With the changing season and the warm days of spring ahead, many parents (myself included) are itching for spring sports to begin, finally putting an end to the bitter cold and snow of winter storms past.
Spring break looms and we will pass another checkpoint on the school calendar with our eyes on the prize — summer vacation! Thinking ahead to these glorious days of no more packed lunches, folder checks, and lost hats that will never make it home, we will optimistically begin researching summer camps for our kiddos and planning family camping trips around New England. While making those plans, parents need to keep in mind that Massachusetts and neighboring states lead the nation in confirmed cases of Lyme disease, which is caused by the bite of an infected deer tick.
The ugly truth
To put things in perspective, according to the Centers for Disease Control (CDC) the 2013 national incidence rate for Lyme disease (the number of new cases per 100,000 people) was 8.6. The Massachusetts Department of Public Health (MDPH) states that Lyme disease is considered endemic throughout the Commonwealth and reports the 2013 incidence rate for Lyme disease in our state is a whopping 65.09, which is a 12% increase from 2012. Areas of high incidence for Lyme disease include most of the eastern half of the state, however, MDPH also notes that isolated areas of high incidence occurred in Franklin, Hampshire, and Worcester counties.
In case you were thinking of taking off to a neighboring state for the summer, know that according to the CDC, Connecticut follows close behind with an incidence rate of 58.7, whereas New Hampshire and Vermont top the charts at 100 and 107.6, respectively. Maine’s incidence rate is 84.8. In fact, the CDC reports that 95% of new cases of Lyme disease came from just 14 states, as it is heavily concentrated in the northeast and upper Midwest.
Maybe you’re thinking Lyme disease is only a problem for older people who like to hunt. I mean, they’re out in the woods, handling deer and other wild game that carry deer ticks. Only older people get Lyme disease, right? Well, surprisingly, you may be floored to learn that Lyme disease is most prevalent among children ages 5 to 9, both nationally and in our state.
Now you’re thinking, I’ll just keep the kids away from the woods. Again, you may also be surprised to learn that you do not need to be walking in the woods to get bitten by a tick — your own backyard can play host to these parasites.
Belchertown resident Beth Knodler knows this all too well. Only 31 at the time, Knodler was bitten in her own backyard by a tick in July 2009. Her family was building a treehouse for her two young children and she believes she was bit while walking back and forth from her house to the edge of the woods on her property.
“I did not know I was bitten for a few days,” she recalls. “I first noticed a rash on the back of my thigh. But it was not a bulls-eye rash! It was oblong, raised, red, and hot to the touch with a large bruise. I cannot stress enough that it was not a circle with a bulls-eye. We could not even find the ‘bite’ location with a magnifying glass!”
Though well known for the classic “bulls-eye” rash, known as erythema migrans, not all tick bites will cause this trademark rash. The MDPH notes that 72% of confirmed cases of Lyme disease reported an erythema migrans, meaning 28% did not, as in Knodler’s case.
This can make it difficult for healthcare providers to quickly diagnosis patients suffering from early Lyme disease. The MDPH notes that symptoms of early Lyme disease usually begin within 3 to 30 days after being bitten by an infected tick and can include: erythema migrans and flu-like symptoms such as fever, headache, stiff neck, sore and aching muscles and joints; fatigue; and possibly swollen glands. If left untreated, Lyme disease can cause lingering long-term health issues.
After being bitten, Knodler was unwell for several days, and her rash continued to grow larger. Over time, Knodler, a young, active, healthy mother of two, began to experience aches, pains, joint swelling, fever, confusion, and short-term memory loss.
“It was heartbreaking,” she says. “I was not eating and it even hurt for my kids to touch me. I would lay on the couch and cry in pain.”
When a Lyme test was finally done, Knodler was told she had the highest Lyme count one doctor had ever seen. She was immediately put on antibiotics, which alleviated many of her symptoms. However, Knodler now suffers from symptoms of late-stage Lyme disease, such as joint pain, swelling, and short-term memory loss.
Untrue: Common misconceptions
Knodler encourages parents to be vigilant.
“Do tick checks as a regular part of your bedtime routine — all year long,” she says. “It is a myth that they die in the winter. You don’t see them as much in the winter, but they are still around, especially a winter without a lot of snow.”
Dr. Jennifer Roche of Amherst Pediatrics confirms that daily tick checks are necessary in all months of the year for families to protect children from the dangers of Lyme disease.
“Calls regarding ticks and tick bites are a frequent occurrence,” Roche says. “Most tick bites do occur between May and October, but with milder winters we have had tick bites in all months.”
According to the CDC, this is because though young ticks, known as nymphs, are most active during the warm weather months, but between May and July, adult ticks can be out searching for a host any time winter temperatures are above freezing. Know that nymphs can be the size of a poppy seed, pencil point, or freckle, making them hard to detect, while adult ticks are the size of a sesame seed.
“Daily checks for ticks are essential in this area,” Roche notes. “They appear to be the most effective strategy to help prevent Lyme disease.”
A person is unlikely to get Lyme disease if the tick is not attached for at least 48 hours, she says. Therefore, all tick bites do not lead to Lyme disease — another misconception.
In fact, according to the CDC, the chances of transmission of Lyme disease from an infected tick increases with the amount of time it is attached to a person; from 0% at 24 hours, 12% at 48 hours, 79% at 72 hours, and 94% at 96 hours.
When checking your child for ticks, remember that ticks like warm places where they can hide out of sight. Common places to check include the back of the knees, armpits, groin area, scalp, hairline, back of the neck, and behind the ears.
If you find a tick attached to yourself or your child, there is no need to panic. Remember that chances of infection increase over time. Remove the tick as soon as possible using tweezers. Grasp the tick close to the skin and pull straight out, then monitor your child for signs and symptoms of early-stage Lyme disease.
If you don’t think you quite got all of the tick out, again, don’t panic. Roche says it is a misconception that the entire tick has to be removed.
“Actually, tick parts often remain after attempted removal,” she adds. “Retained mouthparts are usually expelled by the body and do not increase the likelihood of Lyme transmission.”
Another tick misconception is that any attached ticks should be saved and tested for Lyme disease. According to Roche, this is an unnecessary step because most ticks in our area are positive for the bacteria that causes Lyme disease. Instead Roche emphasizes the importance of closely monitoring your child for symptoms after a tick bite.
“Again, it’s unlikely [that Lyme disease is transmitted] if attached for less than 48 hours and the importance is monitoring for symptoms which typically include a classic rash (ECM), fatigue, malaise, headache, muscle aches, and joint pains,” she says.
What parents can do
Aside from daily tick checks, which should take place year round if your child plays in areas that may be inhabited by ticks (including your backyard), there are many precautions parents can take to reduce the risk of Lyme disease.
Know that ticks find a host by clinging to vegetation and waiting for humans or animals to brush up against them. Ticks cannot fly or jump — you must come in contact with them. Ticks are fond of brushy, wooded, and grassy habitats such as those found along hiking trails, in the woods, the edge of your yard, or within your yard if leaf litter exists. This is because they are also fond of damp, shady, leafy areas, which are often found around homes in the fall.
To keep ticks out of your yard, MDPH recommends the following yard-care tips:
• Keep grass cut short. Ticks are likely to be found in taller, unmown grasses and shrubs.
• Remove leaf litter and brush from around your home.
• Prune low-lying bushes to let in more sunlight (this keeps the yard from being damp and shady).
• Keep wood piles and bird feeders off the ground and away from your home. Mice and small rodents can carry ticks into your yard.
• Rid your yard of plants that attract deer, or use deer fencing on larger properties, as deer can also carry ticks into your yard.
• Use a three-foot-wide woodchip, mulch, or gravel barrier where your lawn meets the woods. Ticks are less likely to cross the barrier as they are prone to drying out.
• Pesticides can be used to reduce ticks on your property, but use of a licensed applicator experienced in tick control is recommended.
To protect yourself and your children when in areas prone to ticks:
• Use an insect repellent that contains 20% to 30% DEET. DEET products should not be used on infants under 2 months of age and should not be used in concentrations higher than 30% on older children.
• Wear long, light-colored pants tucked into socks or boots, and a long-sleeved shirt. This keeps ticks off the skin and easier to identify if on clothing.
• Stay on cleared trails and avoid the edges of habitats where ticks are likely to be.
• And finally, check children for ticks as soon as possible after coming indoors. Then have your child shower or bathe, which serves a dual purpose. Bathing washes off any applied chemicals such as DEET, as well as any ticks that may be searching for a warm place to settle. Ticks can wander for hours on the skin undetected before finding a place to attach on the body. Also, put clothes in the dryer on high heat for 60 minutes to kill any ticks that may be on clothing your child has worn outside.
Before you start cancelling camping trips and put your kids under lock and key this summer, remember our kiddos need their outdoor time and we, as parents, have the ability to prevent tick bites and, therefore, Lyme disease. Yes, it takes some extra effort on our part, but I think we’ll all agree it's well worth it.