Prevention: Here are a few environmental interventions you can recommend to your patients
- Remove leaf litter, clear tall brush, and grass around the home and at edge of lawns. Mow the lawn frequently.
- Keep playground equipment, decks, and patios away from yard edges and trees.
- Live near a wooded area? Place a 3-ft.-wide barrier of gravel or wood chips between the areas.
- Put up a fence to keep unwanted animals out.
- Keep the yard free of potential hiding place for ticks (e.g., mattresses or furniture).
- Stack wood neatly and in a dry area.
- Use pesticides, but do not rely on them solely to prevent ticks exposure.
Personal interventions for patients when outdoors
- Use Environmental Protection Agency–registered insect repellents. Note: Oil of lemon-, eucalyptus-, and para-menthane-diol–containing products should not be used in children aged3 years or less.
- Treat clothing and gear with products containing 0.5% permethrin to repel mosquitoes and ticks.
- Check cloths for ticks. Drying clothes on high heat for 10 minutes will kill ticks. If washing is needed use hot water. Lower temperatures will not kill ticks.
- Do daily body checks for ticks after coming indoors.
- Check pets for ticks.
Tick removal
- Take tweezers, grasp the tick as close to the skin’s surface as possible.
- Pull upward. Do not twist or jerk the tick. Place in a container. Ideally submit for species identification.
- After removal, clean the bite area with alcohol or soap and water.
- Never crush a tick with your fingers.
When should you include TBD in your differential for a sick child?
Headache, fever, arthralgia, and rash are symptoms for several infectious diseases. Obtaining a history of recent activities, tick bite, or travel to areas where these diseases are more prevalent is important. You must have a high index of suspicion. Clinical and laboratory clues may help.
Delay in treatment is more detrimental. If you suspect rickettsia, ehrlichiosis, or anaplasmosis, doxycycline should be started promptly regardless of age. Consultation with an infectious disease specialist is recommended.
The United States recognizes it is not adequately prepared to address the continuing rise of vector-borne diseases. In response, on Jan. 20, 2021, the CDC’s division of vector-borne diseases with input from five federal departments and the EPA developed a joint National Public Health Framework for the Prevention and Control of Vector-Borne Diseases in Humans to tackle issues including risk, detection, diagnosis, treatment, prevention and control of TBD. Stay tuned.
Dr. Word is a pediatric infectious disease specialist and director of the Houston Travel Medicine Clinic. She said she had no relevant financial disclosures.