May Marks Lyme and Tick-Borne Diseases Awareness Month

Ticks can carry at least 30 different diseases. Here from smallest to larges: deer tick, Lone star tick and dog tick. Image courtesy of ticksafety.com

Tick-season is Here

The Chaffee County Board of County Commissioners serving as the Board of Health has proclaimed the Month of May as Lyme & Other Tick-Borne Disease/Conditions Awareness Month for 2024 along with the State of Colorado and the Governor’s Office.

Spring is here and more people are heading out to participate in all the activities that warmer weather brings to our valley. People will be outside in greater numbers and so will ticks. Though ticks may be active year-round, “tick season” is upon us, and it is time to elevate awareness. Both residents and visitors are exposed to ticks and tick-borne diseases through work, play, outdoor recreation, and travel. Pets, horses, and other livestock are also at risk for tick-borne diseases and can put humans at greater risk as well.

Lyme Disease Incidents are One of the Markers of Climate change

The rate of Lyme disease and other tick-borne infections continues to spread rapidly across the United States. The U.S. Environmental Protection Agency (EPA) uses the incidence of Lyme disease as one of the monitors of climate change.

The Centers for Disease Control and Prevention (CDC) now estimates case numbers for Lyme disease to be over 500,000 across the United States annually. In response to this growing risk, U.S. federal entities developed the “National Public Health Strategy for the Prevention and Control of Vector-Borne Diseases (VBDs) in People” (2024) to address the rising public health threat of VBDs.

The VBD National Strategy includes critical federal government activities to prevent and control VBDs. https://www.cdc.gov/ncezid/dvbd/framework.html

Many tick-borne diseases (TBDs) are not “reportable” for humans at the State level, leaving rates of local infections and risk for many other tick-borne diseases, unknown. The Companion Animal Parasite Council reports an upward trend for Lyme disease, ehrlichiosis, and anaplasmosis cases in Colorado dogs since 2012. https://capcvet.org/maps/#/2024/all-year/lyme-disease/dog/united-states

Ticks associated with Rocky Mountain Spotted Fever. Image courtesy of Lyme Disease Association.

In addition to Lyme disease, ticks can transmit many other germs (bacteria, viruses, and protozoan) that can cause many serious and sometimes fatal diseases. These include:

Tick Fever
Spotted Fever Rickettsiosis (such as Rocky Mountain Spotted Fever)
Tularemia
Babesiosis
Ehrlichiosis
Anaplasmosis
Tick-Borne Relapsing Fever

Ticks can also transfer various substances in their saliva that may lead to tick paralysis, alpha-gal syndrome (red-meat allergy), and others. A single tick bite can transmit several germs that can result in multiple diseases at the same time!

Colorado is home to nearly 30 species of ticks. https://pubmed.ncbi.nlm.nih.gov/33164093. Other species of ticks and the pathogens they carry are increasing in prevalence and distribution nationwide. According to the CDC 2018 study report https://www.cdc.gov/mmwr/volumes/67/wr/mm6717e1.htm, tick-borne disease cases more than doubled in the United States in the past 13 years and were 77 percent of all vector-borne disease reports.

Lyme disease accounted for 82 percent of those reports, and case numbers of other TBDs also increased. During this same time period, seven tick-borne diseases were reported for the first time from the United States. New species of ticks are being documented for the first time in the United States as well as in states not previously recorded.

Combating TBDs with Education and Awareness

Education and awareness of TBDs is important for patients to both prevent disease and to be able to advocate for themselves if they are bitten or suspect a tick-borne disease. There is a nationwide need for clinicians to gain more in-depth education for rapidly growing health risks to consider tickborne diseases when evaluating patients. Outdoor workers, people who recreate in the outdoors, travel, or those who have close contact with domestic animals or wildlife are at higher risk. Children are also at higher risk, and symptoms of Lyme and other tick-borne diseases can appear differently, sometimes manifesting solely as neuropsychiatric symptoms.

Diagnosis of tick-borne diseases is often difficult. Nearly 50 percent of people who develop Lyme disease have no recollection of a tick bite. For children, this number is less than 20 percent. https://pubmed.ncbi.nlm.nih.gov/30853264/

Manifestation and recognition of a bull’s eye rash on darker skin tones can further delay the diagnosis and treatment of Lyme disease for people with brown or black skin. This disparity also creates inequity in disease recognition and care for those with brown or black skin https://www.lymedisease.org/racial-disparities-lyme-disease/. See the CDC poster demonstrating the variability of Lyme rashes on various skin tones. https://www.cdc.gov/lyme/resources/NCEZID_rash_poster3r1-508.pdf

Other symptoms of tickborne diseases may appear as flu-like in the early stages of the disease. These include fever, severe headache and neck stiffness, fatigue, muscle/joint pain, nausea, diarrhea, vomiting, rashes of various presentations (spotted, streaked), swollen lymph nodes, and other symptoms that are similar to other illnesses. This makes diagnosis difficult, especially when no history of a tick-bite is noted. The ticks that most often transmit the germ that causes Lyme disease and many other TBDs can be the size of a pinhead.

Laboratory tests for many tick-borne diseases are highly unreliable, especially in the early stages of disease, making diagnosis even more challenging. Acute Lyme and other TBDs may also present as serious and life-threatening illnesses including carditis, facial palsy, and encephalopathy. Some diseases can be fatal if not treated in the first few days. If tick-borne disease is suspected (Lyme carditis, Rocky Mountain spotted fever, etc.), the earlier treatment is initiated, typically the better the outcome.

Many tick-borne diseases can also be transferred from an infected mother to her unborn child during pregnancy. The CDC now states that it is “possible yet rare” for untreated Lyme disease to infect the placenta and spread from mother to fetus. The CDC stresses the importance of diagnosis and treatment during pregnancy https://www.cdc.gov/lyme/resources/toolkit/factsheets/Pregnancy-and-Lyme-Disease-508.pdf. However, research is lacking on the long-term outcome of children that may contract Lyme disease congenitally.

Colorado Cases of Lyme Disease are Growing

Colorado reported eight human cases of Lyme disease in 2019, the largest annually reported case number in the state’s history. Unfortunately, case investigations for Lyme disease have been on hold since 2020. According to Colorado Department of Public Health & Environment, “Lyme disease investigations were on hold due to limited capacity during the pandemic.”

Cases of Lyme and other TBDs in Colorado are underreported due to limited education and prevention awareness, limited surveillance activities, and difficulty in diagnosis. When Lyme and other tick-borne diseases are not quickly and accurately diagnosed or treated, they may result in severe illness, chronic disabling symptoms, or death; and may mimic many other diseases, including acute and long-haul COVID 19.

Various studies have found that 20 to 60 percent of patients who acquire Lyme disease may develop chronic or persistent symptoms. The CDC has just added Lyme disease to the list of disease agents that have been linked to chronic symptoms. https://www.cdc.gov/ncezid/what-we-do/our-topics/chronic-symptoms.html

Because of the complexities of symptoms and health issues for patients with chronic/persistent Lyme disease, many patients go for years being undiagnosed or misdiagnosed with progressively disabling symptoms and are often told that their physical symptoms are solely psychological in origin or “all on their head.” The controversy over the root cause of these symptoms has been plaguing patients and the clinicians that treat patients for over four decades and the science is still unsettled.

The best protection against Lyme and other tick-borne diseases/conditions is awareness, prevention, education, prompt and accurate diagnosis, and early and adequate treatment. Join us!

The Colorado Tickborne Disease Awareness Association (COTBDAA) and Chaffee County Public Health (CCPH) are partnering in this month-long awareness campaign.

May 6: Kicking off the month is Moonlight Monday with donations going to support COTBDAA and the month-long awareness campaign in Chaffee County. Prevention education resources will be available from 5:00 p.m. to 7:00 p.m. at the CCPH table at Moonlight Pizza and Brewpub on May 6.
May 8: In partnership, COTBDAA and CCPH are providing a community conversation and screening of the film, “The Quiet Epidemic”, a powerful documentary that is spurring a grassroots effort to expose the real impact of Lyme disease nationwide. This screening is part of the CCPH- Age Strong Film Club at the Stardust Theater from 2:00 p.m. to 4:30 p.m.. Local expert, Monica White from COTBDAA, and CCPH Director, Andrea Carlstrom, will be on hand to answer questions.

“Lyme disease is the most prevalent vector-borne disease in the U.S. with nearly 500,000 new cases diagnosed each year. The incidence of many less common tick-borne diseases is also increasing with higher numbers and expanding distributions of ticks across the U.S .and the world, said COTBDAA President and Co-Founder Monica White.

“The best way to avoid the many life-threatening or disabling and chronic tick-borne diseases/conditions that have impacted my family, and so many others, is to prevent a tick bite. Children are among the highest risk group for disease, and pregnant women are capable of transmitting infections to their unborn children. Too often people don’t understand the devastating impact of Lyme and other tick-borne diseases/conditions until they or a loved one has been affected. Elevating awareness is critical to supporting public health for everyone.”

Additional Resources and Events:

Link to CCPH website: https://www.chaffeecounty.org/Public-Health-Tick-Born-Disease-Prevention

Link to COTBDAA: https://coloradoticks.org/

Link to Looking Upstream: A We Are Chaffee podcast: Adam Williams and Monica White https://www.wearechaffee.org/white

Link to CCHC COTBDAA blog: https://chaffeeresources.com/staying-tick-safe-in-the-outdoors-by-monica-white/

Link to The Quiet Epidemic Trailer: https://www.thequietepidemic.com/

Link to Ticks and Tick-Borne Diseases of Colorado, Including New State Records for Argas radiatus (Ixodida: Argasidae) and Ixodes brunneus (Ixodida: Ixodidae): https://pubmed.ncbi.nlm.nih.gov/33164093/

Prevent Tick Bites:

Know your surroundings: Depending on where you live, work, or travel, ticks and tick-borne diseases may be different, more prevalent, and active at different times of the year
Wear permethrin-treated clothing and gear
Tuck shirts into pants and long pants into socks, or wear gaiters

Use only EPA-approved tick repellants on exposed skin
Stick to the center of trails
Throw exposed clothing in a dryer at high heat for 10 minutes to kill any “hitchhikers”
Shower when you return indoors
Do tick checks: Use a mirror and/or a partner. Help check young children and check your pets too! Especially…

- Head & Hair
- Nape of neck and in & around ears
- Under arms
- Belly button and waistline
- Between legs and groin area
- Back of knees
- Between toes

If a tick is found, remove it properly:

Use fine-nosed (pointy tweezers)
Grab tick as close to skin as possible and pull tick out with slow and steady motion
Place tick in airtight container
Disinfect the bite area, tweezers, and hands
Consider sending the tick for identification and testing
The time it takes for a tick to transmit germs that cause disease can vary from minutes to hours. The sooner the tick is removed, the better