Parasitol Res. 2015 Feb;114(2):671-8. doi: 10.1007/s00436-014-4232-y. Epub 2014 Nov 22.
Pilot study assessing the effectiveness of factory-treated, long-lasting permethrin-impregnated clothing for the prevention of tick bites during occupational tick exposure in highly infested military training areas, Germany.
The protective effectiveness of factory-based permethrin-impregnated polymer-coated battle dress uniforms (PTBDUs) against tick bites was evaluated at four military training areas in southwestern and central Germany where tick bite incidence is known to be high. Data were analyzed by comparing tick bite incidence using non-permethrin-treated BDUs (NTBDUs) during 2009 versus PTBDUs during 2010 and 2011, the first two years after their formal introduction for in-country use in the German Bundeswehr. During 2009, 262 individual tick bites were reported at the four training sites, resulting in a tick bite incidence of 8.8 % per exposed person when wearing NTBDUs only. In 2010 and 2011, one tick bite case occurred under field conditions each year that PTBDUs were worn, corresponding to a protective effectiveness of 99.6 and 98.6 %. These data imply an annual tick bite incidence of 0.035 and 0.078 % per exposed person, respectively. Between 2010 and 2011, a 0.8 % decline in the protective effectiveness of PTBDUs was observed. Five tick bite incidents occurred while wearing non-impregnated parkas over correctly worn PTBDUs. Ixodes ricinus ticks were collected by standard tick drags from 2009 to 2011, with high mean annual densities ranging from 28.9 to 106.5 ticks per 100 m(2), while single drags revealed tick densities between zero and 381 ticks per 100 m(2).
Overall, 4596 I. ricinus ticks (54 ♂, 82 ♀, 1776 nymphs, and 2684 larvae) were collected, of which 128 (2.8 %; mean annual range, 0-10.1 %) were Borrelia burgdorferi s.l. positive. The Borrelia genospecies distribution was as follows: 112 (87.5 %) Borrelia afzelii, 10 (7.8 %) B. burgdorferi s.s., and 6 (4.7 %) Borrelia garinii. Neither the tick density means from 2009 to 2011 nor associated B. burgdorferi s.l. prevalences differed significantly among the military locations investigated.
The documented tick bite reductions clearly demonstrate the powerful protective effectiveness of properly worn PTBDUs against tick bites. Nevertheless, all apparel worn over PTBDUs should also be impregnated with permethrin in order to prevent tick infestation and subsequent bites.
Ticks are out for the summer: How can bites be prevented?
People who have experienced symptoms related to tick-borne disease generally say they wouldn’t wish these illnesses on anyone. Despite the educational information tick-borne disease patients repeatedly provide in the media and to their friends, many people do not act to prevent tick bites when participating in activities that may put them at risk.
The Tick-Borne Disease Working Group report released earlier this year (we reported on it here) stated that health care providers and the public do not understand the risks of tick-borne disease. Even when they do, information about prevention may not be easily accessible. Recreational parks and trails in Lyme-endemic areas of the United States, like New York state, are more likely to have signs that warn visitors about the dangers of tick exposure. However, tick-borne disease is reported around the country and these warnings are often missing in areas where it is not as prevalent.
Currently only four products are approved as tick repellents in the US. Two of these are categorized as “natural.” Other products that have shown promise in the laboratory are not making progress to market as quickly as they could. Fortunately, there is more that can be done to prevent tick bites.
Prevention starts with wearing clothing that covers the skin. Tuck pants into socks and wear light colors so ticks can easily be seen. When spending time in an environment where ticks may be present, do a whole-body check for ticks at least once every 24 hours. Ticks vary in size depending on their life stage and species, but deer tick nymphs can be as small as a fleck of black pepper. Therefore, it is essential to pay close attention to spots that may appear as new freckles or moles.
Bryon Backenson, New York’s deputy director of communicable disease control, relies on these steps for himself and his team. More than 300 times per year they enter tick-infested environments to collect ticks for surveillance. They cannot wear repellents since they’re actually trying to collect ticks. So far, no one on his team has contracted a tick-borne disease.
The two chemical tick repellents that are approved for human use in the US are Permethrin and DEET.
Permethrin has been developed to be similar to an extract from the chrysanthemum flower. Because of the variety of vector-borne diseases that it can help prevent, it is on the World Health Organization’s List of Essential Medicines.
While it is neurotoxic to arachnids, insects and cats, humans and dogs break it down quickly. Furthermore, less than 1% is absorbed through the skin in humans. Women who have had whole-body exposure to permethrin for scabies treatment during pregnancy have had good outcomes. However, permethrin can cause tumors in rats when eaten. It can also cause skin irritation, which is why it is generally used on clothing. It can sicken cats who get a secondary exposure from dogs or humans that have used the product.
When using topical preventatives containing permethrin on dogs, it is important to follow the usage directions on the label. Most preventatives require dogs to not be bathed within 24-48 hours of application because the natural oils the skin produces must be present for maximum efficacy. Preventing ticks on dogs helps keeps them out of homes and away from people.
An advantage of permethrin is that it can remain effective for more than 21 days after application to clothing. In addition, it does not seem to be toxic to young children. (Always check with your health care provider.)
DEET (tiethyltoluamide) is often used when the skin needs protection. A common commercial product contains 25% DEET and is effective for about four hours. DEET should not be used on infants under two months old, and DEET concentration and frequency of use should be limited on children under 12 years old. Too frequent and too heavy applications of DEET can cause poisoning even in adults, though most adults use DEET without problems. The US EPA has documented four deaths related to DEET. DEET can cause damage to some clothing.
So why do people still use DEET? Exposure to ticks in high-risk areas may make DEET risks lower than the risk of disease. For example, 5% of Appalachian Trail through-hikers contract Lyme disease.
There are also two “natural” tick repellents registered with the US Environmental Protection Agency (EPA) and one in the review process. These repellents should not be used on children under three years old. An overview of these repellents:
2-undecanone is derived from wild tomato. In laboratory testing, this chemical was more effective than DEET at repelling Ixodid species ticks, including those that carry Lyme disease. However, it can cause a skin reaction, especially after repeated applications.
Mixed Essential Oils (rosemary, lemongrass, cedar, peppermint, thyme, geraniol) are available in a variety of formulations. In testing, some formulations have proven more effective than others and effective for different lengths of time. Essential oils have been associated with allergic reactions, respiratory issues, chemical burns and other adverse reactions and may not be safe around babies or during pregnancy.
Nootkatone is an essential oil that can be derived from several sources and is currently under EPA review for development as a marketed product. In laboratory testing, an advantage of this product was that repelled ticks even at low concentrations, possibly reducing the risk of side effects.
Other products show promise as tick repellents, but none have been approved as marketed products in the US. For example, tea tree oil has been found to be effective in repelling ticks from cattle in a peer-reviewed published study, but it has not been studied and approved for human use in the US.
The biggest message in prevention is that tick bites are not inevitable. Tick-bite prevention works if done properly. The biggest barrier to prevention is awareness of the risk of tick-borne disease. If people do not understand the risk of tick-borne diseases, proper clothing seems like too much trouble, and thinking about the safety of tick repellents seems pointless.
This summer, let your friends and relatives know that even if they do not want to use tick repellents, they can use protective clothing. Repellents, in balance with the risk of tick-borne disease, should also be considered. With public education it is possible to reduce the number of people infected with tick-borne diseases.
Yim, W. T. et al. (2016). Repellent effects of Melaleuca alternifolia (tea tree) oil against cattle tick larvae (Rhipicephalus australis) when formulated as emulsions and in β-cyclodextrin inclusion complexes. Veterinary Parasitology, 225, 99-103. doi:10.1016/j.vetpar.2016.06007. https://www.ncbi.nlm.nih.gov/pubmed/27369582
As to the map of the black-legged tick, please remember, it’s not the only tick spreading disease and every single state has been affected by tick-borne illness. The South and places like California have fought hard to be recognized and thousands have gone undiagnosed because authorities state a certain tick or illness doesn’t exist there. For examples of this:
Based on our findings, health-care providers should be aware that migratory songbirds widely disperse B. burgdorferi-infected I. scapularis in Canada’s North, and local residents do not have to visit an endemic area to contract Lyme disease.
Our findings substantiate the fact that migratory songbirds transport neotropical ticks long distances, and import them into Canada during northward spring migration. Health care practitioners need to be aware that migratory songbirds transport pathogen-laden ticks into Canada annually, and pose an unforeseen health risk to Canadians.
So neotropical ticks are ending up in Canada. Doesn’t have a thing to do with climate change. Birds are transporting ticks in places they’ve never been before and bringing their pathogens along for the ride to infect animals and humans.
A tick may take anywhere from a few minutes to 36 hours to transmit diseases to humans, so it’s important that you remove it as soon as you find out you’ve been bitten by one
There are several tick-removal tools available in the market, such as tick tweezers, tick-removal cards and hook-like instruments. But if you don’t have any of these tools on hand, normal fine-tipped tweezers will work just fine
You can lower your risk for tick bites by repelling these parasites using essential oils, diatomaceous earth and garlic
Often mistaken for insects, ticks are small, eight-legged parasites that belong to the arachnid family, along with spiders, scorpions and mites.1 They survive solely by feeding on the blood of their host. They’re known to be resilient, with records suggesting that they existed 65 to 146 million years ago.2
Ticks are more active during warmer months, usually between March and November, living in warm and moist places like bushes, grasses and shrubs. Animals and humans can acquire ticks while walking through these areas.3 There are around 850 tick species in the world, which come in a variety of colors and sizes, but only a select few are known to bite humans.4
When a tick gets on your body, it’s not likely to bite right away. Rather, it will crawl around your body to look for a suitable place to feed, often choosing the soft and moist spots of skin such as on your ears, hairline, waistline, armpits and groin.
A tick will latch onto your body by piercing your skin with its mouth, inserting a feeding tube into the wound and feeding on your blood until it’s full. If not removed, the tick will eventually fall off on its own after it’s engorged — this could take anywhere from a few days to two weeks.5,6
Since tick bites are often painless, it can be hard to tell if you’ve been bitten or not. Some of the minor symptoms that tick bites cause include redness, swelling, itchiness and soreness on the bitten area.7While tick bites are often harmless, some can transmit serious diseases such as:8
A tick may take anywhere from a few minutes to 36 hours to transmit diseases to humans, so it’s important that you remove it as soon as you find out that you’ve been bitten by one.9
How to Remove a Tick Safely
A tick that has burrowed its way into your skin can be difficult to remove because of its barbed feeding tube,10 which also acts as its anchor to your body.11 There are several tick-removal tools available in the market, such as tick tweezers, tick-removal cards and hook-like instruments. But if you don’t have any of these tools on hand, normal fine-tipped tweezers will work just fine. If you’ve been bitten by a tick, follow this step-by-step guide to remove it safely:12,13,14
Grasp the tick with clean tweezers as close to your skin’s surface as possible — this helps you grab the tick as close as possible to its head.
Pull the tick out gently and with steady pressure. Avoid twisting or jerking it, as this can cause its head to break off and stay embedded in your skin. You should also avoid squeezing the tick, since this could squeeze the infectious fluid out of it.
After the tick has been removed, thoroughly clean the bitten area with soap and water. Temporarily put the tick in a sealed container, so you can show it to your physician in case you develop other symptoms after a few days.
How to Remove a Tick Head
It’s not uncommon for a tick head to remain stuck in the skin despite careful removal. Here’s how to tell if a mouthpart of a tick is still stuck in your skin and what you should do to properly remove it:15,16
After pulling out a tick, inspect the bitten area for a small black dot. This is an indicator that the tick head is left behind.
Using pointed tweezers, try to remove the remaining part.
After removing the tick head, clean up the bite area with soap and water.
If you can’t get rid of a lodged tick head, contact your physician to have it removed. Although the tick head will eventually be expelled from your body as the wound heals, it’s still best to have it removed to reduce your risk for infections.17
3 Natural Tick Repellents
To avoid being bitten by ticks, use these natural repellents to keep them at bay, especially during the summer months:
Essential oils — Some of the essential oils that have been found to be effective at repelling ticks include citronella, lemongrass, rose geranium, peppermint and citrus oil.18 These oils can be applied on clothing, lawns and gardens.19 You can also use them on your skin, provided that you dilute them with a carrier oil like coconut oil.20
Food-grade diatomaceous earth (DE) — DE absorbs the oils and fats from the exoskeleton of ticks, causing them to die of dehydration.21 If you want to get rid of ticks around your home, sprinkle this white powder in places where ticks may nest, such as in moist and shaded areas. Be sure to limit its use to places where ticks may hide, as DE can also kill beneficial insects.22
Garlic — According to a study published in the Journal of Medical Entomology, multiple applications of garlic juice-based products on a residential landscape may help suppress tick activity.23
Aside from using the natural tick-repellents mentioned above, you can also reduce your risk for tick bites by simply avoiding areas where ticks are likely to be found, such as tall grasses, shrubs and leaf litter. Wearing protective clothing such as long sleeves, closed shoes and pants tucked into your socks also helps keep ticks from making their way to your body. You should also check your body for ticks every time you come in from the outdoors and while you’re showering.24
What Not to Do When You’re Bitten by a Tick
There are many misconceptions regarding the proper removal of ticks. Some recommended methods are ineffective and will only increase your risk for an infection or injury, so they’re best avoided. These include applying petroleum jelly, nail polish, toothpaste or glue to the tick in an attempt to suffocate it, as well as using sharp forceps, squeezing the tick’s body, or poking it with a hot match or nail.25
Frequently Asked Questions (FAQs)
Q: What do you do if you pull a tick out and its head stays in?
A: You can either remove the stuck tick head on your own or you can have it removed by a doctor.26
Q: What happens if the tick’s head stays in?
A: Stuck mouthparts are often harmless, but they can sometimes cause inflammation or increase the risk for infections, so they’re best removed as soon as possible.27,28
Q: How do you tell if a tick’s head is still embedded in your skin?
A: If a tick head is left behind in your skin, you will see a small black dot on the bite site.29
Q: How do I remove an embedded tick head?
A: You can try to pull out a stuck tick head using a pair of pointed tweezers.30 However, if you can’t remove it easily, do not try to dig it out. Instead, contact a medical professional so they can safely remove it for you.31
Q: Can a tick head regrow its body?
A: No, a detached tick head won’t be able to regrow its entire body. Ticks can only regenerate lost body parts like their legs.32
Q: Do ticks fall off on their own?
A: Yes. If not discovered and removed manually, ticks will continue to feed on their host until they’re full, after which they fall off on their own.33
Q: When should you consult your doctor about a tick bite?
A: Contact your doctor if you develop a rash on the site of the tick bite and if you experience flu-like symptoms. You should also seek immediate medical attention if you experience severe headache, difficulty breathing, paralysis or heart palpitations after being bitten by a tick.34
Fairly accurate article. A few considerations:
Keep the tick not only to show your doctor but also if you are considering having the tick tested. Many states have free tick testing (WI doesn’t). If you develop symptoms it may be well worth your while to find out what the tick could have transmitted to you. Wisconsin IS a part of the Tickapp program and you can register here: https://madisonarealymesupportgroup.com/2018/05/31/tick-app-wi-tick-chats-testing/ They aren’t testing ticks for pathogens but they are tracking them. From the website: “You can send the image of your tick or tick to us, but we are not testing them. Even if a tick is tested for pathogens and none were detected, that does not mean that there is zero chance of you developing a disease.” Important disclaimer.
The article recommends the “wait and see” approach which hasn’t worked for over 40 years. Everyone agrees that prompt diagnosis and treatment is essential yet they continue to promote a lazy approach. In my opinion, particularly if you live in an endemic area, start prophylactic treatment for Lyme disease if you’ve been bitten by a black-legged tick. A month’s worth of doxycycline is far cheaper and less risky than the potential for needing antibiotic treatment for years and years. Don’t even waste your time and money on testing if you were recently bitten. CDC-2 tiered serology testing has missed up to 86% of all cases in one study.
To date, the following are 19 diseases (they keep adding to) are transmitted by ticks:
5. Recently I gave a presentation to the local high school health occupations class on all things Lyme/MSIDS. I was amazed at how little they knew. People STILL aren’t educated on a disease(s) that can kill them or make them want to die.Spread the word. Educate others as this isn’t going away.
“I know there’s a lot of other diseases that we take very seriously, and I think this is something that may have kind of been left on the back burner,” said Rep. Jeff Mursau. “There’s about a dozen states that have gotten out in front of it … and Wisconsin has fallen behind.”
Mursau is one of four lawmakers tackling the issue with a package of five bipartisan bills.
Wisconsin was the fourth worst state in the nation for the numbers of Lyme disease cases in 2017. There were an estimated 4,000 cases, according to the Wisconsin Department of Health Services.
The proposals require the Department of Natural Resources to post signs and provide brochures in state parks and forests informing visitors about how to prevent tick bites and encouraging them to check for ticks after visiting. All state parks and forests would required to sell bug spray with DEET, which can help repeal ticks, under another bill.
Bridget Brown, a section chief for parks operations, said the DNR currently provides information and recommendations in pamphlets and takes steps to educate staff and park visitors about ticks. She said third party groups sell bug spray with DEET in some state parks.
Her main message for visitors this summer: “Be aware that ticks are everywhere.”
Another proposal would require an epidemiologist position at the state Department of Health Services’ Division of Communicable Disease be dedicated to vector-borne diseases spread by mosquitoes, ticks and other insects with a specific focus on Lyme disease.
Brown said state and federal recommendations are to wear clothing that will detract ticks. She said there are ticks in every part of Wisconsin. Deer ticks, wood ticks and lone star ticks can all be found in Wisconsin.
Alicia Cashman, who leads the Madison Area Lyme Support Group, said she is glad that lawmakers are taking the issue seriously. Her entire life was altered when she got Lyme disease several years ago.
“I no longer go into the woods, I no longer visit those places,” she said.
“I spray my yard and I go outside wearing light colored clothing, pants tucked in my socks looking like a geek, but I don’t want to go through this again,” she said.
She’s on board with all the bills except one that establishes a 16-member tick-borne disease study committee to create a report for the Legislature recommending policy changes. The recommendations would have to be “consensus-based,” and Cashman said the issue is so complex that it would be difficult to come to a consensus while also maintaining equal representation of all the stakeholders.
Cashman said the package of bills are a good step, but she believes the state needs to go further in trying to address Lyme disease.
“I think that there needs to be more awareness for sure,” she added.
Mostly accurate, but what I actually said was that consensus will be difficult to reach due to the polarity within the medical community due to there being disagreement on pretty much every single issue related to Lyme/MSIDS.
I also expressed a concern that patients who are chronically ill would have representation from qualified ILADS trained doctors who treat this appropriately and understand the complexity.
After hearing back from a Wisconsin Lyme literate doctor, I now believe the entire #5 bill should be omitted. This doctor pointed out that this is government over reach into the medical profession and pointed out how this is not happening in any other disease. Consider if there was legislation on how doctors treat diabetes, cancer, or Autism.
If you are a patient being treated by one of these practitioners, please tell them how much we need them to be willing to get involved should these bills move forward. My greatest concern is that a potential 16 member panel will only be filled with those espousing the antiquated and unscientific CDC 2006 guidelines that have been removed from the NGC in 2016 for failing to meet federal standards evidence-based clinical practice guidelines, as well as huge government overreach.
We need to protect the freedom our current Lyme/MSIDS treating doctors have but not allow the government to dictate how they treat patients.
Bill #5:LRBs 1652 and 3362 – Establishes a sixteen-member Tick-Borne Disease Study Committee to create a report for the legislature on consensus-based recommendations for policy changes on awareness, prevention, surveillance, diagnosis, reporting, and treatment of Lyme Disease.
I also warned the sponsors of the bill that Lyme rarely comes alone and that many patients are infected with a number of pathogens all requiring different medications for a longer duration of time. I offered to present a Powerpoint on these issues. Pray they’ll take me up on it. I know these bills are well-meaning but they could potentially make things more difficult for patients and the doctors who dare to treat them.
The bill of particular concern in #5 in that it: “Establishes a sixteen-member Tick-Borne Disease Study Committee to create a report for the legislature on consensus-based recommendations for policy changes on awareness, prevention, surveillance, diagnosis, reporting, and treatment of Lyme Disease.”
As you can read from my letter above, nothing about Lyme/MSIDS is agreed upon except the fact early detection and treatment is imperative. If this 16 member committee is only filled with CDC/IDSA believers, patients and the doctors who dare to treat them are doomed as it will be business as usual. Chronically infected patients need representation by qualified ILADS trained practitioners who understand the complexity of diagnosis, testing, and treatment.