Tick, flea and mosquito prevention

May is Lyme disease awareness month. According to a recent publication of the CDC tick and mosquito infections are on the rise. Climate change, increased travel, increased surveillance and lack of vaccines are mentioned as reasons for the rise of these infections.

It becomes increasingly important to be aware of the risks of insect borne illnesses. Not just Lyme disease is on the rise: Ehrlichia/Anaplasma, Babesia, Rickettsia and Powassan infections are also spread by ticks and the number of infections are climbing. West Nile Virus, Zika and other mosquito borne infections are also on the rise and they are just as devastating. Ask a patient with West Nile virus how the disease has affected their lives and you will hear some true horror stories. Many patients don’t fully recover and struggle with chronic symptoms for the rest of their lives.

Then there is the case of Bartonella. It is an emerging infectious disease and only a handful of doctors and scientists appreciate this group of bacteria for what they can be: a stealth pathogen that establishes a chronic infection by hiding inside of cells and manipulating the immune system.

Bartonella is probably carried by ticks but pets can also carry this infection and transmit it to humans through a scratch or bite. While the acute manifestation of infection with Bartonella is considered a benign and self limiting disease, some of these cases result in a chronic debilitating disease. It can be extremely difficult to accurately diagnose this chronic condition and it is even more challenging treating it.

It becomes increasingly important to protect ourselves against these infections that are transmitted by ticks, fleas, horse flies and mosquitoes.

Tick bite prevention

It has to be made clear that ticks are mostly active during spring, summer and early fall but adult female ticks can also infect individuals during the winter.

Insect repellents
You can put permethrin on your clothes and 50% DEET on your skin to protect yourself against ticks. The protective effect of natural products with eucalyptus and lemon is uncertain.

Ticks in urban area
You are not safe in urban area. In the Netherlands 30% of the patients contract Lyme disease within urban area and a recent study in the United Kingdom showed that ticks in four London parks carry Borrelia burgdorferi, the bacteria that cause Lyme disease.

Parks and suburbs are the perfect size to sustain mice but are not quite large enough to sustain small predators such as foxes. Mice can run rampant without natural predators and with mice come ticks. So check for ticks daily.

Ticks can crawl but their main mode of transportation is hitchhiking. That means your pets can bring ticks inside the house. Using tick and flea repellents on your pets is very important and it is probably not a good idea to let pets in the bedroom or sleep in your bed. Insect repellent is not only important to protect against ticks, fleas can also carry and transmit Bartonella species.

You can place a deer fence to prevent deer and small animals from entering your yard. Keep the grass in your yard short and spray regularly with pesticides. Another great tip is placing tick tubes:

Time of attachment and transmission
Health agency guidelines and general media state that a tick needs to be attached at least 24 hours before it transmits Lyme disease. Usually these statements are made without a source for these claims and this rule of thumb has even obstructed the access to care for patients.

When the tick feeds on a host the Lyme bacteria start changing the proteins on their outer surface and start migrating from the midgut of the tick to the saliva glands. From the saliva glands they get excreted into the host. This migration process can take up to 48 hours to complete. But a recent study suggested that Borrelia afzelii can be transmitted within 24 hours and has a different transmission cycle.

When a patient does get infected within the first 24 hours of tick attachment, the physicians will tell them there is no way that they could have contracted Lyme disease because they removed the tick within 24 hours, even when there is a clear erythema migrans and when they do develop symptoms they are told their symptoms are psychosomatic.

To find the source of the claim that ticks don’t transmit Lyme disease within 24 hours of tick attachment a researcher did an extensive search for sources that confirm this claim. Ticks can spread Lyme disease within 24 hours and in the data the researcher evaluated Lyme disease was frequently transmitted within 24 hours of tick attachment.

The claims that removal of ticks within 24 hours or 48 hours of attachment will effectively prevent Lyme disease are not supported by all the published data, and the minimum tick attachment time for transmission of Lyme disease in humans has never been established. Therefore, Lyme infection can never be excluded after a tick bite, irrespective of the estimated duration of attachment time.

When you do get bitten

  • Remove the tick correctly
  • When you get symptoms go to your doctor
  • Not all Lyme patients get an Erythema Migrans, but when you do get one it is diagnostic in and of itself
  • Antibody tests such as the Elisa and Western Blot miss early infections 50% of the time
  • You could have contracted other infections besides Lyme disease
  • Some doctors would treat every tick bite

Mosquito prevention

Mosquitoes can carry many viral and parasitic infections such as Yellow Fever, Chikugunya, West Nile, Zika, Dengue and Malaria.

Some patients who contract West Nile virus never fully recover. During cancer treatment with certain medications such as Rituximab their West Nile infection can relapse and some patients go on to develop a progressive disease that resembles Chronic Fatigue Syndrome, which is a devastating illness.

There are currently no vaccines for these infections although a live Measles vaccine does seem to offer protection against West Nile virus for a while, unfortunately the protection is not life long.

Avoid. Most mosquitoes are most active at dusk and dawn.

Cover up. You can sleep under a canopy to protect you from mosquitoes during sleeping hours and you can wear clothing when you are out at night. Mosquitoes can’t penetrate clothing with a tight weave.

Repellents. Insect repellents such as DEET, oil of lemon and eucalyptus or picaridin work to repel mosquitoes when used on the skin. They should provide at least 90 minutes protection when applied to the skin.

Clean up. Yards contain hundreds of mosquito breeding sites. Get rid of empty water filled natural and artificial containers that can provide mosquito-egg laying habitats.