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In this paper, I will show how applying a spatially explicit context to an existing environmental health surveillance framework is vital for more complete surveillance of disease, and for disease prevention and intervention strategies. As a case study to test the viability of a spatial approach to this existing framework, the risk of human exposure to Lyme disease will be estimated. This spatially explicit framework divides the surveillance process into three components: hazard surveillance, exposure surveillance, and outcome surveillance. The components will be used both collectively and individually, to assess exposure risk to infected ticks. By utilizing all surveillance components, I will identify different areas of risk which would not have been identified otherwise. Hazard surveillance uses maximum entropy modeling and geographically weighted regression analysis to create spatial models that predict the geographic distribution of ticks in Texas. Exposure surveillance uses GIS methods to estimate the risk of human exposures to infected ticks, resulting in a map that predicts the likelihood of human-tick interactions across Texas, using LandScan 2008TM population data. Lastly, outcome surveillance uses kernel density estimation-based methods to describe and analyze the spatial patterns of tick-borne diseases, which results in a continuous map that reflects disease rates based on population location. Data for this study was obtained from the Texas Department of Health Services and the University of North Texas Health Science Center. The data includes disease data on Lyme disease from 2004-2008, and the tick distribution estimates are based on field collections across Texas from 2004-2008.

Murine infection by the Lyme disease spirochete, B. burgdorferi, results in the generation of pathogen-specific antibody that can provide protection against Lyme disease, but the cells involved in this response are poorly characterized. T cells are not required for generating a protective antibody response to B. burgdorferi infection, but their exact role in providing protection against tissue colonization had not been previously determined. We found that TCRβxδ;-/- mice were susceptible to high pathogen loads and decreased antibody titers, but inhibition of CD40L-dependent interactions resulted in partial protection suggesting that a portion of the help provided by T cells was not dependent on CD40L-CD40 interactions between T and B cells. RAG1-/- mice reconstituted with either un-fractionated or B1-enriched peritoneal cells from previously infected mice generated B. burgdorferi-specific antibody, and upon spirochetal challenge suffered significantly lower levels of pathogen load in the joint and heart. Peritoneal cells from previously infected TCRβxδ-/- mice or B2-enriched or B1-purified peritoneal cells conferred little to only moderate protection, suggesting T cells play an important role in protection against spirochetal infection the joint. Consistent with this, T cells from previously infected donor mice, when transferred with B1 or B2 cells into RAG1-/- mice, generated increased antibody titers and were capable of diminishing bacterial burden in the joint and heart. A previously identified class of protective antibody is directed against the spirochetal surface lipoprotein DbpA, and we found that DbpA is a prominent protein antigen recognized by RAG1-/- mice reconstituted with B1-enriched peritoneal cells. Additionally, we found that mice reconstituted with B1 cells also make antibody directed towards the spirochetal glycolipid antigen, BbGL-IIc, which is recognized by Vα14iNKT cells. Consistent with the idea that T cells are important in providing protection against spirochetal infection, RAG1-/- mice reconstituted with B1 and T cells generated a more robust response against DbpA and BbGL-IIc. These results support the hypothesis that T cells act with B1 cells in a CD40L-independent manner to promote the production of antibodies that play an important role in protection of the joint from spirochetal infection.

La maladie de Lyme est émergente au Canada; le risque engendré par cette maladie vient en partie de la ténacité de son vecteur et des méthodes limitées pour réduire son abondance dans l’environnement. Actuellement, peu de moyens de prévention visent de manière efficace et sécuritaire le réservoir principal de la bactérie responsable de la maladie, la souris à patte blanche Peromyscus leucopus. L’objectif de ce projet était d’évaluer l’efficacité des isoxazolines, une nouvelle classe d’antiparasitaire, lorsqu’administré sous forme d’appâts oraux aux micromammifères résidents d’un site endémique pour la maladie de Lyme. Les appâts furent distribués lors de l’été 2018 et 2019, sur les terrains choisis du parc national des Mille-Îles, en Ontario. La capture de micromammifères, en terrain traité et non traité, nous permit d’évaluer l’infestation (nombre de tiques par souris) du réservoir Peromyscus alors que l’effet du traitement sur la densité de tiques dans l’environnement fut estimé par la technique de flanelle. L’impact de la molécule d’isoxazoline employée (sarolaner versus fluralaner), de la biodiversité et du type d’environnement (caractéristiques de la forêt, température, humidité) fut également évalué. Des modèles linéaires mixtes binomiale négative furent composés pour déterminer l’impact de chacune des variables mesurées et du traitement sur les variables dépendantes, soit le nombre de tiques sur les souris capturées et la densité de nymphes dans l’environnement. Après deux étés de traitement, les souris capturées sur les microsites traités furent significativement moins infestées que les souris capturées sur les microsites contrôles pour 3 des 5 sites étudiés. Par contre, aucune diminution significative du nombre de nymphes dans l’environnement ne fut observée, probablement dû à la courte durée du devis d’étude. La densité de nymphes dans l’environnement variait toutefois en fonction de l’année d’échantillonnage et était positivement corrélée avec la biodiversité au niveau du microsite. Le nombre de tiques sur Peromyscus spp. était associé au sexe (les mâles étant plus infesté) et à la taille de l’animal, au mois et à l’année de la capture, à une forte densité de larves dans l’environnement et au traitement effectué sur le microsite de capture. Le fluralaner se montra plus efficace à réduire l’infestation moyenne des rongeurs. Cette étude fut la première à étudier l’utilisation de saronaler oral chez le réservoir principal de l’agent de la maladie de Lyme en milieu naturel. L’effet du traitement chez les micromammifères est prometteur, mais son efficacité pour réduire la densité de tiques dans l’environnement reste à confirmer. / Lyme disease is the most common vector-borne disease in North America; the risk caused by the disease is partly due to its tick vector’s tenacity and limited number of approaches to reduce its abundance in the environment. Few existing methods efficiently and safely target the principal host for the bacteria, white-footed mice Peromyscus leucopus.The objective of this thesis was to evaluate the efficacy of a new family of antiparasitic drug, isoxazolines, when passively administered as an oral bait to micromammals in endemic site for Lyme disease. Oral baits were distributed during the summer of 2018 and 2019 on five selected sites in the Thousand Islands National Park. Density of ticks in the environment was estimated using drag sampling while small mammal trapping allowed biodiversity and infestation (number of ticks per mouse) to be assess. Impact of isoxazoline used (sarolaner or fluralaner), biodiversity and characteristics of environment (type of forests, temperature, humidity) were also evaluated. Linear mixed models were fitted to determine the impact of measured variables and treatment on infestation level and density of questing nymphs. Results show a significant reduction in tick load for mice captured on treatment plots compared to control plots for 3 out of 5 sites. However, we did not observe a significant reduction in the density of questing nymphs, probably due to the limited duration of the study. Density of nymphs followed interannual variation and was best explained by humidity levels at the time of sampling and plot-level host biodiversity. Peromyscus spp. infestation was linked to the sex (male being more infested) and body length of the mice, high density of questing larvae, year and month of capture and treatment applied to the microsite. Fluralaner showed to be more efficient at reducing mice average tick load. This study was the first to use oral sarolaner to treat the most important reservoir for the Lyme disease agent in the environment. Our protocol did not significantly reduce questing nymphs in the environment for the duration of this study but could potentially diminish Lyme disease human risk with long term use through reduced Peromyscus infestation.

La maladie de Lyme est la maladie transmise par tiques la plus répandue dans l’hémisphère du Nord. Le système de surveillance des cas humains de la maladie de Lyme est basé sur un système passif des cas par les professionnels de santé qui présente plusieurs failles rendant la surveillance incomplète. Avec l’expansion de l’usage de l’internet et des réseaux sociaux, des chercheurs proposent l’utilisation des données provenant des réseaux sociaux comme outil de surveillance, cette approche est appelée l’infodémiologie. Cette approche a été testée dans plusieurs études avec succès. L’objectif de ce mémoire est de construire une base de données à partir des tweets auto-déclarés, des tweets classifiés et étiquetés comme un cas potentiel de Lyme ou non à l’aide des modèles de classificateurs basés sur des transformateurs comme, BERTweet, DistilBERT et ALBERT. Pour ce faire, un total de 20 000 tweets en anglais en lien avec la maladie de Lyme sans restriction géographique de 2010 à 2022 a été collecté avec la plateforme API twitter. Nous avons procédé au nettoyage la base de données. Ensuite les données nettoyées ont été classifiées en binaire comme cas potentiels ou non de la maladie de Lyme sur la base des symptômes de la maladie comme mots-clés. À l’aide des modèles de classification basés sur les transformateurs, la classification automatique des données est évaluée en premier sans, et ensuite avec des émojis convertis en mots. Nous avons trouvé que les modèles de classification basés sur les transformateurs performent mieux que les modèles de classification classiques comme TF-IDF, Naive Bayes et autres ; surtout le modèle BERTweet a surpassé tous les modèles évalués avec un score F1 moyen de 89,3%, une précision de 97%, une exactitude de 90% et un rappel de 82,6%. Aussi l’incorporation des émojis dans notre base de données améliore la performance de tous les modèles d’au moins 5% mais BERTweet a une fois de plus le mieux performé avec une augmentation de tous les paramètres évalués. Les tweets en anglais sont majoritairement en provenance des États-Unis et pour contrecarrer cette prédominance, les futurs travaux devraient collecter des tweets de toutes langues en lien avec la maladie de Lyme surtout parce que les pays européens où la maladie de Lyme sont en émergence ne sont pas des pays anglophones. / Lyme disease is the most common tick-borne disease in the Northern Hemisphere. The surveillance system for human cases of Lyme disease has several flaws which make the surveillance incomplete. Nowadays with the extensive use of internet and social networks, researchers propose the use of data from social networks as a surveillance tool, this approach is called Infodemiology. This approach has been successfully tested in several studies. The aim of this thesis is to build a database from self-reported tweets, capable of classifying a tweet as a potential case of Lyme or not using BERT transformer-based classifier models. A total of 20,000 English tweets related to Lyme disease without geographical restriction from 2010 to 2022 were collected with twitter API. Then these data were cleaned and manually classified by binary classification as potential Lyme cases or not using as keywords the symptoms of Lyme disease; Also, emojis have been converted into words and integrated. Using classification models based on BERT transformers, the labeling of data as disease-related or non-disease-related is evaluated first without, and then with emojis. Transformer-based classification models performed better than conventional classification models, especially the BERTweet model outperformed all evaluated models with an average F1 score of 89.3%, precision of 97%, accuracy of 90%, and recall of 82.6%. Also, the incorporation of emojis in our database improves the performance of all models by at least 5% but BERTweet once again performed best with an increase in all parameters evaluated. Tweets in English are mostly from the United States and to counteract this predominance, future work should collect tweets of all languages related to Lyme disease especially because the European countries where Lyme disease are emerging are not English-speaking countries.

Lyme disease is an emerging tick-borne illness in Canada, with human case numbers increasing 15- to 20-fold since Lyme disease became nationally notifiable in 2009 until the present. In Ontario, Canada's largest province by population, average Lyme disease incidence across the province is similar to that of national estimates. However, in eastern Ontario, which is near tick endemic regions in the northeastern Unites States, Lyme disease incidence is disproportionately higher compared to the rest of the province. The objectives of this thesis are to identify environmental Lyme disease risk areas in Ontario, to explore spatiotemporal trends in Lyme disease emergence, and to identify neighbourhood-level socioecological risk factors for Lyme disease. In addition, this thesis also aims to assess the risk of other tick-borne illnesses that are transmitted by the blacklegged tick, Ixodes scapularis, which is also the main vector for Lyme disease in Canada. Using maximum entropy species distribution modelling to correlate blacklegged tick occurrence data with environmental variables, predictive risk models for I. scapularis and the Lyme disease pathogen, Borrelia burgdorferi, were developed. The model prediction was used to classify low and high environment risk areas and, using a case-control epidemiological study, we assessed that residence in risk areas was a strong predictor of Lyme disease. However, this relationship was modulated by socioecological factors linked to higher overall rurality of the locality of home residence. Spatial cluster analyses further revealed that human Lyme disease cases clustered in regions with the high numbers of reported B. burgdorferi-infected ticks in the environment. Many individuals residing in large metropolitan regions, like the City of Ottawa, reported tick exposures outside their public health unit of residence; however, local clusters of Lyme disease were also detected in suburban regions near conservation areas, trails, and urban woodlands. The prevalence of other tick-borne pathogens was low, although several pathogens of public health significance including Borrelia miyamotoi and Anaplasma phagocytophilum were detected at multiple sites surveyed for ticks between 2017-2021. Overall, this thesis identify patterns in Lyme disease emergence (and potentially other tick-borne illnesses), defines environmental risk areas for Lyme disease in Ontario, and highlights important socioecological risk factors for Lyme disease in eastern Ontario.

Une intervention préventive « Une seule santé » intégrant des composantes environnementales et communautaires pour la prévention et la réduction du risque de la maladie de Lyme a été réalisée dans une municipalité de la province du Québec, au Canada. La maladie de Lyme est la maladie vectorielle la plus fréquente en Amérique du Nord. Transmise à l’humain par la piqûre d’une tique infectée par la bactérie Borrelia burgdorferi, cette maladie se propage vers le nord du territoire canadien, par le déplacement des vecteurs et hôtes de la maladie influencés principalement par les changements climatiques. L’approche « Une seule santé » représente un moyen innovant pour faire face à la problématique. Cette approche repose sur l’idée que relier la santé humaine, animale et environnementale permet de mettre en œuvre des programmes plus efficaces qui apportent de meilleurs résultats pour améliorer la santé publique. Ce projet de maîtrise est une première étude d’évaluation d’une intervention « Une seule santé » qui utilise une approche participative et d'engagement communautaire. Le premier objectif du projet était d’évaluer, à l’aide d’une étude transversale, si les niveaux de connaissances, d'attitudes et de pratiques concernant les tiques et la maladie de Lyme étaient différents entre les citoyens de Bromont qui ont participé ou non à l'intervention. La méthodologie utilisée était quantitative. Les résultats suggèrent qu’il y a une association positive entre la perception de l’efficacité des mesures préventives et l’adoption de ces mesures quand il y a une participation à l’intervention. Le deuxième objectif était l’évaluation de la mise en œuvre de l’intervention à partir de sept indicateurs de performance de qualité. La méthodologie utilisée était un devis mixte, principalement qualitative. Les résultats démontrent que la mise en œuvre de l’intervention intégrée, elle a été perçue comme pertinente, utile et originale par les résidents. L’approche participative et l’engagement communautaire utilisés pour l’intervention étaient considérés comme des bons moyens de responsabiliser les citoyens en matière de prévention. La participation de la communauté dans l’intervention a permis de cibler les besoins spécifiques des résidents de la région relatifs à la maladie de Lyme. Le développement d’une intervention dans le contexte de la prévention de la santé en partenariat avec la municipalité, la communauté, les entités de recherche et la santé publique est bien apprécié. De plus, le projet a permis de documenter le travail en collaboration avec la municipalité et la communauté pour mieux planifier et développer les futures interventions adaptées à la population et à la problématique. / A "One Health" preventive intervention integrating environmental and community components for the prevention and risk reduction of Lyme disease was implemented in a municipality in the province of Quebec, Canada. Lyme disease is the most common vector-borne disease in North America. Transmitted to humans by the bite of a tick infected with the bacterium Borrelia burgdorferi, this disease is spreading northward in Canada, through the movement of vectors and hosts of the disease, mainly influenced by climate change. The "One Health" approach represents an innovative way to address this issue. This approach is based on the idea that linking human, animal, and environmental health allows for more effective programs that lead to better public health outcomes. This master's project is an initial evaluation study of a "One Health" intervention that uses a participatory and community engagement approach. The first objective of the project was to assess, through a cross-sectional study, whether the levels of knowledge, attitudes and practices regarding ticks and Lyme disease differed between Bromont citizens who did and did not participate in the intervention. The methodology used was quantitative. The results suggest that there is a positive association with the perception of the effectiveness of preventive measures and the adoption of these measures when there is participation in the intervention. The second objective was to evaluate the implementation of the intervention using seven quality performance indicators. The methodology used was a mixed-methods, primarily qualitative. The results show that the implementation of the integrated intervention was perceived as relevant, useful, and original by the residents. The participatory approach and community engagement used in the intervention were considered good ways to empower citizens in prevention. Community involvement in the intervention helped to target the specific needs of residents related to Lyme disease. The development of an intervention in the context of health prevention in partnership with the municipality, the community, research entities and public health is well appreciated. In addition, the project documented the collaborative work with the municipality and the community to better plan and develop future interventions adapted to the population and the issue.

To increase capacity for monitoring and surveillance of tick-borne diseases, publicly available tick distribution and climate change datasets are required to create accurate predictive distribution models. It is difficult, however, to assess model accuracy and utility when using incomplete datasets.  The more recent development of comprehensive tick databases for Europe and availability of climate change scenarios from multiple IPCC Assessment Reports allows for improved modeling efforts. Multiple tick datasets were combined and three climate change projections were compared by predicting current and future distributions of Ixodes ricinus ticks in Europe using the MaxEnt species distribution model. Overall, much of Europe contains suitable habitat for the Ixodes ricinus tick, both now and under future climate change projections.  Contraction of habitable areas is predicted to occur at lower latitudes and altitudes, while expansion is predicted to occur at higher altitudes in mountainous regions and the higher latitudes, primarily in northern Scandinavia.