Dr. Sorana Segal-Maurer, director of infectious diseases at NewYork-Presbyterian Queens, offers tips to guard against tick bites

Tick season is upon us, and the threat of tick-borne disease is on the rise. According to the Centers for Disease Control and Prevention, the number of reported cases nearly tripled between 2004 and 2017, and researchers discovered seven new tick-borne pathogens with the potential to infect people.

State and local health departments in the U.S. reported a record number of cases in 2017: 59,349, up from 48,610 in 2016. The actual number is thought to be much higher since people tend to under-report tick-borne illnesses.

However, with common sense, simple precautions, and vigilance, you and your loved ones can still enjoy time outdoors this summer. Dr. Sorana Segal-Maurer, director of the Dr. James J. Rahal, Jr. Division of Infectious Diseases at NewYork-Presbyterian Queens and professor of clinical medicine at Weill Cornell Medicine, spoke with Health Matters about how to keep you and your loved ones tick-free, and what to do in the event of a bite.

We had a mild, wet winter in the Northeast and mid-Atlantic. Could that lead to a heavier 2019 tick season?

Yes, but not just because of one season. We’ve had several seasons now that have been a little bit rainier and milder, and I think that’s going to increase ticks this season. This is because there’s a complex interaction when it comes to climate. Warm, wet weather may increase the acorn crop, and acorns are an important source of food for field mice, which are carriers of the bacteria that cause Lyme disease. When you have more acorns in year one, then year two you’ll have more mice for baby ticks to feed on, and year three you’ll end up with more ticks, then they get onto deer and reproduce. So, all of these weather changes will affect how many deer you have, how many mice you have, and then a year or two years later you’ll see more ticks.

During mild springs, people also get outdoors sooner than usual and become an unexpected additional food source for ticks. Also, people may not be as cautious since it’s early in the season and may assume that it’s still too cold for the ticks to be out.

What precautions can people take to avoid being bitten?

Wear light-colored clothing so ticks are easier to see, and socks over pants and long-sleeved shirts to prevent ticks from getting near your skin. And don’t forget hats.

A concentration of DEET of up to 30% has proven effective either due to its smell or its ability to camouflage us when the ticks are putting out their feelers. The other thing that’s been studied is eucalyptus oil for those wishing to avoid DEET. Pre-treatment of clothing with permethrin is also very effective, but you have to be careful about its use around cats. If you treat dogs with permethrin, cats need to be kept away from them.

When you’re outside, stay on paths. Once you brush against foliage, you’re putting yourself at risk.

Who’s most at risk?

Kids are at risk because they may veer off walking paths and run through foliage without realizing it, as are pets because they’re always face-down smelling all these fabulous things outdoors. Hikers are at risk, and anybody who’s active outdoors, and not just in the countryside. In big parks in Queens, certainly as you get to Long Island, Westchester, and once you start getting more rural, you’re going to be at risk.

What should you do if you’ve been in an area with ticks?

Immediately do a tick check when you get indoors. You can put your clothing into a hot dryer for at least 20 minutes. Water doesn’t kill ticks, but heat does. And then, of course, do a body check. Ticks like to go anywhere it’s warm and protected, like under your arms, between your legs, around private parts, the back of your knees, your neck, in your hair, or behind your ears.

If you find a tick on your body, should you remove it? What is the best way to do it?

Yes. Once they attach, they’re very difficult to pull out. There are a number of talked-about remedies that do not work and can be dangerous, like using petroleum jelly to “smother the tick” or “burning it off,” which just serves to cause a nasty burn. There’s really no way of doing it other than making sure you have a very sharp pair of tweezers. Not blunt tweezers, because if you squeeze the tick, you increase the potential to infect yourself. Try to pull it out from the mouth straight out, not twisting. That’s very important.

When you’re disposing of it, either flush it down the toilet or drop it in rubbing alcohol in case you end up with a rash and want to bring it in for identification.

After removing the tick, what are the next steps?

Call your healthcare provider. If it’s been attached for more than 24–48 hours and you can reasonably see it (it is engorged and larger than the size of a poppy seed or grain of sand), it has probably fed. In general, it’s one dose of doxycycline as a preemptive treatment. If you don’t know that you’ve been bitten and now have symptoms, you have to get a full course of treatment, which will be determined based on your diagnosis.

Anything else people should be aware of?

These ticks can be infected with multiple diseases. If you’re diagnosed with Lyme, get treated for it but be vigilant if you have additional symptoms or you don’t feel like you have returned to your baseline. Make sure that your healthcare provider looks for all of the other infections that we see with these tick-borne illnesses.

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