Even though the stay-at-home order has been lifted, it is still smart to continue social distancing. We all feel the need to get out of the house, and thankfully that cabin fever can be remedied by exploring the great outdoors. Creeks and rivers, meandering trails, and welcoming woods.
But one tiny creature is always unwelcome: ticks.
I think we are all acquainted with this tiny terror. Six legs. Sucks blood. Transmits nasty diseases. Missouri is Ground Zero for most tick-borne diseases. This includes Ehrlichia, Tularemia, Anaplasmosis, STARI (Southern Tick Associated Rash Illness), Q Fever, Heartland Virus Disease (another newly described illness), and Rocky Mountain Spotted Fever (RMSF). Whew! That’s a bunch (and those are just the human ones; the vets could rattle off another lengthy list). But did you catch what was missing? You’re right! Lyme. Lyme disease in Missouri is exceptionally rare. It is found primarily on the East coast and oddly enough, Michigan.
Our Show-Me ticks that cause human diseases are the Lone Star Tick (it has a white dot on the back) and the American Dog Tick (mottled light and dark brown). Most disease is transferred by seed ticks (nymph stage) and most need to be attached for 24 hours (RMSF needs only six hours!). You can approximate how long a tick has been attached by how engorged it is. Around day two or three is when ticks start to look puffy. If the body is totally distended and colored tan or gray, then it has been attached for several days.
It is not the tick itself that causes disease but the bacteria and virus strains it harbors within its body. Most tick related illnesses share the same (often frustratingly vague) symptoms of fever, fatigue, and joint pain and/or rash. Thankfully the treatment for most tick associated illnesses is the same type of antibiotic across the board, even for young children (thanks to a change in recommendations a few years ago).
As always, prevention is better than treatment. To keep the little buggers off, you should do a few quick things before a stroll through the woods and tall grass: wear long pants tucked into socks or boots and apply an insect repellent (repellent should be applied after sunscreen). You have a few to choose from:
1) DEET in a concentration around 20-30 percent. Much lower and it isn’t effective; much higher and it’s overkill (and overpriced). The effectiveness of DEET seems to plateau above 50 percent, and higher concentrations can cause skin irritation. Not recommended in children less than three years old.
2) Picaridin is most effective around 10-20 percent concentration. Not for children under age two years.
3) Avon Skin So Soft (IR3535), but the effect only lasts about three hours
For those who prefer plant-based products:
4) Lemon eucalyptus oil in concentrations ranging 10-40 percent may be more effective than the synthetic products, but only lasts around two hours and is not recommended in children under three years old.
5) Finally Permethrin (derived from chrysanthemum flowers) actually kills ticks that come in contact with it. You can purchase treated clothing (or DIY it yourself). We also use this to treat head lice and scabies.
And of course once you come inside, strip down to bare skin and check for those moving freckles. Make sure to investigate all those nooks and crannies. And your hair, too (I remember as a kid finding a tick on the tip top of my head while I was sitting in the middle of church one Sunday morning; I was horrified!) A sticky lint roller is a great tool to grab crawling ticks.
Don’t forget to check your fur babies too. Dogs, cats, and other pets can carry lots of ticks. And remember to protect them with flea and tick collars.
When it comes to removing attached ticks, get low. Use tweezers to get down as close to where the head meets the skin as possible. Pull slow and steady rather than a quick yank or twist - you don’t want to leave the tick’s pathogen-riddled mouthparts behind. You don’t want to squeeze the body because you’re likely to squish the nasty pathogens from the tick’s gut into your bloodstream.
Don’t let those little vampires keep you from enjoying Missouri’s natural wonders. Get outside! Keep hunting, hiking, and exploring. And pick those ticks!
Dr. Bonni Welch Heithold is a 2003 Salem High School graduate. She graduated from the University of Missouri – School of Medicine in 2011 and completed her pediatric residency three years later. She practices in Columbia where she lives with her husband, Jake, and their two daughters.
Ticks and Tick-borne Diseases. University of Missouri - Extension
CDC.gov > Ticks
Diaz, J.H.D. (2015) “Chemical and Plant-Based Insect Repellents: Efficacy, Safety, and Toxicity”. Wilderness and Environmental Medicine, 27
Stultz, J et al. (2019) “Doxycycline and Tooth Discoloration in Children: Changing of Recommendations Based on Evidence of Safety” Annals of Pharmacotherapy