Podcast: How Do I Avoid Bug Bites?

Dr. Jennifer Small-Saunders:  There are labs that provide tick testing, and so they will look at the tick and see what diseases it carries, but it’s really not recommended because just because a tick has a disease doesn’t mean that disease was transmitted to you. It can actually cause more harm than good in terms of your mental health and mental psyche. 

Courtney:  Welcome to Health Matters, your weekly dose of the latest in health and wellness from New York Presbyterian. I’m Courtney Allison.

Itchy bug bites may feel like a rite of summer, but with the New York area on high alert for ticks and mosquito-borne diseases in the news, how do we prevent bites from pests and when should we be concerned that they are more than just an annoyance?

This week, we talk with Dr. Jennifer Small Saunders, an infectious disease doctor  with New York Presbyterian and Columbia. We discuss the most common diseases carried by mosquitoes and ticks in the U.S., how to spot symptoms and the best strategies for preventing bites in the first place.

Dr. Jennifer Small Saunders, thank you so much for joining us today.

Dr. Jennifer Small-Saunders: Yeah, it’s great to be here.

Courtney:  So it’s summertime. A lot of us are picnicking, grilling, maybe we’re doing yard work. I know you’re an expert in diseases, but before we dive into those specifics, can you explain why some people seem more prone to mosquito bites than others? You know, I think about going for a hike with my partner with friends. I’ll come home with like 20 mosquito bites and they’ll have none.

Dr. Jennifer Small-Saunders: Good question. And it really has to do the mosquitoes really like changes in your metabolism. So maybe you were sweating more than your partner or maybe, you know, your body temperature was higher. They really like heat and carbon dioxide. And so it, it just has to do with how our individual bodies process those, or a metabolizing someone that’s running will have a lot more release of chemical carbon dioxide and heat than someone who’s slowly walking.

Courtney: That’s so interesting, so it’s metabolism changes!  Um, so if you are a mosquito magnet like me and you’re bitten, how concerned should you be about a mosquito-born disease? 

Dr. Jennifer Small-Saunders: So in general, I would say there are diseases in this area that are transmitted by mosquitoes, but they’re very rare and the serious symptoms of some of the diseases are also very rare. So really when you get bit by a mosquito, it’s more the annoyance of the mosquito bite.

Courtney: There are some diseases that have made headlines in recent years that I think are on people’s minds. West Nile Virus, Eastern Equine Encephalitis, Zika. Could you briefly describe these diseases, understanding they are rare?

Dr. Jennifer Small-Saunders: Of course. And I think the most common in this area is West Nile Virus. It’s been in the headlines for a while, and we do see cases here at the hospital. In terms of the symptoms, most people are asymptomatic. About one in five people who do get it will get a fever, and maybe feel unwell, sort of feel like a cold. And then more rare, um, there’s people who get a more serious disease. But again, it’s like very rare.

Courtney: What about Eastern Equine Encephalitis or Zika?

Dr. Jennifer Small-Saunders: Yeah, so Eastern Equine Encephalitis is caused by a different virus. And it circulates between mosquitoes and birds that are living in freshwater swamps. And so for this one, again, it’s rare, but you can get fever, headache, vomiting, and diarrhea. And then in more serious cases, it can affect the brain.

And then when we think about Zika—for me, I think about Zika in sort of a cluster with other viruses spread really in tropical subtropical areas. It’s spread by a mosquito. You can get fever, rash, headache, joint pains, um, but most people actually don’t have any symptoms from Zika. The sort of scary thing that was in the news is it can affect pregnant women and be passed to the baby. But we do see cases in Florida, and some of those other tropical areas in the United States. Not really so much in the Northeast, but if you travel, right, that is a possibility.

Courtney: You mentioned you might not even see any symptoms. So in that case, does it just tend to resolve?

Dr. Jennifer Small-Saunders: It does.

Courtney: That’s good to hear. So for all of these, are there treatments for these illnesses?

Dr. Jennifer Small-Saunders: The treatment is all what we call supportive care and for the most part, that’s all you need. So even when we talked about West Nile or Eastern equine encephalitis, if you’re getting just a fever and some muscle aches, right? You take your Ibuprofen or your Tylenol. 

Courtney: I realize sometimes it is just hard to avoid being bit by a mosquito, so what symptoms should we look out for, which means, you know, maybe you should seek emergency treatment.

Dr. Jennifer Small-Saunders: When you have a mosquito bite in general, it first starts red and itchy. And that’s generally where it stops for most people. but if you start developing a fever or if you start feeling more confused or start vomiting after a mosquito bite, then those are times that it’s really good to seek out medical help, and ’cause the earlier we catch these things, the better. And the other thing is that mosquito bites can get infected, right? So if you’re scratching and scratching and scratching and you introduce bacteria into your mosquito bite, that can also get infected. So if your mosquito bite becomes extra red or more painful or you start seeing sort of red streaks from it, that’s also good to go see a doctor, ’cause you may need antibiotics.

Courtney: What can we do to prevent mosquito bites that put us at risk?

Dr. Jennifer Small-Saunders: There’s first like what you can do to protect yourself, but mosquitoes are also bugs that live in the environment. So there’s things you can do for your environment that can also help prevent mosquito bites. So in terms of yourself, right, wearing long pants, long sleeves, covering your body, um. And then using a verified mosquito repellent.

When you think about your environment, um, mosquitoes like to breed and live in standing water. So if you have flower pots that are empty and sort of  full of warm, of water, that’s where mosquitoes can breed. Or like buckets, tires, bird baths. So it’s really important to get rid of that standing water ’cause that will decrease the amount of mosquitoes in your property. 

Courtney: So switching gears to another bug that I think is on people’s mind. I’ve been reading that New York State is on red alert for ticks this summer and that we’re at high risk for being bitten. What’s important to know about tick bites and how concerned should we be about ticks?

Dr. Jennifer Small-Saunders: Yeah, so ticks like mosquitoes can carry a variety of different diseases. Um, and especially in the Northeast, we’re sort of primed for it because of Lyme disease, which lots of people have heard about. but they can carry a variety of other diseases as well and these, I would say, are probably more common than the mosquito-borne diseases that we’re seeing. So, if you find a tick, this is where it is worth monitoring yourself a little bit more closely.

Courtney: So say someone gets bitten by a tick, what are the symptoms of Lyme disease to look out for?

Dr. Jennifer Small-Saunders: Lyme disease is spread by the deer tick, which is around the Eastern United States and so often the first sign for Lyme disease is this very characteristic rash, which we call the bullseye rash. So if you see a tick, you can pull the tick off you. Monitor that area for a rash, but sometimes you won’t even know you’re bitten by a tick and you’re checking your skin and, or you’re checking your child. And then you look and you’re like, oh, what is this weird rash that looks like a bullseye? And that’s pretty classic for a Lyme disease infection. And that’s really where to seek medical attention, because that’s where you can start antibiotics.

With Lyme disease we wanna treat it, right away. It is very treatable. We can treat it, with a few weeks of antibiotics, but if it goes unnoticed, that’s where you get arthritis and your joints hurt or you can get sort of heart problems. But again, those are very rare. 

Courtney: How can we protect ourselves against tick bites?

Dr. Jennifer Small-Saunders: The thing that actually is very helpful for ticks, is light colored clothing because they’re super small and you can actually see them much better if you have light colored clothing on. And then again, um, insect repellents. So there are repellents that do say that they are good for tick prevention.

And then in terms of the environment, really, you know, ideally, staying out of tall grasses, right? If you’re like wandering through fields and you decide to go hiking: walk in the center of your hiking trail. And then really, after the hike, do a tick check.

And so that’s really going over your body, over your skin, checking your children, even checking pets, because if your pet has a tick and then it can get onto you, um that’s really important. 

Courtney: So can you talk through what steps you should take if you do find a tick?

Dr. Jennifer Small-Saunders: If you do see a tick, the first thing you wanna do is pull it off. There’s actually videos on the CDC website called Tick Bot that can help walk you through the process of getting the tick off. Because what you wanna do is pull the whole tick out, you don’t wanna leave its little head in your skin. You wanna use tweezers to really pull the whole tick out, make sure you get the entire tick, the body and the head. And then you actually, you know, get rid of the tick. You don’t wanna just, like, put it down somewhere and assume it’s not gonna keep crawling around, so you wanna throw it in the garbage or the toilet, et cetera.

Courtney: So if you find a tick on you, should you send it to a lab?

Dr. Jennifer Small-Saunders: So you actually shouldn’t send the tick to the lab. There are labs that provide tick testing, and they will look at the tick and see what diseases it carries, but it’s really not recommended because. It can actually cause more harm than good in terms of your mental health and mental psyche. 

So every, just because a tick has a disease doesn’t mean that disease was transmitted to you. You don’t know how long the tick was on you. You don’t know if that virus, um, or bacteria passed into your bloodstream. You don’t know if it was enough to cause an infection in you. So at the end of the day, a negative tick may make you feel better, but a positive tick may make you feel horrible and actually just because you got bitten by a tick, it doesn’t mean you’re gonna get Lyme Disease or Anaplasma or Ehrlichia.

Courtney: Is preventing bites in the first place the best way.

Dr. Jennifer Small-Saunders: Yeah, so really for any of these, mosquito or tick-borne diseases, preventing bites is the best way. So, even though it’s not fun to wear long pants hiking in the summer wearing those long pants and ideally tucking them into your socks, but if you decide not to do that, you know, really making sure you check yourself for ticks and wear those repellents.

I make sure my kids wear spray, I make sure my dogs have their tick prevention, and if I see a tick on them, I do make sure to pull it out. We still go out and have fun in the summer. They still go to summer camp, we still go hiking. It’s just really making sure you wear all that protection and you really check yourself after, and you monitor if you have a bite that doesn’t seem to be getting better.

Courtney: Well, so you’ve shared so many amazing things with us today. What’s your takeaway message for people when it comes to these diseases from ticks and mosquitoes?

Dr. Jennifer Small-Saunders: If you do happen to get bit by a mosquito or you happen to get bit by a tick. It doesn’t mean you’re gonna get one of these crazy rare diseases. It feels scary in the moment, but as long as you’re sort of vigilant and you look out for any of your symptoms in yourself, for the most part, these diseases are not gonna be a huge issue.

Courtney: Thank you so much, Dr. Small Saunders. I really appreciate all these tips.

Dr. Jennifer Small-Saunders: Thanks for having me.

Courtney: Our many thanks to Dr. Jennifer Small Saunders. I’m Courtney Allison. Health Matters is a production of New York Presbyterian. The views shared on this podcast solely reflect the expertise and experience of our guests.

To learn more about Dr. Small Saunders’s work, check out the show notes.

New York Presbyterian is here to help you stay amazing at every stage of your life. To get the latest episodes of Health Matters, be sure to follow and subscribe on Apple Podcast, Spotify, or wherever you get podcasts.