In May 2018, the US CDC published a study in its Morbidity and Mortality Weekly Report that outlined the trends in vectorborne disease incidence in the US between 2004 and 2016. This study found that tickborne illnesses more than doubled over that 12-year period, representing more than 75% of all reported vectorborne disease cases. The majority of tickborne disease cases (82%) were Lyme disease, but there were also 9 vectorborne human diseases identified for the first time in the US during that period. The CDC received reports of more than 45,000 tickborne disease cases each year between 2016 and 2018, with a record peak of 59,349 cases in 2017. Similar to the study described above, Lyme disease represented the largest proportion of cases reported in 2016-18. Other tickborne diseases included anaplasmosis, spotted fever group (SFG) rickettsiosis (spotted fevers), babesiosis, tularemia, and Powassan virus.

So, as tick season hits in full swing here are some helpful tips from the CDC–

  • Know where to expect ticks. Ticks live in grassy, brushy, or wooded areas, or even on animals. Spending time outside walking your dog, camping, gardening, or hunting could bring you in close contact with ticks. Many people get ticks in their own yard or neighborhood.
  • How to remove a tick
    1. Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible.
    2. Pull upward with steady, even pressure. Don’t twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal.
    3. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol or soap and water.
    4. Never crush a tick with your fingers. Dispose of a live tick by putting it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet.
  • If you develop a rash or fever within several weeks of removing a tick, see your doctor. Be sure to tell the doctor about your recent tick bite, when the bite occurred, and where you most likely acquired the tick.
  • Avoid folklore remedies such as “painting” the tick with nail polish or petroleum jelly, or using heat to make the tick detach from the skin. Your goal is to remove the tick as quickly as possible–not waiting for it to detach.
  • The most common symptoms of tick-related illnesses are:
    • Fever/chills: With all tickborne diseases, patients can experience fever at varying degrees and time of onset.
    • Aches and pains: Tickborne disease symptoms include headache, fatigue, and muscle aches. With Lyme disease you may also experience joint pain. The severity and time of onset of these symptoms can depend on the disease and the patient’s personal tolerance level.
    • Rash: Lyme disease, southern tick-associated rash illness (STARI), Rocky Mountain spotted fever (RMSF), ehrlichiosis, and tularemia can result in distinctive rashes:
      • In Lyme disease, the rash may appear within 3-30 days, typically before the onset of fever. The Lyme disease rash is the first sign of infection and is usually a circular rash called erythema migrans or EM. This rash occurs in approximately 70-80% of infected persons and begins at the site of a tick bite. It may be warm, but is not usually painful. Some patients develop additional EM lesions in other areas of the body several days later.
      • The rash of (STARI) is nearly identical to that of Lyme disease, with a red, expanding “bulls eye” lesion that develops around the site of a lone star tick bite. Unlike Lyme disease, STARI has not been linked to any arthritic or neurologic symptoms.
      • The rash seen with Rocky Mountain spotted fever (RMSF) varies greatly from person to person in appearance, location, and time of onset. About 10% of people with RMSF never develop a rash. Most often, the rash begins 2-5 days after the onset of fever as small, flat, pink, non-itchy spots (macules) on the wrists, forearms, and ankles and spreads to the trunk. It sometimes involves the palms and soles. The red to purple, spotted (petechial) rash of RMSF is usually not seen until the sixth day or later after onset of symptoms and occurs in 35-60% of patients with the infection.
      • In the most common form of tularemia, a skin ulcer appears at the site where the organism entered the body. The ulcer is accompanied by swelling of regional lymph glands, usually in the armpit or groin.
      • In about 30% of patients (and up to 60% of children), ehrlichiosis can cause a rash. The appearance of the rash ranges from macular to maculopapular to petechial, and may appear after the onset of fever.

    Tickborne diseases can result in mild symptoms treatable at home to severe infections requiring hospitalization. Although easily treated with antibiotics, these diseases can be difficult for physicians to diagnose. However, early recognition and treatment of the infection decreases the risk of serious complications. So see your doctor immediately if you have been bitten by a tick and experience any of the symptoms described here.

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