Prevention

There are a variety of measures that people can take to help decrease the risk of acquiring a tick-borne disease. The best method is to avoid tick-bites, and, if a tick-bite occurs, remove it quickly. While rapid removal does not guarantee that a microbe hasn't been transmitted, it markedly decreases the risk. For example, Powassan virus can be transmitted within 15 minutes of the tick attachment while Borrelia burgdorferi transmission would be rare if a tick has been attached less than 24 hours.

Tick Removal

Nymphal ticks are very small — about the size of a freckle or a poppy seed. Therefore, ticks can be easily missed. When removing a tick, use fine-tipped tweezers; get as close as possible to the skin surface, go under the body, and pull up. Do not squeeze the body and do not burn the tick or smother the tick with vaseline; these latter approaches may actually cause the tick to spew its salivary and abdominal contents into the human skin.

 

Tick-Bite Prevention

  • Avoid Tick-infested Areas: Ticks do not do well under dry or hot conditions because they can get dehydrated quite easily. They prefer moderate temperatures and high humidity. This may be why ticks are often found under leaf litter, in tall grasses, and in low-lying vegetation. Avoiding these areas would lead to a lower risk. However, remember that outdoor pets (cats, dogs) might bring ticks into the house and thus increase the risk of a tick bite for the pet owners.
  • Personal Protection: When spending time in infested areas, such as while hiking or walking, minimizing skin exposure is vital in the prevention process. Long pants tucked into socks as well as long-sleeved shirts are good options as ticks cannot penetrate clothing. Light colored clothing is also advisable so as to more easily spot ticks. Personal protection measures should be considered throughout the year, as ticks can be active in the winter months as well as in the higher risk spring and early summer months.
  • Tick Repellent: Insect repellent that contains 20-35 percent DEET is recommended and actually just as effective as those which contain 100 percent DEET. The lower concentration is recommended as DEET can be toxic, therefore be sure to avoid contact with eyes, mouth, or open wounds and take care when applying to children. Picaridin can also be effective as well as formulas containing IR3535. DEET and IR3535 last the longest, eight to ten hours, while Oil of Lemon Eucalyptus, while effective in concentrations of 30 percent, lasts up to six hours. Another very good option is to apply the insecticide permethrin to clothing; however it should not be applied directly to skin. Permethrin — which both repels and kills ticks — can be sprayed on shoes, hats, socks, pants; the spraying application should only be done outdoors however. Once sprayed, permethrin stays on the clothes for 20 or more washing machine cycles.
  • Tick Checks: Tick checks should occur as soon as possible following exposure to Lyme endemic areas. Following a visual inspection, a manual inspection should commence to feel around the body, especially through the hair, in and around ears, inside the belly button, behind the knees, and around waist. Washing clothes is also helpful following exposure; however, the washing machine will not kill ticks. One hour in the dryer on high heat will kill ticks.
  • Landscape Management: The Connecticut Agricultural Experiment Station offers general principles of management for homeowners in endemic areas. First and foremost, tall grasses and brush should be cleared, as well as leaf litter along the edge of the yard. Putting wood chips under foundation plantings and creating a mulch or wood chip barrier around the property perimeter is advised. The Japanese Barberry bush is associated with a higher tick abundance; therefore consider eliminating all of those. Landscape companies can help with applying acaracide, a tick pecticide, in the yard.
  • Awareness of Hosts of Ticks: The primary host for adult black-legged ticks is the white-tailed deer. Deer fencing and culling have been shown to decrease risk. This approach works most effectively on geographically isolated areas where it is possible to keep deer population low, such as on an island. Bait boxes work for small animals (e.g., mice, chipmunks) that are tick carriers and can be placed around the perimeter of one's property; the small animal enters the bait box and is brushed with an acaracide to kill the ticks.
  • Antibiotic treatment after Tick-bites: In the United States there has been only one six-week study which led to the recommendation by the Infectious Diseases Society of America that a single 200 mg dose of doxycycline should be given if the tick is attached for a least 36 hours and if the local rate of infected ticks is at least 20%. The International Lyme & Associated Diseases society points out that a 6 week duration study is too short as symptoms of Lyme disease may develop many months later; their recommendation from the 2014 Guidelines is a minimum of 20 days for all tick bites regardless of hours of attachment. A meta-analysis of four randomized trials (Warshafsky et al 2010) concluded that antibiotic prophylaxis significantly reduced the odds of developing Lyme disease compared to placebo in endemic areas after an Ixodes tick bite; the one U.S. study was for one day while the other 3 studies used 10 days of oral antibiotic therapy.
  • Vaccines: Between 1998 and 2002, there was a vaccine in the United States for humans, but it was taken off of the market. There are new vaccines under development, but none are yet commercially available for humans in the U.S. There are vaccines for dogs that can be helpful to decrease the risk of pets getting Lyme disease. There are also vaccines for the mice that are administered as a food product in a bait-box; in one study, the use of these bait boxes in a neighborhood led to a 76% decrease in infection of ticks. This works because when mice are vaccinated, ticks aren't able to acquire the spirochete that causes Lyme disease when they feeds on the mice.