6 Tips to Avoid Getting Tick’d this Summer

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If you’re like me, summer is the season where a dip in the pool for my kids can replace a bath on many nights. Stripping them down for a cavity check is not part of my ideal bedtime routine.

However, my husband is from Connecticut, the birthplace of Lyme Disease, so I’ve had to buck up and participate in these nightly pat downs.

It’s that time of year again and in light of increasing Lyme cases here in Maryland, here is some general information about the disease and simple practices to protect you and your loved ones. To skip to the nitty gritty, click here.

First, some history – Lyme Disease (LD) was discovered in 1982 through an outbreak of “Juvenile Rheumatoid Arthritis” in Lyme, Connecticut.

A closer examination at the evidence revealed the outbreak was actually a bacterial infection transmitted to humans from deer ticks. Maryland is among the top ten states with the highest reports of LD infection.

Notable “hot spots” include Montgomery, Baltimore, Howard and Harford Counties. Here, environmental conditions highly support the lifespan of deer ticks. While Lyme Disease season generally runs from late spring through the early fall, most cases occur earlier in the season.

Nymphal stage ticks eagerly seek their food source at this time; they are smaller and more difficult to detect than adult deer ticks. Both transmit the bacteria that causes LD, though the more satiated adult tick is less likely to do so.

Lyme Disease presents in 3 stages, the first is called Early Localized Disease.

This stage usually manifests with a circular red rash known as erythema migrans at the bite site (see photo below), The rash will appear within the first 30 days (avg. 7-14 days) and increases gradually in size; more than one circle may appear. Some reports itching or burning and not all rashes have the traditional central “target-like” clearing.

Most commonly, bite sites in children include the head, neck, arms and legs. Other sites can include the armpits, groin and trunk. This early stage can include other less common symptoms including fever, fatigue, headache, joint and muscle pain. However, 80% of people with LD develop the rash.

True erythema migrans (EM) confirms a diagnosis of LD in the early stages if there is a history of possible tick exposure. Laboratory results can be unreliable during this period. That said, many rashes can be mistaken for EM, including a temporary hypersensitivity reaction to tick bites.

A medical professional should examine any rash suspected to be EM. Interestingly, data shows that in most confirmed cases of LD patients cannot identify a history of a known tick bite at the site of the rash.

The Early Disseminated Disease stage follows in the weeks after the bite, when the bacteria enters the bloodstream. Patients report multiple EM rash lesions, temporary facial paralysis and rarely, neurological (<1%) and cardiac infections (<0.5%). Most people now have positive blood test results to aid in the diagnosis.

Patients in the last stage of LD, Late Stage, typically present with swelling and tenderness of the large joints, most commonly the knee. Even in these later stages, antibiotic treatment most commonly provides a full recovery.

Lyme Disease is not believed to be chronic. The take home is, of those children who do contract Lyme Disease, even when not detected early, most (99%) will make an uncomplicated recovery with proper treatment.

Prevention aids in reducing the already low number of children who are at risk for more serious complications.

So what can we do to protect our families from Lyme Disease?

Below is a list of measures you can take to reduce your family’s risk. While personal protection is not proven statistically to reduce infection rates, it is still highly recommended by the CDC and the medical community.

They believe families can adopt these preventative measures easily enough to amount to a reasonable reduction of infection.

Recommendations for Prevention in Areas of Known Tick Abundance

  1. CLOTHING: Wear protective clothing during outdoor activity, reducing areas of exposed skin; light clothes show ticks more easily.
  2. REPELLENT: Use effective repellents on skin and/or clothing for prolonged outdoor activities (see Tick Repellents below).
  3. CHECKING: Check for and remove ticks after outdoor activities (see Tick Removal below).
  4. BATHING: Bathe after outdoor activities to wash away stalkers.
  5. DRYING: Place exposed clothing in dryer on high heat for 60 minutes after activity to kill any ticks that remain on clothing.
  6. AVOIDING: When possible, avoid prolonged outdoor activities in high-risk areas.

Most Effective Tick Repellents

Apply tick repellents with proper technique and reapply as recommended.

Several types and formulations are available and approved for use in the US.

Below is a list of the most effective ingredients and sample products available that contain them.

  • Permethrin: This is a synthetic compound applied to clothing and bedding; it is effective against mosquitoes, flies, ticks and chiggers. Used predominately on clothing for tick prevention, doctors also prescribe it for treating lice and scabies. Use permethrin in combination with DEET for best protection against insect bites. Clothing treated correctly can remain effective for up to 2 weeks.
  • DEET: Deet is the “gold standard” of insect repellents and the most effective topical tick repellent. Concentrations of 10-30% are safe for children over 2 months of age when applied per manufacturer’s instructions; non-spray formulations are favored. Avoid sunscreen combination products.
    • Pros: longer duration, broad spectrum of insects, low toxicity when applied according to published guidelines. Safe for pregnant and lactating women when used as directed.
    • Cons: It can be oily/sticky on application with an unfavorable odor. It can reduce effectiveness of sunscreen when applied simultaneously. May cause skin reaction with excessive absorption at higher concentrations.
    • Available As: Sawyer Controlled Release Formula
  • Picaridin: This is a plant-derived ingredient, as effective as DEET at 20% concentrations against ticks and mosquitos, but for shorter duration.
    • Pros: less irritating to skin, more tolerable odor and less greasy/sticky than DEET; less toxic at higher concentrations than DEET.
    • Cons: requires more frequent application (every 1-3 hours), no studies in pregnant women however toxicity profile suggests it is unlikely to cause a problem when used correctly.
    • Available As: Sawyer Picaridin Insect Repellent
  • PMD (lemon eucalyptus oil): A plant-derived ingredient with varying evidence for efficacy against ticks. It is reported to be half as effective as DEET against mosquitos, flies and gnats. NOT RECOMMENDED FOR CHILDREN UNDER 3 years of age due to lack of studies.
    • Pros: natural, low toxicity profile.
    • Cons: varied reports of effectiveness against ticks, can cause eye irritation (avoid application to face and hands of children) and has not been studied for use in children less than 3 yrs of age.
    • Available As: Repel Lemon Eucalyptus Natural Insect Repellent
  • Bio-UD: This is a tomato-derived natural repellent effective against mosquitos at concentrations available in the US.
    • Pros: Natural, very low toxicity rating.
    • Cons: Limited studies appear to show effectiveness against ticks only at very high concentrations, which are not available for purchase in the US.
    • Available As: Bite Blocker Insect Repellent
  • IR 3535: This is a synthetic insecticide with varied reports of effectiveness against ticks and mosquitos.

All agents remain, like many others, toxic to varying degrees when ingested, inhaled or applied in extreme amounts. Keep out of the hands and reach of small children.

Technique for Proper Tick Removal

Should you find a tick on your child, yourself or another unfortunate person, remove the tick immediately using the technique described below.

Research shows Lyme Disease is typically transmitted after 48 hours of tick attachment.

Therefore, if the presumed tick exposure was within 2 days of discovering the tick, odds of contracting the disease are low.

  • Using forceps, tweezers or covered fingers, grasp tick at the insertion site and pull firmly upwards.
  • Do not twist, jerk or crush the tick; fluids may contain infected agents.
  • Disinfect the bite site and wash hands with soap and warm water.
  • Any remaining mouthparts left in the skin should be left alone; they will expel naturally.
  • Tick saliva can cause temporary redness and swelling to the bite site; this differs from erythema migrans and will dissipate over 24-48 hours.
  • Observe the area for development of erythema migrans for up to 30 days.
  • Removal within 48 hours typically prevents infection.

What To Do After Tick Removal

  • Remove the tick using the technique described above.
  • Save the tick for proper identification.
  • Monitor the area for up to 30 days for rash.

When to Call the Doctor

  • Tick is identified as a deer tick and has been attached longer than 36 hours and/or is engorged.
  • Signs and symptoms of disease (as described above) appear after a confirmed bite or possible exposure. These include erythema migrans-like rash, fatigue, fever, headache, neck pain, joint or muscle aches.
  • Note: Prophylactic antibiotics can be administered for children and adults who meet the following criteria:
    • Children over 8 years of age, men and non-lactating and non-pregnant women.
    • Treatment is started within 72 hours of tick bite.
    • Local rate of infection of ticks is greater than 20%.

Well, there you have it – a crash course for parents on how best to protect your precious little explorers from Lyme Disease this summer.

While we can’t do much ourselves about the increasing rates of infection in Maryland, we can educate ourselves on the disease and prevent it by incorporating some extra surveillance into our summer routines.

One suggestion I find useful is to combine a good daily tick check with a thorough sunscreen application at least once daily. Even if it happens the morning after an evening firefly hunt, you’re still within a favorable window to avoid transmission.

So relax and feel confident in your new found knowledge, grab some repellent and some extra knee socks and kick off summer with a little less worry.

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Amanda Gorman
Amanda is a board-certified pediatric nurse practitioner, and the owner of Nest Collaborative, an online pediatric practice specializing in pediatric and lactation telemedicine services in Maryland.
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