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Lyme Disease Prevented with Care and Caution

It's still the season for Lyme Disease so people should take precautions.

August 21, 2002

During the summer months people look forward to casting off their winter clothes and spending more time outdoors enjoying a variety of activities. But the same sunny months are prime tick season, and as a result the possibility of getting Lyme disease is much higher.

"We definitely see more cases in the warmer months," said Linda Smith of the Fairfax County Health Department. With proper care and caution, this disease can be avoided or prevented, she said..

"The summer months have the most cases," agreed Dr. David Goodfriend, director of the Loudoun County Health Department. Loudoun bears the dubious distinction of having more cases than any other county in Virginia. This year through May, Loudoun has had 20 cases, while Fairfax had three.

"For the last two or three years, Loudoun has had a rate 20 times that of the rest of the state," he said, offering a number of reasons why. "Loudoun has kept its rural heritage. There are a lot of areas where ticks thrive, and we have a large deer population." At the same time the population of Loudoun is growing quickly, and more and more people are going to areas where ticks. live. He also noted that "our families are very aware of deer ticks, so more people are being diagnosed."

Although Loudoun County has the highest number of cases in Virginia and Fairfax County is second, Virginia does not have a high risk-rate compared with other parts of the country. Lyme disease infects about 16,000 people every year nationwide. From 1990-99, there were 1,003 cases in Virginia, according to the Centers for Disease Control. In contrast there were 40,762 cases in New York state in the same period, 20,634 in Connecticut and 17,072 in Pennsylvania. Maryland had 4,177 in the same time frame.

Virginia reported 149 cases in 2000, 156 cases in 2001. There were 19 cases in 2000 and 37 cases in 2001 in Fairfax County; 61 cases in 2000 and 55 cases in 2001 in Loudoun County.

WHILE LYME DISEASE is not as serious a threat in Virginia as it is in other places, doctors urge people to take precautions.

Dr. Ida Falls of Fair Oaks Hospital says that "people aren't being as careful as they used to. Added to that is the fact "that more communities are being built farther out where more deer are, increasing their risk."

Precautions include wearing light-colored clothing while also reducing the amount of exposed skin by wearing hats, long-sleeved shirts, and pants tucked into boots. Clothes can also be treated with the repellent permethrin, and products containing DEET (but not more than 35 percent) can be used on the skin. Products containing DEET should not be used on children under 2, and only 10-percent DEET concentrations should be used for children older than 2.

Ticks thrive in dense, moist areas, so grass should be kept short, and woodpiles should be kept away from recreational areas.

For more intense tick prevention, liquid chemicals can be used in the summer, while granular pesticides are best in the fall and spring. If a yard is infested enough to use these methods, professional exterminators should be consulted first.

For other protection, the Virginia Department of Health Web site states that there is a vaccine that has recently been licensed for persons between 15 and 70 that is given in three doses over one year. However, this vaccine has not proved to be 100-percent effective, so it is not widely used.

LYME DISEASE WAS first discovered in 1977 in the town of Lyme, Conn., when researchers were studying an unusually high number of children with arthritis. Since its discovery Lyme disease has accounted for more than 95 percent of all vector-borne illnesses (illnesses transmitted by a carrier) in the United States, even though it is mostly localized in the Northeast, mid-Atlantic and Upper North Central regions, according to the Centers for Disease Control.

Small rodents mostly carry the bacteria that cause Lyme disease, but deer can also harbor it. However, the only way for the disease to be transmitted to a human is through a tick, most commonly the black-legged or deer tick (Ixodes scapularis) in the Eastern United States.

Deer ticks generally live for about two years and require three blood meals in their lifetime. It is when they become adults and feed and mate on white-tailed deer throughout the fall and winter that they may become hosts to the disease. In the spring, females drop off to lay 2,000 to 3,000 eggs that hatch into larvae, which will also carry the bacteria. During the summer months, these larvae will feed on rodents like the white-footed mouse and squirrels, then molt into their nymph stage of development.

IT WILL NOT BE UNTIL the next spring and summer that the nymphs, which had lain dormant during the winter, will become active and possibly transmit the bacteria to humans. Unlike fleas, ticks do not jump from host to host but instead crawl to the end of long blades of grass and wait for an animal to brush against them. These insects are especially hard to spot because they are usually no bigger than the head of a pin.

Once a deer tick infected with Lyme disease has come into contact with a human, the transfer does not occur unless the tick has been attached to the body for 36 hours. Once the person is infected, symptoms can take between three and 32 days to appear. The most noticeable symptom is the characteristic bulls-eye rash known as “erythema migrans.”

However, this rash does not appear on nearly 40 percent of the people who contract Lyme disease.

The management coordinator at Fair Oaks Hospital, Mary Louis Nawrocki, advises people to look for other telltale signs besides the rash. "A person infected with Lyme disease often displays flu-like symptoms such as stiff joints, sore throat, fever, fatigue and headaches. People need to watch for these symptoms carefully if they know that they've come into contact with a tick," she said.

These symptoms disappear if left alone for a few weeks; however, if the disease is left untreated, serious complications can arise, such as disorders of the joints, nervous system or the heart. If treated promptly, usually with doxycyclin or amoxicillin, the early stages of the disease clear up within days, and complications are minimal to nonexistent. If complications arise — such as arthritis in weight-bearing joints, Bell's palsy or meningitis — treatment can still be successful using intravenous antibiotics.

IF SOMEONE DISCOVERS he has a tick embedded in the skin, it should be removed promptly. When removing the tick, people should use fin-tipped tweezers and grip the tick's body as close to the skin as possible, pulling straight out slowly and gently. Yanking the tick will only make removal incomplete, as the mouth contains barbs that attach to the skin. Afterward the wound should be washed and antiseptic applied. Do not use a lighted match or nail polish remover to attempt to remove the tick. It won't work and can lead to scarring. Petroleum jelly is also ineffective.