‘Tis the Season: Addressing Tick-Borne Illnesses
Andrew Handel, MD, discusses prevention, how to remove ticks, and the burden of Lyme disease in certain populations.
With the warm weather brings the return of people being outside and the possibility of contracting tick-borne diseases. According to the Centers for Disease Control and Prevention (CDC), more than 89,000 cases of Lyme disease were reported in 2023 by state health departments and the District of Columbia. However, these numbers come from routine national surveillance and may underrepresent the actual burden. 1
CDC also estimates that approximately 476,000 people in the US are diagnosed with Lyme disease each year using other data collection methods. This number likely includes patients who are treated based on clinical suspicion but do not actually have Lyme disease, according to the federal agency.1
A newly published study in the Journal of Medical Entomology provides critical insights into the emergence of babesiosis—another tick-borne illness—in the Mid-Atlantic region. Babesiosis can be more severe than Lyme disease, and can become a life-threatening disease for the elderly. 2
With this possibility, it is important for clinicians and the general public to consider tick-safety when outside in areas where they live.
“Ticks tend to live on tall grasses and brush in forested areas, so if you go out and you hiking and you know you're going to be in exposed areas where ticks like to live, you want to make sure to stay in the middle of that path, far away from the sides where the ticks are hanging out on the tall grass waiting to grab onto you,” Andrew Handel, MD, said.
Handel is a pediatric infectious diseases physician at Stony Brook Children's Hospital and at Stony Brook’s Regional Tick-Borne Disease Center in Hampton Bays, NY, which is the first and only dedicated tick clinic in the Northeast. The center offers tick removal, diagnosis, and treatment. It can test for tick-borne illnesses as well as counsel patients on tick bite prevention and tick identification.
Prevention Strategies
Handel explains that along with trying to stay clear of areas where the ticks live, there are several other strategies to stay tick-free. These include:
- Wear light-colored, long-sleeve shirts and pants to make ticks more identifiable.
- Tuck your pants into your socks so the ticks don't have access to your skin
- Use 20-30% DEET insect repellent
- Perform routine tick checks when coming from the outdoors or nightly tick checks
- Check unexpected and common places on your body for ticks. Ticks love to hide in the beltline, behind the ears, hairline, and in skin folds
- If outdoors for an extensive time, consider treating clothes with permethrin, which kills ticks on contact
- Put your clothes in the dryer for 10 minutes on high heat to kill any ticks
Checking for Ticks and Pulling Them Off
Handel says it is important to check for ticks after being out in nature, and for those who live in endemic areas such as the northeastern part of the US. In these latter areas it is a good habit to get into even when just out in the yard. He offers some guidance on checking for them.
“You want to really inspect all of your skin, head to toe, looking for any small ticks—many of them look like just the size of poppy seeds. Areas that are really important to check are behind the ears, along the beltline, and in skin folds,” Handel said. “Ticks really like to get into the skin folds, so whether that's in the armpit or the groin, and hide there, making it difficult to find them. And any areas that have hair you want to search really well there too, because again, the ticks have a way of getting underneath the hair and making it really difficult to find. So if you're not thorough, you might miss one.”
In terms of pulling ticks off, Handel says there is a very specific method.
“With your tweezers, you're going to grab them as close to the skin as possible, right at the head of the tick, where it's biting, and just firmly pull it upward. You don't want to twist it. You don't want to grab the belly and squeeze it. That can actually make it more likely that you end up with a tick-borne infection,” Handel said. “So you're going to take the tick, remove it very gently with the tweezers and put it in a sterile container, or a sealed container." He says by holding onto the tick it can be identified, which can be understood if it is a potential carrier of Lyme disease, for example.
He also cautions people not to try other methods such as burning the tick off or putting petroleum jelly or an ointment on the spot where the tick is. He says this could also lead to tick-borne infections.
Lyme Disease in Specific Populations
Lyme disease has a tendency to be in 2 populations: children of a certain age and seniors. “The first is in children, when they're around 5 to 9 years old. And then a second peak happens in older adults, generally starting around 60 years or older,” Handel said. “There's not definitive proof as to why it happens, but it seems to be exposure to the ticks.”
Stony Book has a free tick-borne disease helpline. For people interested in using it, they can call (631) 726-TICK (8425).
