FACEBOOK LIVE WITH DR. FRID
Dr. Elena Frid will be speaking with Teresa Priolo about Lyme disease prevalence, symtoms, and prevention tips against ticks.
May 19th – 11:00 AM
Go to Fox5 Facebook: https://www.facebook.com/FOX5NY/
https://www.ruralhealthinfo.org/rural-monitor/tick-borne-diseases/ MAY 17, 2017 by Jenn Lukens – The Rural Monitor
Blacklegged ticks are known to carry the bacterium Borrelia burgdorferi, the pathogen that causes Lyme disease (Photo credit: James Gathany, CDC Public Health Image Library)
Part parasite and part predator, the tick has become one of the nation’s most harmful bugs. Overgrown, humid areas are prime real estate for these critters, making rural America more susceptible to their growing numbers and the diseases they carry.
Even with the paranoia they incite, ticks have managed to lie low, out of the spotlight. Not until recently has the national conversation started picking up speed as Lyme and other tick-borne illnesses have become the most prolific zoonotic diseases in our nation. Lyme disease, the most-reported of the 20+ tick-borne diseases in the United States, is estimated to infect around 300,000 people every year.
Thankfully, out of the 90 tick species found in the U.S., only a handful are known to transmit bacteria harmful to humans. But the microscopic pathogens that have evolved with the growing tick population can cause a myriad of health issues including neurological disorders, heart problems, extreme fatigue, depression, and even death, to name a few.
Many individuals and groups are working to eradicate these diseases, or at least decrease their incidence. Scientists are developing vaccines. Medical researchers are studying alternative diagnostic and treatment methods. Organizations are actively promoting policy changes and increased funding. Each effort is one step closer to blocking the rapid spread of tick-borne diseases across the nation.
Nancy Lankow isn’t sure how she missed it. She and her husband habitually do tick checks before bed, but she didn’t notice the blacklegged tick attached to her upper arm. She suspects picking it up in the flowerbed or woods outside her country home near Hackensack, Minnesota. It took some effort getting it out. “It was well dug-in. As you can see from the picture, it looked like it was headed to the other side of the earth,” said Lankow.
She sent the photo and a note to her primary care physician at the Essentia Health St. Joseph’s-Brainerd Clinic, a rural facility about 60 miles from her home. By the time the clinic called back, a bull’s-eye rash had spread on her arm. Lankow recalled, “They said, ‘Can you be here by four o’clock?’ I decided, at that time, there was no question that it was Lyme.”
Lankow’s case was classic. Her bull’s-eye rash is the most recognizable symptom of Lyme disease, but it doesn’t appear in every case. The corkscrew-like bacteria that causes Lyme can drill into any part of the body, invoking a constantly changing set of symptoms.
With one look at the infected area, Lankow’s doctor prescribed several weeks of antibiotics – the recommended treatment for most tick-borne diseases – and commended her for being proactive. Waiting even a few weeks could have put her at greater risk for a prolonged battle with Lyme disease. For rural residents like Lankow, the ability to see a local medical provider and begin treatment within days of showing symptoms is critical.
In general, rural residents are more susceptible to tick-borne illnesses because of their proximity to preferred tick habitats, whether through their occupation or recreational activity of choice. Rural landscapes offer an ideal environment for disease-producing bacteria and their zoological hosts.
Growing up in a rural area, Lankow was used to ticks, “but now Lyme disease has upped the ante,” she stated. Minnesota is ranked in the top seven states with the most reported cases of Lyme, an indication that the disease, which started in the Northeast, is on the move. Reforestation, increased travel, changing weather patterns, and changes in ecosystems and small mammal communities are just some factors contributing to the increase and migration of tick-borne illnesses.
The number of reported tick-borne disease cases has increased over the past two decades. At least a quarter of all new Lyme cases occur in children ages 5-14, affecting their ability to learn, socialize, and even get out of bed. Experts agree that their susceptibility is largely due to lifestyle, as children tend to spend more time outdoors than other age groups.
Although Lyme is the most common tick-borne disease in the U.S., numerous others exist and new ones are being discovered. Anaplasmosis, Babesiosis, Ehrlichiosis, Powassan virus, Rocky Mountain Spotted Fever (RMSF), and Tularemia are just a few. Diseases tend to claim different parts of the country, incite different symptoms, and are transmitted from different tick species.
Dr. Maria Gomes-Solecki is a doctor of veterinary medicine studying the development of oral vaccine delivery vehicles at the University of Tennessee Health Science Center. One of her accomplishments has been the invention of a vaccine that prevents the spread of Lyme disease in white-footed mice, a common host, thereby reducing the number of ticks carrying the Borrelia burgdorferi bacterium.
Her vaccine was tested via pellets put in live traps and strategically placed throughout a few sites the size of football fields in southeast New York. Mice that ate the pellets received a boost in antibodies, killing the B. burgdorferi bacterium inside their bodies. The results of the 5-year study showed a 76% reduction of the pathogen in nymphal ticks (the kind that transmits the bacterium to humans). Her field study, funded by the Centers for Disease Control and Prevention (CDC) and the National Institute of Health (NIH), provides a method for inducing “protective immunity” from tick-borne diseases through animals.
“If you just target mice and are able to reduce the number of infected ticks, it should be a huge impact in the number of people infected later down the line,” said Gomes-Solecki. Currently, the vaccine is circulating through United States Department of Agriculture (USDA) licensure process for commercialization approval. Gomes-Solecki and her team have rural areas in mind for upcoming pellet distribution.
“In a completely rural area, you would have to think about distribution from planes or something on more of a mass scale,” commented Gomes-Solecki. “In state and local parks, the park departments often know where the populations of animals are and know where to put the boxes that would contain the vaccines.”
The vaccine is one of several efforts of its kind to decrease tick-borne diseases through ecological methods. This One Health approach, or “the collaborative efforts of multiple disciplines – working locally, nationally, and globally – to achieve the best health for people, animals, and our environment,” is what CDC, USDA, and zoonotic experts are looking to as the solution for managing and reducing the spread of diseases like Lyme. Her work to develop a human vaccine is on hold for now, waiting for more funding in order to continue.
Dr. Robert Bransfield, clinical associate professor at Robert Wood Johnson Medical School and former president of the International Lyme and Associated Diseases Educational Foundation (ILADEF), sees patients with tick-borne diseases at his private practice in Red Bank, New Jersey.
Bransfield speaks from experience: “When there is a failure in the healthcare system, people are sent to psychiatrists.” His patients come from all over the country, even flying in from rural areas where psychiatrists are few and far between. Loggers, farmers, Amish, and Mennonites – most arrive after the cognitive problems have already set in.
By the time they get to him, “They are sick, and they feel lost. Insurance companies are turning their backs on them, families don’t understand it, employers don’t understand it, and they don’t understand it. They feel upset and need to know how to deal with something that we call an ‘invisible disability.’”
In many cases, the brain is one of the last places the bacteria hits, so many of Bransfield’s patients have had ongoing symptoms for years. “I see depression, people who are suicidal. Sometimes they can get violent.” According to Bransfield’s research, as many as 1,200 suicides every year in America are related to Lyme disease. Those with mental symptoms from Lyme are in the hundreds of thousands.
They are sick, and they feel lost. Insurance companies are turning their backs on them, families don’t understand it, employers don’t understand it, and they don’t understand it. They feel upset and need to know how to deal with something that we call an ‘invisible disability.’
In his article Lyme Disease and Cognitive Impairments, Bransfield explains that the cognitive symptoms of Lyme disease include difficulty sustaining attention, memory, processing information, slurred speech, reading comprehension, and organization/planning. Bransfield recalls seeing these symptoms in patients at his practice in the Great Dismal Swamp region on the border of Virginia and North Carolina before Lyme disease was a known illness. Conversations would include delayed responses and grasping for words. “It was the oddest thing. People at the clinic didn’t understand it,” he recalled. It wasn’t until after Lyme disease was discovered in the early 1980s, that Bransfield made the connection.
Because of the complexity of tick-borne diseases, Bransfield uses a multi-level approach to finding a solution. He starts by treating the symptoms. “Whether depression, anxiety, or insomnia…I methodically attack each of those [symptoms] and try to improve them. That can often break the cycle of disease progression,” he said. Sometimes this includes prescribing antibiotics, and other times, it’s with things like a CPAP machine for better sleep.
Since the 1990s, Pat Smith and her national nonprofit, the Lyme Disease Association, Inc. (LDA), have been encouraging the passage of a bill allowing a work group to advise the government in Lyme disease solutions and research priorities. Earlier this year, Congress passed the 21st Century Cures Act, which addresses the needs of many diseases and includes the formation of a tick-borne diseases working group.
Lyme patients, advocates, treating physicians, and researchers will join the work group set to start by the end of 2017. “We will have representation at the table from those who have been most affected by the disease,” said Smith. “This will be a huge game changer that would influence public policy and, we hope, funding.”
Smith was on her New Jersey district’s board of education when Lyme broke out in the 1980s. She got involved with a state-wide Lyme organization out of concern and because of her own experience with the disease: two of her daughters contracted Lyme, one missing school for years as a result. Smith became president of the group and helped develop it into LDA. Run by volunteers, the organization’s mission extends well beyond its policy work — it also funds research and education efforts, as well as paying for diagnoses and treatment for uninsured children who have Lyme disease. LDA also serves as the lead organization for LDAnet, a network of 45 independent tick-borne illness groups across the country.
LDA often awards educational grants to its partners, many of whom are working to improve the situation for rural areas: events like the one Midcoast Lyme Education and Support recently put on in Maine’s rural midcoast region draws people from every part of the state. LDA’s educational materials are distributed regularly to public health offices, the military, individuals, schools, and partner groups like the Lyme Association of Greater Kansas City that supplies school nurses in rural districts with LDA resources.
I was stunned to realize how much I didn’t know that was already knowable. My conception of Lyme – a bit of a rash, maybe some achy joints, then you get an antibiotic and everything goes away – was inaccurate.
While practicing in rural Howland and Lincoln, Maine, Dr. Beatrice Szantyr, an internist/pediatrician now retired from clinical work, took a closer look at the disease to help a patient. “I was stunned to realize how much I didn’t know that was already knowable. My conception of Lyme – a bit of a rash, maybe some achy joints, then you get an antibiotic and everything goes away – was inaccurate,” she recalled.
She attributes the lack of clarity among the medical community to the emphasis on certain objective aspects of the disease when it was first uncovered. “In retrospect, that likely suppressed some of the early information that was really important to have,” said Szantyr. Additionally, the lack of highly sensitive and reproducible tests, the persistence of illness in some patients despite treatment with antibiotics thought to be effective, and the still incomplete science of this infection have resulted in conflicting views about Lyme disease.
The debate is ongoing in the medical field and government groups specifically regarding its definition, diagnosis, and treatment.
Szantyr has spent thousands of hours exploring and educating medical and public audiences on tick-borne diseases. As a member of the International Lyme and Associated Diseases Society (ILADS), medical advisor to MaineLyme, and member of Maine’s Vector Borne Disease Work Group, she has helped to bring tick-borne illnesses to the forefront of medical and public health conversations in her state.
When advising clinicians regarding diagnosing a tick-borne disease, Szantyr said, “You cannot abdicate your clinical judgement. No laboratory test is ever going to be better than putting together all the data that you have and making a clinical assessment.” She also recommends providers have a working knowledge of local tick-borne diseases and not dismissing symptoms just because there are no known local cases of the disease. As people and animals travel, so do ticks, widening the spread of their growing population. Doctors can boost their knowledge and get continuing medical education (CME) credits through courses like Dr. Elizabeth Maloney’s Partnership for Tick-borne Diseases Education.
Dr. Beatrice Szantyr’s tips for preventing tick-borne illnesses:
When caught early, antibiotics have been shown to be effective treatment for Lyme and other tick-borne disease. Follow up is important. In Lankow’s case, the rash went away and no other symptoms set in after her three-week antibiotic cycle. The experience has made her a strong believer in prevention and early detection. “Keep watching and respond quickly. Don’t wait. My daughter learned that the hard way.”
Keep watching and respond quickly. Don’t wait. My daughter learned that the hard way.
Lankow’s daughter was diagnosed with Lyme after several weeks of escalating symptoms, which became debilitating. Several other family members have also had the disease, including her husband. But, like so many rural residents, that hasn’t stopped them from enjoying the great outdoors, gardening, and cutting and splitting firewood. “I don’t think it’s going to make a big change in what we do. We’ll be very careful on tick checks and perhaps more assiduous with tick spray,” said Lankow.
Additional Resources
http://www.wkow.com/story/35435206/2017/05/15/wisconsin-health-officials-warn-of-tick-borne-diseases-as-summer-nears Posted: May 15, 2017 6:25 PM
WKOW 27 abc was at my house today. Video in link above.
DANE COUNTY (WKOW) — As peak tick season begins in May, public health officials are warning to be extra careful of tick-borne diseases this year.
https://rawlsmd.com/health-articles/effective-tick-repellents-lyme-seasonutm_campaign=may+6+2017+rawlsmd+newsletter%3A+soul+doctor+%28LRvgrS%29&utm_medium=email&_ke=YWNhc2htYW5AY2hhcnRlci5uZXQ%3D&utm_source=master+rawlsmd+segment++%5Blive+-+2-26-17%5D Dr. Rawls and Ellen Berman 4/19/17
How to Avoid Ticks
Stay on the trail. Ticks hide under moist leaf litter until climbing onto a blade of grass, a twig or branch. Once in dry air they don’t last very long. Open, unshaded areas, well-managed trails, and mowed yards free of leaf litter are less likely to harbor ticks.
Cover up. Before you venture outdoors, cover your body with clothing. Wear a light-colored, long-sleeved shirt, and pants all the way down to your feet.
Be extremely vigilant. Whenever you brush by vegetation, stop and check for the possibility of a tick crawling up your legs or body. Ticks are difficult to spot and some are smaller than a pinhead. Put on reading glasses if you need help spotting a tiny critter.
Treat your pets. All blood-sucking insects carry potential disease-causing microbes. Since pets bring ticks inside, have your pet regularly treated to reduce ticks and fleas.
WHEN YOU COME INDOORS:
Check your clothes for ticks. Tumble dry clothing on high heat for at least ten minutes.
Take a shower. Showering within two hours of coming indoors helps wash off unattached ticks and gives you a chance to thoroughly check your body.
Conduct a full body check. Be aware that ticks prefer warm, moist places, so pay special attention to armpits, in and around the ears, back of knees, between the legs, and around your hair.
New Picaridin Repellents Outperformed DEET
Update by Kathy White, MSW, April 3, 2017
To repel ticks and mosquitoes, the CDC website recommends permethrin (an insecticide) on clothing plus DEET or picaridin on exposed skin. Picaridin has been used for decades in other countries and is now available in the U.S. It is less toxic than DEET and is approved for children.
http://www.consumerreports.org/products/insect-repellent/ratings-overview/ This review will show you the active ingredient, effectiveness for mosquitoes and ticks, type, cost, and if it resists damage to materials.
For instance the top 3 scores for deer ticks was:
Oil of lemon eucalyptus is not for children under age 3. It can cause eye irritation. Natrapel with 20% picaridin (available at Target) also worked better than DEET. Repel Scented Family Repellent with 15% DEET worked better than Deep Woods Off with 25% DEET, perhaps because of the fragrance. These two DEET products were rated in the top 5. Ecosmart Organic repellent and IR3535 didn’t work too well. Citronella candles and wristbands and the natural oils geraniol, lemongrass, and rosemary didn’t work at all or lasted less than an hour.
Permethrin, an insecticide, repels ticks and insects. If ticks & insects touch it, they won’t bite and will drop off & die. Apply it to clothes (never skin), the outside of shoes, backpacks, tents, & sleeping bags. Follow label directions. Don’t spray it on the clothes of young children who put things in their mouths. For more on Permethrin: http://www.tickencounter.org/prevention/permethrin
You can purchase treated insect shield clothing with permethrin already embedded or do it yourself: http://npic.orst.edu/pest/mosquito/ptc.html
Does it work? http://www.tickencounter.org/prevention/should_i_wear_tick_repellent_clothing
Subjects wearing permethrin-treated sneakers and socks were 73.6 times less likely to have a tick bite than subjects wearing untreated footware. Subjects wearing permethrin-treated shorts and T-shirts were 4.74 and 2.17 times, respectively, less likely to receive a tick bite than subjects wearing untreated shorts and T-shirts. On subjects wearing untreated outfits, 97.6% of attached nymphs were alive, whereas signifcantly fewer (22.6%) attached nymphs were alive on subjects wearing repellent-treated outfits.
http://www.consumerreports.org/insect-repellents/permethrin-treated-clothing-mosquito-bites/ Consumer Reports tests 3 brands and found that the clothing was less effective for mosquitoes after being washed. No data on effectiveness for ticks.
https://www.epa.gov/insect-repellents/find-insect-repellent-right-you The EPA also has this website; however, they do not endorse any product and rely upon the manufacturer’s honesty. For instance, you can type in time you want to be protected (I typed in 5-8 hours), and insect (I typed in tick). I left all other boxes blank to get the most results. The results were similar to the Consumer Report review, but check it out for yourself, realizing that there often is not third party testing.
You can also get Lyme EZ Tick Gaitors, www.LymeEZ.com
https://player.vimeo.com/video/146926372“>
How to Remove a Tick: http://www.tickencounter.org/prevention/tick_removal
The steps to safely removing a tick start with a pointy tick removal tweezer. Most household tweezers have large, blunt tips in comparison to ticks. This only increases the chances of tearing the tick and spreading possible infections into the bite area.
https://madisonarealymesupportgroup.com/2017/02/04/methods-of-tick-removal-a-systematic-review-of-the-literature/ (Use fine pointy tweezers or tick removal tool)
https://madisonarealymesupportgroup.com/2016/07/02/nifty-tick-removal-and-how-to-check-for-ticks/ (Tick Ease removal tool and video)
Tick Removers:
A study at Ohio State University in 1995 compared the Pro-Tick Remedy to two other tick removers and tweezers. www.tickinfo.com The researchers found that the Pro-Tick Remedy was better than tweezers & the other tick removers at removing ticks with all the mouthparts intact, and did the best job of removing the cement. (Ticks inject “cement” to hold the tick in place while feeding. The cement isn’t known to cause health problems, but it can cause irritation until the body absorbs it. It causes a hard lump until it is absorbed, which can take a few weeks or more.)
The report said, “While others (tick removers and tweezers) broke the tip of the hypostome and chelicerae (mouthparts) in at least one tick, the Pro-Tick Remedy succeeded in removing all 51 ticks without damaging any mouthparts . . . the Pro-Tick Remedy removed the most … cement while causing the least damage.”
A second study included Lone Star ticks, which have a longer hypostome and are harder to remove. All the tick removers tested did very well at removing adult ticks & were much better than tweezers for the tiny nymphs. The Pro-Tick did better than any other tool tested at removal of nymph ticks. It removed all the mouthparts of 72% of the Lone Star nymphs. Tweezers only removed all the mouthparts in 4% of the nymphs. The researchers concluded that tweezers should never be used for removing tick nymphs. The Pro Tick Remedy is sold at www.scs-mall.com, or you can buy it by sending a check for $6.50 payable to “Lyme Association of K.C.” to: Lyme Association of Kansas City, P.O. Box 25853, Overland Park, KS 66225.
Powassan Virus Is the Scary New Reason to Avoid Ticks
Amanda MacMillan
May 04, 2017
For more, visit http://time.com/time-health/.
http://time.com/4767290/powassan-virus-ticks/ (Video here)
Lyme disease isn’t the only tick-borne illness that can come from a walk in the woods. Health experts are warning that another pathogen, Powassan virus, can cause dangerous inflammation in the brain and may be transmitted to humans much faster than Lyme. While it is rare, a recent study of ticks in Maine, along with a few widely reported cases of human infection, suggest that it may be becoming more common. /react-text
What is Powassan virus?
The virus causes encephalitis, or swelling of the brain, and it kills about 10% of people who become sick, https://www.cdc.gov/powassan/symptoms.html.
About half of people are left with permanent neurological problems.
Powassan virus was first identified in 1958 and was first recognized in deer ticks, the type that bite humans and also carry Lyme disease, in the mid-1990s. About 75 cases have been reported to the CDC over the last 10 years, and most have been in the Northeast and the Great Lakes region. https://www.cdc.gov/powassan/statistics.html
One of those cases, in 2013, was a woman in Maine who died a few weeks after being bitten by a tick and contracting Powassan virus. Her diagnosis, along with two subsequent cases in the same county, prompted scientists at the Maine Medical Center Research Institute to test ticks at various sites across the state.
The researchers released their preliminary findings in April and told Bangor Daily News that, “We were kind of surprised that we found as much as we did.” Out of 203 different pools of adult ticks—meaning all of the ticks collected from a given area—15 tested positive for Powassan. The researchers also found that populations of deer ticks were increasing in several areas in the state. http://vitalsigns.bangordailynews.com/2017/04/26/home/tick-researchers-found-powassan-virus-in-these-maine-towns/
Another recent CDC case report detailed the first-ever diagnosis of a human Powassan infection in Connecticut: a 5-month-old baby who was admitted to the hospital in November 2016 for vomiting, fever and seizures. The baby’s parents reported that he had been bitten by a tick about two weeks earlier and estimated that the tick bad been attached for less than three hours. The baby spent a week in the hospital, and it took several months for him to fully recover. https://www.cdc.gov/mmwr/volumes/66/wr/mm6615a3.htm?s_cid=mm6615a3_w#contribAff
Should you be worried about Powassan virus?
This news, coupled with experts’ prediction that 2017 will be an especially bad year for ticks in the Northeast, is cause for concern. So is the fact that Powassan is deadlier than Lyme disease—and appears to be transmitted much faster. In animal studies, Powassan virus could be passed from tick to host after only about 15 minutes of attachment. For Lyme disease, it takes 24 hours. http://www.npr.org/sections/goatsandsoda/2017/03/06/518219485/forbidding-forecast-for-lyme-disease-in-the-northeast
***This statement about Lyme transmission time is not accurate. Please see this article: https://madisonarealymesupportgroup.com/2017/04/14/transmission-time-for-lymemsids-infection/***
But Rafal Tokarz, associate research scientist at the Columbia University Mailman School of Public Health, stresses that Powassan is still very rare, and says it’s too early to know for sure if Powassan is truly becoming more prevalent.
Tokarz’s own research, mostly on ticks in regions around New York City, has shown that only about 1% to 2% of ticks are infected with bacteria that cause the Powassan virus. That finding is consistent with most studies that have been done in other parts of the country, he says. https://www.mailman.columbia.edu/public-health-now/news/scientists-uncover-details-rise-tick-borne-disease-long-island
MORE: A New Cause of Lyme Disease Has Been Discovered
http://time.com/4212500/a-new-cause-of-lyme-disease-has-been-discovered/?iid=sr-link6
The recent report from Maine suggests higher numbers, but Tokarz points out that the researches tested entire pools at once. So while about 7% of tick pools tested positive for the virus, “there is no way to know how many ticks in each pool were infected,” he says. “It could be one out of 100, or it could be all 100.”
Nicholas Bennett, medical director of infectious diseases & immunology at Connecticut Children’s Medical Center, says that an increase in reported Powassan cases may also be due to more doctors being aware of the virus and actually testing for it. Like all tick-borne diseases, he says, the CDC’s numbers are probably much lower than the actual number of infections that occur each year, because many go unsolved or misdiagnosed. In November, Bennett was instrumental in getting that 5-month-old baby tested and diagnosed at Connecticut Children’s. “I may have been the first doctor to pick up on a case of Powassan in this state, but I’m sure it wasn’t the first to see a case in this state,” he says. “This isn’t a virus that’s on our standard list of tests, or that we look for automatically.”
And while some Powassan infections become very serious, many other people only develop a mild illness or have no symptoms at all.
More research is needed to determine how worrying Powassan is. But, Bennett says, research does suggest that tick populations and tick-borne diseases in general are on the rise.
What to do if a tick bites you
If you are bitten by a tick, rushing to the doctor right away won’t do you much good, Bennett says. The tests for these viruses aren’t pleasant—they involve blood and spinal-fluid drawings—and may not show signs of infection for several days or weeks.
MORE: Why Bed Bugs Are Becoming So Much Harder to Kill
http://time.com/4733708/bed-bugs-insecticide-resistance/?iid=sr-link1
“It’s perfectly reasonable to wait and see if you develop symptoms,” he says. There’s not much doctors can do for people who aren’t seriously ill, anyway. Doctors do not have a cure for Powassan and can only monitor the symptoms and provide care like respiratory support and IV fluids.
“The good news is that if you or your child are feeling a little under the weather or have a low-grade fever, there’s a million other probably causes other than Powassan,” says Bennett. “But if there are neurological symptoms—weakness, dizziness, seizures—then it’s important to get to the doctor.”
How to avoid ticks
The CDC says that people should protect themselves from Powassan virus the same way they do other tick-borne illnesses: by wearing insect repellant when spending time in areas where ticks are present, inspecting clothing and skin afterward and bathing or showering upon returning home. If pets have been outdoors, make sure they’re inspected regularly as well. https://www.cdc.gov/ticks/avoid/on_people.html
“Take precautions and be on the lookout for ticks whenever possible,” Tokarz says. “Whether it’s Powassan or something more common like Lyme or another tick-borne disease, you really don’t want to get any of them.”
