The Warm Weather Has Arrived and the Ticks Have Returned
By Don Drake, Connelly Law Offices, Ltd.
"It was a beautiful Memorial Day weekend, as many of us in southern New England paid remembrance to those who gave their all to provide us with the freedoms we enjoy," stated professional fiduciary and certified elder law Attorney RJ Connelly III. "When I was at an event on Monday, I looked at the fully bloomed trees and the rapidly growing underbrush and realized we have entered tick season again. Although tick activity is truly weather-dependent, there are two peaks during the year here in New England, and the first begins in March or April and it lasts through August. The second occurs in October-November, but most tick-borne diseases occur from June to August."
An Ancient Parasite
Ticks have been around for centuries. Tick fossils have been found in New Jersey dating back some ninety million years. The highest numbers of ticks are located on the East Coast, especially in the New England area and the Midwest regions of the country.
Ticks, as small as they are, can transmit serious illnesses with their bites, and while these ailments are unpleasant for anyone who acquires them, the risks can be hazardous and even deadly for seniors. The primary reason is that our immune system begins to weaken as we age, increasing our vulnerability to what ticks carry.
Ticks can be infected with many bacteria, viruses, and parasites. Some of the most common diseases spread by these insects include Lyme disease, babesiosis, ehrlichiosis, Rocky Mountain spotted fever, anaplasmosis, Southern Tick Associated Rash Illness, Tick-Borne Relapsing Fever, and Tularemia.
Ticks Are Born to Bite
"One need not be a rocket scientist to conclude that the best way to avoid these illnesses is to avoid the bite from the tick; however, staying indoors during the summer months is not an option for most and probably offers its own health risks," said Attorney Connelly. "So, the next best thing is to understand tick behavior and how best to avoid contact with them."
First, ticks do not jump, fly, or fall on people but have a unique way of finding their blood meal. Ticks perch themselves on tall grass or low-hanging brush, awaiting a host to come along. Sitting with their front legs extended, they grab onto their victims as they walk by.
"They also have the unique ability to sense heat and detect carbon dioxide, which we exhale as we breathe," stated Attorney Connelly. "Once a tick is on you, they quickly seek a place to attach and feed. Ticks can find a spot anywhere on you but are particularly fond of areas around the neck, head, underarms, and groin."
The CDC recently analyzed data trends for all nationally notifiable diseases caused by an infected mosquito, tick, or flea bite. The number of cases has tripled since 2004, and those caused by ticks have doubled. Of the tick-borne illnesses, 82% were Lyme disease, a bacterial infection that causes rash and flu-like symptoms that can spread to the joints and nervous system if left untreated.
"The increase in tick-related illnesses may have many explanations, but the most likely reason is that we are now much more aware of the symptoms of tick-borne diseases and therefore seek treatment," Attorney Connelly said. "Another reason that has been offered is that increased travel by people and animals means that these parasites, which were once isolated in certain pockets of the country, have now taken hold in new areas."
In any case, being aware of the diseases carried by ticks and the symptoms of these illnesses must be taken seriously, especially for seniors. Let's look at them.
Lyme disease is transmitted to humans through the bite of infected black-legged ticks. Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, an infection can spread to joints, the heart, and the nervous system. Lyme disease is diagnosed based on symptoms, physical findings (the tell-tale bulls-eye rash), and the possibility of exposure to infected ticks from animals or being in high-risk areas like brush and woodlands.
This rare disease is caused by a microscopic parasite, Babesia microti, which infects red blood cells. It is spread to humans also through the bite of an infected black-legged tick. It is typically spread by the young tick which are small and difficult to spot. Most cases occur in the Northeast and Midwest. Although rare, the number of cases reported continues to increase. Most people who get babesiosis do not develop any symptoms, and some people with weaker immune systems — like the elderly, young, and immunocompromised individuals (those with conditions like AIDS, Lupus, etc.) — may experience mild flu-like symptoms which could aggravate these pre-existing conditions.
This term is for bacterial diseases transmitted to humans from ticks — primarily the lone star tick. Most cases occur in June and July in the Midwest and South. The symptoms are like the flu — fever, muscle aches, nausea, chills, headache, fatigue — and usually appear within one or two weeks after being bitten by an infected tick.
People over fifty are at higher risk of contracting the illness. If treated early, it can be cured. However, if medical intervention does not occur, there is a fatality rate of up to 3%.
Like ehrlichiosis, it is caused by a different type of bacteria and spread to humans by the black-legged and western black-legged ticks. Most cases occur during the summer months in upper Midwestern and Northeastern states. The average number of cases yearly has steadily increased since it was discovered in 1999 — from 348 cases in 2000 to 1,761 cases in 2010. The case fatality rate ranges from 0.2%–3%.
The symptoms are also like a flu-like illness and appear within one to two weeks after being bitten. Some people may have very few symptoms, and others may develop severe symptoms such as hemorrhaging, kidney failure, or breathing problems. Again, the young and seniors are most at risk.
Powassan (POWV) Viruses
This is a rare (but rapidly increasing) virus, spread to humans from the black-legged tick. POWV primarily occurs in the Northeast or Great Lakes region, particularly in Minnesota and Wisconsin. Many people who contract POWV do not have any symptoms, but those who do may experience a fever, headache, vomiting, mental confusion, memory loss, or seizures.
If left untreated, the POWV can spread to the central nervous system, leading to encephalitis or meningitis. Unfortunately, no medication or vaccine exists to treat or prevent POWV. According to the CDC, about half of those who survive the POWV will have permanent neurological problems, and 10% of the encephalitis cases caused by POWV are fatal.
On May 17 this year, the Maine Center for Disease Control and Prevention (Maine CDC) confirmed a fatal Powassan virus disease in a Sagadahoc County resident. The adult developed neurologic symptoms and died in the hospital after becoming infected, most likely in Maine. This is the first tickborne illness identified in that state this year.
Spotted fever rickettsiosis is a term for diseases caused by spotted fever group rickettsia, a type of bacteria. These are spread to humans by either mites or ticks — specifically, the Gulf and Pacific Coast ticks. Since 2010, there have been about 3,000 cases yearly, with a fatality rate of less than 1%. These mainly occur during the summer months in the South and Southeastern states.
The first sign of a spotted fever is an eschar, or a chestnut brown scab on the tick bite, which can take up to a week to appear. Once the eschar forms, patients may experience flu-like symptoms. All spotted fevers are treated with doxycycline.
These infections can range from mild to life-threatening if left untreated. The most serious of this group of tick-borne diseases is Rocky Mountain spotted fever (RMSF), which causes fever, headache, and rash. In severe cases, RMSF can permanently damage blood vessels in the limbs, causing hearing loss, paralysis, or mental disabilities.
Tularemia - Rabbit Fever
An infection caused by the highly contagious Francisella tularensis bacterium can be spread to humans from the dog, wood, or lone star ticks. Tularemia is also known as rabbit fever because it can infect and kill rabbits, hares, and rats.
There are around two hundred cases in people reported each year, primarily in the states of Kansas, Oklahoma, Missouri, and Arkansas. It can also spread to humans from contact with infected animals or exposure to aerosolized bacteria, which can happen if someone accidentally runs a mower over an animal that died of the disease. The symptoms of tularemia depend on how the bacteria enter the body.
Suppose tularemia is contracted from an infected tick bite or from handling an infected animal. In that case, patients can develop glandular tularemia, which causes swollen lymph nodes in the armpits or groin. Sometimes, this is accompanied by an ulcer at the location of the tick bite or site where the bacteria entered the body. The infection can be treated with multiple antibiotics, and most patients will fully recover.
Thought to be transmitted by the lone star tick, and it's usually found in parts of the Midwest and Southern US. States where the tick is most common include Arkansas, Missouri, Indiana, Tennessee, Kentucky, and North Carolina. It was first discovered in 2009, and there have been several cases each year — including two people who have died.
The virus causes flu-like symptoms, such as fever, fatigue, muscle aches, headaches, and diarrhea. Patients may also have a low white blood cell count. There is no medicine or vaccine to treat or prevent the Heartland virus.
This is part of a group called thogotoviruses, and it's new on the radar of tick-borne illnesses. There have been a few cases, mainly in the South and Midwest, and some of these patients died. According to the CDC, the virus is thought to spread through the bite of an infected tick, but the exact way it infects people is still unknown. People infected with the bourbon virus may develop flu-like symptoms, nausea, and vomiting. They may also have low white blood cells and platelet counts.
Red Meat Allergy
A bite from the Lone Star tick can cause people to develop an allergy to red meat, including beef and pork. The Lone Star tick has been implicated in initiating red meat allergy in the US, and again, this tick is found predominantly in the Southeast from Texas to Iowa and New England.
Types of Ticks
Black-legged, American Dog and Lone Star Ticks
These ticks are common in the southern New England states (Connecticut, Rhode Island, Massachusetts) and are becoming common in the northern New England states of Vermont, New Hampshire, and Maine.
About 25% to 33% of Blacklegged (deer) Ticks in New England may bear and transmit serious illnesses, including Lyme disease, Babesiosis, and Anaplasmosis. Think about those odds -- these ticks have a one in three chance of contracting diseases.
American Dog ticks, larger than Black-legged ones and thus easier to spot and remove, do not carry or transmit the same diseases as Black-legged ones. However, Dog ticks may carry and transmit Tularemia and Rock Mountain Spotted Fever.
The Turkey Tick
The Turkey Tick or Northeastern Water Tick, the female of this species, bears a white spot on its back. They can carry a variety of Erlichia diseases, among others. Wild turkeys are a typical host for this insect, earning it the nickname Turkey Tick.
Asian Long-horned Tick
Asian long-horned tick preys primarily on livestock and wildlife and isn’t yet considered a threat to humans in the United States, but the operative phrase here is "isn't yet considered".
We also received a question regarding whether pets can spread a tick-borne illness to humans. No evidence supports this concern; however, ticks can undoubtedly ride a pet into the home, crawl upon a human, and bite them. There has also been some talk that tick diseases do not infect cats; however, research has shown that cats can have tick-related diseases in their blood but do not exhibit the same symptoms as dogs.
Things to Do to Prevent Tick Bites
You can do many things to try and avoid tick bites; unfortunately, none of these things are foolproof, so it's essential to take many safety measures to keep yourself healthy. Here are some tips:
As much as you can, avoid areas where ticks are present. This includes moist and humid locations, grassy and wooded areas, and trails. Ticks are found in shrubs and leaf litter too.
If you must go hiking, avoid brushing against bushes or thick plants. Walk where it is clear, along the center of trails.
Treat hiking boots and clothing with permethrin-based anti-tick products.
Protect skin from bites for hours by applying tick repellents containing DEET. Use it according to instructions; use it cautiously or check with your doctor on children.
Even when advised to avoid tick-prone areas to prevent tick bites, there is no guarantee that you can one hundred percent do so. When you know you have exposed yourself to ticks, check after coming indoors.
Ticks may have attached to your clothes, and if so, wash them immediately and place them in high heat. Exposing ticks to hot temperatures kills them.
It could also spell a significant difference if you immediately shower to wash off ticks. If a tick has already found its way to your body crevices and has attached itself, this could be the best time to inspect areas such as the armpits, the ear area, around the waist, behind the knees, the belly button, and through the hair.
Removing a Tick
Doubtlessly, measures to prevent tick bites from happening will always be the best defense against tick bite illnesses. Still, there could be instances when a tick would still find a way to grab a bite or two in its quest for blood. What do you do?
Should you find a tick attached to your skin, remove it immediately. Observe tick removal directions.
If fever or rash develops after a bite, see your doctor.
It would be helpful if you could bag the tick that bit for clinical inspection, easier diagnosis, and medication.
Create a Tick-Safe Environment
Reducing the chances of ticks infesting your home or surroundings is your first step to preventing tick bites. While you can’t completely control the presence of ticks outside your home, there are steps you can take to lessen the chances of an infestation at home and in its immediate surroundings.
Regularly clean your yard and free it of tall grasses and bushes. Don’t let leaf litter stand for days. Place gravel or sand on areas by the swing or the children’s play area to obstruct ticks.
Avoid storing unused equipment in shaded areas for extended periods that could create a haven for ticks.
Control tick presence with the use of home-grade anti-tick chemicals. You can also consult professional pest control specialists who can apply tick treatments, helping you and your loved ones prevent tick bites. But remember that many seniors have respiratory issues that could be affected by chemical sprays.
Use tick-control soaps or shampoos on your pets. Your dog or other pets at home could be the most convenient vehicle for ticks to invade your domain and cause tick problems.
"Currently, there is no way to eradicate ticks from our lives, but there are certainly ways to combat them," said Attorney Connelly. "Educate yourself in these ways so you and the rest of your family members can continue enjoying the outdoors. And, if you think you were bitten, seek medical advice. Remember, better safe than sorry."
"For health-minded seniors, their families, or for healthcare providers, please click on the photo below to download the handout from the Centers for Disease Control on ticks and the diseases they carry. It is an invaluable resource."