June 17, 2010 – The Health Department is warning New Yorkers to take extra precautions against tick bites from June through November, when ticks are most active. City residents should be aware of tick-borne diseases such as Lyme disease, babesiosis, anaplasmosis, Rocky Mountain spotted fever and ehrlichiosis. Reported cases of Lyme disease and babesiosis have increased steadily since 2003. Last year alone, the total number of cases of Lyme disease rose from 538 to 643, an increase driven partly by improved electronic reporting from laboratories. Most tick-borne infections reported in New York City were acquired outside the city, in areas such as the Hudson Valley, Long Island, New Jersey and Connecticut. The one exception is Rocky Mountain spotted fever which is known to be transmitted in NYC.

“Lyme and other tick-borne diseases are a serious summertime problem for city residents who spend time in wooded areas outside the five boroughs,” said Dr. Thomas Farley, New York City Health Commissioner. “New Yorkers should protect themselves by wearing long sleeves and socks and using an insect repellent containing DEET. They should also check for ticks on their body and clothing immediately after being in wooded or grassy areas.”

Besides advising New Yorkers to take precautions, the Health Department issued a medical advisory directing physicians to watch for tick-borne illness among their patients and to report cases to the Health Department.

How to Prevent Tick Bites and Tick-Borne Illness

• Check for ticks on your body (including your armpits, scalp, and groin) or clothing soon after returning from wooded or grassy areas. Some ticks are very small (about the size of a poppy seed) so ask for help to inspect areas that you cannot see yourself.
• Quickly remove any ticks you find, using fine-tipped tweezers if possible. 
• Avoid walking in heavily wooded areas; try to stick to cleared paths.
• Apply insect repellents that contain DEET (use according to manufacturer’s instructions). Other repellents such as picaridin and oil of lemon eucalyptus (also used to prevent mosquito bites) may provide some protection, but there is limited information about their effectiveness against ticks.
• Permethrin is another type of repellent that can be applied to pants, socks, and shoes which typically stays effective through several washings. Permethrin should never be applied directly to skin.
• Wear light-colored clothing to allow you to better see ticks that crawl on your clothing.
• Wear long-sleeved shirts and tuck your pant legs into your socks so that ticks cannot crawl up the inside of your pant legs.
• Speak to your veterinarian about tick prevention products for your pet dogs and cats.
• If you get a rash or a fever after being outdoors in wooded or grassy areas, let your doctor know you may have been exposed to ticks, even if you don’t remember having a tick bite.

How to Remove Ticks

Use tweezers to grasp the body of the tick as close to your skin’s surface as possible, and pull up on the tick with slow, even pressure. Avoid squeezing or crushing the tick’s body. After the tick is removed, wash the bite area thoroughly with soap and water to help reduce the chance of infection. Matches, petroleum jelly or other home remedies are not effective in removing ticks.

Tick-borne Diseases among NYC Residents by Year of Diagnosis*

*Number of confirmed Lyme disease cases and confirmed and probable cases for other tick-borne diseases.
 **1 case each of ehrlichiosis, type unspecified, from 2008 and 2009 not included.

Notable Tick-borne Diseases of the Northeast

Lyme disease is transmitted by the blacklegged tick. Most people with Lyme disease develop a characteristic rash: a red, slowly expanding spot around the bite that is usually 5cm or larger in diameter. Other symptoms include fever, headache, fatigue, and muscle/joint pain. Lyme disease can be diagnosed by a blood test and is treated with antibiotics. If left untreated, it can cause meningitis, facial palsy, muscle/joint or heart abnormalities.

Rocky Mountain spotted fever is a serious disease that is usually transmitted by the American dog tick. It can be acquired within all boroughs of New York City. Symptoms can include spotted rash fever, headache, nausea, diarrhea, vomiting, loss of appetite and muscle aches and pains.

Babesiosis is another infection transmitted by the blacklegged tick. Symptoms include fever, fatigue, jaundice, muscle pain, and anemia. The disease is more severe in patients who have weakened immune systems. 

Anaplasmosis is also transmitted by the blacklegged tick. Though diagnosis can be difficult, symptoms include the sudden onset of high fever, headache, muscle aches, chills, nausea, vomiting, joint pains, and loss of appetite. 

Ehrlichiosis is transmitted by the lone star tick. The symptoms are similar to anaplasmosis.

All of the tick-borne illnesses described above can be treated with antibiotics. If you think you may have a tick-borne illness you should see your health care provider immediately. For more information, visit nyc.gov/html/doh/html/ehs/ehstick.shtml.

###