A Ticklist for Staying Safe While Spending Time Outdoors

Whether you like camping, taking the dog out for a walk, or simply spending time enjoying nature, it’s always good to be aware of how you and your family can help protect yourselves when you’re outside. Depending on where you live and spend your time, mosquitoes can carry diseases such as malaria, West Nile virus, Zika, and yellow fever.^1,2 Also high on the watchlist are ticks, which are second only to mosquitoes for spreading disease in humans if infected with bacteria, viruses, or parasites.³

The names of some of these tick-borne diseases may or may not be familiar— Anaplasmosis, Babesiosis, Tick-Borne Encephalitis (TBE) or Tick-Borne Relapsing Fever, and Lyme disease. These diseases are caused by a variety of pathogens, which when transmitted, can result in an attack on the immune system, leading to a variety of health complications, such as unstable blood pressure, muscle and joint aches, meningitis, neurological problems, respiratory failure, and, in rare cases, even death.^4-7

According to The Centers for Disease Control and Prevention (CDC), Lyme disease is the most common vector-borne disease in North America and Europe. Studies show that approximately 476,000 cases occur per year in the United States and 129,000 cases are reported annually in Europe.^8-10 As a result of varying disease surveillance systems, many cases of Lyme disease likely remain unaccounted for.

Less commonly known is tick-borne encephalitis (TBE), which can affect the brain and spine.¹¹ Symptoms include those that may be initially mistaken for summer flu.^12,13 Ticks infected with the TBE virus have been found in more than 36 countries across Europe, in parts of Asia, e.g., China and Japan and North Africa, e.g., Tunisia.^14,15 So, if you’re traveling to any of these countries, you might need to take steps to help protect yourself.

When to be super alert about ticks

For the most part, ticks are inactive during winter.¹¹ However Patrick Kelly, Director of Global Clinical Epidemiology, Tick-Borne Infections, says that changes with a shift of seasons.¹¹ “By the time, temperatures nudge the 43°F/6°C mark, sometimes as early as February, they’re well and truly on the move,” he says. “Unlike many insects, ticks don’t jump or fly. They either lay in wait at the top of vegetation with their legs extended until a suitable host passes by or they may actively “hunt” and seek a potential host by crawling directly to them.”

How to protect yourself from ticks before you head outdoors

When traveling or spending time outdoors, find out if the area is known for ticks or other insects and speak with your doctor to ensure you’re up to date with vaccinations or other preventative measures specific to the area. Then check your kit. Use effective insect repellents to treat your footwear, clothing and camping gear, and wear light-colored clothing which make ticks easy to spot, including long-sleeved tops and long trousers tucked into socks.¹² Avoid tick-infested areas of forest and woodland from spring until fall, whenever possible.¹²

Check for ticks on your return

Use a mirror to check your own body and your children’s bodies for ticks, paying special attention to the hairline, behind the ears, elbows, back of the knees, groin and armpits.¹⁶ Generally, people don’t ‘feel’ a tick bite, but may experience a mild itch tick still attached. It’s important to remove attached ticks as soon as possible.¹²

How to remove a tick

Use fine-tipped tweezers or a tick-removal tool. Grasp the tick as close to the skin as possible, and slowly pull it upwards, taking care not to twist or jerk it as you go. You can dispose of a live tick by putting it in alcohol, placing it in a sealed container, wrapping it tightly in tape, or flushing it down the toilet. Clean the bite with alcohol or wash it with soap and water. If a small part of the tick’s mouth remains in the wound, try to remove it with tweezers. This is not dangerous, and should disappear after a couple of days.^13,17,18

When to seek help for tick bites

See a doctor if you’ve been bitten by a tick and the bite area does not start to heal, or if you fall ill within one month of being bitten by a tick.¹⁷

References
1. Centers for Disease Control and Prevention. Flea-borne (murine) typhus, Typhus Fevers. https://www.cdc.gov/typhus/murine/index.html. Last reviewed November 13, 2020. Accessed July 3, 2023.
2. Centers for Disease Control and Prevention. Mosquito-Borne Diseases. https://www.cdc.gov/niosh/topics/outdoor/mosquito-borne/default.html. Last reviewed March 21, 2016. Accessed July 3, 2023.
3. Lawrie C, et al. Ixodid and Argasid Tick Species and West Nile Virus. Emerg. Infect. Dis. 10, 2004;10:653–657.
4. Centers for Disease Control and Prevention. Signs and Symptoms of Anaplasmosis. https://www.cdc.gov/anaplasmosis/symptoms/index.html. Last reviewed January 11, 2019. Accessed July 2023.
5. Centers for Disease Control and Prevention. Babesiosis Disease. Available from: https://www.cdc.gov/parasites/babesiosis/disease.html. Last reviewed May 17, 2018. Accessed July 2023.
6. Centers for Disease Control and Prevention. Symptoms of Tick-borne Relapsing Fever (TBRF). https://www.cdc.gov/relapsing-fever/symptoms/index.html. Last reviewed October 15, 2015. Accessed July 3, 2023.
7. Centers for Disease Control and Prevention. Signs and Symptoms of Untreated Lyme Disease. https://www.cdc.gov/lyme/signs_symptoms/index.html. Last reviewed January 15, 2021. Accessed July 3, 2023.
8. Centers for Disease Control and Prevention. Lyme Disease. https://www.cdc.gov/lyme/index.html. Last reviewed January 19, 2022. Accessed July 3, 2023.
9. Kugeler KJ, et al. Estimating the frequency of Lyme disease diagnoses—United States, 2010-2018. Emerg Infect Dis. 2021; 27:2.
10. Burn L, et al. Incidence of Lyme Borreliosis in Europe from National Surveillance Systems (2005–2020). Vector Borne and Zoonotic Diseases. 2023; 23(4):156-171.
11. Lindquist L, et al. Tick-borne encephalitis. The Lancet. 2008; 371:1861–1871.
12. Travel Health Pro. Country information. Tick borne encephalitis. https://travelhealthpro.org.uk/disease/173/tick-borne-encephalitis. Accessed July 3, 2023.
13. Kaiser R. Tick-borne encephalitis. Infect Dis Clin North Am. 2008;22(3):561-75.
14. Dobler G, et al., eds. The TBE Book. 6th ed. Singapore: Global Health Press; 2022. Available from https://tbenews.com/tbe/. Accessed July 3, 2023. Control and Prevention. Geographic Distribution. Available from: https://www.cdc.gov/tick-borne-encephalitis/geographic-distribution/index.html Last reviewed March 7 2023. Accessed July 2023.
15. Centers for Disease Control and Prevention. Lyme Disease Charts and Figures. Available from: https://www.cdc.gov/lyme/datasurveillance/charts-figures-recent.html. Last reviewed October 27, 2022. Accessed July 3, 2023.
16. Centers for Disease Control and Prevention. Preventing tick bites. https://www.cdc.gov/lyme/prev/on_people.html. Last reviewed September 30, 2019. Accessed July 3, 2023.
17. European Centre for Disease Prevention and Control. Leaflet for travellers on ticks, tickborne diseases and preventive measure. https://www.ecdc.europa.eu/sites/ default/files/media/en/healthtopics/emerging_and_vector-borne_diseases/tick_borne_diseases/public_health_measures/Documents/Travellers_Leaflet_highres.pdf. Accessed: July 3, 2023.
18. Centers for Disease Prevention and Control. Tick removal. https://www.cdc.gov/ticks/removing_a_tick.html. Last reviewed May 13, 2022. Accessed July 3, 2023.

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