How to prevent Tick-borne diseases

Prevention of all tick-borne diseases can be divided into several strategies. These are environmental, personal, and prophylactic (after a tick bite has occurred). * Environmental strategies (control of the population of deer and other vectors and tick control measures) are beyond the scope of this section. * Personal strategies include avoiding grassy areas with shrubs that attract ticks, wearing white or light-colored clothing so that attached ticks can be seen easily and removed, tucking pant legs into socks, walking in the center of paths to avoid vegetation on which ticks lie in wait of a host, applying lotion containing diethyltoluamide to the skin (avoiding face and hands), applying permethrin to clothing, and performing daily tick checks and removing ticks as soon as they are detected. # * Diethyltoluamide concentrations of about 30% are recommended; neurotoxicity (eg, seizures) is reported in children, and some authorities recommend avoiding repeated use in children. * Tick removal is best accomplished by grabbing the tick as close to the skin as possible with a very fine forceps and pulling it gradually, but firmly, out from the skin. Gloves should be worn when removing ticks, and the bite site should be thoroughly disinfected with alcohol or another skin antiseptic solution. Care should be taken to avoid squeezing the tick during removal, since squeezing may inject infectious material into the skin. Use of gasoline, petroleum, and other organic solvents to suffocate ticks, as well as burning the tick with a match, should be avoided. Often, the complete mouthparts do not come out with the rest of the tick. Leaving these in does not increase the risk of disease transmission, but they may cause a local infection or foreign body reaction. * Another method is to inject a wheal of lidocaine with epinephrine intradermally beneath the tick. By blanching the area and, thus, removing the blood, ticks have been reported to crawl out on their own accord. This method is intuitive but has not been tested in any large clinical trials. # Prophylactic measures include the use of vaccines, which are available for some tick-borne diseases and are discussed in the individual sections. # Last, some individual tick-borne diseases, specifically Lyme disease and relapsing fever, can be prevented by antibiotics. See the individual chapters on these diseases for specifics. Author: Jonathan A Edlow, MD, Associate Chief, Associate Professor of Medicine (Emergency Medicine), Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School