Transcription:
Buggin’ Out: A Parent’s Guide to Mosquitos and Tick Disease

Bill Klaproth: (Host) So let's talk about mosquitoes and ticks. When it comes to mosquitoes, what diseases do I need to worry about with my child? And also, why do I get bit more than others? And then how about ticks? How common are infections caused by ticks and what do I need to know as a parent? So let's find out what Dr. Sandra Arnold, division chief of pediatric infectious diseases at the University of Tennessee Health Science Center and Le Bonheur Children's Hospital. This is the Peds Pod by Le Bonheur children's Hospital, I'm Bill Klaproth. Dr. Arnold, thank you so much for your time, it is great to talk with you. So first off, are diseases from mosquito, something I need to worry about living in the US.

Dr. Sandra Arnold: (Guest) Absolutely. There are diseases that you can get from mosquitoes in this country. There are not very many of them, but there are also many diseases you can get from mosquitoes, from countries that are very nearby. Those to the South, especially in central and South America and the Caribbean. Those are places that a lot of people traveled to, so everybody needs to be aware of all of these possibilities and protect themselves.

Host: So when it comes to children, what are the possible diseases a child can get from mosquitoes, and how common are those?

Dr. Arnold: So in the U.S mosquito, borne diseases are not very common. Children and adults get the same diseases. They tend to be more common in adults because adults have a higher risk of exposure. Usually from occupational exposures, working outside for example. But these diseases, like I said, are not terribly common. If you take West Nile virus, which has probably the most common mosquito-borne disease in the United States today, it tends to cycle up and down. So there are summers where they were more cases in summers, where there were fewer cases. As of July 28th of this year, there have been only 17 cases of West Nile virus across the entire country. And that's only in 11 States, 12 of these were associated with neurological disease. So the encephalitis that you think about when you hear about West Nile virus, so we're talking about not a very common disease, but these are things which anybody could potentially be exposed to. Other diseases that you can get from mosquitoes are also causes of encephalitis or brain infection. And those include Eastern equine encephalitis, lacrosse encephalitis, and St. Louis encephalitis, and these tend to be localized to specific regions of the country, whereas West Nile virus is found actually in every state of the United States. When it arrived here in the late nineties, early two-thousands, but basically spread all the way across the country, over subsequent summers. And now you can see it anywhere whereas most of these other viruses still have very specific geographic locations. Other viruses that you can get from travel are things that you may have heard of like Chikungunya virus, dengue virus, yellow fever virus, and then Zika, which is the most common one that people think of because it's the most recent and it was very newsworthy because of the terrible things it did to newborn babies and unborn babies, which was to cause severe disruptions in the growth of the brain and resulting in very disabled children. And those viruses are predominant in this part of the world are predominantly found in the Caribbean and Central and South America. But there have been very small pockets of outbreaks in places like Florida and Texas, where the mosquito exists. And if a case is introduced, a mosquito may be able to pick it up from an infected person and then spread it to someone else. But those have been very small and self-limited outbreaks. So to get those viruses, generally, you have to travel to a place where they're circulating.

Host: And these types of diseases are generally rare, is that right? So we don't have to really be overly concerned, but we need to be aware of the potential dangers of diseases through mosquito bites?

Dr. Arnold: Absolutely, I think that's correct. Certainly, the ones that I just mentioned, Chikungunya, Dengue, and Zika are very rare in the United States, but are pretty common in the places that I mentioned, so that if you're traveling, you need to be very aware and wear appropriate mosquito repellents, which we can talk about as well. Things like West Nile virus, there around and they are endemic, meaning every year there are cases of them in the United States, but they are rare.

Host: Okay, and are there other things parents should be aware of concerning mosquitoes?

Dr. Arnold: It's important to know, thinking about West Nile virus, being the most common that this is spread by a particular group of mosquitoes from the Aedes group. Mostly, mosquito called Aedes aegypti and this is a day-biting mosquito, and it's hard to kill by spraying. So you can't really rely on your health department to go around and spray the neighborhoods because they live very close to the ground and they don't travel very far and they don't get high up in the air. So aerial spraying of a neighborhood doesn't do very much prevent that. So what you need to do to prevent mosquitoes around your house is to eliminate standing water. This is the most important thing that anybody can do because mosquitoes lay their eggs in water that doesn't move, so standing water. And that can accumulate in a lot of places. I see puddles in my driveway where they're a little divot in the pavement and that standing water, it doesn't last for very long so it's generally not a big issue, but anywhere where you could get a deep enough pool of standing water and mosquito can lay its eggs. So on top of a pool cover, in a bottle cap, in a birdbath, all of these sorts of places. If you have old tires out, they're great for collecting standing water. So you need to be super aware that if you have standing water around your house, that's a breeding ground for mosquitoes and try to keep on top of it. The other thing is decaying vegetation and things like that. Piles of leaves and sticks, et cetera, those can also be placed as to where mosquitoes will breed. And then finally keeping your grass short. So there are things that you can do to actually limit the number of these sorts of mosquitoes around your house. Cause they don't have a very large flying range. They're not going to come even from up the street to your house. They're going to be around your house. They're going to lay eggs there. And those mosquitoes are going to be the ones that bother you. So you can actually do a lot to keep certain types of mosquitoes away from your house. Those that transmit West Nile virus, especially.

Host: Those are great tips for all of us. Eliminate standing water, get rid of decaying vegetation, and keep your grass short. Great tips, Dr. Arnold. And then what about mosquito repellent, we hear about DEET to make sure you have a mosquito repellent with DEET in it and other things. Can you give us some guidance on that?

Dr. Arnold: Sure, so DEET is probably the best repellent for mosquitoes. It's got a very long chemical name, but DEETS a lot easier to say. And the CDC recommends there's actually a list of things that they recommend, but I can tell you that in studies, DEET is the one that has, it seems to be the best at preventing mosquito bites, especially from disease-carrying insects. And what's recommended is 20% DEET or higher. So if you go to the store, you can see there's a very large swath of bug sprays, even just with some of the brands like off that people tend to be attracted to. And if it's less than 20%, it's probably not worth using. It's very safe, we don't use it on very young children, in those cases, babies who were in strollers, if you're going out you're best to get a sort of netting to put over the stroller cause you can't put DEET containing bug spray on babies that are under two months of age. But for everybody else, it's very safe, but you want to do the more than 20%. So deep woods off, cutter, those sorts of brands are the ones that have the higher percentage of DEET, and those are the ones that you should go for. There are other types of repellents that you can spray on your body. There's one called picaridin it is also cutter also makes, for example, a product with picaridin in it. Oil of lemon eucalyptus is another one that's more of a botanical. So if you go and you see the botanical bug sprays, that one is on there but it is probably not as effective, but people like the idea of it because it's not necessarily quote a chemical. So there are these other products and you can find them listed on various websites, but for me, and I'm somebody that tends to get a lot of bites, I find that the high percent DEET works really well.

Host: More great advice. So look for a bug spray with at least 20% DEET or higher. And then you just said, I'm a person that tends to get bit more often, do you know the reason why some people are bitten more than others?

Dr. Arnold: So there are some published studies that say that people with certain blood types, like blood type O which I am or more attractive, whereas blood type a, they are less attracted, that doesn't explain that my husband gets bitten as much as I do though, cause he's blood type A. So that's obviously not the whole story, carbon dioxide, that we exhale in our breath is something that they are attracted to and larger people. The more CO2 you exhale, the more likely they are to be attracted to you. But then there are things that we have, that we can't really control, genetic differences in the amount of certain substances that we produce in our bodies that may be attractions for mosquitoes. So things that might be in our sweat and of course, mosquitoes are out when it's warm. So we tend to be warm. Things like lactic acid, uric acid, and ammonia, chemicals that our bodies produce in our metabolism. There are genetic differences in the amount of these that each individual produces that may influence how attracted mosquitoes are to us, And then also our skin bacteria, which is something that is very different from person to person in terms of the quantities of the different types of healthy bacteria that we have, and some of these may be more or less likely to attract mosquitoes. So there's not a whole lot you can do about these things. The one thing you can do something about is they're attracted most to dark clothing. So if you're going to be out where there are mosquitoes, basically outside in the summertime, it's an encouragement to wear brightly colored clothing. So you think bright colors would attract them, but it's actually dark colors. So the things that you wouldn't want to wear when it's really hot, like black and dark blue, you probably shouldn't.

Host: Okay, great advice for us, Dr. Arnold. Thank you for that. Okay, let's turn to ticks now, another big topic. So what are the diseases you can get from ticks?

Dr. Arnold: There are quite a few diseases that you can get from ticks in the United States and somewhat like the mosquito-borne diseases, these are location dependent. The epidemiology of these diseases is location dependent. For example, Lyme disease is the disease that most people think of when they think of things that you can get from ticks, but you can't get Lyme disease in every part of the United States. I'm in Tennessee and it's not really found down here. Of course, people in Memphis where I live can get Lyme disease, but it's usually because they've traveled somewhere where there is Lyme disease, which is the upper Midwest and the Northeast. Other diseases you can get from ticks are things like the Babesiosis., which is probably something people haven't heard of. It pretty much circulates in the same places that Lyme disease does, and you acquire it from the same tick. To actually the range of the ticks and the animals that they feed off of that determines where a tick-borne disease occurs. Now, if you live where I live, the diseases that are most common are Rocky Mountain spotted fever, which sounds weird because we are not in the Rocky Mountains, but that's what it's called and a disease called ehrlichiosis. There's also a disease called anaplasmosis, which is more common in the Northeast also. There's a disease called STARI, which stands for Southern tick-associated rash illness. Which is a bit more mysterious. It's not 100% known what bacteria causes it, and it causes a skin lesion just like Lyme disease, but it's not Lyme disease. It doesn't have all the other stages that Lyme disease has. There's a disease known as tick-borne relapsing fever, which you do get over in the Rocky Mountains, tick paralysis, which is a crazy disease where the tick emits a toxin that causes you to be paralyzed, and then when you pull the tick off, you are no longer paralyzed. It's pretty cool to treat because you cure people very quickly and easily. And then finally, a disease called tularemia, which has many forms, one of which is a tick-borne form and is also found in the Southeast to be spread by ticks, but it can also be spread through animals, through aerosolization of animal blood. So if you're a hunter and you hunt rabbits and you skin rabbits, you could get Tularemia. but the ones that are the most common would be Lyme disease, Rocky Mountain spotted fever, or the ketosis and anaplasmosis.

Host: Oh, my, that's a lot of stuff.

Dr. Arnold: Absolutely.

Host: I'm feeling very scratchy and itchy talking about this right now. So we talked about how to prevent mosquito bites. Can you tell us how can we prevent tick bites in myself and my child?

Dr. Arnold: Right, so you can prevent tick bites in the same way that you can prevent mosquito bites. That is using insect repellent, still the best way to do it. Avoidance is very important, so again, you want to keep the grass short and keep the bushes trimmed and the vegetative matter in your yard at a minimum, but ticks are everywhere, especially around here in the South. And so I've had patients who live you know, in the middle of a city where there isn't a lot of vegetation, there aren't a lot of bushes and tall grass and still get tick-borne diseases. So it's impossible to avoid them altogether, but things that you can do to prevent it like I said, wear the same sorts of repellents we discussed with a high percentage of DEET, actually OFF makes one that says ticks right on it, but it's just the same as deep woods off. The other thing is that you can wear light-colored clothing when you're out if you're out hiking in the woods and that basically allows you to see the ticks, to brush them off because ticks don't land on you, sting you and fly away. They land on you then they attach and they feed off you for a few days. And they get very engorged. I know it's horrible to think that. And so doing tick checks is probably the most important thing you can do after insect repellent after you've been out in the woods. If you went hiking like I did recently you want to check yourself for ticks, because if they haven't been attached for very long or they may not even be attached yet, you can get them off and they are much more likely to transmit the disease for the longer that they're attached to you. Also, when you're out, you can wear pants and long sleeves, so cover more of your skin. And this is also true for mosquitoes and you can tuck your pants into your socks, not your typical, the way you think of yourself going hiking, but these would protect you from ticks and mosquitoes. If you're going somewhere where you know there are going to be a lot of mosquitoes and we would recommend this. If somebody were traveling to Sub-Saharan Africa, for example, you can buy something called permethrin, which is the stuff that you would spray around your yard to prevent mosquitoes from being there altogether. You can soak your clothes in it, you can also get bed nets and soaked bed nets in them. That's more for mosquitoes that bite at nighttime, obviously, but you can soak your clothes in permethrin. So if you're a big hiker that you can get this at the outdoor store and soak your clothes in it and it will help keep the ticks away. And then obviously keep the grass short in your yard because they like to climb on the grass and the quest for you from the tip of the grass, and they can obviously get to you more easily. If the grass is higher.

Host: So, last question, Dr. Arnold, and thank you so much for your time, what do we do if we find a tick on ourselves or our child?

Dr. Arnold: So there's a very specific way. You do have to pull it off, so it's not going to come off just by brushing it away or flicking it off. You need to get tweezers and you need to go right down to the skin to where the mouthparts are. And you need to gently pull it out. So, if you grab it, you might break off the mouthparts in, and those will be left behind. And there may still be disease-causing agents, you know, in the saliva that are going to get into your body. You want to try to get the whole thing. It's not the easiest thing in the world, but it's also not the hardest. You just have to gently pull back and it will release and you'll be able to pull it off. Don't try to burn it. Warm soapy water is not going to get it to detach. We don't recommend giving antibiotics generally after you've had a tick bite since most ticks don't transmit disease. And you can't tell by looking at it, whether it does. You can save the tick and go to your doctor if you want and show it to them, cause some of them are pretty easy to identify. And if you live in a place where there are a lot of ticks down here, for example, the lone star tick has a spot on its back. And so you can say, Oh, that's a lone star tick. So it may transmit disease and we should know about that, but generally, most of these diseases are treated with the same antibiotic, which is a drug called doxycycline. And so you can wait to see if you get ill because all of these diseases are treatable, but you don't know who's going to get them.

Host: So would you recommend that a parent do this on their own or bring the child to a clinic, so probably the quicker, the better, if you spot it, you want it out of there, so just be careful, use the tweezers, go down low and get the thing out. Well, Dr. Arnold, this has really been fascinating and informative. Thank you so much for your time.

Dr. Arnold: Absolutely, you have a great day.

Host: That's Dr. Sandra Arnold, and to learn more, visit lebonheur.org/podcast, and be sure to subscribe to the Peds Pod on Apple Podcasts, Google Play, or wherever you listen to your podcasts, you can also check out lebonheur.org/podcast to view our full podcast library. And if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by Le Bonheur Children's Hospital. Thanks for listening.