What are ticks?
Ticks are bugs that feed on the blood of mammals, birds, and reptiles. Deer ticks and dog ticks are found throughout Massachusetts and may spread different disease-causing germs when they bite you. Ticks are generally found in unkempt grassy, brushy, or wooded areas. Ticks do not fly or jump. They attach to animals or people that come into direct contact with them.
Deer ticks (Ixodes scapularis): Both nymph (young) and adult deer ticks will bite humans. Most cases of lyme disease are contracted when deer ticks are in the nymphal stage because they are difficult to detect due to their small size. The highest risk of being bitten by a deer tick is from May through July. However, adults can also be out searching for a host any time winter temperatures are above freezing. Deer tick nymphs are the size of a poppy seed and deer tick adults are the size of a sesame seed. Primary vector for Lyme disease, babesiosis, anaplasmosis, and deer tick virus. Deer ticks are also known as black-legged ticks. Found throughout Massachusetts.
American dog ticks (Dermacentor variabilis): In general, only the adult dog tickwill bite humans. The highest risk of being bitten by a dog tick occurs during the spring and summer seasons. Adult dog ticks are about the size of a watermelon seed. Primary vector for Rocky Mountain spotted fever and capable of spreading tularemia. American dog ticks are also known as wood ticks. Found throughout Massachusetts.
Lone star ticks (Amblyomma americanum): All stages can bite humans. Active when temperatures are over 50°F with peak activity from May to August. These ticks are a little smaller than American dog ticks. Lone star ticks are known to transmit Rocky Mountain spotted fever, tularemia, and ehrlichiosis. Southern Tick Associated Rash Illness (STARI) is commonly transmitted by this species in the southern states and this illness has been found as far north as New York state. Found on Cape Cod and the Islands.
Woodchuck ticks (Ixodes cookei): Mostly found on woodchucks and rarely bites humans. Can be found throughout the summer months with peak activity during July. Very similar in size and appearance to deer ticks. This is the primary vector for Powassan virus (POW). Also known as groundhog tick. Found throughout Massachusetts.
Lyme disease is caused by bacteria (Borrelia burgdorferi). Deer ticks need to be attached from 24-48 hours to transmit this disease. Initial symptoms usually begin 3 to 30 days after a person is bitten by an infected deer tick and may include an expanding rash at the site of the bite and/or flu-like symptoms. If left untreated, the bacteria can spread to almost any site in the body and can cause arthritis, neurologic difficulties, and/or heart problems. Cases of Lyme disease occur throughout Massachusetts. This is the most common tick transmitted disease in Massachusetts. Over the last decade, the number of cases has averaged over 3,000.
Anaplasmosis is caused by bacteria (Anaplasma phagocytophilum) that affect certain white blood cells called granulocytes. Deer ticks need to be attached from 12-24 hours to transmit this disease. Symptoms typically appear suddenly 7 to 14 days after being bitten by an infected deer tick and can include fever, headache, muscle aches, chills, sweating, nausea, and vomiting. Because symptoms may become life-threatening, immediate treatment is necessary. The elderly, people with diabetes or collagen vascular disease, and people without a healthy immune system are more likely to develop serious symptoms. In Massachusetts, cases occur most frequently on Cape Cod, Martha’s Vineyard, Nantucket, and in Berkshire County. The state has tracked this disease since 2008 when there were 41 confirmed cases. The number of human infections in Massachusetts has steadily risen to 677 in 2015.
Babesiosis is caused by a parasite that affects red blood cells. The two most common parasites in humans are Babesia microti and Babesia divergens. Most people who are infected will show no or only very mild signs of illness. Symptoms, when they do occur, begin gradually about 1 to 6 weeks after being bitten by an infected deer tick and can include fever, chills, headache, achy joints and muscles, fatigue, nausea, vomiting, abdominal pain, and dark urine. The elderly and people without a healthy spleen or immune system are more likely to develop serious symptoms. In Massachusetts, cases occur most frequently on Cape Cod, Martha’s Vineyard, and Nantucket. The state has tracked this disease since 2008 when there were 51 confirmed cases. The number of human infections steadily rose to 535 in 2014. There were 414 cases in Massachusetts in 2015.
Ehrlichiosis is a bacterial disease (Ehrlichia chaffeensis) that causes fever, headache, muscle aches and pain, anorexia, diarrhea, abdominal pain, and confusion. Symptoms occur 1-2 weeks after being bitten. Illness may be severe with rare fatalities. Transmitted by the lone star tick which has only been found in southeastern Massachusetts. Recently reported in Massachusetts. There were 20 cases in 2014 and 7 in 2015.
Powassan virus/deer tick virus are two closely related viruses spread by two different ticks. Powassan virus is spread by woodchuck ticks and deer tick virus is spread by deer ticks. Some evidence shows that ticks only need to be attached for 15 minutes to transmit these viruses. Symptoms of these diseases can include but are not limited to fever, headache, vomiting, weakness, confusion, loss of coordination, speech difficulties, and memory loss. About 10% of infections result in death. People that initially recover from these viruses may experience long term neurological problems. Although rare, these viruses are likely found throughout Massachussetts because their vectors are widespread. From 2013-2015 there have been 5 confirmed and 2 probable cases in the state.
Borrelia miyamotoi is a bacterial disease first identified in Japan in 1995. Onset of disease and symptoms are similar to lyme disease with which it is closely related. However, unlike lyme disease, no rash is associated with Borrelia miyamotoi. Deer ticks, which are common throughout Massachusetts, spread this disease. First reported in New England in 2001. There is evidence to suggest that at least 5% of lyme disease cases are actually Borrelia miyamotoi.
Rocky Mountain spotted fever (RMSF) is a rare bacterial disease (Rickettsia rickettsii) that usually presents as a high fever with severe headache and fatigue 3 to 14 days after being bitten by an infected dog tick. A rash that spreads to the palms of the hands and soles of the feet often appears 3 to 5 days after the fever begins. In Massachusetts, cases occur most frequently in the southeastern part of the state, on Cape Cod, and on Martha’s Vineyard.
Tularemia is caused by bacteria (Francisella tularensis) that can be spread to people in a number of ways, including through the bite of an infected dog tick. Symptoms vary depending on the way the germs are transmitted and usually begin between 3 to 5 days after an exposure, although it can take as long as 21 days. People infected by a tick bite typically have a slow healing skin sore (ulcer) and swollen glands (lymph nodes). In Massachusetts, cases occur most frequently on Cape Cod, Martha’s Vineyard, and Nantucket.
How can I protect my family, my pets, and myself from tick bites?
Prevention begins with you! Follow these tips if you live, work, or spend leisure time in an area likely to have ticks:
1. The single most important thing you can do is check yourself for ticks once a day. Favorite places ticks like to go on your body include areas between the toes, back of the knees, groin, armpits, and neck, along the hairline, and behind the ears. Remember to check your children and pets, too. Remove any attached tick as soon as possible.
2. Use repellents that contain DEET on your exposed skin, and those that contain permethrin on your clothes.
3. Stick to main pathways and the center of trails when hiking to avoid ticks.
4. Wear long-sleeved, light colored shirts and long pants tucked into your socks. This may be difficult to do when the weather is hot, but it will help keep ticks away from your skin and make it easier to spot a tick on your clothing.
5. Talk to your veterinarian about the best ways to protect your pets and livestock from ticks.
NOTE: There is currently no human vaccine available to protect against Lyme disease or any other tick-borne disease found in Massachusetts.
How can I reduce the number of ticks around my home?
You don’t have to be walking in the woods to be bitten by a tick. You can be in your own backyard! You can reduce the number of ticks around your home by following these tips:
- Keep grass cut short.
- Remove leaf litter and brush from around your home.
- Prune low lying bushes to let in more sunlight.
- Keep woodpiles and birdfeeders off the ground and away from your home to reduce the number of rodents which serve as hosts for ticks.
- Keep the plants around stone walls cut short.
- Use a three-foot wide woodchip, mulch or gravel barrier where your lawn meets the woods. Ticks are less likely to cross the barrier into the lawn because they are prone to drying out. It also serves as a reminder that people who cross the barrier into the wooded area may be at higher risk of getting ticks.
- Ask your local nursery about plants to use in your yard that do not attract deer.
- Use deer fencing (for yards 15 acres or more).
If you choose to use a pesticide to reduce the number of ticks on your property, hire a licensed applicator experienced with tick control. Your local landscaper or arborist may be a licensed applicator. In general, good tick control can be achieved with no more than two pesticide applications in any year. When selecting an applicator, ask if they will provide:
1. A written pest control plan that includes information on the pesticide to be used.
2. Information about non-chemical pest control alternatives.
3. Signs to be posted around the property after the application. Signs do not need to be posted after application of non-chemical pest control alternatives.
NOTE: Limited information is available regarding efficacy of non-chemical pest control alternatives. These alternatives are not required to be applied by a licensed applicator.
What are communities doing to control ticks?
- Four-poster device
- Tick Tubes
- Baited box
- Community deer hunts
What kind of repellent should I use?
Different products work against different kinds of bugs. It is important to look at the “active ingredient” on the product label. Products with DEET (N,N-diethyl-m-toluamide) or permethrin are recommended for protection against ticks. Some repellents, such as picaridin or oil of lemon eucalyptus, have been found to provide protection against mosquitoes but have not been shown to work against ticks.
DEET is the active ingredient found in most repellent products. It can be used directly on exposed skin or on clothing. If you use it on your clothes, be aware that DEET can damage some synthetic fabrics such as acetate, rayon or spandex. There are over 200 products containing DEET registered with the Environmental Protection Agency (EPA), ranging in concentration from 5% to 100% DEET. In general, the higher the percentage of DEET, the longer the duration of activity. Read the product label to determine the percentage of DEET included and how often it should be reapplied. DEET products should not be used on infants under 2 months of age. Children older than two months should use concentrations of 30% or less.
Permethrin products are intended for use on items such as clothing, shoes, bed nets and camping gear and should not be applied to skin. Apply the permethrin to your clothes before you put them on and follow the product’s instructions. Use these products wisely!
- Follow the instructions on the product label. If you have questions after reading the label, contact the manufacturer.
- Don’t use repellents under clothing.
- Don’t use repellents on cuts or irritated skin.
- Don’t use repellents near the mouth or eyes and use them sparingly around the ears. When using spray products, spray the repellent on your hands first, then apply it to your face.
- Use just enough repellent to lightly cover exposed skin and/or clothing. Putting on a larger amount does not make the product work any better.
- Don’t let children handle the product. When using repellents on children, put some on your hands first, then apply it to the child.
- Don’t put repellents on a child’s hands.
- When you come inside, wash your skin and the clothes that had repellent on them.
Do “natural” repellents work?
A number of plant-derived products are available for use as repellents. Limited information is available regarding how well these products work and how safe they are. The information that is available shows that these products do not work as well or as long as products containing DEET or permethrin against ticks.
What should I do if I have a reaction to a repellent?
If you suspect that you or your child is having an adverse reaction to a repellent (for example, if you develop a rash or other symptoms you think were caused by using a repellent), remove any treated clothing, wash the affected area with soap and water, and contact your doctor or local poison control center. If you go to the doctor, take the repellent with you; the label information may be useful to your physician. The toll-free telephone number for the Regional Center for Poison Control and Prevention (serving Massachusetts and Rhode Island) is (800) 222-1222.
What should I do if I find a tick on myself?
The tick should be carefully removed as soon as possible. The longer an infected tick remains attached to a person or animal, the higher the likelihood of disease transmission. Use fine point tweezers to grip the mouthparts of the tick as close to the skin as possible. The tick should not be squeezed or twisted, but pulled straight outward with steady, gentle pressure. You should not apply kerosene, petroleum jelly, nail polish, or a hot match tip to remove the tick. These measures are not effective and may result in injury. Circle the calendar date and note where on the body the tick was removed. You may want to save the tick for identification. Your physician may choose to treat you following a deer tick bite. Notify your health care provider if you have been bitten by a deer tick or if you develop a rash or other signs of illness following a tick bite.
Tick Identification and Testing Services
MDPH does not offer tick identification or tick testing. If you choose to have a tick tested, it is important to keep in mind the following:
- Tests performed on the ticks are not perfect and they do not test for all infections ticks may be carrying. Therefore, even with a negative result, people should still monitor themselves for the appearance of rash, fever or other unusual symptoms and immediately seek the advice of a health care provider should any symptoms occur.
- If someone has been infected by a tick bite, symptoms may begin to occur even before the results of tick testing are available. People should not to wait for tick testing results before seeking medical advice should any symptoms develop.
- A positive test on a tick is not an automatic indication that treatment is needed. A positive test indicates that the tick was infected but not that the tick was successful in spreading the infection to the person bitten. The longer a tick is attached to you, the greater the chance that it will spread infection. Discuss any positive test results with your health care provider.
The following organizations, listed alphabetically, do offer tick identification and/or testing services for a fee. The listing of these organizations does not constitute an endorsement by the Massachusetts Department of Public Health of the organization, or information, products, or services provided, and none should be inferred. This list is provided as a guide to tick identification and/or testing services available for Massachusetts’ residents. This list may not be comprehensive and the contact and price information may change at any time. The information was up-to-date as of February, 2016k. Any questions people have about situations that may affect their health should be directed to their health care provider.
Analytical Services, Inc
130 Allen Brook Lane
Williston, VT 05495
$65/tick for species identification and testing for the bacteria that cause Lyme disease, with a 5-business day turn-around.
Connecticut Veterinary Medical Diagnostic Laboratory
Department of Pathobiology and Veterinary Science
61 North Eagleville Rd., U-3089
Storrs, CT 06269-3089
Phone: (860) 486-3738
Fax: (860) 486-3936
$50 to test for the bacteria that cause Lyme disease
Connecticut Pathology Laboratories Inc.
1320 Main Street, Suite 24
Willimantic, CT 06226
$64 to test for the bacteria that cause Lyme disease
320 Needham St., Suite 200
Newton, MA 02464
$20 per specimen or image evaluation (species identification, stage of development & estimated feeding duration). Turn-around time is usually the same day the specimens are received. Digital images, if of sufficient quality, can be uploaded to the web site for even faster service. Imaging instructions are provided on the website.
220 Norwood Park
Norwood, MA 02062
$75/tick for species identification and testing for the bacteria that cause Lyme disease
University of Massachusetts Laboratory of Medical Zoology
101 Fernald Hall
University of Massachusetts
Amherst, MA 01003
$50/tick for species identification and testing for the most common bacteria carried by the species of tick submitted.
For further information:
Cape Cod Cooperative Extension – http://www.capecodextension.org/ticks/
Connecticut Agricultural Experiment Station – http://www.ct.gov/caes/lib/caes/documents/publications/bulletins/b1010.pdf
CDC – www.cdc.gov/ticks
Tick Encounter – www.tickencounter.org