EID Journal: Seroprevalence Of B. Miyamotoi In N.E. United States

(Photo Credit- CDC)

 

# 8794

 

 

Although they’ve undoubtedly been around and infecting mankind for a long time, in recent years we’ve seen a surge in the number of `new’ tickborne illnesses identified in the United States and around the world.  And as new tests are being developed and deployed, we are finding out that the number of tick borne infections reported previously have only represented  `the tip of the iceberg’.

 

Last year, the CDC revised their Estimate Of Yearly Lyme Disease Diagnoses In The United States, indicating that the number of Lyme Disease diagnoses in the country is probably closer to 300,000 than the 30,000 that are officially reported each year to the CDC.

 

In 2012, the CDC announced the identification of the The Heartland Virus in two farmers from the Midwest (see a New Phlebovirus Discovered In Missouri). Last March (see MMWR: Heartland Virus Disease — United States, 2012–2013) we saw an update from the CDC indicating that 6 more cases had been identified (5 in Missouri, 1 in Tennessee), and last month we saw the  Oklahoma DOH Reports 1st Heartland Virus Fatality.

 

Like many vector-transmitted diseases, the Heartland Virus is likely under-reported.

 

A couple of weeks ago, in The Tick Borne Identity, we looked at a study out of the University of North Florida, that claims to have found a new strain of Borellia (aka Lyme Disease), that is prevalent in ticks in the Southeastern states. In 2011 we saw the NEJM: Emergence Of A New Bacterial Cause Of Ehrlichiosis, while in recent years Babesia microti infection (see Maryn McKenna On Babesia And The Blood Supply) is increasingly viewed as a serious public health concern.

 

One of the more recent discoveries involves a tickborne bacteria called Borrelia miyamotoi, which was first described in ticks Japan in the mid-1990s, .  We’ll let the CDC carry the narrative for a spell:

 

What you need to know about Borrelia miyamotoi, a newly described human pathogen

What is Borrelia miyamotoi?

Borrelia miyamotoi are spiral-shaped bacteria that are closely related to bacteria that cause tick-borne relapsing fever (TBRF). They are more distantly related to the bacteria that cause Lyme disease. First identified in 1995 in ticks from Japan, the bacteria have since been detected in two species of North American ticks, the black-legged or “deer” tick (Ixodes scapularis) and the western black-legged tick (Ixodes pacificus). These ticks are already known to transmit several diseases, including Lyme disease, anaplasmosis, and babesiosis.

What type of illness does B. miyamotoi cause?

Human infections with B. miyamotoi were first described in 2011 in a report from Russia. Most of the patients had fever, headache, and muscle aches--symptoms typical of TBRF. Symptoms similar to those of Lyme disease, such as the erythema migrans rash (bull’s-eye rash), arthritis, or facial palsy, were uncommon.

Recently, three cases of human infection with B. miyamotoi were identified in the United States. One patient was an elderly, immunocompromised woman with confusion and an unsteady gait. The bacteria were seen in samples of the patient’s spinal fluid, and she recovered when treated with antibiotics. The two other patients had fever, chills, and muscle aches, similar to the symptoms of the patients in Russia.

 

While the number of  B. miyamotoi cases reported in the United States remains small, surveillance and testing is just in its infancy.  To that end we have research, published in the July edition of the EID Journal, that looks at the seroprevalence of  B. miyamotoi  infection in archived blood samples (collected 1991–2012) from residents of the Northeastern United States.

 

Volume 20, Number 7—July 2014

Research

Borrelia miyamotoi sensu lato Seroreactivity and Seroprevalence in the Northeastern United States

Peter J. Krause , Sukanya Narasimhan, Gary P. Wormser, Alan G. Barbour, Alexander E. Platonov, Janna Brancato, Timothy Lepore, Kenneth Dardick, Mark Mamula, Lindsay Rollend, Tanner K. Steeves, Maria Diuk-Wasser, Sahar Usmani-Brown, Phillip Williamson, Denis S. Sarksyan, Erol Fikrig, Durland Fish, and the Tick Borne Diseases Group

Abstract

Borrelia miyamotoi sensu lato, a relapsing fever Borrelia sp., is transmitted by the same ticks that transmit B. burgdorferi (the Lyme disease pathogen) and occurs in all Lyme disease–endemic areas of the United States. To determine the seroprevalence of IgG against B. miyamotoi sensu lato in the northeastern United States and assess whether serum from B. miyamotoi sensu lato–infected persons is reactive to B. burgdorferi antigens, we tested archived serum samples from area residents during 1991–2012.

Of 639 samples from healthy persons, 25 were positive for B. miyamotoi sensu lato and 60 for B. burgdorferi. Samples from ≈10% of B. miyamotoi sensu lato–seropositive persons without a recent history of Lyme disease were seropositive for B. burgdorferi.

Our results suggest that human B. miyamotoi sensu lato infection may be common in southern New England and that B. burgdorferi antibody testing is not an effective surrogate for detecting B. miyamotoi sensu lato infection.

In the same EID journal edition, in -  Human Exposure to Tickborne Relapsing Fever Spirochete Borrelia miyamotoi, the Netherlands by Fonville M, Friesema IHM, Hengeveld PD, Docters van Leeuwen A, Jahfari S, Harms MG, et al. - we see a case described as:

 

Conditions reported to be associated with B. miyamotoi infection were systemic, including malaise and fever, meningoencephalitis, and neurologic symptoms. Because of the nature of these manifestations and because regular diagnostic tests for B. burgdorferi will most probably not detect B. miyamotoi infections (3,5), B. miyamotoi infections may remain undiagnosed.

Nevertheless, the relationship between B. miyamotoi infection and illness is not very well established; the case-patients reported, including the patient in the Netherlands, were usually hospitalized, severely ill, and often immunocompromised (3–5). The extent to which B. miyamotoi causes infection and disease in immunocompetent persons is unknown.

 

The authors of the first EID report (both of which are worth reading in their entirety), conclude by writing:

 

The determination of B. miyamotoi sensu lato seroprevalence in our population is important because it indicates that this pathogen may infect persons at a rate that is similar to that of B. microti in the northeastern United States (16,23,24). Our data suggest that acute B. miyamotoi sensu lato infection in some persons may be misdiagnosed as Lyme disease because of the presence of antibody to B. burgdorferi from a previous B. burgdorferi infection, a false-positive test reaction, and/or cross-reactivity.

Antibody testing for B. burgdorferi, however, is not adequate to detect infection with B. miyamotoi sensu lato in the United States. The potential for misdiagnosis may be greater in locations like northern California, were the prevalence of B. miyamotoi sensu lato in ticks equals or exceeds the prevalence of B. burgdorferi in ticks (32). Further studies are needed to better characterize the epidemiology and improve the serodiagnosis of human B. miyamotoi sensu lato infection.

The Tick Borne Identity

Tickborne Diseases of The United States – CDC

 

# 8768

 

While mosquito-borne diseases are getting a publicity boost due to the recent arrival of Chikungunya to the Americas (see Florida Surveillance: Imported Chikungunya, Dengue, Malaria) -  ticks  - and the myriad of diseases they can carry, are back in the news again as well.

 

Last night CIDRAP NEWS carried a summary of a recent PLoS One study (Co-Infection of Blacklegged Ticks with Babesia microti and Borrelia burgdorferi Is Higher than Expected and Acquired from Small Mammal Hosts) that found that nearly 7% of deer ticks  sampled in upstate New York carried both Lyme bacteria (B burgdorferi) and a malaria-like parasite called Babesia microti.

And earlier this year, a researcher at  the University of North Florida – Dr. Kerry Clark – published a paper showing that two ’strains of Borrelia are present in the ticks in the Southeastern states (Florida & Georgia) – areas not commonly thought of as being `Lyme territory’ - and are capable of causing human illness.

 

Press Release for Tuesday, May 13, 2014

UNF Professor Confirms Lyme Disease in Humans from Southern States

Media Contact: Joanna Norris, Director
Department of Public Relations
(904) 620-2102

Dr. Kerry Clark, associate professor of public health at the University of North Florida, and his colleagues have found additional cases of Lyme disease in patients from several states in the southeastern U.S. These cases include two additional Lyme disease Borrelia species recently identified in patients in Florida and Georgia.

Overall, 42 percent of 215 patients from southern states tested positive for some Lyme Borrelia species. More than 90 cases of Lyme infection were confirmed among patients from Florida, Georgia, North Carolina, Texas and Virginia. Of these southern cases, 69 percent were found to have infection with B. burgdorferi, 22 percent with B. americana and 3 percent with B. andersonii.

“For years, medical practitioners and the public have been told that Lyme disease is rare to nonexistent in the southern United States. Our earlier research demonstrated that Lyme disease bacteria were present in animals and ticks in our region,” said Clark. “The more recent evidence shows that the disease is also present in human patients in the South, and suggests that it’s common among patients presenting with signs and symptoms consistent with the clinical presentation of Lyme disease recognized in the northeastern part of the country.”

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Of particular note, the authors indicate that patients infected with these two strains of Borrelia may not be reliably detected using standard Lyme tests.

 

Something, that if validated, might help explain the large number of people who have complained of Lyme-like illness, but have tested negative for the disease.

 

In 2012, The Heartland Virus – a New Phlebovirus Discovered In Missouri – made headlines when it was detected in two Missouri farmers with no epidemiological links and living 60 miles apart. Last March (see MMWR: Heartland Virus Disease — United States, 2012–2013) we saw an update from the CDC indicating that 6 more cases had been identified (5 in Missouri, 1 in Tennessee). 

 

And  at the end of last month, we saw Oklahoma DOH Reports 1st Heartland Virus Fatality. Like many vector-transmitted diseases, the Heartland Virus is likely under-reported.

 

Last year, the CDC revised their Estimate Of Yearly Lyme Disease Diagnoses In The United States, indicating that the number of Lyme Disease diagnoses in the country is probably closer to 300,000 than the 30,000 that are officially reported each year to the CDC. 

 

The CDC lists a growing number of diseases carried by ticks in the United States, including: Anaplasmosis, Babesiosis , Ehrlichiosis, Lyme disease, Rickettsia parkeri Rickettsiosis, Rocky Mountain Spotted Fever (RMSF), STARI (Southern Tick-Associated Rash Illness), Tickborne relapsing fever (TBRF), Tularemia, and 364D Rickettsiosis.

 

And not only are the number of known tickborne diseases increasing, so are the number of ticks.  This all-too-common report comes from WPRI.com, in Rhode Island.

 

Despite harsh winter, tick count expected to grow

By Sara Lapointe with Angie Angers Published: June 20, 2014, 2:49 pm

KINGSTON, R.I. (WPRI) — Summer is here and tick season is fast approaching.

The University of Rhode Island’s tick expert and Director of the URI Center for Vector-Borne Disease, Tom Mather, says that even though you may have trouble noticing the tiny deer ticks in the woods, there are “really a lot of them out there right now.” The nymphal deer tick counts are 85 percent higher than average over the past 5 years.

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The reasons behind an increase in ticks in recent decades are complex, and not completely understood, but some of the factors commonly cited are:

 

• Warmer winters;
• Encroachment of humans into rural and suburban areas;
• A decrease in the use of insecticides.

 

In 2011, in NRDC Report: Climate Change and Health Threats, we looked at a study that suggested that climate change could exacerbate a number of vector-borne illnesses.

 

Last April, in anticipation of this summer’s tick season, the CDC held a COCA Call on Tickborne diseases, with an emphasis on Lyme Disease and Rocky Mountain Spotted Fever. Although primarily of interest to clinicians, this presentation would be of interest to many in the public health arena. 

This webinar is archived on the CDC site.

 

 

Tickborne Diseases: A Springtime Review of Diagnosis, Treatment and Prevention

Date:Thursday, April 10, 2014

Presenter(s)

Christina Nelson, MD, MPH
Medical Epidemiologist
Bacterial Diseases Branch
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention

Naomi Drexler, MPH
Epidemiologist
Rickettsial Zoonoses Branch
National Center for Emerging and Zoonotic Infectious Diseases
Centers for Disease Control and Prevention

Overview

From May through July, people get tick bites and tickborne diseases more often than any other time of year in the United States. In 2012, over 4,000 cases of Rocky Mountain spotted fever and 30,000 cases of Lyme disease were reported to CDC. Tickborne diseases can cause symptoms that range from mild to life-threatening. Early recognition and treatment of tickborne diseases decreases the risk of serious complications. During this COCA call, CDC subject matter experts will describe the signs and symptoms, treatment, management, and prevention of tickborne diseases in the U.S., with an emphasis on Lyme disease and Rocky Mountain spotted fever.

• Slides: View Now
• Webcast: Watch Now
• Audio: Listen Now
• Transcript: Read Now

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Given the smorgasbord of  of diseases carried by ticks it makes sense to avoid their bites whenever possible.  This advice from the Minnesota Department of Health.

 

And for some more Tick-borne disease related blogs, you may wish to revisit:

 

PHAC: Lyme Disease Risk Increasing In Canada

EID Journal: Novel Bunyavirus In Livestock – Minnesota

Korean CDC On SFTS Cases

Referral: Maryn McKenna On Babesia And The Blood Supply

NEJM: Emergence Of A New Bacterial Cause Of Ehrlichiosis

tick . . . tick . . . tick . . .

Minnesota: Powassan Virus Fatality

CDC: Estimate Of Yearly Lyme Disease Diagnoses In The United States

Tickborne Diseases of The United States – CDC

 

 

# 7580

 

 

We’ve a press release from the CDC today outlining their findings that the estimated number of Lyme Disease diagnoses in the country is probably closer to 300,000 than the 30,000 that are officially reported each year to the CDC.

 

 

The CDC lists a growing number of diseases carried by ticks in the United States, including: Anaplasmosis, Babesiosis , Ehrlichiosis, Lyme disease, Rickettsia parkeri Rickettsiosis, Rocky Mountain Spotted Fever (RMSF), STARI (Southern Tick-Associated Rash Illness), Tickborne relapsing fever (TBRF), Tularemia, and 364D Rickettsiosis.

 

Last month, in PHAC: Lyme Disease Risk Increasing In Canada, we saw rising concerns in Canada over the incidence of Lyme and tickborne diseases as well. All of which makes tick awareness, and tick-bite prevention a growing public health issue.

 

 

Here is the CDC’s press release.

 

CDC provides estimate of Americans diagnosed with Lyme disease each year

Preliminary estimates released by the Centers for Disease Control and Prevention indicate that the number of Americans diagnosed with Lyme disease each year is around 300,000. The preliminary estimates were presented Sunday night in Boston at the 2013 International Conference on Lyme Borreliosis and Other Tick-Borne Diseases.

 

This early estimate is based on findings from three ongoing CDC studies that use different methods, but all aim to define the approximate number of people diagnosed with Lyme disease each year. The first project analyzes medical claims information for approximately 22 million insured people annually for six years, the second project is based on a survey of clinical laboratories and the third project analyzes self-reported Lyme disease cases from a survey of the general public.

 

Each year, more than 30,000 cases of Lyme disease are reported to CDC, making it the most commonly reported tick-borne illness in the United States. The new estimate suggests that the total number of people diagnosed with Lyme disease is roughly 10 times higher than the yearly reported number.  This new estimate supports studies published in the 1990s indicating that the true number of cases is between 3- and 12-fold higher than the number of reported cases.

 

“We know that routine surveillance only gives us part of the picture, and that the true number of illnesses is much greater,” said Paul Mead, M.D., M.P.H, chief of epidemiology and surveillance for CDC’s Lyme disease program. “This new preliminary estimate confirms that Lyme disease is a tremendous public health problem in the United States, and clearly highlights the urgent need for prevention.”

 

CDC continues to analyze the data in the three studies to refine the estimates and better understand the overall burden of Lyme disease in the United States and will publish finalized estimates when the studies are complete. Efforts are also underway at CDC and by other researchers to identify novel methods to kill ticks and prevent illness in people.

 

“We know people can prevent tick bites through steps like using repellents and tick checks. Although these measures are effective, they aren’t fail-proof and people don’t always use them,” said Lyle R. Petersen, M.D., M.P.H, director of CDC’s Division of Vector-Borne Diseases. “We need to move to a broader approach to tick reduction, involving entire communities, to combat this public health problem.”

 

This community approach would involve homeowners trying to kill ticks in their own yards, and communities addressing a variety of issues. These issues include rodents that carry the Lyme disease bacteria, deer that play a key role in the ticks’ lifecycle, suburban planning, and the interaction between deer, rodents, ticks, and humans. All must be addressed to effectively fight Lyme disease.

 

Most Lyme disease cases reported to CDC through national surveillance are concentrated heavily in the Northeast and upper Midwest, with 96 percent of cases in 13 states. Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system.

 

CDC recommends people take steps to help prevent Lyme disease and other tickborne diseases:

• Wear repellent
• Check for ticks daily
• Shower soon after being outdoors
• Call your doctor if you get a fever or rash

For more information on Lyme disease, visit www.cdc.gov/lyme.

PHAC: Lyme Disease Risk Increasing In Canada

Female blacklegged ticks in various
stages of feeding. Note the change in
size and colour.-  Credit PHAC

 

#7527

 

Lyme disease, spread by infected ticks, has become a major vector-borne disease in the United States with nearly 35,000 confirmed or suspected cases reported in 2011 (cite Reported Cases of Lyme Disease by Year, United States, 2002-2011).

 

While cases have been reported in Canada (Lyme became a reportable disease there in 2009), they have run about 1/100th the rate seen in the United States (just 258 cases in 2011).

 

But those numbers may poised to increase, according to the following public health notice posted today by the PHAC, as infected ticks appear to be spreading into new regions of Canada.

 

 

Public Health Notice: Lyme disease

Why you should take note

Lyme disease is a serious illness spread by the bite of certain ticks; specifically, blacklegged ticks. Ticks are small, insect-like parasites that feed on the blood of animals, including humans. In regions where blacklegged ticks are found, people can come into contact with ticks by brushing against vegetation while participating in outdoor activities, such as, hiking, camping and gardening. When a tick bites, it attaches to the skin and the bite is usually painless. For most Canadians, the risk of getting Lyme disease is fairly low, but is increasing.

 

Risk to Canadians

The Public Health Agency of Canada, in partnership with provincial and territorial public health authorities, conducts surveillance for Lyme disease in Canada and studies show the risk of the disease is growing in this country. Risk occurs in parts of Manitoba, Ontario, southern Quebec, New Brunswick, Nova Scotia and southern British Columbia, and is increasing in south eastern and south central Canada due to spread of populations of the ticks that carry the bacterium that causes Lyme disease.

 

You are most at risk of being exposed to Lyme disease in the regions listed above where blacklegged and western blacklegged ticks are found. But migratory birds can also carry these ticks to other parts of Canada. Current research tells us that blacklegged ticks may be establishing themselves in new areas that are not identified yet. This may mean that risk of Lyme disease may occur over broader regions of Canada than we are presently aware of.

 

Although blacklegged ticks can be active throughout much of the year in some locations, your risk of acquiring Lyme disease, especially in areas where tick populations are established, is greatest during the summer months when younger ticks are most active.

 

Lyme disease is much more common in the United States than in Canada, with risk areas in the Midwest and northeastern states. In 2011, approximately 35,000 cases of Lyme disease were reported in the United States compared to approximately 258 cases in Canada for the same year.

 

(Continue . . . )

 

As Public Health Canada’s Lyme FAQ explains, black legged ticks carry and can transmit more than just Lyme disease:

 

Although rarer than Lyme disease, there are other infections that can also be contracted from blacklegged ticks. These include Anaplasma phagocytophilum, the agent of human granulocytic anaplasmosis; Babesia microti, the agent of human babesiosis and Powassan encephalitis virus. Most of the precautions outlined above will also help to protect individuals from these infections.

 

The CDC lists a growing number of diseases carried by ticks in the United States, including: Anaplasmosis, Babesiosis , Ehrlichiosis, Lyme disease, Rickettsia parkeri Rickettsiosis, Rocky Mountain Spotted Fever (RMSF), STARI (Southern Tick-Associated Rash Illness), Tickborne relapsing fever (TBRF), Tularemia, and 364D Rickettsiosis.

 

We’ve discussed a number these in the past, including:

 

Referral: Maryn McKenna On Babesia And The Blood Supply

NEJM: Emergence Of A New Bacterial Cause Of Ehrlichiosis

New Phlebovirus Discovered In Missouri

tick . . . tick . . . tick . . .

Minnesota: Powassan Virus Fatality

 

When you consider the wide panoply of diseases carried by ticks it makes sense to avoid tick bites whenever possible.

 

This from the Minnesota Department of Health.

 

Lastly, the CDC offers the following advice:

 

Preventing Tick Bites

While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months (April-September) when ticks are most active.

Avoid Direct Contact with Ticks

• Avoid wooded and bushy areas with high grass and leaf litter.
• Walk in the center of trails.

Repel Ticks with DEET or Permethrin

• Use repellents that contain 20% or more DEET (N, N-diethyl-m-toluamide) on the exposed skin for protection that lasts up to several hours. Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth.
• Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents. It remains protective through several washings. Pre-treated clothing is available and remains protective for up to 70 washings.
• Other repellents registered by the Environmental Protection Agency (EPA) may be found at http://cfpub.epa.gov/oppref/insect/.

Find and Remove Ticks from Your Body

• Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you.
• Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.
• Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs. Tumble clothes in a dryer on high heat for an hour to kill remaining ticks.

tick . . . tick . . . tick . . .

 

 

# 6247

 

 

While not greeted as warmly as the first robin of spring - in another sign of the change of seasons - this weekend after a trek in the woods I found my first tick of spring crawling up my pants leg.

 

With a near absence of winter this year across much of the southeast, insects – including disease vectoring ticks and mosquitoes – appear to be getting an earlier start this spring.

 

As you can see by the chart below, in the nymph stage, ticks are not much larger than a spec of dirt.  Tenacious hangers on to the skin, they can be easily missed when bathing. 

 

 

And the problem isn’t limited to the deep south.

 

A couple of weeks ago, Maryn McKenna – reporting from the ICEID conference, wrote about concerns over the upcoming Lyme season in the Northeast:

 

Acorns And Mice Driving Unusual Lyme Disease Risks (ICEID 2)

 

 

And even in the UK, the HPA has issued warnings about the upcoming `tick season’.

 

 

HPA advises public to be 'tick aware' to reduce the risk of Lyme disease

27 March 2012

The Health Protection Agency (HPA) is reminding people to be ‘tick aware’ this year and take sensible precautions to reduce their risk of Lyme disease, as Tick Bite Prevention Week (26 March – 1 April) begins.

 

Lyme disease is a bacterial infection which is transmitted by tick bites. Ticks are tiny spider-like creatures which can be found in forests, woodland, heaths, moorland areas and in suburban parkland. Most ticks do not carry the infection but any area in which ticks are present should be regarded as potential risk areas for acquiring Lyme disease. Late spring, early summer and autumn are peak times for tick bites and coincide with people venturing into the great outdoors in the warmer weather.

 

There were 905 laboratory-confirmed cases of Lyme disease reported to the HPA in England and Wales in 2010. The majority of cases (741) were acquired in the UK rather than overseas, with 86 per cent of these (637) identified among residents in the south of England (the South West, South East and London).

 

However, not all cases of Lyme disease are confirmed by laboratory testing and, as in previous years, the overall number of Lyme disease cases in England and Wales is estimated at between 2,000 and 3,000 cases a year. Incidence of Lyme disease acquired in England and Wales remains low compared to in some other European countries or in North America.

 

(Continue . . .)

 

 

 

The CDC’s Division of Vector-Borne Diseases (DVBD)  recommends taking the following steps to prevent tick borne infections:

 

Preventing Tick Bites

While it is a good idea to take preventive measures against ticks year-round, be extra vigilant in warmer months (April-September) when ticks are most active.

Avoid Direct Contact with Ticks

• Avoid wooded and bushy areas with high grass and leaf litter.
• Walk in the center of trails.

Repel Ticks with DEET or Permethrin

• Use repellents that contain 20% or more DEET (N, N-diethyl-m-toluamide) on the exposed skin for protection that lasts up to several hours. Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth.
• Use products that contain permethrin on clothing. Treat clothing and gear, such as boots, pants, socks and tents. It remains protective through several washings. Pre-treated clothing is available and remains protective for up to 70 washings.
• Other repellents registered by the Environmental Protection Agency (EPA) may be found at http://cfpub.epa.gov/oppref/insect/.

Find and Remove Ticks from Your Body

• Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you.
• Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.
• Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs. Tumble clothes in a dryer on high heat for an hour to kill remaining ticks.

 

With more than 20,000 new cases of Lyme disease reported each year, and undoubtedly many others that go unreported or undiagnosed, Lyme is one of the fastest growing emerging infectious diseases in the country.

 

But Lyme is not the only tick-borne illness to be aware of. Others include:

 

• Anaplasmosis
• Babesiosis
• Ehrlichiosis
• Lyme disease
• Rocky Mountain spotted fever
• Other spotted fevers
• Southern Tick-Associated Rash Illness
• Other tickborne diseases

 

All of which illustrates the need to become more aware of the threat posed by these vicious vectors, and proactive in preventing them from passing on their diseases to you and your family.