Transcription:
Tick-borne Disease Prevention

Melanie Cole (Host):  The Vector-Borne Disease Laboratory at Main Medical Center Research Institute is dedicated to the control of emerging tick and mosquito borne diseases. My guest today is Chuck Lubelczyk. He’s a Vector Ecologist at Main Medical Center Research Institute. Welcome to the show, Chuck. Tell us about people hearing the words “vector-borne”; there’s a lot in the media today about mosquitos and ticks and tell us what you do as a vector ecologist and what’s involved.

Chuck Lubelczyk (Guest):  So, as a vector ecologist we have kind of a lucky job of going out actually into the field and primarily collecting ticks and mosquitos in the northeast to look for various diseases such as Lyme Disease, Anaplasmosis or West Nile Virus and Eastern Equine Encephalitis Virus.

Melanie:  Wow. So, you actually go and collect these things and then bring the insects back and test them for these various diseases to see if they’re in the area?

Chuck:  Yes. So, our lab here we work a lot on what is called surveillance, which would be to look for disease activity in certain areas. We work primarily in Maine but also to some extent in New Hampshire and Vermont where we are going out and looking, in many cases, for outbreaks or at least the emergence of these diseases in new areas and where they are occurring for the very first time. We try to keep track and to the extent of how much disease activity is going on.

Melanie:  Let’s start by speaking about ticks. Those little buggers can get in your socks. They can get in all kinds of places. What do you say to people to protect themselves from ticks, if they’re out in the woods and do you have to be out in the wood for them to get at you?

Chuck:  Primarily, you are going to be out in the field where you’re going to collect ticks. However, we do find that in rare cases people with companion animals, either cats or dogs, will actually have ticks brought into their homes. People can actually get them from the animals bringing them into homes, ticks jump off onto the bed, onto the couch and the ticks can then get on people that way. So, in many ways, a lot of the public health measures that you would do to look for ticks like tick checks or applying repellants are also applicable to your companion animals as well as yourselves. Primarily, we do tell folks what we do a lot is to actually wear very good clothes in the field. Clothing that will prevent ticks and mosquitos from getting in contact with your skin are really the first line of defense against them.

Melanie:  We’ll talk about defense, too, but give us your best tick check advice. How do you check when you’re done in the field – your dog and yourself and your kids?

Chuck:  You come in from the field and the first thing you’re going to do is, ideally, to have on light colored clothing. So, you’re going to check your clothes first. If you’re in light colored clothing, not because the ticks don’t like light colored clothing but because they show up a lot easier on them, you’ll go check your clothes first. Anywhere from the shoulder on down to the ankles. Most of your tick exposure will occur at the knee level or below. So, we frequently will tell folks to cover up or tighten the cuffs of their pants. That is frequently the first area where ticks will get underneath the clothing to get access to your skin. You want to look on your body, or on the bodies of your children or your pets, in the areas that are dark and protected. So, behind the ears, the navel, the underarms, under the legs, behind the knees--areas that are not going to get rubbed by fabric,  areas that will stay warm and cozy and dark for the ticks to be happy in.

Melanie:  If you do find one, how do you get it off?  People have said over the years, “Oh, the head will stay in. You have to use a match or alcohol.”  Tell us how to get a tick out of your skin.

Chuck:  The most reliable way to do it is to rely on a very fine pair of forceps or tweezers. This is a patient process in that you really need to take some time to gently tug the tick out from underneath the skin to prevent exactly that from happening. If you pull too quickly or too fast, you can have the beak or the head of the tick remain in while the whole body pulls away with the tweezers. So, actually, gently tugging the tick will help to get it out from under your skin. You can also rely on a variety of tick pullers, as they’re generally called. You can get them at veterinarian offices or outdoor supply places and they will all work to really extract the tick out of your skin without doing a lot of damage. One of the things we tell people is, “Don’t rely on matches; don’t rely on alcohol, petroleum jelly.” We’ve even heard of people using peanut butter and credit cards to try to extract the tick out of the skin. We see a lot that people do a lot more damage to their skin from these really kind of crazy methods than if they just gently applied a little bit of patience and forceps or tweezers to get the tick out.

Melanie:  Do they have like little barbs that hold them in?  Is that why it’s so hard to get them out?

Chuck:  Yes. The two species that we have up here in the northeast, the deer tick actually has barbs like little recurve fishhooks on their beak so they are kind of very well-anchored in. The other tick species we have, the American dog tick, actually has a different method in that it secretes kind of a super glue to hold onto its host. So, we will actually have people that will rip away part of their skin with the super glue if they try to rip the tick off too quickly.

Melanie:  So, what do you do with it?  People say you burn it; they say don’t throw it out and they live. What do you do with a tick once you’ve pulled it out?

Chuck:  Many places in states will have identification programs, if you’re not really sure what tick it is. Not all ticks are going to be transmitters of disease. So, the first thing would be to keep it in the event you want to have it identified. Some places will actually offer testing services where people can submit their ticks in to be tested for various tick borne diseases so that is another possibility as well. It’s also a good idea to hold onto it in the event you are going to go see a physician because that would add some clinical data to the picture. If you end up being diagnosed with a tick-borne disease having the tick that they can go back and examine might help to fill in some of the pieces of the puzzle.

Melanie:  Is weather a big factor?  Do they come out more when it’s wet like mosquitos or dry?  Are they around in the winter?

Chuck:  Well, up here, we see the potential for ticks at any time of the year when it gets above 40 degrees Fahrenheit and the snow begins to melt. So, we have tick activity, potentially, at almost any time as long as it’s warm. Ticks in the summertime generally like moister conditions. They don’t really do well in really dry conditions and deer ticks, in particular, kind of have that goldilocks complex.  They don’t like it too hot, they don’t like it too cold, they don’t like it too wet, don’t like it too dry, but if you think about your humid, warm summer days are pretty optimal for deer ticks.

Melanie:  What are some of the diseases that you get from ticks and are there solutions to these disease or cures for them?

Chuck:  In the northeast, we currently have about, I would say, 6-8 different disease agents that have been found in deer ticks. Now, a lot of this is that we have better molecular techniques to detect these pathogens in the ticks. In some cases, though, these are so new, we don’t really know what the infectious potential is for them. However, currently we know that at least in New England we have five disease agents either bacteria or viruses that are cycling in ticks that would cause either human or veterinary disease.

Melanie:  Now, people have said that Lyme disease is so hard to detect and that it’s often hard to treat because it goes undetected for so long. If you were bitten by a tick or even if you don’t know if you were, how do you know if something is wrong?  Or, what are some red flags?

Chuck:  The highest alert symptom for Lyme disease would be what is called the “erythema migrans” or bullseye rash. This doesn’t appear in every case of Lyme disease but its somewhere between 60-80% of people that have Lyme will come down with this large bullseye rash that will form, usually at the site of the bite, though not always, and expand out to about the size of a dinner plate. This rash will normally occur 3-30 days after a tick has bitten somebody. With the testing, most tests that are done now are an antibody test and physicians would recommend people should wait a couple of weeks before being testing. So, the problem with a lot of the testing, people say it’s not reliable, but a lot of it is that the tests are being done too early. Someone will find a tick on themselves Monday morning after being outside on Sunday. They go to the doctor Monday afternoon and try to get tested. That’s actually too early. They ought to be waiting at least 2-3 weeks after the tick bite to get tested because you want to allow your antibody levels to build and be detectable at that point.

Melanie:  Now, in just the last few minutes, Chuck, give us your best advice about prevention of tick problems and vector-borne diseases and why people should come to Maine Medical Center for their care.

Chuck:  We actually rely a lot on repellants when we’re in the field. Repellants such as a DEET base repellant or ones that are based with permethrin as the active ingredient work very well to keep ticks and mosquitos off of clothing and off of people. If you have companion animals, certainly apply top spot medicines such as Frontline, or another compound from your veterinarian, that will help to repel ticks off because certainly animals do bring ticks into households. Relying on good clothing or reliable clothing when you’re in the field with socks during the summertime; long sleeves and long pants will help to reduce the amount of tick exposure as well. At Maine Medical Center, there are infectious disease doctors and several specialists that are very well-versed in the treatment of what’s called “travel medicine” in infectious diseases. So, these are doctors that deal with everything from Lyme disease to malaria and they’ve got a very solid background in the care and treatment of those kinds of infections.

Melanie:  Thank you so much. It’s very important information for people to hear, Chuck. Thanks for being with us today. You’re listening to MMC Radio. For more information you can go to mmc.org. That’s mmc.org. This is Melanie Cole. Thanks so much for listening.