Last month, the Rhode Island General Assembly enacted a law requiring the State’s Department of Elementary and Secondary Education, in collaboration with the Rhode Island Department of Health, to make Lyme disease awareness and prevention resources available to all Rhode Island public school students.
While creating a greater awareness among school age children is good, be aware that Lyme disease affects more than just children; it affects persons of all ages and genders, and occurs most commonly in the northeastern, mid-Atlantic and north-central United States.
The bacterial organism (spirochete) responsible for Lyme disease normally lives in mice, squirrels and other small animals. In the northeastern United States, it is transmitted among these animals, and to humans, through the deer tick. Ticks, which have a two-year life cycle, usually attach themselves to mice or squirrels in their first year of life and are then transported by deer in their second year.
Lyme disease was first recognized in 1975 after researchers began investigating why unusually large numbers of children were being diagnosed with juvenile rheumatoid arthritis in the Lyme, Connecticut area. Most of the affected children lived and played near wooded areas where ticks live.
Sometimes Lyme disease can be difficult to diagnose because it can look like a number of other diseases. The classic “bull’s-eye” rash, a red, circular rash, is not observed in all patients. For those who do get the rash, it can appear several days after a bite from an infected tick and can last from a few hours to several weeks, disappear then reappear. Unfortunately, the rash can also look like other skin rashes such as eczema, hives, sunburn and poison ivy.
Ticks take up to 24 hours from the time of first contact with the skin before they actually start to feed on a host’s blood. The tick must remain firmly attached to the skin for 48 to 72 hours to pass the Lyme disease spirochete to humans. An individual who has been bitten by a tick has a very low risk of acquiring Lyme disease if the tick is removed before it is engorged with blood. A tick that has not bitten cannot cause Lyme disease.
Some medical practitioners advocate treating Lyme disease with antibiotics for months or even years, including with antibiotics administered intravenously. However, it is our position, along with the Infectious Diseases Society of America, and the American Lyme Disease Foundation that such treatment is neither recommended nor supported by medical evidence. Patients treated with prolonged courses of antibiotics may develop other bacterial infections with resistant organisms, some of which may be life-threatening.
We concur with the position advocated by the American Lyme Disease Foundation which is that Lyme disease, whatever the stage, is almost always cured by a single course of conventional antibiotic treatment (in some patients with Lyme arthritis, a second course may be indicated).
Ultimately, the best way to avoid Lyme disease is to follow several common sense precautions when walking in or near woods, overgrown fields or trails:
- Wear protective clothing (long-sleeved shirts, long pants tucked into socks), including closed footwear (no sandals). Wearing light-colored clothing will make it easier to spot ticks.
- Use insect repellant containing DEET (follow manufacturer directions) on skin or clothes.
- If possible, stay on cleared, well-traveled trails.
- Avoid sitting directly on the ground or on stone walls (havens for ticks and their hosts).
- Keep long hair tied back, especially when gardening.
The American Lyme Disease Foundation also recommends that you do a final, full-body tick-check at the end of the day (also check children and pets). Upon returning home, clothes can be spun in the dryer for 20-30 minutes at high temperature to kill any unseen ticks. A shower and shampoo may help to remove crawling ticks, but will not remove attached ticks. So, be sure to inspect yourself and your children carefully after a shower. If you need to remove a tick from your skin, remove the tick with tweezers, and as close to the skin as possible.
Ultimately, don’t let the fear of Lyme disease prevent you from getting out and enjoying a nature walk, gardening, or any other outside activity near trails, fields or woods. The New England outdoors has something to offer everyone. While the old adage goes, “an apple a day keeps the doctor away,” it’s not the only way! Following the above precautions will minimize your risk of getting Lyme disease and having to see a doctor. However, if you do get bitten by a tick and a rash appears on your skin, see your primary care physician.