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July 2012 New York City Department of Health and Mental Hygiene Vol.3(3):17-24
 

IN THIS ISSUE

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Preventing and Managing Lyme and Other Tick-borne Diseases
  • Advise patients to use tick checks, DEET, and showers to avoid tick bites; if a tick is attached, it should be removed promptly and safely.

  • Ask patients with suggestive symptoms such as fever, headache, malaise, and/or rash about travel history, as most tick-borne infections are acquired outside of New York City.

  • Follow recommended testing protocols, including repeat testing if indicated, because symptoms may be nonspecific and immune response is often delayed.

 

PREVENTION

Educate patients who visit, live, work, or travel in endemic areas on prevention of tick bites and tick-borne diseases (see Box 1) and on correct removal of an embedded tick (see Box 2) (Resources). Most infections result from an undetected tick; early detection and prompt removal reduce the chance of disease.5 The interval between the tick's attachment and transmission of the infection is 24 hours or longer for Lyme disease, anaplasmosis, and babesiosis, and only 6 to 10 hours for RMSF.6 For all diseases, the risk from an infected tick bite increases greatly the longer the tick is attached.7 Advise patients to contact you or go immediately to the emergency department if they develop symptoms of fever, headache, confusion, weakness, paralysis, numbness, vomiting, or difficulty breathing in the days following a tick bite. Rocky Mountain spotted fever features a petechial rash (Figure 1) and is a medical emergency. Erythema migrans--a red ring-like or expanding rash (Figure 2)--is diagnostic for Lyme disease and should prompt the patient to seek medical attention, but it is not an emergency.

BOX 1. WHAT TO TELL YOUR PATIENTS ABOUT PREVENTING TICK-BORNE DISEASES5-8
  • Be aware of tick-infested areas where you live, work, or travel.
  • Avoid grassy, wooded, or bushy areas and walk on cleared paths or in the center of trails.
  • Keep grass cut and remove leaf litter, brush, and weeds around the home. Small amounts of acaricides (pesticides against ticks) applied at the right time of year reduce the number of ticks in the yard.
  • Wear a hat and long-sleeved, light-colored shirt and long pants tucked into boots or socks when outdoors.
  • For adults: Use insect repellent containing 20% or more DEET, avoiding face and hands; always follow product label instructions. In high-prevalence tick areas, product may need to be reapplied more frequently than for repelling mosquitoes.
  • For children: Use repellent containing no more than 20% to 30% DEET. Parents should apply the repellent lightly to the child's skin, avoiding the eyes, hands, and mouth. Always follow product directions. Do not use DEET on children younger than 2 months old.
  • Treat clothing and gear such as backpacks and tents with permethrin. Do not use permethrin on skin.
  • Upon returning indoors, conduct a full-body check for ticks using a hand-held or full-length mirror. Parents should check children for ticks under arms, in and around ears, inside belly button, behind knees, between legs, around waist, and especially in hair.
  • Bathe or shower as soon as possible after coming indoors (preferably within 2 hours) to wash off insect repellent and more easily find ticks.
  • Speak with a veterinarian about tick preventive measures for pets.
BOX 2. FOR PATIENTS WHO HAVE FOUND A TICK ON THE SKIN7,9
  • If the tick has not bitten you, promptly remove it using rubber gloves or tissue paper and discard it. Do not squeeze, crush, or puncture it as its body fluids may be infectious.
  • If the tick is embedded, remove it carefully, using fine-tipped tweezers (see Box 3).
  • Tumble clothes in dryer on high heat for an hour to kill any remaining ticks.
  • Observe the area where the tick appeared for several days for a reaction to the bite such as a rash or signs of infection.
  • Remove ticks from pets the same way you would remove a tick on a person. Protect yourself from potential exposures with gloves.
  • Call a health care provider if you develop a rash or fever within several weeks of removing a tick. Tell the doctor when the bite occurred and where you most likely acquired the tick.

BOX 3. HOW TO SAFELY REMOVE AN EMBEDDED TICK9
  • Remove ticks on the skin as soon as possible. DO NOT use polish, petroleum jelly, or a hot match. DO NOT wait for the tick to detach.
  • Use fine-tipped tweezers, if available; if not, use fingers shielded with tissue paper or rubber gloves.
  • Grasp the mouthparts close to the skin and slowly pull tick straight out with steady outward pressure until it lets go.
  • Do not squash, squeeze, twist, or jerk the tick during removal, as that may transmit disease.
  • If the mouthparts become detached, remove them with clean tweezers; if this can't be done easily, leave the mouth alone and let skin heal.
  • Thoroughly clean the bite area and hands with rubbing alcohol, iodine scrub, or soap and water.
  • Clean and disinfect any instruments that touched the tick.

Image of Tick Removal Video
FIGURE 1. PETECHIAL RASH - ROCKY MOUNTAIN SPOTTED FEVER
Image of Petechial Rash

FIGURE 2. ERYTHEMA MIGRANS RASH - LYME DISEASE
Image of Erythema Migrans Rash
Source: Centers for the Disease Control and Prevention Public Health Image Library

 

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