Tick-borne Disease Education and Prevention Program

Lyme Disease

What is it?

Lyme Disease is an infection caused by a type of bacteria (Borrelia burgdorferi) that is carried inside deer ticks (not all deer ticks are infected). Lyme disease can affect people of any age.

How is it spread?

A tick that has the Lyme disease bacteria can pass it on to the humans and animals it bites. Deer ticks can bite any time throughout the year, however different stages of ticks are more active in different seasons:

October - May

Be alert for adult ticks - normally the size of a sesame seed, but can be as big as a small raisin after feeding. In winter, adult ticks are usually active when the temperature is above 45 degrees F; usually inactive when ground is snow covered and in temperatures below 45 degrees F.

May - September

Watch for immature ticks - about the size of a poppy seed. One stage of immature ticks, called nymphs, cause about 90% of all Lyme disease cases.

What are the symptoms?

Early symptoms may develop within a few days to a month after the tick bite.

May include: in about half or more of the cases, a slowly expanding rash usually at the site of the tick bite. The rash usually appears either as a solid red expanding rash or a central spot surrounded by clear skin that is in turn ringed by an expanding red rash (looks like a bull's eye). On light colored skin, the rash appears reddish; a dark, bruise-like appearance is more common on dark colored skin. Sometimes multiple rashes appear and they can be found anywhere on the body.

Other common symptoms, with or without the rash, are flu-like, and may include fatigue, headache, neck stiffness, pain or stiffness in muscles or joints, swollen glands, slight fever, and chills.

Later symptoms may develop within weeks, months or even years after the tick bite in untreated patients.

May include: nervous system problems (including meningitis, headaches, paralysis of facial muscles, trouble concentrating and loss of memory), arthritis (swelling and pain, usually in the large joints, such as the knee) and heart abnormalities (including irregular heart beat, palpitations and heart block).

How is it diagnosed and treated?

Diagnosis should be made based on clinical symptoms, aided by lab tests. Current therapy includes the use of antibiotics. Prognosis is improved with prompt diagnosis and appropriate, early treatment.

Anaplasmosis

What is it?

Anaplasmosis is a disease caused by the bacterium Anaplasma phagocytophilum. These bacteria are spread to people by tick bites primarily from the blacklegged tick (Ixodes scapularis) and the western blacklegged tick (Ixodes pacificus).

How is it spread?

Anaplasmosis is transmitted by the bite of infected ticks. In the Northeast the bacteria is carried by the deer tick. In rare cases, A. phagocytophilum has been spread by blood transfusion.

What are the symptoms?

People with anaplasmosis will often have fever, headache, chills, and muscle aches. People may also experience nausea vomiting and diarrhea. Signs and symptoms of anaplasmosis typically begin within 1–2 weeks after the bite of an infected tick.

How is it diagnosed and treated?

Diagnosis should be made based on clinical symptoms, aided by lab tests. Current therapy includes the use of antibiotics.

Ehrlichiosis

What is it?

Ehrlichiosis is a tick-borne disease which can be caused by either of two different Ehrlichia bacteria. Human Monocyctic Ehrlichiosis (HME) is transmitted by the lone-star tick. Human Granulocytic Ehrlichiosis (HGE) is transmitted by the deer tick.

How is it spread?

Ehrlichiosis is transmitted by the bite of infected ticks, including the deer tick and the lone star tick. Ehrlichiosis cannot be spread from person-to-person. Anyone can get ehrlichiosis, although the majority of known cases have been in adults.

What are the symptoms?

The symptoms of HME and HGE are the same and usually include fever, muscle aches, weakness and headache. Patients may also experience confusion, nausea, vomiting and joint pain. Unlike Lyme disease or Rocky Mountain spotted fever, a rash is not common. Infection usually produces mild to moderately severe illness, with high fever and headache, but may occasionally be life-threatening or even fatal. Symptoms usually appear one to three weeks after the bite of an infected tick. However, not every exposure results in infection.

How is it diagnosed and treated?

Diagnosis should be made based on clinical symptoms, aided by lab tests. Patients suspected of having ehrlichiosis should be treated immediately. Tetracycline antibiotics are usually rapidly effective.

Babesiosis

What is it?

Babesiosis is a rare, severe and sometimes fatal tick-borne disease caused by an infection with a red blood cell parasite. Babesiosis is seen most often in the elderly or in people with weakened immune systems. Severe cases of babesiosis can occur in people who have had their spleen removed.

How is it spread?

Babesiosis is spread by the bite of an infected deer tick. Transmission can also occur via contaminated blood transfusion.

What are the symptoms?

The disease can cause fever, fatigue and hemolytic anemia lasting from several days to several months. It may take from one to 8 weeks, sometimes longer, for symptoms to appear. Infections can occur without producing symptoms.

How is it diagnosed and treated?

Diagnosis involves examining blood smears and recognizing the characteristic "ring" form taken by the Babesia parasite within the red blood cells of the patient. Standardized treatments for babesiosis have not been developed. However, some drugs used in the treatment of malaria have been found to be effective in some patients with babesiosis.

Powassan Virus

What is it?

Powassan Virus (POW) is a rare, but often serious disease that is caused by a virus spread by infected ticks. Approximately 50 cases of POW virus disease were reported in the United States over the past 10 years. POW virus is one of a group of arthropod-borne viruses (arboviruses) that can cause inflammation of the brain (encephalitis).

How is it spread?

POW virus is transmitted by the bite of an infected tick. POW virus is not transmitted directly from person-to-person.

What are the symptoms?

Many people who become infected with POW virus do not develop any symptoms. POW virus can cause encephalitis (inflammation of the brain) and meningitis (inflammation of the membranes that surround the brain and spinal cord). Symptoms can include fever, headache, vomiting, weakness, confusion, loss of coordination, speech difficulties, and seizures.

How is it diagnosed and treated?

Diagnosis is based on a combination of signs and symptoms and laboratory tests of blood or spinal fluid. These tests typically detect antibodies that the immune system makes against the viral infection. There is no specific medicine to cure or treat POW virus disease. Treatment for severe illnesses may include hospitalization, respiratory support, and intravenous fluids.

Personal Protection Techniques

1. Tick checks
   Removing an attached tick quickly and correctly may reduce your chances of getting Lyme disease. Check your entire body for ticks each night before bedtime, or more often when outdoors. Check your child's body for ticks - or teach older children how to check themselves. Examine all areas of the skin, including the groin, backs of the knees, armpits, scalp, and back of the neck. Look as well as feel for ticks.

2. Dress right to prevent tick bites
   When outdoors, stay in open spaces or on well maintained trails. Wear long sleeves and long pants. Tuck pant legs into socks and shirt into pants. Wearing light-colored clothing will help you spot a tick more easily. Check your body for ticks often when outdoors. Before coming indoors, brush off your clothing.

3. Tick repellents
   Consider using a tick repellent - a repellent containing DEET (N,N-diethyl-m-toluamide) can be used on exposed skin and clothing. Another repellent, Permethrin, cannot be put on your skin, but can help repel ticks if it is applied to your clothing. Follow the label directions carefully.

4. Check and protect your pets
   Pets that are allowed outdoors can get ticks on their fur and bring them indoors. A tick attached to your pet will not bite you, but a loose tick may brush off and seek you as a host. Frequently inspect your pets for ticks, remove any attached or unattached ticks, and use tick-control products that your veterinarian recommends.

Tick Removal

An attached tick should be removed correctly as soon as it is discovered. Removing an attached tick quickly and correctly may reduce your chances of getting Lyme disease.

1. Use fine point tweezers to grasp the tick where its mouth parts enter the skin.
2. Pull the tick straight out. Be careful not to squeeze, crush, or puncture the body of the tick.
3. After removing the tick, disinfect the area and the tweezers, and wash your hands.
4. Save the tick and have it identified at the Cornell Cooperative Extension.
5. Do not try to remove ticks by using petroleum jelly (Vaseline), lit cigarettes or other home remedies because these methods may just increase your chance of getting infected.

Tick Identification

Cornell Cooperative Extension
c/o Horticulture Laboratory
10 Patriot Hills Drive
Stony Point, NY 10980
(845) 429-7085, option 3
www.rocklandcce.org/

Horticulture Lab Hours:
April - October: Monday-Thursday 9:00 a.m.-2:00 p.m.
November - March: Monday-Thursday 9:00 a.m.-Noon

Fee:
$15.00 Identification Fee (Wednesday is Senior Day, Lab Services are 50% off)

In addition, The Insect Diagnostic Laboratory at Cornell University (IDL) welcomes emailed photos and mailed-in samples for identification. The fee is $25. Directions on How to Send Samples or Email Photos (or Both) for Identification.

For Diagnosis and Treatment, Contact:
Your health care provider, an infectious disease physician, or call the Lyme Disease Practice at the Westchester Medical Center, (914) 493-8425.

Managing the Environment

1. Keep your property clean
   Leaf litter and brush should be moved as far away from the house as possible. Prune low-lying bushes to let in more sunlight. Be thorough about raking up leaves and dead foliage, especially in the fall. Ticks tend to survive the winter by hiding under leaf litter.

2. Landscape planning
   Make sure any plants near your house are not varieties that deer favor. Your local nursery or the Cornell Cooperative Extension (429-7085) can provide you with this information. A three foot strip of mulch around the edge of the yard can help to reduce your exposure to ticks. Ticks prefer the woodland edge, and mulch will create a barrier which they are reluctant to cross.

3. Woodpiles
   These are favorite places for mice to build their homes. Keep your wood pile neat, off the ground, and in a sunny area (or covered) so it remains dry.

4. Stone walls
   These should be avoided because they attract small mammals, which increases the potential for ticks. Do not sit on stone walls, particularly during the summer months.

5. Lawns
   Shaded lawns can help support a tick population. Mow lawns regularly, and trim the edges. Prune trees to allow more sunlight in.

6. Bird feeders
   Birds can harbor infected ticks. Make sure the ground below the feeder is bare and that the feeder is not too close to your house. Clean up the ground around the bird feeder regularly to limit any food available to rodents.

7. Fences
   Building an 8-foot-high deer fence can keep deer out of your yard, but it won't help with smaller mammals and birds.

8. Chemical controls
   If ticks are abundant on your property, consider the use of pesticides. Just one application a year (in late May or early June) of an approved pesticide may greatly reduce the nymphal tick numbers on your property. Consider hiring a professionally trained pesticide applicator.

Call the Cornell Cooperative Extension (845-429-7085) for more information on managing the environment.

For general information on Lyme disease or to request a free packet of Lyme disease educational materials, contact the Rockland County Department of Health, Health Promotion and Chronic Disease Prevention Program, at 845-364-2501.

Additional Information

Order CDC Lyme Disease Educational Materials

New York State Department of Health page includes information on Lyme disease and other diseases spread by ticks, and suggested repellants.

National Institutes of Allergy and Infectious Disesases (NIAID): This website provides information on understanding Lyme disease and NIAID's role in Lyme disease research.

American Academy of Pediatrics: This website provides information for parents on the signs and symptoms of Lyme disease, ways to reduce your child's chances of getting bitten by ticks, and the correct procedure for removing attached ticks from the skin.

Lyme Disease Association: This website posts Lyme news, events and updates, and Lyme educational materials available to order or download. Includes pictures of "bulls-eye" rashes" available to view.