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Tick-Borne Diseases

Information for Health Professionals

Overview of Tick-Borne Diseases in Californiaā€‹

ā€‹ā€‹ā€‹Reportable

ā€‹ā€‹ā€‹ā€‹Risk & Seasonality

    • Seasonal tick risk graphicRisk for tick bites and tick-borne diseases varies depending upon the tick species and time of year in California, though generally, risk of exposure is year-round.ā€‹ā€‹

      • ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹Western blacklegged tick (Ixodes pacificus): the adult life stage is most active in fall and winter; the nymphal life stage is most active in spring. ā€‹ā€‹

      • ā€‹ā€‹ā€‹Pacific Coast tick (Dermacentor occidentalis) and American dog tick (Dermacentor similis*): the adult and nymphal life stages are most active in early spring to mid-summer. ā€‹ā€‹

    • Risk for tick bites in general is lowest during the late summer months, but ticks may still be active, particularly in moist, cooler areas of the state.

ā€‹ā€‹Travel-related Exposure

    • Many tick-borne disease cases in California are travel-related, including in-state and out-of-state travel. In other parts of the United States, risk for tick-borne diseases varies with tick species and location.

    • ā€‹Approximately 1/3 of California residents reported with Lyme disease are exposed out-of-state.

ā€‹ā€‹ā€‹Symptā€‹ā€‹oms

    • Symptoms of tick-borne illness are often non-specific and flu-like, including arthralgia, myalgia, fever, and rash; diagnostic tests may appear negative in the early days of infection/illness.

ā€‹ā€‹Patient Hiā€‹ā€‹ā€‹ā€‹story

    • It is important to collect patient history regarding:

      • Recent tick bites

      • Outdoor activity in tick habitat areas

      • Contact with pets 

      • Travel to areas with high incidence of tick-borne diseases

ā€‹ā€‹ā€‹Management

    • Prompt and correct tick removal is critical to decrease the risk of pathogen transmission.

    • Some tick-borne diseases are treated with a course of antibiotics. ā€‹ā€‹ā€‹ā€‹

* The American dog tick has been divided into two different species: Dermacentor variabilis primarily occurring east of the Rocky Mountains in North America and Dermacentor similis occurring west of the Rocky Mountains (Lado et alā€‹., 2021). While the predominant species in California has been found to be D. similis, there may be areas in California where D. variabilis occurs.ā€‹ā€‹

Patients Presenting with Tick Bite


Tick Removal

Prompt and correct removal of an embedded tick is critical to reduce the risk of tick-borne disease pathogen transmission, particularly for Lyme disease and Rocky Mountain spotted fever. Prompt tick removal also reduces the possibility of excessive hypersensitivity or foreign body reactions such as a granuloma.

Manual removal of ticks is the best approach and simply requires a pair of medium-tipped forceps; curved forceps are particularly helpful.

Rickettsia rickettsii, the causative agent of Rocky Mountain spotted fever, can be transmitted soon after tick attachment, and Borrelia burgdorferi, the agent of Lyme disease, can be transmitted after a day or more of attachment; thus, prompt tick removal is key.

Steps

  1. ā€‹ā€‹If possible, cleanse the area around the embedded tick with soap and water or antiseptic solution.

  2. Removing embedded tick from the skin with forceps

    Using forceps, grasp the tickā€™s mouthparts as close to the skin as possible. 

    • ā€‹ā€‹ā€‹ā€‹Some commercial tick-removal devices (with beveled slits designed to grasp the tick at the mouthparts) have been shown to be effective at facilitating the removal of ticks.

  3. Using gentle, continuous traction, pull the tick slowly upwards, perpendicularly away from the skin. Do not twist or jerk the tick while pulling.

    • ā€‹ā€‹Occasionally during the removal process, the body of the tick may become separated from the head, leaving the tickā€™s mouthparts embedded in the skin. These should be removed because they can cause local irritating inflammatory reactions. The embedded mouthparts can be extracted similarly to splinter removal or with a small skin punch biopsy.

  4. Once removed, cleanse the bite wound with soap and water.ā€‹ā€‹ā€‹

Tick Disposal

If desired, the tick may be saved for identification by placing it in alcohol or using clear tape to secure the tick onto a piece of paper. Identification may assist differential diagnosis, as certain species transmit different pathogens. Otherwise, dispose in biomedical waste.


The California Department of Public Health (CDPH) does not recommend testing a tick for the purpose of medical decision making. View CDPHā€™s tick testing resource (PDF) for more information.


Management

The patient should be instructed to monitor for signs of tick-borne disease, such as fever, rash, and flu-like symptoms, for up to 30 days after the tick bite and to seek medical care if symptoms develop.

    • Note that not all erythema migrans rashes (for Lyme disease) present in the classic "bull's-eye" shape. For examples of Lyme disease rashes and look-alikes, please see the CDC Lyme Disease Rashes webpage.

Antibiotic prophylaxis has not been shown to prevent tick-borne disease other than Lyme disease in highly endemic areas and is not recommended for prevention of anaplasmosis, babesiosis, ehrlichiosis, or Rocky Mountain spotted fever.


Consideration of Lyme Disease PEP

Patient Discussion & Education

Questions to Ask Patients

Use these questions to start a conversation with your patient and assess their risk of tick-borne disease(s):

  1. When did you first notice this tick bite?

    • ā€‹ā€‹Have you noticed any new lumps, bumps, or rashes on your skin?

  2. Have you been outdoors in the past few days? Where? When? What activities?

    • ā€‹ā€‹ā€‹ā€‹Do you often engage in outdoor activities? Where?

  3. Did you travel within or outside of California in the last 30 days? If so, where?

  4. Do you have pets?



Note that for various reasons, some patients may not recognize a tick bite; embedded nymphal ticks can be tiny and unrecognizable. Thus, if assessing risk of tick-borne illness absent an obvious tick bite, discuss recent travel and be sure to ask the patient about any recent insect bite or new lump, rash, or irregularity in/on the skin.

Patient Education

  • Patients should be reminded about the importance of tick bite prevention and prompt tick removal to avoid disease transmission from an infected tick. ā€‹ā€‹CDPH tick ID card - back (sample image)  CDPH tick ID card - front (sample image)

  • Note that irritation/allergic reaction at a tick bite site may occur and is not the same as a Lyme disease rash.

  • ā€‹Patients should be instructed to monitor for signs of tick-borne illness, such as fever, rash, and flu-like symptoms, for up to 30 days after a tick bite and to seek medical care if symptoms develop.


Tick Removal

        • ā€‹ā€‹ā€‹Tick-removal is a simple procedure that can be taught to patients, particularly if a patient is bitten frequently or cannot readily make an office visit. Note that medical intervention may be necessary if the tick is embedded in a sensitive or difficult-to-reach area, or if the patient lacks the necessary tools or self-confidence to remove the tick without assistance.

        • ā€‹Tweezers are a common tool that most people have around the house or can pack while camping/hiking.

        • ā€‹ā€‹Tick removal techniques such as: 1) coating the tickā€™ā€‹s body with nail polish, petroleum jelly, alcohol, or gasoline, 2) lighting the tick with a match, 3) swabbing the tick with liquid soap, or 4) injecting lidocaine at the tick attachment site, are popular but inaccurate lore. These techniques are based on the premise that these noxious stimuli may stop the tickā€™s respiration and will make the tick ā€œback outā€ and detach from the skin. These methods are ineffective at best, dangerous at worse, delay removal, and should not be used.

        • ā€‹ā€‹For more information about what to do if bitten by a tick, please direct patients to the CDPH Tick-Borne Disease Prevention webpage.ā€‹ā€‹

Provider Resources

Information for Health Professionals
CDC Resources for Healthcare Providers
Lyme Disease-specific Resourcesā€‹
Interactive Maps

Academic Referencesā€‹ for Tick Removal

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