina State University website. June 2009. Available at: http://www.ces.ncsu.edu/depts/ent/notes/Urban/ticks.htm. Accessed April 1, 2010.
 
13. US Census Bureau. Annual estimates of the population for counties of South Carolina: April 1, 2000 to July 1, 2009. August 16, 2010. Available at: http://quickfacts.census.gov/qfd/states/45/45091.html. Accessed October 3, 2010.
 
14. Babcock GD, Talbot TO, Rogerson PA, et al. Use of CUSUM and Shewhart charts to monitor regional trends of birth defect reports in New York state. Birth Defects Res A Clin Mol Teratol 2005;73:669-678.
 
15. Kirkland KB, Wilkinson WE, Sexton DJ. Therapeutic delay and mortality in cases of Rocky Mountain spotted fever. Clin Infect Dis 1995;20:1118-1121.
 
16. O'Reilly M, Paddock C, Elchos B, et al. Physician knowledge of the diagnosis and management of Rocky Mountain spotted fever, Mississippi, 2002. Ann N Y Acad Sci 2003;990:295-301.
 
17. Fortenberry JD, Orr DP, Zimet GD, et al. Weekly and seasonal variation in sexual behaviors among adolescent women with sexually transmitted diseases. J Adolesc Health 1997;20:420-425.
 
18. Soper DE. Pelvic inflammatory disease. Obstet Gynecol 2010;116(2 pt 1):419-428.
 
19. Ismail N, Bloch KC, McBride JW. Human ehrlichiosis and anaplasmosis. Clin Lab Med 2010;30:261-292.