Biting Commentary – It’s Summer, So Beware of Deer Ticks and Lyme Disease

It’s good and healthy that many children are active and play outdoors during their time away from school. But for those who take their play into high grass, shrubs, or wooded areas this summer comes the risk of being bitten by a nymph deer tick and becoming infected with the bacteria that causes Lyme disease.
While there are many “pests” that can bite and sting, it’s the tick that is the most concerning for disease transmission in Western Mass. and beyond.
Experts say the winter’s plentiful snowfall combined with a wet spring have created the perfect conditions for ticks to emerge now in the warm weather and find a host to latch onto.
In fact, the Tick Encounter Resource Center, operated by the University of Rhode Island, recently put its tick alert level at red — which is high — for the entire Northeast and Mid-Atlantic region. According to the Centers for Disease Control and Prevention (CDC), the peak season for ticks runs from April through September.
The deer tick can be very difficult to spot, ranging in size from a small poppyseed to an apple seed. They are easier to identify, however, after becoming very swollen while feeding on the blood of their host. Many tick identification charts exist; a good resource is the Massachusetts Department of Public Health website at www.mass.gov/dph/tick.
The worry about being bitten by a deer tick is that it can sometimes transmit Lyme disease; however, the risk is very low at 1.4{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}. Lyme disease is caused by bacteria carried by the blacklegged tick, which is more commonly referred to as the deer tick. The greatest risk of becoming infected occurs when a tick carrying the bacteria stays attached to someone for at least 72 hours.
To remove the tick, grasp it as close to the skin as possible using a set of fine-tipped tweezers. Holding the tweezers parallel to the skin surface, pull straight upward being careful not to twist or crush the tick. After removal, clean the bite area using rubbing alcohol or soap and water, and be sure to wash your hands.
If your child develops a rash or fever within two weeks of the tick’s removal, or the tick was attached to him or her for longer than 24 hours, contact your pediatrician.
Early signs and symptoms of Lyme disease are similar to the flu and can include chills, fever, headache, fatigue, and achiness. This usually occurs one to two weeks after a tick bite. A classic symptom is the development of a bull’s-eye rash, which can develop at the site of the bite, as well as on other parts of the body. The rash may start out as a red oval patch that expands greater than two inches, and then may clear in the center.
If left untreated, Lyme disease, in its later stages, can affect the heart and can also spread to the nervous system, resulting in facial paralysis known as Bell’s palsy, or meningitis. In this later stage, children can also develop arthritis, most often affecting the knees, which can become inflamed and swollen.
The good news is that Lyme disease can be cured and is often treated with antibiotics.
However, prevention is always the best medicine.
When sending your child outdoors to play this summer in areas where ticks are known to be present, dress them in long pants, long-sleeved shirts, socks, and tuck their pant legs into boots. If you don’t have boots, make sure your child wears a closed shoe and never a sandal when playing in possible tick-infested areas.
The AAP recommends using bug sprays on children that contain no more than 30{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} DEET, and advises against using insect repellents for children younger than two months. While these repellents will protect your children from ticks, mosquitoes, fleas, chiggers, and biting flies, they are not effective for stinging insects such as bees, hornets and wasps.
But not all repellents are created equal. While the Environmental Protection Agency has deemed the normal use of DEET to have no adverse health effects, for those who prefer not to apply chemicals to their child’s body, the Centers for Disease Control and Prevention in 2005 approved two alternatives to DEET — the synthetic compound called picaridin (also listed as KBR 3023) and the plant-based ingredient of oil of lemon eucalyptus, derived from eucalyptus leaves.
The AAP considers permethrin as the most effective repellent for ticks. It is used to treat clothing and usually kills ticks as they move across the fabric. You can purchase permethrin products online or at sporting goods stores and treat your child’s clothing yourself – it usually lasts for about 50 washes – or purchase insect-repellent clothing at various retail stores.
As with any product, insect repellents are only effective and safe when reading and closely following the label for proper application.
After your child returns home from playing outdoors, remove his or her clothing and inspect all skin surfaces for any ticks. While ticks can bite anywhere, they can often be found in such concealed areas as the back of the neck, armpits, the groin, and behind the knees. Having your child take a shower is also a good idea to wash off any ticks you may have missed when inspecting their skin.
Of special note, there is no reason to send ticks to special laboratories to have them tested to see if they harbor the Lyme bacteria. In addition, there is no indication for a single dose of an antibiotic to be given to a child to prevent Lyme disease transmission after a tick bite.
It is also important to know that babesiosis and human granulocytic anaplasmosis organisms can also be transmitted from the same tick that carries the Lyme bacteria. However, this occurs much less commonly in Massachusetts.  Call your pediatrician if you have concerns about these infections after a tick bite.
You can also check the Massachusetts Department of Public Health website for additional information on ticks and Lyme disease by visiting mass.gov/eohhs.
For more information on Baystate Children’s Hospital, visit baystatehealth.org/bch.
Dr. Donna Fisher is chief of Pediatric Infectious Diseases at Baystate Children’s Hospital.

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