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Learn how a Lyme disease infection and Powassan virus may coincide in the Northeast, highlighting challenges in diagnosis and the need for enhanced tools and awareness.

Considering Lyme disease and Powassan virus are both spread by the black-legged deer tick, how often do people contract both? This question forms the basis of the latest research published by the Lyme and Tick-borne Diseases Research Center at Columbia University Irving Medical Center, established by Global Lyme Alliance and the Lyme Disease Association. Dr. Brian Fallon, the center's director, along with collaborators from The Rockefeller University and Institute for Experimental Immunology, dive into this investigation.  

Powassan Virus in Summary

Powassan virus is a rare but potentially serious tick-borne virus that can start with symptoms such as fever, headache, vomiting, and generalized weakness. However, if the disease progresses, can cause severe neurological symptoms, including inflammation of the brain (encephalitis) and the membranes surrounding the brain and spinal cord (meningitis). This virus is transmitted to humans through the bite of infected black-legged ticks, which can also carry the Lyme disease bacteria, Borrelia burgdorferi.

The transmission speeds for these pathogens are quite different. B. burgdorferi can take 24 to 72 hours to transmit from a tick to a person, whereas Powassan virus may be transmitted in as little as 15 minutes. Rapid removal of a tick reduces the risk of acquiring the Lyme disease bacteria but may not prevent Powassan virus transmission. Therefore, it is important to take preventative measures against tick bites. Surveillance studies reveal that ticks are more commonly infected with B. burgdorferi than Powassan virus, with coinfections of ticks being rare. Nonetheless, this raises the possibility that people could potentially be exposed to both pathogens.

Research Findings: Investigating Coinfection Rates

To determine how many individuals may have contracted both the Lyme disease bacteria and Powassan virus, they analyzed blood samples from 554 individuals living in the Northeastern U.S., a region endemic to Lyme disease. Among these, 538 reported a history of Lyme disease, while the remaining 16 did not. They used several diagnostic tests called an ELISA to look for Powassan virus antibodies — basically, the body's defense signals against Powassan virus – and their study showed a mixed bag of results.

Challenges in Diagnosing Dual Infections

The tests didn’t always agree with each other, and it was hard to tell for sure who had truly been exposed to Powassan virus and who hadn’t. The results suggest that the incidence of individuals with a history of exposure to both the Lyme disease bacteria and Powassan virus may range between 4 to 23%, with the true incidence rate likely somewhere in between those percentages. Overall, it can be difficult to diagnose Powassan virus because there are other similar viruses that can cause false positive results for Powassan virus. To truly get a handle on the incidence of Powassan virus and Lyme disease co-infection or subsequent infection, patients would need to be enrolled in a study at the time of their Lyme or Powassan disease diagnosis.  

The Need for Enhanced Diagnostic Tools and Awareness

Moving forward, further research is needed to develop improved diagnostic tools for both Lyme and Powassan virus disease. Additionally, raising awareness among healthcare professionals and the public about the potential for co-infections is crucial for timely diagnosis and appropriate management. By addressing these challenges, we can better protect individuals in endemic regions and mitigate the impact of tick-borne diseases on public health.  


Publication: Kapoor T, Murray L, Kuvaldina M, Jiang CS, Peace AA, Agudelo M, Jurado A, Robbiani DF, Klemens O, Lattwein E, Sabalza M, Fallon BA, MacDonald MR. Prevalence of Powassan Virus Seropositivity Among People with History of Lyme Disease and Non-Lyme Community Controls in the Northeastern United States. Vector Borne Zoonotic Dis. 2024 Apr;24(4):226-236. doi: 10.1089/vbz.2022.0030. Epub 2024 Mar 1. PMID: 38436222

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GLA Contributor

Cara DeAngelis, Ph.D.

GLA Contributor

GLA’s Research Liaison