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, be extra vigilant now and through September, when ticks are most active.

“Although ticks can pose quite a problem, that shouldn’t stop people from enjoying outdoor activities,” said Dr. Paul Gerstein, Emergency Department staff physician at Baystate Mary Lane Hospital. “But to be safe, families should simply be more vigilant and take proper precautions to avoid a tick bite.”

According to the National Centers for Disease Control and Prevention (CDC), in 2011, 96{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of Lyme disease cases were reported from 13 states, Massachusetts being one of them. According to the Mass. Department of Public Health, reports of Lyme disease have risen for most of the past decade across Massachusetts. Statewide, 3,342 confirmed and 1,708 probable Lyme disease cases were reported in Massachusetts in 2012, representing a 19{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} increase over the number of probable and confirmed cases reported in 2011.

“There is no way to ensure zero risk of Lyme disease and other tick-borne illnesses. However, exercising caution is the best way to reduce risk,” said Gerstein. “Wearing light-colored clothing will help you and others notice ticks on your clothing before they can attach themselves to your skin. Also, by tucking your shirt into your pants and your pants into your socks, ticks will be less able to crawl onto exposed skin.”

Applying repellents that contain 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} or more DEET on the exposed skin can offer protection that lasts up to several hours, noted Gerstein, who encourages 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 repellents 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, you should scan your body for what appears to be a small black dot that feels like a scab,” said Gerstein. “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, 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, don’t panic, advised Gerstein. “By removing a tick in the first 24 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 directly out. Avoid using petroleum jelly and hot matches, which are not effective or 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, you should 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.

“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 or two inches in diameter. 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 70-80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of infected persons 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 your 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 bites with greater than 24 hours skin attachment, but before any signs 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 www.cdc.gov/features/stopticks.