Emergency Physician Offers Tips to Reduce Risk of Tick-borne Disease

WARE — While it is a good idea to take preventive measures against ticks year-round, said Dr. Paul Gerstein, Emergency Department physician at Baystate Mary Lane Hospital, “be extra vigilant now and through September when ticks are most active. The tiny deer tick is the primary transmitting agent of Lyme disease, anaplasmosis, and babesiosis. One or more of these infections can be acquired from a single deer-tick bite.”

According to the Mass. Department of Public Health, 4,080 confirmed Lyme disease cases and 1,585 probable cases were reported in Massachusetts in 2013, an increase of 12{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} from the numbers reported in 2012. The highest rates were among children age 5-9 and adults age 65-74. The majority of cases had onsets in June, July, and August.

Gerstein recommends some simple measures to avoid tick bites. “If you will be outdoors in or near a grassy or wooded area, or gardening in the vicinity of a bird feeder (that can attract mice which can carry Lyme disease bacterium), wear long sleeves and long pants. Tuck your pant legs into your socks to keep ticks from crawling up along exposed skin. Light-colored clothing will show the dark-colored, tiny deer ticks more clearly if they are on your clothing.

“Applying repellents that contain 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} or more DEET on the exposed skin can offer protection that lasts up to several hours,” he went on, encouraging families to always follow product instructions. “Parents should apply this product to their children, avoiding hands, eyes, and mouth.”

The CDC also recommends picaridin and oil of lemon eucalyptus. These repellants offer protection similar to low concentrations of DEET when used in similar concentrations. Spraying pant legs and socks with permethrin (lice spray) will also repel ticks.

“Once indoors, take a prompt shower to wash off ticks that have not yet attached,” said Gerstein. “You should scan your body for what appears to be a small black dot that feels like a scab, if attached. While checking for ticks, pay special attention to the areas that they prefer to hide, like the back of the neck, the hairline, the armpits, the upper back, the groin, behind the ears, and behind the knees. Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine them.

“If you do find a tick, there is no need for panic,” he added. “By removing a tick in the first 24 to 48 hours after attachment, you reduce your risk of infection to almost zero.”

Using tweezers, grasp the tick as close to the skin surface as possible, and pull it straight out. Avoid using petroleum jelly and hot matches, which are not effective and can cause injury. These methods may make matters worse by triggering the tick to release more of its bodily fluids, and that could cause further infection.

Once the tick is removed, dispose of it and wash the area of the bite and your hands with warm, soapy water. Don’t worry about mouth parts remaining embedded. These will not cause harm and cannot transmit disease. The body will expel these parts in a few days, and they do not need removal. No further treatment is usually necessary.

“In the case of a tick bite, watch for early symptoms of tick-borne disease,” said Gerstein. “These include headaches, lethargy, fever, chills, muscle and joint aches, a stiff neck, and, most importantly, an expanding, circular or oval area of redness at least one to two inches in diameter around the area of the bite. Small areas of redness around a tick bite are common and not an indication of Lyme disease if they do not expand.”

In Lyme disease, the rash may appear within three to 30 days, typically before the onset of fever. This rash appears in approximately 70{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of infected people and begins at the site of a tick bite. However, the rash may fade before it is noticed in about 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of cases, so it’s important to check with a doctor for any flu-like illness in the summer months, even without an apparent rash.

According to Gerstein, Lyme disease in its early phases is easily treated and completely cured by a two-week oral antibiotic treatment. Single-dose antibiotic preventive treatment (prophylaxis) is available for older children and adults immediately after tick bite with greater than 48 hours skin attachment, but without any rash or symptoms of Lyme disease. A trip to the doctor’s office or local emergency department is warranted for prolonged deer-tick attachment or any signs of illness, to enable prompt treatment.

For more information about ticks, visit the Centers for Disease Control and Prevention at www.cdc.gov/ticks/index.html.