As the days grow steadily warmer and longer, local residents are celebrating the much-anticipated spring by venturing outdoors — gardening in the yard, playing in community parks, strolling along wooded trails.
Unfortunately, they’re not alone. The increasingly balmy weather also heralds the return of the dreaded annual tick season.
With the arrival of National Lyme Disease Awareness Month in May, in a region plagued by consistently high rates of infection, local officials are ramping up efforts to make sure Washington-area residents know how to enjoy the outdoors safely — and what to do if they experience a tick bite or the symptoms of a tick-borne illness.
“There’s a lot of Lyme disease out there, and we don’t have any reason to think that the infection rates and our number of ticks are suddenly going to drop,” said Katherine Feldman, public health veterinarian with the Maryland Department of Health and Mental Hygiene. “We want everyone to be aware of the potential for Lyme infection.”
The illness, which is caused by bacteria that can be transmitted through the bite of an infected black-legged tick in the eastern United States, can cause serious heart and nervous system problems if it isn’t promptly diagnosed and treated with antibiotics.
But there are several simple steps people can take to help avoid infection, Feldman said, including dressing in light-colored clothing that will make it easier to see a tick; conducting a thorough check after spending time outside; and showering or bathing soon after any exposure to a possible tick habitat.
As tick populations have continued to spread into new territories — thanks in part to shifting climate patterns and widespread residential development, experts say — Lyme disease has become a mounting problem in the Washington region.
In 2013, 95 percent of confirmed Lyme disease cases were reported from 14 states; Maryland, with 801 confirmed Lyme cases, and Virginia, with 925, were on that list. A recent study led by University of Richmond biologist R. Jory Brinkerhoff showed that Lyme infections in Virginia are continuing to rise, in large part because of an increase in the black-legged tick population, according to the Centers for Disease Control and Prevention.
So local officials want everyone — whether they’re trail hikers in Virginia, joggers in Rock Creek Park or campers in suburban Maryland — to get up to speed on basic facts about ticks and the illnesses they carry.
Starting this month, Virginia officials are launching a multi-pronged tick awareness campaign, which includes distributing informational flyers, publishing answers to frequently asked questions on social media, and alerting community groups and homeowners’ associations about the risks of tick exposure and Lyme disease.
Some jurisdictions are taking these efforts even further: In Loudoun County, home to one of the highest rates of Lyme infection in Virginia with nearly 200 confirmed cases reported last year, school officials will distribute a Lyme disease brochure to students. The county will place animated ads in movie theaters, highlighting basic preventive measures and key information about the disease, officials said.
David Gaines, public health entomologist for the Virginia Health Department and co-author of the recent Lyme disease study in Virginia, said the department would also step up outreach at summer camps.
“Last year . . . we brought them a supply of repellents and taught them how to apply them, and how to dress protectively in tick habitats,” he said. This year, the educational campaign also aims to include local scout troops.
Similar initiatives are underway in Maryland, where May has been declared Tick-borne Disease Awareness Month. Maryland health officials recently created an online tick bite notification form, Feldman said, to help residents and camp counselors identify a tick that has bitten them and determine how long the parasite might have been attached based on the size of its body.
A tick typically must be attached for at least 24 hours before Lyme-causing bacteria is introduced into the human host’s bloodstream.
“Just knowing what kind of tick bit you can help you understand what you’re at risk for,” Feldman said. “Lyme disease is far and away the most common [infection] in Maryland, but there are other diseases you can get from ticks, so we want people to be aware of all tick bites and take measures to keep all ticks off them.”
Lyme disease is most often transmitted through the bite of a nymph — or juvenile — black-legged tick, also known as a deer tick. The tiny insects can be hard to spot, with bodies as small as a freckle or the tip of a pencil.
A recent infection is often associated with a red, irritated rash at the site of the bite. But not everyone gets a rash, experts warn, so it’s important to be aware of other possible symptoms, including fever, headache, fatigue, and muscle or joint pain.
People are most at risk from Lyme infection in areas where rodents, deer and other small animals are easily able to transfer ticks to human hosts, Feldman said. The threat is especially high near waterways (ticks love moisture) and in recently developed areas where tick habitat borders residential communities.
That makes the Washington area, with its abundance of suburban neighborhoods and plenty of creeks, ponds and rivers, a prime spot.
And for those who may have hoped that the recent colder-than-average winters might help — no such luck: Black-legged ticks, native to the upper Northeast, are well-accustomed to the cold.
“Winters here are no comparison to winters they might experience in New Jersey or Connecticut,” Gaines said. “And as the climate appears to be changing and warming, it appears that their populations are expanding.”
When it comes to certain facts about Lyme — how to prevent a bite, what to do if you find a tick or exhibit symptoms of infection — there tends to be consensus among scientists, physicians and government officials. But other aspects of Lyme disease, such as how best to diagnose or treat it, are bitterly contested.
The U.S. government, through the Centers for Disease Control and Prevention and the treatment guidelines established by the Infectious Diseases Society of America, takes the position that diagnostic testing is generally reliable, particularly for people who have been infected for some time. A course of antibiotics is given to combat the infection, and experts at the CDC maintain that the vast majority of patients make a full recovery.
For those who experience lingering symptoms, the underlying cause is contested: Some think the problems are caused by a continued immune response to a treated infection, while others say the symptoms may signal an active, ongoing Lyme infection.
It’s a controversy that has consumed many Lyme disease patients, including
15-year-old Sydney Cox, a Loudoun girl who tested positive for Lyme disease in the eighth grade and has struggled to overcome devastating neurological symptoms.
For years she has experienced unrelenting joint pain, headaches and significant cognitive impairments. Her family is raising money to pay for long-term treatment with intravenous antibiotics, a measure that the CDC says is not proven to help Lyme victims and is potentially dangerous.
But Elizabeth Cox, Sydney’s mother, feels the family has little choice.
“It’s worth trying, because I just don’t know what else to do,” she said. “The whole thing is so scary as a parent.”
Brian Fallon, director of the Lyme and Tick-borne Diseases Research Center at Columbia University, said there is a great need for more research and controlled trials to investigate the nature of ongoing Lyme symptoms, which patients often call “chronic Lyme disease” and scientists and medical experts typically refer to as “post-treatment Lyme disease syndrome.”
Research indicates that the use of IV antibiotics can be helpful in some instances and harmful in others, Fallon said.
“But if a person’s life is so profoundly affected [by Lyme] that they can’t function . . . then it certainly makes sense to entertain that possibility,” he said. “There are significant risks but also the potential of significant benefits.”
It is a highly contentious and complex debate, he said, and more concrete information is needed to guide effective treatments.
Meanwhile, local health officials say they will continue to avoid the controversy wherever possible, focusing instead on the indisputable facts about ticks and early diagnosis.
“There is consensus that prevention is the best thing that we can do,” said David Goodfriend, director of the Loudoun County Health Department. “As for people who have been treated and are still having ongoing health problems, I think what we can all agree on is that it would be great if they’d never been infected to begin with.”
Feldman, the Maryland health veterinarian, noted that basic steps can dramatically reduce the likelihood of infection and said that people shouldn’t let fear drive them out of their gardens, back yards and parks.
“I hear a lot of people say they’re never going outside again, and that’s super distressing to me. We don’t want people to live in a cocoon inside their house, never taking a breath of fresh air or appreciating all the natural world has to offer,” she said. “If people take these steps, they can go outside and enjoy the outdoors — safely.”
Public health officials agree that the best way to avoid a Lyme infection is to take precautions to avoid ticks and tick bites. The Centers for Disease Control and Prevention encourage these preventive measures:
→Avoid wooded, shady areas with tall grass and leaf litter.
→Walk in the center of trails.
→Use a tick repellent on skin and clothing that contains 20 to 30 percent DEET.
→For outdoor gear such as boots, pants and tents, use a repellent that contains permethrin.
→Conduct a thorough, full-body check after exposure to tick-infested areas.
→Conduct thorough checks for ticks on all outdoor gear and pets.
→Shower or bathe as soon as possible after spending time outdoors.
→Tumble clothes in a dryer on high heat to kill any remaining ticks.
→Reduce tick habitat in yards by clearing tall grasses and brush, stacking wood neatly in a dry area to discourage tick-carrying rodents, and, if possible, keeping playground equipment in a sunny location. Ticks dry out quickly and prefer shady, moist environments.
To be correctly diagnosed and treated for a Lyme infection, experts say it is important to recognize warning signs of the disease.
Early symptoms include:
→Red, expanding rash
→Muscle and joint aches
→Swollen lymph nodes
If untreated, additional symptoms might arise days or weeks after infection, including:
→Facial or Bell’s palsy (loss of muscle tone on one or both sides of the face)
→Severe headaches or inflammation of the spinal cord
→Pain and swelling in large joints, such as the knees
→Heart palpitations and dizziness
Long-term Lyme infections can lead to more serious symptoms, such as:
→Arthritis and severe joint pain and swelling
→Chronic neurological problems, including shooting pains, tingling in the hands or feet and short-term memory loss
SOURCE: CENTERS FOR DISEASE CONTROL AND PREVENTION