While at times during the long winter of 2015 it seemed like we might never see summer again, it has finally arrived, and with it a renewed concern about tick bites and Lyme Disease. The disease is concentrated heavily in the northeast and upper Midwest and we see cases in our practice every year. In 2013, the Center for Disease Control (CDC) confirmed 674 cases in the state of Vermont, and according to the VT Department of Health, the highest incidence of Lyme Disease occurs in Rutland, Windham and Windsor counties.
What is Lyme Disease and how is it transmitted? Lyme Disease is caused by a bacterium called Borrelia burgdorferi and is transmitted to humans through the bite of infected black-legged ticks. It is not transmitted through human-to-human contact, so you cannot be infected by having contact with a person who has Lyme Disease.
What are the symptoms of Lyme Disease? The most common symptoms of Lyme Disease are a “bulls-eye” rash known as erythema migrans (EM), fatigue, chills, fever, headache, muscle and joint aches, and swollen lymph nodes. Not everyone who gets Lyme Disease exhibits these symptoms, so it can be a difficult disease to diagnose. The EM rash can occur anywhere on the body and gradually expands over the course of a few days.
Is there a blood test for Lyme Disease? There is, but there is also a fairly high rate of false negative results from this test, so we do not use it as an exclusive diagnostic tool. The blood test looks for specific antibodies to the Borrelia burgdorferi bacterium, but those antibodies can take up to two weeks to develop in a person who has been bitten by an infected tick. Depending on the timing of the test, there may be a negative reading even though the person is already infected and exhibiting the EM rash and other symptoms. If a person has a known tick bite and is exhibiting classic Lyme Disease symptoms, we will often proceed with treatment, even if the blood test comes back negative.
What is the treatment for Lyme Disease? The Infectious Diseases Society of America (ISDA) guidelines for treatment of Lyme Disease involve a course of antibiotics for a few weeks. There are other treatment guidelines that your practitioner may want to follow, including a longer course of antibiotics, or the guidelines put forth by the International Lyme and Associated Diseases Society (ILADS). As with any illness, you should discuss all the various treatment options available with your health care provider, particularly if you are pregnant or have any other health concerns.
How can I best prevent Lyme Disease? Reducing your exposure to tick bites is the most effective way to prevent Lyme Disease. Ticks thrive in wooded and bushy areas and in places with tall grass and leaf piles, but can be found in many environments across our region.
• Use products containing 20 – 30% DEET on skin and clothing before venturing outside. Use special care in applying these products, particularly on children, avoiding hands, mouths and eyes.
• Apply products containing 0.5% permethin on clothing – pants, boots, and socks as well as any camping or hiking gear.
• When returning indoors, check your full body for ticks. They like to hide in dark, warm places, so pay attention to the armpit, groin, belly button, and ear areas.
• Use tick prevention products on your pets and check their fur frequently.
• Reduce the tick population in your yard by following these guidelines from the CDC: http://www.cdc.gov/lyme/prev/in_the_yard.html
What should I do if I find a tick on my child or me? First of all, don’t panic. If the tick is still crawling, remove it with a pair of tweezers. Submerge it in rubbing alcohol, seal it in a bag or container, or flush it down the toilet. Don’t ever crush a tick with your fingers.
If the tick is attached to your skin, use a pair of fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible and pull upward with steady, even pressure. Don’t twist or jerk the tick while removing it – this can cause the body of the tick to detach from the mouth, leaving the mouth still attached. If this happens, use the tweezers to gently remove the remaining mouth parts. Wash the area thoroughly with soap and water or use rubbing alcohol or an iodine solution to clean the area of the bite as well as your hands.
It takes a period of many hours, or even days, for a tick to firmly attach itself to a person and inject the venom that contains the Borrelia burgdorferi bacteria, so finding and removing ticks promptly is a key step in preventing Lyme Disease. Tick venom numbs the skin as it is injected, so many people never realize they have been bitten. People may develop Lyme Disease without ever having been aware that they were bitten.
While Lyme Disease is a serious concern in our region, it should not be a reason to avoid your favorite outdoor activities. Developing a regular routine of applying tick repellent products before venturing outdoors, as well as making a habit of checking yourself for ticks every time you come inside should become as second nature as wearing sunscreen and using seatbelts. For further information about Lyme Disease and how to prevent it, the CDC has a downloadable brochure: http://www.cdc.gov/lyme/resources/brochure/lymediseasebrochure.pdf. The Vermont Department of Health has a very useful webpage on Lyme Disease, also with a downloadable brochure: http://healthvermont.gov/prevent/lyme/lyme_disease.aspx Now that you know about Lyme Disease and how to protect yourself and your family, I encourage you to get outside and enjoy this all-too-brief season!
Richard Fletcher, APRN, FNP is a family nurse practitioner at Putney Family Healthcare, a department of Brattleboro Memorial Hospital. He can be reached at 802-387-5581.