Tick-Borne Disease Prevention and Treatment

Editor’s note: The Guide to Venomous and Medically Important Invertebrates is a new reference for PMPs and others authored by military entomologists David E. Bowles, James A. Swaby and Harold J. Harlan. The book examines a broad range of hazardous invertebrates from across the globe — including ticks. The following excerpt reviews how to prevent ticks and how to properly remove them.

Situational awareness and effective personal protection measures are key to avoiding tick problems. Because soft ticks and many hard ticks favor animal dwellings (e.g., burrows, caves, nests) that serve as habitat for their natural hosts, try to avoid such areas if possible. Remember, soft ticks are nocturnal, fast-feeding ticks that do not attach for long periods to feed.

If camping, select campsites well away from rodent burrows, inspect cabins and other temporary or infrequently used dwellings, for signs of rodents and birds. If avoiding such places is not possible, emphasis should be placed on personal protection measures to minimize risk of attack. Most hard ticks are “edge dwellers” or “edge species,” so when outdoors avoid transitional vegetation along where woodlands transition to grasslands or brushy areas. Where practical, enclosed sleeping quarters are best (i.e., closed doors and windows, window/tent screens; sealed tent floors and zippered openings).

Repellents can also substantially increase protection. That said, ticks easily crawl under loose-fitting clothing, so applying repellent only to exposed skin is generally an inadequate defense to protect against tick bites. Proper wearing of protective clothing is crucial. Because ticks grab onto the host from a resting point on vegetation and then climb the body, a highly practical means of preventing them from attaching is to wear long pants tucked into footwear or socks. This simple arrangement prevents ticks from crawling under the pant legs and onto the skin. Wearing light-colored clothing facilitates finding the ticks and removing them. In addition, wearing permethrin-treated clothing is an important tick prevention tool.

After returning from outdoors, carefully inspect your body for crawling or attached ticks and remove them. In some cases, the larvae and nymphs are very small (pinhead size) and can be difficult to detect. In addition, because ticks can attach anywhere and many bites are generally painless, they may go unnoticed. A hot bath or shower helps remove crawling ticks, and clothing should be changed and washed. Children and pets should similarly be inspected for ticks. When an attached tick is found, remove it immediately. Follow the procedures and precautions described below for proper tick removal. The longer a tick remains attached, the more blood engorged it becomes, the more difficult it is to remove, and the more likely it is to transmit disease. Follow the guidance presented, collect any ticks you find on you and save them in a sealed container or Ziploc plastic bag. Alternatively, a high-quality photo of the tick may serve this purpose. The tick specimen or photo should be given to your medical provider should you later become sick. Always inform attending medical personnel that you visited a high-risk area, or had contact with ticks, because this will aid them in their differential diagnosis of your condition. It’s possible that part of the tick’s mouthpart may remain in the skin following removal.

TICK REMOVAL. Follow these procedures to properly remove attached ticks (per U.S. Centers for Disease Control and Prevention):

• Use medium-tipped forceps (sold as various commercially available ‘tick removal devices’). Place tips around mouthparts where they enter the skin.
• Slowly and gently pull the tick away from the skin or slide forceps along the skin (follow device directions). Do not jerk, crush, squeeze or puncture the tick.
• Directly place tick in sealable container.
• Disinfect the bite site using standard procedures.
• If possible, save the tick alive for identification and disease testing. Place it in labeled (date, your name, geographic location, etc.), sealed bag or vial with a lightly moistened paper towel or even a few grass blades, then store at refrigerated temperature if possible.
• If forceps are unavailable, use index finger and thumb with rubber (latex) gloves, plastic or even a paper towel to prevent finger contamination. Tick feces can contain pathogens so bare fingers can transfer these pathogens to cuts, abrasions, and nasal or eye mucous membranes.
• Do not apply petroleum jelly (e.g. Vaseline), fingernail polish or similar chemicals over ticks, burn them or use various commercial gadgets to detach them. These methods usually don’t work, and may crush, squeeze or cause the tick to regurgitate, thus increasing disease transmission and/or infection.

WHY IT’S IMPORTANT. Preventing tick attachment and feeding, and rapid removal of attached ticks are crucial because they carry many tickborne pathogens that may cause serious diseases. Some vaccines are available and may be appropriate for some travelers or other people who routinely contact high-risk tick habitats. Additionally, some antibiotics may serve as prophylactics for bacterial pathogens but, similar to vaccines, they are only prescribed when a person’s travel/adventure destination and objectives are likely to expose them to high-risk tick-borne diseases. Vaccines and prophylactic medication take time to become effective, so travelers should see their health-care provider or travel medicine clinic at least six weeks before going to high-risk areas. Regardless, no vaccine or prophylactic drug is 100% effective, so using personal protection measures is essential to protect health. After returning from areas with high risk of tick-borne disease transmission, travelers should be alert for any onset of illness and should seek prompt medical attention as needed. Bacterial tick-borne diseases usually are effectively treated using broad-spectrum antibiotics, but viral diseases often can’t be specifically treated with medicines and require supportive care. Because viral diseases are difficult to treat, it is imperative that medical assistance be provided at the earliest opportunity following the onset of illness.