As we appear to be gaining more control over the SARS-CoV-2 virus I worry about the risk of another problem. Most of us have spent the last year feeling like hibernating bears because of the restrictions the pandemic has placed on our lifestyles and freedoms. I can say for myself that I am excited to be able to go outside in the sunlight, walk around the neighborhood with my girlfriends, and break bread with family members whose thoughtful, funny and somewhat oppositional banter I have so missed. Finally spring has sprung and we are all excited to go outside and see each other as well as to enjoy nature as its beauty is reawakened.
Ok, this sounds good. On the other hand, I can’t help but worry that in our attempt to return to a full life, inside and outside the home, we may be somewhat negligent in our efforts to avoid the various ticks and other bugs that are also enjoying nature’s beauty as they search for their next meal.
I live in New Jersey, which is considered a Lyme endemic state. According to the most recently available statistics the incidence of Lyme disease in New Jersey increased from 36.1 cases per 100,000 population in 2007 to 44.9 in 2018. This increase and the recent recognition that Lyme disease can be found in all 50 states highlights the importance of everyone, and parents especially, being aware of basic information about ticks. The Ixodes scapularis tick (also known as the blacklegged tick or “deer tick”), is responsible for carrying and transmitting Lyme disease in the Eastern part of the United States and has a natural life cycle of two years. The Ixodes pacificus tick, more frequently found on the West coast, can live approximately three years. Male ticks attach, but don’t feed or become engorged. On the other hand, the adult female tick must have three blood meals during development to reach adulthood and be capable of laying a large batch eggs and then dying. It is the female tick, and it’s need for blood feeding, that is responsible for the spread of Lyme disease.
The tick life-cycle is as follows: Ixodes scapularis eggs are laid down by the adult female tick in the spring, hatch in the summer, and then as previously noted, a blood meal is required at three different life stages for survival: once as a larva that first summer, later as a nymph the following spring and subsequently as an adult that it becomes in the fall and remains until it goes on to lay eggs the following spring - thus restarting the cycle. These “bugs” get their blood meal from mammals, birds, amphibians, and reptiles. The larval stage cannot transmit disease. Only the nymphal and adult ticks can transmit Lyme disease.
These ticks often become infected by taking a blood meal from an infected white footed deer mouse (scientific name Peromyscus leucopus) which is the most common source of the infection. When they grow, the adult tick attaches to a deer for its next blood nourishment. Humans are not really the natural host for these creatures, but they can easily become inadvertent hosts when they walk in the grassy wooded areas where these creatures hang out and are in need of a blood meal.
This past year New Jersey (as I suspect is true for many other states) has seen the size of its deer population increase in numbers and geographic spread. Given deer are one of the natural hosts (or meals) for ticks that carry Borrelia burgdorferi, the bacteria that causes Lyme disease, their increase is another cause for real concern this summer. This increase is not just due to natural causes but also can be seen as a “side effect” of our not inappropriate preoccupation with fighting the COVID-19 pandemic. Manpower and financial resources that are routinely utilized to control the state’s deer population, such as the culling of deer, were otherwise allocated in some parts of the state.
As we all get over our “cabin fever” we must remember to make an extra effort to protect ourselves, and especially our children, from ticks. Children and adolescents make up 25% of the 476,000 annual new cases of Lyme disease. Kids are at heightened risk because they are physically closer to where the ticks hang out during their hunt for blood (called questing). Children love to roll around in the leaves where these infection-loaded creatures hide. Summer camps and outdoor sport activities enhance a young person’s risk. Getting bitten on the head and/or neck make it easier for these infections to affect the central nervous system (i.e. the brain and spinal cord.) This may well be a partial explanation why children with evidence of a previous tick-bite not uncommonly present with psychiatric symptoms - at least in my practice. More on this connection in future blogs.
Many who’ve been victims of tick-borne illnesses know that the frequently heard saying that “Lyme disease is easy to diagnosis and easy to treat” is misleading and too often untrue. However, all sides do agree that prevention of infection by the use of repellents, the wearing of proper clothing (long sleeved tops, long pants and socks) as well as doing full body tick-checks after being outside (please don’t forget the scalp!) is without question the best approach.
So…PLEASE remember to protect yourself and your child from these disease carrying bugs as you enjoy the beautiful outdoors.
Stay safe and well,
RG
