Spending time in the great outdoors, whether hiking, camping, or just hanging out in your own backyard, is a fun and healthy way to enjoy the summer weather. But beware! Creatures are lurking in the tall grass and in the bushes—eight- legged creatures that hunger for your blood—just waiting for the opportunity to crawl onto your body and sink their little mouthparts into your skin and start sucking. In other words, it’s tick season, folks, which, in the United States, begins in the spring and continues through the summer months, well into the fall season. While not all ticks carry disease, tickborne diseases continue to be a public health issue in the US.1

Ticks are not insects—with eight legs, they are classified as arachnids, but they are different from spiders. Ticks are external parasites, living on the blood of a host animal, which, depending on the tick’s species, can be mammalian, avian, reptilian, or even amphibian. Ticks are common in the United States—at some point in your life, you’ve probably carried one of these uninvited passengers somewhere on your body, whether aware of it or not. These small blood-sucking bugs vary in size—from as small as a pin’s head to as large as a pencil eraser,2 and are typically brown, reddish brown, or black in color.3

Ticks hide in tall grass or shrubs. They cannot jump or fly, so they wait to latch onto a host as it walks by. Ticks tend to embed themselves in an area where the skin is soft, warm, moist, and well-supplied with blood, such as the neck, armpit, groin, breast, hairline, or the back of a knee.3 Once latched onto a host using its mouthparts, a tick will ingest the host’s blood, a process that can last several days, until it becomes engorged and falls off the host.4

RISK FACTORS

The risk of becoming infected with a tickborne disease depends largely on three factors: the density of the tick population, the proportion that carry disease, and factors that influence human exposure.3 Predicting the annual number of tickborne disease cases, including how an upcoming season will compare with previous years, is a complicated, unclear science. However, the incidence of tickborne infections has increased over the last 20 years. There was a 50-percent increase in the total number of reported cases of tickborne disease between 2008 and 2018, with a record breaking 59,349 cases in 2017, according to the Center for Disease Control and Prevention.5

REMOVAL AND TREATMENT

Most tick bites are harmless and have no symptoms; it typically takes more than 24 hours of feeding for disease-carrying ticks to infect a person.2 This is why it’s important to remove an attached tick as soon as possible. If you have spent time outdoors, you should conduct a thorough body check for ticks. You can do this by running your hands over your body to check for new bumps on your skin.7 Make sure to closely to inspect areas where ticks are most likely to bite (head, ears, neck, armpits, under the breasts, groin region). Next, make sure your clothing doesn’t have any lingering guests on it. Go outside to shake out your clothes before adding them to the laundry. Make sure to your wash them with hot water and dry them on the hottest setting possible to kill the ticks. Finally, take a shower to wash off any ticks you may have missed.7 You should also check your pets to make sure they aren’t carrying ticks.

If you do find a tick on your body, do not panic. Instead, search for a pair of tweezers to remove it. Fine-tipped are best. Grasp the tick as close to the skin as possible and pull upward with steady, even pressure.4 Once it has been extracted, double check to make sure that entire tick has been removed. Next, thoroughly clean the bite area with rubbing alcohol and soap and water.

If possible, try to record the identify the species of tick or take a picture of it, as this may be helpful if it the bite requires medical attention. Finally, it’s critical to dispose of the tick properly. Do not crush it with your fingers. This can cause the tick to burst and release any pathogens it may be carrying. Instead, drown it in rubbing alcohol or flush it down the toilet.7

WHEN TO SEE A DOCTOR

If you have been infected with a tick-borne disease, signs might not appear for several days or weeks. These symptoms include a red spot near the bite, with or without the classic “bull’s eye” appearance (i.e., a larger circle of redness expanding outward from the central red spot surrounding the bite mark), neck stiffness, muscle or joint pain, and a fever and/or chills.4 If you begin experiencing these symptoms, it’s important to seek medical attention right away and let your doctor know that a tick recently bit you.2

PREVENTION

This best way to prevent tick-borne disease is to prevent ticks from latching onto your body. Proper clothes are a successful barrier against ticks.6 Wearing long-sleeved shirted and pants can limit exposed skin. This is an especially effective measure when the hems of the pants are tucked into a pair of boots of socks. Wearing light-colored clothing is a tradeoff—ticks are more easily spotted on lighter colored fabrics but are attracted to lighter colors as well.3 Another important method to consider is abstaining from walking through dense underbrush and heavily wooded areas. If you can’t give up that hike or run you’ve been looking forward to, there are ways to mitigate your exposure to ticks. For starters, stay in the center of the trail to avoid brushing against vegetation. When possible, try to keep moving, which makes it more difficult for a tick to crawl onto you and helps shed any ticks you have picked up along the way. Bug sprays that contain at least 20-percent DEET, as well as lemon and eucalyptus oils, can also discourage ticks from latching onto you.

TICK-BORNE DISEASES

Ticks are found across the United States and are susceptible to carrying a variety of diseases. Here are the most common ones in the United States:

Lyme disease—The most common vector-borne disease in the United States.8 Symptoms include fever, headache, fatigue, and a characteristic red bullseye mark around the tick bite. Most cases of Lyme disease are successfully treated by antibiotics. If left untreated, the infection can spread to joints, the heart, and the nervous system.

Babesiosis—Caused by parasites that infect red blood cells.9 It often occurs the same time as Lyme disease. Many people infected with babesiosis feel fine and do not develop symptoms, which may include fever, chills, sweats, body aches, loss of appetite, nausea,
or fatigue. This disease is treated by antiparasitic drugs, not antibiotics.

 Ehrlichiosis—A bacterial illness that causes flu-like symptoms. Most people infected with ehrlichiosis experience only mild symptoms and are able to fight off the illness on their own. Some people may require with antibiotic treatment. However, untreated ehrlichiosis could result in an illness serious enough to require hospitalization in some individuals.10

Rocky mountain spotted fever (RMSF)—A potentially deadly bacterial infection. Its trademark symptom is a rash of small, flat, pink, non-itchy spots that appear on the limbs and spread to the trunk.11 This develops 2 to 4 days after other symptoms, including muscles aches and fever. Early treatment with the antibiotic, doxycycline, can prevent death and severe illness.12

Southern tick-associated rash illness (STARI) —An infectious
disease that looks, acts, and is treated the same as Lyme disease. In addition to symptoms of fatigue, headache, fever, and muscle pains, STARI also creates a red bullseye lesion around the site of tick bite.13 There is no known causative agent for the disease.

Sources

1. Eisen RJ, Kugeler KJ, Eisen L, at al. Tick-borne zoonoses in the United States: persistent and emerging threats to human health. ILAR J. 2017;58:319–35. 
2. Tick Bites: Symptoms and Treatments. Healthline website. Updated May 24, 2017. https://www.healthline.com/health/tick-bites. Accessed July 14, 2020.
3. Rahlenbeck S, Fingerle V, Doggett S. Prevention of tick-borne diseases: an overview. Br J Gen Pract. 2016;66(650):492–494. 
4. Tick Bites/Prevention. Center for Disease Control and Prevention website. Updated January 10, 2019. https://www.cdc.gov/ticks/tickbornediseases/tick-bites-prevention.html. Accessed July 14, 2020.
5. Tickborne Disease Surveillance Data Summary. Center for Disease Control and Prevention website. Updated November 4, 2019. https://www.cdc.gov/ticks/data-summary/index.html. Accessed July 14, 2020.
6. Tick ID. Center for Disease Control and Prevention website. Updated January 10, 2019. https://www.cdc.gov/ticks/tickbornediseases/tickID.html. Accessed July 14, 2020.
7. Stuntz, D. Tick Checking 101: Steps to Take For Every Hike. American Forests website. Updated September 8, 2017. https://www.americanforests.org/blog/tick-checking-101-steps-take-every-hike/. Accessed July 21, 2020.
8. Lyme Disease. Center for Disease Control and Prevention website. Updated December 16, 2019. https://www.cdc.gov/lyme/index.html. Accessed July 14, 2020.
9. Babesiosis. Center for Disease Control and Prevention website. Updated January 10, 2019. https://www.cdc.gov/ticks/tickbornediseases/babesiosis.html#. Accessed July 22, 2020.
10. Ehrlichiosis. The Mayo Clinic website. https://www.mayoclinic.org/diseases-conditions/ehrlichiosis/symptoms-causes/syc-20372142#:~:text=Overview,two%20of%20a%20tick%20bite. Accessed July 22, 2020.
11. Rocky Mountain Spotted Fever (RMSF). Center for Disease Control and Prevention website. Updated January 10, 2019. https://www.cdc.gov/ticks/tickbornediseases/rmsf.html. Accessed July 22, 2020.
12. Rocky Mountain Spotted Fever (RMSF) – Signs and Symptoms. Center for Disease Control and Prevention website. Updated January 10, 2019. https://www.cdc.gov/rmsf/symptoms/index.html. Accessed July 22, 2020.
13. STARI or Lyme? Center for Disease Control and Prevention website. Updated November 19, 2018. https://www.cdc.gov/stari/disease/index.html. Accessed July 22, 2020.