	Notes from the School Nurse

It's Spring! Time to Prevent Lyme Disease

* The information below was obtained from the CDC website to provide you with current NYS guidelines. Please consult with your family physician as needed.

When you're outside this spring and summer, prevent tick bites and reduce your risk of Lyme disease and other tick-borne disease by following these tips. People become infected with the Lyme disease bacteria when they are bitten by an infected blacklegged tick.

Immature ticks (larvae and nymphs) are so small that they can be difficult to see. However, all stages of ticks need to feed on blood to continue on to the next stages - therefore these tiny ticks can be an important threat. Ticks (including species other than the blacklegged ticks) can also transmit diseases other than Lyme disease, including Rocky Mountain spotted fever, erlichiosis, anaplasmosis, Colorado tick fever, and Powassan encephalitis. Fortunately there are several tactics you and your family can use to prevent tick bites and reduce your risk of tick-borne disease.

Protect Yourself from Tick Bites

Know where to expect ticks. Blacklegged ticks live in moist and humid environments, particularly in or near wooded or grassy areas. You may come into contact with ticks during outdoor activities around your home or when walking through vegetation such as leaf litter or shrubs. To avoid ticks, walk in the center of trails.
Use a repellent with DEET (on skin or clothing) or permethrin (on clothing) and wear long sleeves, long pants and socks. Products containing permethrin can be used to treat boots, clothing and camping gear which can remain protective through several washings. Repellents containing 20% or more DEET (N, N-diethyl-m-toluamide) can be applied to the skin, and they can protect up to several hours. Always follow product instructions! Parents should apply this product to their children, taking care to avoid application to hands, eyes, and mouth.
It may sound silly, but tuck your pant legs into your socks so that ticks cannot crawl up inside of your pant legs. Some ticks can crawl down into shoes and are small enough to crawl through most socks.

Perform Daily Tick Checks

Check your body for ticks after being outdoors, even in your own yard. Conduct a body check upon return from potentially tick-infested areas by searching your entire body for ticks. Use a hand-held or full-length mirror to view all parts of your body and remove any tick you find. Take special care to check these parts of your body and your child's body for ticks:

Under the arms
In and around the ears
Inside belly button
Back of the knees
In and around all head and body hair
Between the legs
Around the waist

What to Do If You Are Bitten by a Tick

Remove an attached tick using pointy tweezers as soon as you notice it. If a tick is attached to your skin for less than 24 hours, your chance of getting Lyme disease is extremely small. But to be safe, watch for signs or symptoms of Lyme disease such as rash or fever, and see a healthcare provider if these develop. Your risk of acquiring a tick-borne illness depends on many factors, including where you live, what type of tick bit you, and how long the tick was attached. If you become ill after a tick bite, see a healthcare provider.

Removing Ticks

To Remove Attached Ticks:

1. Grasp the tick as close to the skin surface as possible.

Use fine-tipped tweezers or notched tick extractor, and protect your fingers with a tissue, paper towel, or latex gloves (see figure). Persons should avoid removing ticks with bare hands.

2. Grasp the tick as close to the skin surface as possible and pull upward with steady, even pressure. Do not twist or jerk the tick; this may cause the mouthparts to break off and remain in the skin. (If this happens, remove mouthparts with tweezers. Consult your health care provider if illness occurs.)

3. After removing the tick, thoroughly disinfect the bite site and wash your hands with soap and water.

Do not squeeze, crush, or puncture the body of the tick because its fluids may contain infectious organisms. Skin accidentally exposed to tick fluids can be disinfected with iodine scrub, rubbing alcohol, or water containing detergents.

5. Save the tick for identification in case you become ill. This may help your doctor make an accurate diagnosis. Place the tick in a sealable plastic bag and put it in your freezer. Write the date of the bite on a piece of paper with a pencil and place it in the bag.

Note: Folklore remedies such as petroleum jelly or hot matches do little to encourage a tick to detach from skin. In fact, they may make matters worse by irritating the tick and stimulating it to release additional saliva, increasing the chances of transmitting the pathogen. These methods of tick removal should be avoided. In addition, a number of tick removal devices have been marketed, but none are better than a plain set of fine tipped tweezers.

Check your clothing and pets for ticks. Ticks may be carried into the house on clothing and pets. Both should be examined carefully, and any ticks that are found should be removed. Placing clothes into a dryer on high heat effectively kills ticks. See the "Prevent Ticks on Animals" section of this page for more information.

Lyme Disease Symptoms

The Lyme disease bacterium can infect several parts of the body, producing different symptoms at different times. Not all patients with Lyme disease will have all symptoms, and many of the symptoms can occur with other diseases as well. If you believe you may have Lyme disease, it is important that you consult your health care provider for proper diagnosis.

The first sign of infection is usually a circular rash called erythemamigrans or EM. This rash occurs in approximately 70-80% of infected persons and begins at the site of a tick bite after a delay of 3-30 days. A distinctive feature of the rash is that it gradually expands over a period of several days, reaching up to 12 inches (30 cm) across. The center of the rash may clear as it enlarges, resulting in a bull's-eye appearance. It may be warm but is not usually painful. Some patients develop additional EM lesions in other areas of the body after several days. Patients also experience symptoms of fatigue, chills, fever, headache, and muscle and joint aches, and swollen lymph nodes. In some cases, these may be the only symptoms of infection. Untreated, the infection may spread to other parts of the body within a few days to weeks, producing an array of discrete symptoms. These include loss of muscle tone on one or both sides of the face (called facial or "Bell's palsy), severe headaches and neck stiffness due to meningitis, shooting pains that may interfere with sleep, heart palpitations and dizziness due to changes in heartbeat, and pain that moves from joint to joint. Many of these symptoms will resolve, even without treatment. After several months, approximately 60% of patients with untreated infection will begin to have intermittent bouts of arthritis, with severe joint pain and swelling. Large joints are most often affected, particularly the knees. In addition, up to 5% of untreated patients may develop chronic neurological complaints months to years after infection. These include shooting pains, numbness or tingling in the hands or feet, and problems with concentration and short term memory.

Most cases of Lyme disease can be cured with antibiotics, especially if treatment is begun early in the course of illness. However, a small percentage of patients with Lyme disease have symptoms that last months to years after treatment with antibiotics. These symptoms can include muscle and joint pains, arthritis, cognitive defects, sleep disturbance, or fatigue. The cause of these symptoms is not known. There is some evidence that they result from an autoimmune response, in which a person's immune system continues to respond even after the infection has been cleared.

Prevent Ticks on Animals

Prevent family pets from bringing ticks into the home. Maintain your family pet under a veterinarian's care. Two of the ways to get rid of ticks on dogs and cats are putting on tick medicine or using a tick collar. Be sure to use these products according to the package instructions.

For more information on Ticks and Lyme Disease please visit the CDC Web site at http://www.cdc.gov/Features/LymeDisease/

Diane M. Sabanos R.N. ~ St. Mary’s School Nurse

Mrs. Sabanos' Site