We have finally turned the page on the winter weather and as the sun begins to warm the earth and flowers peek through the soil, those who have spent the cold months indoors start to come out and enjoy the beauty that New England offers. But just as we emerge from our winter naps so, too, do the ticks that populate our region. And these parasites offer a particular danger to our seniors.
Ticks have been around for centuries. In fact, tick fossils have been found in New Jersey (no New Jersey jokes, please) dating back some 90 million years. The highest numbers of ticks are found on the East Coast, especially the New England area and the Midwest regions of the country.
Ticks, as small as they are, can pack quite a wallop in their bites and while these illnesses are unpleasant for anyone who acquires them, for seniors, the risks can be especially dangerous. The major reason for this is that as we age, our immune system begins to weaken, increasing our vulnerability.
Ticks can be infected with a plethora of 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. We will take a closer look at these in a bit.
Obviously, the best way to avoid these illnesses is not to get bitten, but staying
indoors during the summer months is not an option for most and probably offers its own health risks, so the next best thing is to understand tick behavior and how best to avoid contact with them.
Ticks do not jump, fly or fall on people but they do 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 ability to sense heat and detect carbon dioxide, which we exhale as we breathe. Once a tick is on you, they quickly seek a place to attach and feed. Ticks can find a spot anywhere on you, but they 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 the bite of an infected mosquito, tick or flea. The number of cases has tripled since 2004 and those caused by ticks have doubled. Of the tick-borne illnesses, 82% were cases of Lyme disease, a bacterial infection that causes a 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. Another reason that has been offered is that increased travel by people and animals mean 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 take a 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, 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 is a rare disease 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 continue to increase. Most people who get babesiosis do not develop any symptoms, but some people with weaker immune systems — the elderly, very 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 is a term for a group of 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 similar to a flu — fever, muscle aches, nausea, chills, headache, fatigue — and they usually appear within one or two weeks after being bitten by an infected tick. People over the age of 50 are at higher risk for contracting the illness. If treated early, it can be cured however if medical intervention does not occur, there is a fatality rate up to 3%.
Similar to ehrlichiosis, but it is caused by a different type of bacteria and spread to humans also by the black-legged tick and the western black-legged tick. The majority of cases occur during the summer months in upper Midwestern and Northeastern states. The average number of cases each year 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 similar to 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 very young and seniors are most at risk.
Powassan (POW) Viruses
Also a rare virus spread to humans from the black-legged tick. POW virus
primarily occurs in the Northeast or Great Lakes region, particularly in Minnesota and Wisconsin. Many people who contract POW virus do not have any symptoms, but those who do may experience a fever, headache, vomiting, and also mental confusion, memory loss, or seizures.
If left untreated, the POW virus can spread to the central nervous system and lead to encephalitis or meningitis. Unfortunately, there is no medication or vaccine to treat or prevent POW virus. About half of those who survive the POW virus will have permanent neurological problems, and 10% of the encephalitis cases caused by POW are fatal, according to the CDC.
Spotted fever rickettsiosis is a term for a group of diseases caused by spotted fever group rickettsia, a type of bacteria. These are spread to humans by either mites or ticks — specifically, the Gulf Coast tick and Pacific Coast tick. Since
2010, there have been about 3,000 cases each year with a fatality rate less than 1%. These mostly occur during the summer months in the South and Southeastern states.
The first sign of a spotted fever is an eschar, or a dark 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 the Rocky Mountain spotted fever (RMSF), which causes fever, headache, and rash. In severe cases, RMSF can result in permanent damage to blood vessels in the limbs, hearing loss, paralysis, or mental disabilities.
Tularemia - Rabbit Fever
An infection caused by the highly contagious Francisella tularensis bacterium,
which can be spread to humans from the dog tick, wood tick, or lone star tick. Tularemia is also known as rabbit fever because it can infect and kill rabbits, hares, and rats.
There are around 200 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 entered the body.
If the tularemia is contracted from an infected tick bite or from handling an infected animal, 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 make a full recovery.
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, including 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, and
headaches, and also 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 a part of a group called thogotoviruses, and it's relatively new on the radar. There have only been a few cases so far, mostly in the South and Midwest, and some of these patients died. The virus is thought to spread through the bite of an infected tick, but the exact way it infects people is still unknown, according to the CDC.
People who become infected with the Bourbon virus may develop flu-like symptoms as well as nausea and vomiting. They may also have low white blood cell 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 the red meat allergy in the US and again, this tick is found predominantly in the Southeast from Texas, to Iowa, into New England.
Now, let's discus the 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 we spoke of earlier, including Lyme disease, Babesiosis, and Anaplasmosis. Think about
those odds -- these ticks have a one in three chance of carrying diseases.
American Dog ticks, which are larger than Black-legged ticks and thus easier to spot and remove, do not carry and transmit the same diseases as do Black-legged ticks. 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 common 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 pets and whether they can spread a tick borne illness to humans. Currently, there is no evidence to support this concern, however ticks can certainly ride a pet into the home and crawl upon a human and bite them. There has also been some talk that cats are not infected by tick diseases, however research has shown that cats can have tick related diseases in their blood, they do not exhibit the same symptoms as do dogs.
Things to Do to Prevent Tick Bites
There are many things you can do to try and avoid tick bites, unfortunately, no one of these things are fool-proof, so it's important 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. Be sure to use according to instruction; on children, use with caution or check with your doctor.
Even when advised to avoid tick-prone areas so you can prevent tick bites, there is really no guarantee that you can one hundred percent do so. When you know you have possibly exposed yourself to ticks, make sure to check after coming indoors.
Ticks may have attached onto your clothes and if so, wash them immediately and place in high heat. Exposing ticks to a certain heat degree kills them.
It could also spell a big 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 on 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 can 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 surrounding is your first step to prevent 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 create an obstruction for ticks.
Avoid storing unused equipment in shaded areas for longer 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 thereby 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 that you have at home could be the most convenient vehicle for ticks to invade your domain and cause tick problems.
Even as it looks like there is no a way at this time to completely eradicate ticks from our lives, there are certainly ways to combat them. Educate yourself about these ways so you and the rest of the family members can continue enjoying the outdoors. And, if you think you were bitten, seek medical advice. 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.
Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.