With an enemy usually no bigger than the head of a pin, it's no wonder growing numbers of Americans living in northern states are losing the war against Lyme disease, the most commonly reported illness transmitted by ticks in the US.
Reported cases are at a record high: Nearly 18,000 people a year are infected, according to the Centers for Disease Control and Prevention, which receives reports on only a minority of cases.
Although the surgeon general's goal stated in Healthy People 2010 is to reduce Lyme-disease cases by 44 percent in states where Lyme-infected deer ticks now reign unchecked (the northeast from Maryland to Massachusetts and in Wisconsin, Minnesota and northern California), prevailing forces seem determined to spell failure.
The deer population is exploding, with nothing more than a short hunting season to curb their numbers. More and more Americans seeking residences and recreation are moving into deer habitat, in suburban and rural wooded areas. And the deer, seeking ever-shrinking natural sources of food, are coming closer and closer to populated areas, brazenly nibbling on landscaped vegetation right outside people's homes.
But while most people who live or work in areas where Lyme disease is prevalent are aware of the illness and its potential complications, no more than half take any of the recommended precautions to protect themselves from a surreptitious bite by a Lyme-carrying tick.
According to Dr. Gregory Poland, a Lyme disease expert and a professor of medicine and infectious diseases at the Mayo Clinic, "All the behavioral measures intended to prevent Lyme disease are incomplete and impractical." Because of that, many people take chances that no Lyme-carrying ticks will bite them or that antibiotics will cure them.
In a report in The Mayo Clinic Proceedings in July 2001, Poland noted that studies had not yet demonstrated that wearing protective clothing made a difference in the risk of developing Lyme disease. And while these and later studies are not the gold standard of research, it is easy to see why the advice falls short of complete or near-complete protection.
The main carrier of Lyme disease is the nymph of a tick ( Ixodes scapularis or Ixodes pacificus ) that is no bigger than the head of a pin and able to crawl unnoticed through the tiniest of openings, establish a resting site on the skin and start feeding on blood without creating the slightest sensation to warn of its presence.
Not until the immature tick has fed for a while and become engorged with blood is it likely to be noticed, even by those who do daily body checks. Seventy percent of people who contract Lyme disease don't recall being bitten.
The Lyme disease bacterium, a spirochete called Borrelia burgdorferi, lives in the midgut of the tick and when a feeding tick spits out the water from its blood meal, it can transfer the bacterium into its host.
"Short of a vaccine, I don't see how we will control this disease or achieve the goal of Healthy People 2010," Poland said in an interview. "What would help in suburban areas is controlling the deer population" through hunting (not popular in residential areas) or birth control.
Small mammals like the white-footed mouse are hosts for immature ticks, and deer are hosts and dispersal systems for adult ticks.
Still, recommended measures intended to reduce exposure to infected ticks and curb ticks' ability to find safe feeding stations on people are worth taking, Poland said.
Most people who contract Lyme disease do so on their own property. A combination of practical and, to some, undesirable measures can reduce the likelihood that infected ticks will inhabit the yard.
First, the practical. Fence in the yard to keep deer out. Rake dead leaves, remove dead branches and fallen trees and keep the grass cut short. Store woodpiles away from the house and keep them covered.
Less practical is to remove shrubbery, especially plantings that appeal to deer. But, as I discovered the hard way, deer like almost everything.
Forget about the lists of deer-resistant plants; the deer don't read them. Lest you end up with a yard devoid of greenery, you might try the following, which deer seem to leave alone: barberry, needle-bearing evergreens, ornamental grasses, forsythia, bee balm, small marigolds, ajuga and foxglove. If you put in new trees, their leaves should be taller than a deer's head.
Deer prefer tender young shoots, accounting for the failure of one abandoned recommendation -- selective burning of sites heavily infested with ticks. This reduces the tick population only briefly; when new growth appears, the deer and their ticks are back in full force.
Also, forget about getting a flock of guinea hens. Though rumored to devour ticks, Poland said they were ineffective.
Another possible measure that helps but also has distinct disadvantages is to have the yard professionally treated with an acaricide, or tick-killing pesticide, which requires repeated applications and can be toxic to people and pets, desirable wildlife and nearby waterways.
Avoid tick-infested areas from May through July. Consult your local health department, park or extension service for information on tick distribution.
When you read what you should wear to reduce the chances that a tick will find its way onto your skin, it is no wonder that few people do it during the summer.
The advice calls for long socks (preferably white); long light-colored pants, with pant legs tucked into the socks and taped shut; long-sleeved shirt, a hat and closed shoes. About the only part that appeals is the light-colored clothing, to give you a better chance of detecting a crawling tick.
You can also use a tick repellent containing about 20 percent to 30 percent DEET on clothing and exposed skin, but not the face. Though most products suggest reapplication every two to three hours, a new product, Cutter Tick Defense, contains two additional agents that the company says enhance the degree and length of effectiveness of DEET as a tick repellent for up to six hours. (The product is also said to repel mosquitoes and biting flies.)
While DEET can be used safely on children occasionally -- say, when taking a hike in the woods -- it is not wise to use it daily, Poland said.
Another option is to spray clothing with permethrin, which kills ticks upon contact. This must never be used on bare skin, and it is not advisable for routine use on children's clothing, Poland said.
After returning from an area likely to be infested with ticks, an immediate shower and scrubbing with a washcloth is recommended. Clothing should be washed in hot water after being removed at the door.
Do daily body checks, looking closely at hairy areas and junctures between clothing and skin (sock and underwear lines, for example). Removing attached ticks within a day can prevent infection. Using fine-pointed tweezers, grasp the tick gently nearest the skin and pull it straight out; do not twist. Flush it down the toilet, wash your hands and clean the site with disinfectant.
When hiking or camping, stay on wide, well-trodden paths in mature woods.
Finally, protect and check pets that wander outdoors. Consider giving furry dogs a close shave from spring through fall so that you can more easily detect crawling ticks. Monthly applications of tick treatments for dogs during the entire tick season can help as well.
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