Commentary: Prevent Lyme disease by avoiding tick bites

The next time you are outdoors enjoying nature, take the time to protect yourself from small unseen enemies. Seemingly harmless tick bites can be very dangerous to your health.

Black-legged or deer tick bites transmit the bacterium Borrelia burgdorferi and B. mayonii, which cause Lyme disease. It is frequently characterized by an expanding red rash, commonly referred to as a “bull’s eye rash.” Rashes can occur anywhere on the body and vary in size and shape. Other symptoms can include fever and or chills, fatigue, muscle and joint aches, and headaches.

Lyme disease is the most common vector-borne disease in the United States with approximately 20,000 new cases reported each year. In 2018, the Division of Public Health (DPH) reported 520 confirmed and probable Lyme disease cases. Delaware is among the top 10 states with the highest incidence rates in the United States.

Most cases of Lyme disease can be cured with a few weeks of antibiotics taken by mouth. Some patients may require a second course or require IV antibiotics. A small percentage of patients with Lyme disease, though, have symptoms like muscle and joint pains, arthritis, cognitive defects, sleep disturbance, and fatigue that last months or years after treatment and can be challenging for the patient.

Rick Hong, M.D.

Not all patients with Lyme disease will develop the characteristic bulls-eye rash, and tick exposures often go undetected, making Lyme disease difficult to diagnose. Untreated Lyme infections can lead to severe joint pain and swelling, loss of muscle tone on one or both sides of the face (called “Bell’s palsy”), heart palpitations, dizziness, and severe headaches and neck stiffness. Lyme disease also causes neurological problems such as numbness or tingling in the hands or feet and problems with concentration and short-term memory.

Preventing tick bites is critically important to prevent illness and long-lasting health effects. DPH recommends that everyone memorize and follow the five “BLAST” steps:

• Bathe or shower within two hours of coming indoors.

• Look for ticks on your body and remove them.

• Apply repellent to your body and clothes.

• Spray your yard.

• Treat your pet with a veterinarian-approved medicine that kills ticks.

When outdoors, wear light-colored clothes to easily spot ticks. Apply Environmental Protection Agency (EPA)-registered insect repellents containing DEET, picaridin, IR3535, oil of lemon eucalyptus, para-menthane-diol, or 2-undecanone to your skin. Treat clothing and gear with products containing 0.5% permethrin.

Ticks, especially tiny immature ticks, are difficult to see. The Centers for Disease Control and Prevention (CDC) advises checking for ticks daily, especially under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and on the hairline and scalp. Check yourself, your children and pets.

If you find a tick, use tweezers (not your fingers) to remove it. Do not try using alcohol, flames, or other remedies to remove them. Put the tick in a sealed plastic bag and dispose of it in the trash. Monitor the bite site for a red “bull’s eye” rash, or other symptoms. Immediately seek medical attention if you experience symptoms or any other odd rash, as it could indicate Lyme disease or another tickborne disease.

For the first time in Delaware, the week of May 19–25, 2019, has been designated as Lyme Disease Awareness Week. DPH is highlighting many activities that are a part of its ongoing BLAST Lyme disease awareness campaign.

It includes educational presentations to camps, schools and other organizations, and paid advertising. Webinars, with free CEUs, on how to recognize, diagnose and treat Lyme disease, along with educational flyers are available to medical providers on the BLAST campaign website at de.gov/lyme. Children can learn about Lyme disease on the “Kids Korner,” and adults can find detailed tick removal instructions and a printable poster of common symptoms.

Lastly, DPH is making poly-vinyl tick bite prevention signs available to municipalities and parks statewide free of charge, while supplies last. To request a trail sign, contact DPH at 302-744-4930. To request an educational presentation, contact DPH at 888-295-5156.

For more information about Lyme disease, visit: https://dhss.delaware.gov/dhss/dph/epi/lyme.html.

Rick Hong, M.D. is the medical director for the Division of Public Health.

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