Prevent Tick Bites for Outdoor Workers
For some workers, it would be very difficult to avoid the areas that ticks love the best- wooded and brushy areas, areas with high grass, or deep understory/ leaf litter. But it is important to be aware when you will be exposed to, and working in an area where ticks are likely to be so that you can take the extra precautions before entering those areas.
Before work:
1) Use a DEET, picaridin or IR3535 (20% or more) repellent on exposed skin. This will repel ticks for several hours.
2) Treat your clothing with permethrin. You can treat your boots, socks, shirts, gloves, hats, and bandanas or neckerchiefs with a product that contains 0.5% permethrin. This will remain on your clothes/gear and protect you from tick bites through several washings. If you purchase pre-treated clothing, the protection may last longer.
3) Dress appropriately. Wear long pants, socks and tall boots whenever possible. White or light colored clothing will make it easier to see if you have any unfriendly hitchhikers, especially those little tiny Deer ticks, or blacklegged ticks which are roughly the size of sesame seeds who are the harbingers of Lyme and Powassan.
4) Pack as much clean clothing you can feasibly change into at the end of the day. For instance, if there’s no facilities where you can fully change, bring a fresh pair of socks and shoes.
During work:
1) Carry a lint roller. On your breaks, lint roll all of your clothes to remove any ticks that may be crawling on you.
2) Comb/brush your hair. Not only will you look fantastic you’ll be getting rid of ticks too!
After work:
1) Lint roll your clothes & comb through your hair again as soon as you leave the area and before you get into your car. This will prevent ticks from hiding in the car, and crawling back on to you later, when you are less focused on tick bite prevention.
2) Change out of whatever clothes you can, and put on the clean ones you packed before work. Put your dirty clothes in a plastic bag and tie it at the top.
2) When you get home, throw whatever clean clothing and gear you can into your dryer on high heat for 10 minutes if they are dry. Wash your dirty clothes in hot water and dry on high heat. Cold water cycles will not kill ticks.
3) As soon as you are able, within two hours of finishing work, conduct a full-body tick check and hop in the shower.
Removing Ticks
While it can take 24-48 hours for a tick to transmit Lyme disease, it only takes them 15 minutes to transmit Powassan. You want to get ticks off you as FAST as possible. Do not use the old methods of “suffocating” ticks with petroleum jelly or peppermint oil, and waiting for it to detach on its own.
1) Using needle-nose or fine tipped tweezers to grasp the tick as close to the skin as possible.
2) Pull firmly and directly up, don’t twist.
3) If you find the mouth is still embedded in your skin, do your best to remove it with the tweezers. If you are unable to get it out, leave it alone and let the skin heal.
4) Use isopropyl (rubbing) alcohol, iodine scrub, or warm soapy water to wash your hands and the affected area.
5) Soak the tick in rubbing alcohol, place it in a sealed container and throw it away, or flush it down the toilet.
Follow Up from a Tick Bite
1) If you have any concerns, go see your doctor or call them.
2) If a rash or fever develops, even within several weeks of removing a tick go see your doctor. Explain you recently had a tick bite, and any details that are relevant or that they ask for.
3) Clinical signs of Powassan Disease include:
Unexplained Rash or Fever
1) If you develop an unexplained rash or a fever, even if you have not pulled a tick off recently, it is important to get checked out and explain to your doctor that you work outside. Particularly if your rash is a bull’s eye shape or spreads.
Common Tick-borne Illnesses Found in Massachusetts & Their Symptoms
| Name | Type of Tick | Transmission | Symptoms | Possible Treatment Options |
| Lyme | Blacklegged Tick, a.k.a Deer Tick (Ixodes scapularis) | In most cases an infected tick must be attached to the host for 36-48 hours. Most people are infected by the bite of tiny nymph ticks (less than 2mm), which is so small they may not even notice. | 3 to 30 days after tick bite: Fever, chills, headache, fatigue, muscle and joint aches and swollen lymph nodes. Erythema migrans rash, looks like a bull’s eye. It expands gradually over the course of days, may be warm but not itchy or painful. | Your doctor may prescribe antibiotics, which have been found to be very effective in early stages of Lyme disease. |
| Powassan | Blacklegged Tick, a.k.a Deer Tick (Ixodes scapularis) and Groundhog Tick (Ixodes cookei) | In most cases an infected tick transmits the Powassan virus within 15 minutes of biting the host. | Many people do not experience any symptoms.
Common symptoms within 1 week to 1 month include encephalitis (inflammation of the brain) and meningitis (inflammation of the membranes that surround the brain and spinal cord). You may experience fever, headache, vomiting, weakness, confusion , loss of coordination, speech difficulties, and seizures. |
Powassan is an RNA Virus for which there are no vaccines or medications to treat or prevent infection.
If you suspect you may have Powassan see your doctor immediately for their recommendation.
People with severe Powassan infections may need to be hospitalized. |
| Babesiosis | Blacklegged Tick, a.k.a Deer Tick (Ixodes scapularis) | Typically transmitted by infected nymphal stage ticks, so you may not realize that you’ve been bitten. The infected tick generally must be attached for 24-36 hours to transmit Babesiosis. | Many people experience no symptoms. Others experience flu-like symptoms such as fever, chills, sweats, headache, body aches, loss of appetite, nausea or fatigue. It can also cause jaundice (yellowing of the skin) and dark urine. | Babesiosis is a parasitic blood infection and should be treated by your healthcare provider if you are having symptoms of infection. |
| Rocky Mountain Spotted Fever | American dog tick (Dermacentor variabilis), Rocky Mountain wood tick (Dermacentor andersoni), and the Brown Dog Tick (Rhipicephalus sangunineus) | Bite from infected tick, and spreads within 24 hours of a tick attaching. | Symptoms typically begin 2-14 days after tick bite and can include; fever, rash (occurs 2-5 days after fever), headache, nausea, vomiting, abdominal pain, muscle pain, lack of appetite, red conjunctiva (membrane around eyes) | Rocky Mountain Spotted Fever infections are rare in Massachusetts with only seven cases being reported between 1995 and 2011. Antibiotics is the usual course of treatment. |
| Anaplasmosis | Blacklegged Tick, a.k.a Deer Tick (Ixodes scapularis) | Bite from infected tick. | Typical symptoms occur within 1-2 weeks of a tick bite and can include fever, headache, chills, nausea, cough, confusion and muscle aches. | Bacterial infection that your doctor may treat with antibiotics. |
| Tularemia | Dog Tick (Dermacentor variabilis), the Wood Tick (Dermacentor Andersoni), and the Lone Star Tick (Amblyomma americanum) | Bite from infected tick or deer fly, skin contact with infected animals (domestic cats are particularly susceptible), ingestion of contaminated water, inhalation of contaminated aerosols or agricultural dusts, laboratory exposure | The main symptom of a Tularemia infection is a fever, which can be as high as 104 degrees. Other symptoms can include; skin ulcer accompanied by swelling of lymph glands, cough, sore throat, chest pain, difficulty breathing- all depending on the mode of transmission. | Tularemia infections are rare, and can be treated with antibiotics. |
Sources
Centers for Disease Control; https://www.cdc.gov/ticks/diseases/index.html
Massachusetts Department of Health and Human Services; http://www.mass.gov/eohhs/gov/departments/dph/programs/id/epidemiology/ticks/