How to Protect Against Ticks and Lyme Disease

Dr. Acker: A bite from a tick does not automatically mean Lyme disease. Has to be the deer tick that transmits Lyme. That tick has to be carrying the bacteria. That tick has to be on you for a long enough time that it takes a blood meal, so at least 36 to 48 hours. Even then, it's not 100% guarantee that you're gonna get Lyme. 

Courtney Allison: Welcome to Health Matters, your dose of the latest in health and wellness from NewYork-Presbyterian. I'm Courtney Allison. 

This season on Health Matters, we're covering your health from A to Z, asking our experts to break down the health topics and wellness trends we're all curious about. Today, we're at L for Lyme disease. 

With emergency room visits due to tick bites spiking in the US, we spoke with two experts at NewYork-Presbyterian and Weill Cornell Medicine: Dr. Laura Kirkman, an adult infectious disease physician and scientist, and Dr. Karen Acker, a pediatric infectious disease physician and epidemiologist at Children's Hospital of New York at NewYork-Presbyterian. We asked for the facts. How and when do ticks bite? And just how worried should we be about the spread of Lyme disease? They shared tips on how to prevent tick bites, how to remove an attached tick, and the signs and treatments for Lyme disease, so you'll be ready to head outside and enjoy your summer safely. 

Welcome, Dr. Laura Kirkman and Dr. Karen Acker, to Health Matters. Thank you so much for joining us today to speak about all things ticks and Lyme disease. 

Dr. Acker: Thank you so much for having us. 

Dr. Kirkman: Yes, thank you. 

Courtney Allison: So Dr. Kirkman, let's start with you. Could you tell us about ticks broadly? I was surprised to learn that there are hundreds of species in the world. What are the major species in the US? 

Dr. Acker: Well, there are more than hundreds in the world. 

Courtney Allison: Really?

Dr. Acker: There are two different types. You have soft bodies and you have hard-bodied ticks, and it's over 1,000 probably globally. 

Courtney Allison: Wow.

Dr. Acker: But very few of them feed on humans. Here, the ones we worry the most about are probably the dog tick or the brown tick and the blacklegged tick, and then the lone star tick is a new tick to the Northeast. 

Courtney Allison: So where are ticks typically found? 

Dr. Acker: So it kinda depends on the region. Here in the Northeast, it's a little cooler, and so there are ticks out in tall grasses, but it can be in mowed lawns or playgrounds. They're out questing, so reaching out for the next vertebrate host for a blood meal. 

Courtney Allison: It's interesting you said playgrounds. We associate ticks with wooded areas, with tall grass, but if a parent is taking their child to the playground, is that a place to also be watching? 

Dr. Acker: I think in the Northeast you should always do tick checks. 

Courtney Allison: Anything to add, Dr. Acker? 

Dr. Kirkman: It's always a good idea, and when your kids are in the outdoors, in the woods, definitely wanna do it then. 

Courtney Allison: We think about ticks more in summertime and warmer weather. When are ticks most active? Are they seasonal, or should we be concerned in colder months too? 

Dr. Acker: It depends really on temperature even more than months. Above freezing, they're active. So if you have a warm February, you're gonna have more tick activity than you would expect. You also need to think about the life cycle. Ticks have around a two-year life cycle. So they go from eggs to larvae to nymphs to adults, and they need that blood meal to make it through each step of their life cycle. So as they emerge, you're gonna have a bunch of smaller ticks looking for blood. 

Courtney Allison: So can we talk about when the tick bites a human? How do they go about it? 

Dr. Acker: They'll crawl around on you for a bit, and once it's attached to your skin and it kind of saws through and makes a little pool of blood, then it can feed for a very long time. It can get much bigger than it was when it started feeding on you. 

Courtney Allison: Ooh. So how do you know if you've been bitten, and what should you do if a tick does bite you? 

Dr. Acker: You don't feel the tick feeding on you. It should still be there. It's gonna just hang out there until you get it off. 

Courtney Allison: What kinds of illnesses do ticks carry or cause? 

Dr. Acker: Different ticks spread different illnesses or pathogens. And I say pathogens, not bacteria, because besides bacteria, they can transmit viruses, they can transmit parasites and different types of bacteria. 

Courtney Allison: We hear the most about Lyme disease. Dr. Acker, what is Lyme disease? 

Dr. Kirkman: Lyme disease refers to an infection transmitted by this tick we call the blacklegged tick or deer tick, or Ixodes is the genus, and it transmits this type of bacteria called Borrelia. A bite from a tick does not automatically mean Lyme disease. Depends on the tick. It has to be the deer tick that transmits Lyme. That tick has to be carrying the bacteria. That tick has to be on you for a long enough time that it takes a blood meal, so at least 36 to 48 hours is kind of the general range. Even then, it's not 100% guarantee that you're gonna get Lyme. But this infection, once it gets transmitted and you actually get the infection, there's various phases of infection that can occur. It's divided into three phases. The first is early localized. So you get a tick bite, and you may get a rash at the site of the tick bite. And maybe during that time, and this can occur anywhere from 3 to 10 days maybe after the tick bite, you could also maybe have some fever and just general malaise, not feeling great. 

Courtney Allison: Can you say more about the rash? What does the rash look like? 

Dr. Kirkman: That rash has a particular appearance called a bull's eye rash because it's this kind of red, round rash with a central clearing, although it doesn't always fit that classic appearance. Typically, it's not raised, but it has a really clear border. It's not this ephemeral blurry rash on the body. It does have a circular or oval type of appearance. If that doesn't get treated or noticed, or it may not happen at all, you could progress into the next phase, which we call early disseminated. It's still early, in the first few weeks after the tick bite, but now the infection is not just in the local area of the tick bite. It gets to other areas. So that rash could be present on multiple areas of your body. 

Courtney Allison: And so what are the symptoms you might see as it spreads? 

Dr. Kirkman: You could have facial nerve paralysis, also known as Bell's palsy, where one side of your face is weak. The heart can be affected, leading to abnormal rhythm. It can go to the fluid around the brain and cause inflammation around the brain. Fortunately, most of those manifestations are relatively rare, but those can happen. And then the last phase is the late phase, and that's characterized as a joint infection or an arthritis. And typically, it's one joint that's involved. 

Courtney Allison: How high is the risk of getting Lyme disease? 

Dr. Kirkman: Really, the risk of getting Lyme, even after a known tick bite, is pretty low, around 2%. That risk gets higher if it's been on you for a certain amount of time. But you have a window of time to find the tick, and we have a prophylactic measure with a dose of doxycycline. So we have a lot of options. I tell parents that as a parent myself, there's a lot of things I worry about. It's not Lyme that's keeping me up in the middle of the night

Courtney Allison: A tick that makes the news a lot is the lone star tick, which seems to cause a red meat allergy. Could you share any more about that? 

Dr. Kirkman: We've been hearing a lot about this. The lone star tick is another type of tick. It's seen in the East of the United States, but more in the South. The geography is expanding, so we are seeing it in the Northeast now as well. And there's this phenomenon or syndrome called alpha-gal syndrome, and alpha gal is a type of sugar that's present in both tick saliva and meat. And so with a tick bite, the thought is that it exposes the person to this, and an immune response is generated, and then with an exposure to red meat from beef, pork, any type of non-primate mammalian meat could trigger this allergic reaction, or IgE-mediated reaction. The symptoms that are most common will be rash, like hives, or maybe some GI symptoms like vomiting, but the concern is in anaphylaxis, where you have low blood pressure, you feel dizzy, or like you're gonna faint. That is a growing concern that if we're seeing lone star tick and more people are getting exposed and bitten, but I think there's still a lot we don't understand about it. 

Courtney Allison: The CDC reported weekly visits to the emergency room for tick bites are on the rise, that they're at their highest level for Americans in about a decade. What might be causing that? 

Dr. Kirkman: I imagine there's multiple factors that could be at play. One is just climate change and changes in migration of various animals. I don't know if there's also an element of awareness, that people are more aware of ticks and looking for them. 

Dr. Acker: The other thing is humans just have more contact with areas where there are more ticks and deer. The suburbs expand into the woods, the more you're gonna have humans getting tick bites. 

Courtney Allison: How do you test for Lyme disease? How is it diagnosed so that someone could get treatment? 

Dr. Kirkman: The way we diagnose Lyme disease is by testing for the antibody response that we have. So we make these proteins called antibodies in response to an infection, and we use that to really diagnose if you've been exposed to Lyme. That means, though, there needs to be enough time between your exposure and developing that antibody response before you can test and reliably say you have an infection or not. So for early localized, no need to test. I say if you are an area where there's lots of Lyme disease present or that tick is present, we call it Lyme endemic area, and you have a rash that looks consistent, that's an indication to just treat without testing. 

Courtney Allison: And when you say treat, what's the first line of defense if you suspect Lyme disease? 

Dr. Kirkman: Fortunately, we have very good antibiotic options for treating Lyme. First line is an antibiotic called doxycycline. Another alternative that we often use in pediatrics as well is amoxicillin. Both are good options. 

Dr. Acker: In adult medicine, we just use doxycycline. 

Dr. Kirkman: Yeah.

Courtney Allison: Let's say you or your child has been bitten by a tick. How do you know if you should treat for Lyme disease? 

Dr. Acker: If you just find one crawling around on you, don't worry. There's no transmission happening. But if you find one, especially if you find it engorged, then I would reach out to your physician and say, "Engorged tick," and often they can prevent Lyme from developing by giving you a one dose of doxycycline. Uh, at least in adults we do that. 

Dr. Kirkman: Yes, we do that in kids, too, so I'm very glad to have that option. 

Dr. Acker: It is [laughs] an excellent option [laughs] 'cause then you're just done. 

Dr. Kirkman: Yeah.

Dr. Acker: And you definitely wouldn't test for anything then. And if you treat early, then you also can interfere with your body's ability to make those antibodies in response. So there's no point in testing later either. You just take your one dose, take the tick off properly, and you're done. 

Dr. Kirkman: The risk is really the amount of time the tick is attached to you and, and feeding. So it's over 36 hours, that's where the risk jumps up. Under that, it's very unlikely to transmit Lyme. 

Courtney Allison: And how do you remove a tick if you find one biting you or your child? 

Dr. Kirkman: So you want to use a fine-tipped tweezer. Get very close to the skin so that you can get the tweezer around the tick that's embedded in the skin and get a good grab on it, and then pull it out, pulling out the entire tick. We don't recommend putting anything on it, like applying Vaseline to suffocate the tick or fire or anything like that. Don't try to burn a tick off you. [laughs] 

Courtney Allison: I was surprised to see that was a thing people thought they should do. [laughs] 

Dr. Kirkman: I mean, people can get creative. 

Dr. Acker: I think some people thought you would be killing the bacteria or something, but you're not. You're just actually encouraging more regurgitation [laughs] into you, so. 

Courtney Allison: And then should we take a photo or send the tick into a lab? 

Dr. Kirkman: Yeah, if you've removed the tick sufficiently, you don't need to send it for testing or identify the tick per se. When you visualize it under the microscope, you can identify it, and that'll give us information about which pathogens are transmitted, but it doesn't tell you that, one, that tick actually contained that pathogen, 'cause not all ticks do, and even if it did, it doesn't tell you that it was transmitted to the person. So I think all that identification probably creates a lot of undue fear. 

Courtney Allison: So how can we prevent tick bites? 

Dr. Acker: If you live in endemic area and you're out in the woods, you should check every night.

Dr. Kirkman: Yeah, that's why tick checks are important, because you may not notice it, and they can really go to areas that are not as easily visualized. Big high-risk areas are the scalp. So if you have a thick head of hair, you need to look through the, the nape of the neck and the hairline, under the arms, the groin, belly button even, behind the knees. It is nice if you have another person to help you out, but a mirror can help as well. And for kids, I would also look in their private areas. Look around the buttocks and the genital area, diaper area as well. 

Dr. Acker: These are the size of a poppy seed, so they are hard to see. Preventing the tick bite is super important. There's a list of repellents that are approved for mosquitoes and ticks. You can get clothes that are pre-dipped in something called permethrin, or you could dip it yourself. 

Dr. Kirkman: Similarly, I recommend long pants and high socks. 

Dr. Acker: And if you do [laughs] follow Dr. Acker's fashion tips with the long pants- 

Dr. Kirkman: [laughs]

Dr. Acker: ... and high socks- 

Dr. Kirkman: [laughs]

Dr. Acker: ... when you get inside, don't throw them on your bed- 

Courtney Allison: [gasps]

Dr. Acker: ... because the tick will waddle off your pants and then sleep with you. 

Dr. Kirkman: And that's a good point to be making about a pet. If you're out with your dog, maybe check your dog too before they jump on your bed. 

Dr. Acker: For dogs, there are lots of good tick repellents, and I think everyone should just be using those, and you can do tick checks on your dog too. You should. 

Courtney Allison: Given the headlines already this year, how worried should we be? 

Dr. Kirkman: We know that Lyme, along with various other infections that are impacted by climate change, they are increasing. We just have to remain diligent with our known prevention me- measures and in recognizing when we have a tick on us so we can remove it properly. 

Courtney Allison: Dr. Kirkman, Dr. Acker, thank you so much for joining us today to talk about ticks and Lyme as we prepare for summer. It's been wonderful having you. 

Dr. Kirkman: Thank you so much. 

Dr. Acker: Yes, [laughs] thanks for having us. [upbeat music] 

Courtney Allison: Our many thanks to Dr. Laura Kirkman and Dr. Karen Acker. I'm Courtney Allison. Health Matters is a production of NewYork-Presbyterian. The views shared on this podcast solely reflect the expertise and experience of our guests. 

To learn more about the work Dr. Kirkman and Dr. Acker do with patients, check out the show notes. 

NewYork-Presbyterian is here to help you stay amazing at every stage of your life. 

Join us next time when we discuss the mind diet and how to make food choices that support our brain health. That's in two weeks right here on Health Matters. So you don't miss it, be sure to follow and subscribe on Apple Podcasts, Spotify, or wherever you get podcasts.