September: Don’t let down guard against Lyme disease

By Catherine Brown, D.V.M., M.Sc., M.P.H and Allen Steere, MD.

As the summer winds down and our thoughts turn to back-to-school preparation and pumpkin lattes, it’s important to remember that the local threat of Lyme disease doesn’t immediately fade away.

In fact, September is still part of the peak season for ticks, especially the black-legged tick — more commonly referred to as the deer tick — which can transmit Lyme disease (and, less commonly, other diseases) to humans and pets with its bite. This year, as you’ve probably heard, there may have been even more ticks around than usual. Summer and early fall are often when symptoms of Lyme disease tend to show up.

 

Lyme disease is still a risk, even as weather starts to cool in September.

 

Using precautions can help curtail your risk of exposure to Lyme disease. Along with taking precautions, we need to sort out the facts from myths.

Ticks like damp shady areas and they’re also ground dwelling. They live in vegetation, under leaf litter, close to the ground. They move up grass stems and leaves, waiting for a person or animal to brush past. People tend to think of ticks as being solely in forested areas, and that’s a mistake. In Massachusetts, ticks can also be found in suburban areas.

Unfortunately, there isn’t one, single step one could take to completely protect themselves from ticks, but there are two important routines that are proven effective — one before you go outside and the other when you get back inside.

When going into areas of risk, it is advisable to use a tick repellant that includes an EPA-registered ingredient. Those active ingredients will be listed on the packaging of the product, and include DEET and permethrin. DEET should be applied to exposed skin, while permethrin should be used on shoes and clothing.

Upon returning from the outdoors, run your hands over your body, feeling for a little bump that might be an attached tick. Taking a shower within about two hours will rinse off any unattached ticks you may have missed, and a research study concluded that throwing clothes in the dryer on high heat for about 10 minutes will kill ticks that may be on your clothing.

If you discover a tick, don’t panic. If it hasn’t attached to your body, you can simply brush it off and move on.

If a tick has attached, it’s important to remove the tick promptly and properly, since the longer a tick is attached, the more increased its chance to spread disease.

The standard recommendation is to use tweezers that have fine points on them, grasp the tick as close to the skin as possible, then pull straight up firmly — don’t twist — and pull it out. There’s a lot of false information online about tick removal, and some of those methods may irritate the tick or delay complete removal, increasing the risk of disease transmission.

After a tick is removed, check that area of skin for signs of Lyme disease. The most commonly discussed sign is a slowly expanding redness that occurs at the site of the tick bite. The redness can occur a couple days after a bite or up to a month after.  Although the rash is common, it may go unnoticed or be dismissed as being caused by something else.

Typically, flu-like symptoms of Lyme disease will present, including headache, neck stiffness, some joint pain and some muscle pain.

This can be a confusing presentation of the disease, since such symptoms may be caused by viral infection, as well as by Lyme disease or its co-infecting agents. If flu-like symptoms develop during summer and if you have had potential exposure to ticks, visit your physician.

If early Lyme disease is diagnosed, the typical course of treatment is several weeks of antibiotic therapy, which usually is sufficient to treat the infection. If Lyme disease isn’t treated promptly, it can cause more serious symptoms, including neurological or heart problems or arthritis. These manifestations of the illness can still be treated with antibiotic therapy, but the course of therapy may need to be a little longer.

The Massachusetts Department of Public Health has a dedicated website, mass.gov/mosquitoesandticks, with information on protecting yourself from tick-borne illness.

Catherine Brown, D.V.M., M.Sc., M.P.H. is the Deputy State Epidemiologist and State Public Health Veterinarian at the Massachusetts Department of Public Health.

Allen Steere, MD, is principal investigator for the Center for Immunology and Inflammatory Diseases at Massachusetts General Hospital.

 

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