Tick-borne disease podcast transcript - July 10, 2008

Doug Schultz, MDH Communications
Melissa Kemperman, MDH tick-borne specialist

Doug: Welcome to this podcast from the Minnesota Department of Health on Lyme disease and other tick-borne diseases. I’m Doug Schultz from the Minnesota Department of Health Communications Office. And with me is Melissa Kemperman, a tick-borne disease specialist with the health department.
Late spring and early summer are prime time for tick borne diseases in our state. Last year, a record number of Minnesotans -- more than 1,200 -- were reported to have Lyme disease. Which is caused by the bite of the deer tick or black legged tick. Cases of two other diseases spread by deer ticks were also at record levels. Melissa Kemperman’s here to help us find out more about these diseases and how we can protect ourselves from them.
Welcome, Melissa.

Melissa: Thank you Doug. It’s good to be here!

Doug: I mentioned in our opening about the record number of Lyme disease cases in recent years–1,200 cases certainly seems like a lot, but, is it really? I mean, how does that compare to some other common diseases in Minnesota and is Lyme disease something that most Minnesotans should be concerned about?

Melissa: Many Minnesotans should be concerned about lyme disease and other diseases that one can get from ticks. 1,200 is certainly a lot of cases and we’ve been seeing an increasing number of cases reported over the past few years. Now compared to other diseases reported in Minnesota it is up there although it is not as high as some but it is more than many other diseases. But it is hard to compare illnesses. For instance, the incidence of West Nile virus is much smaller than lyme disease but a greater percent of West Nile cases end up as fatalities. So, it’s just hard to compare cases. That being said, tick borne disease cases can certainly be serious.
If they’re undiagnosed, untreated, they can lead to severe illness, dehabiliting conditions. Or in the case of two illnesses called anaplasmosis and Babesiosis, even death.
Now, these illnesses are essentially diseases of the outdoors because you pick them up when you get exposed to ticks outside. We Minnesotans love spending time outdoors! We love hiking, biking, hunting, birdwatching, and many of us actually live kind of in the middle of the woods in parts of Minnesota where there’s uh the black legged tick or the deer tick that carries these illneses.
And unfortunately, we encounter those ticks once in awhile. So, it’s important to know when and where we’re at risk and what we can do to protect ourselves.
So, the key points here are that:
We’re at risk in late May through early July and in portions of east central, north central, and southeast Minnesota where there’s hardwood forests.

Doug: Ok, and we’ll talk about those areas in a minute. But first I want to get kinda some basic background on Lyme disease and the other diseases. What is Lyme disease exactly and how do you get it?

Melissa: Well Lyme disease is a potentially serious bacterial infection. It’s caused by the bite of an infected blacklegged tick. The blacklegged tick is also known as the deer tick or sometimes the bear tick. It’s scientific name is Ixodes scapularis. And this tick is found in woodlands or at the very edge of woodlands.
In order to get Lyme disease, someone has to be bitten by a tick that‘s infected with the Lyme disease bacteria. And the name of that bacteria is Borrelia burgdorferi. Not all ticks are infected with it, and the tick needs to be attached at least 24-48 hours to transmit the bacteria. So, that’s why if you find a tick on yourself, it is important to remove it as quickly as possible. And do keep in mind. Lyme disease is one of only several tick-borne diseases found here in Minnesota.

Doug: What are the other ones?
Melissa:
The kind of tick that carries Lyme disease, also carries Human anaplasmosis and Babesiosis. Human anaplasmosis was formerly known as human granulocytic ehrlichiosis.

Doug: Easy for you to say.

Melissa: Yes, a lot of tongue twisters here. Anaplasmosis is also a bacterial disease that was first recognized in Minnesota only in the early 1990s. So we haven’t known about it for that long. It’s less common than Lyme disease. For instance in 2007 we had 322 cases reported, compared to more than 1,000 Lyme disease cases. But it can be quite severe and it’s something we take very seriously. Babesiosis is a third tick borne disease here in Minnesota. It can also be quite severe. It’s caused by a protozoan and occurs much less frequently, we just had 24 cases in 2007.

Doug: Protozoan, is that a parasite?

Melissa: Yes, it’s a bigger form of parasite.

Doug: So, Melissa. How do I know if I’ve been bitten by a deer tick or some other tick?

Melissa: Well the problem is, is a lot of people never do realize that. Now what people should be looking for after they’ve spent time in the woods is a tick that’s smaller and darker in color than the common wood tick that people also encounter this time of year. The Blacklegged ticks also lack the wood tick’s characteristic white markings. The back end of the female blacklegged tick is reddish in color.
The adult blacklegged ticks, is about the size of a sesame seed and the nymph isn’t much larger than a poppy seed.
Both the adult and the nymphs can carry diseases like Lyme disease.
Because these ticks are so small and because they carry diseases it’s important to check yourself for ticks after spending time in tick habitat.
Keep in mind, they’re so small that they’re hard to see and that’s why preventing bites in the first place is important.

Doug: Ok, And how do we prevent these diseases? How can I protect myself from tick bites?

Melissa: Well when you’re out in the wood in the late spring, early summer, and fall, when these ticks are active you should really use tick repellents. We advise repellents that contain either DEET or permethrin. You can use repellents containing up to 30% DEET on your skin or on your clothing. And the Permethrin-based products, are applied to clothing only ahead of time. They can last through several washings, are highly effective. Ticks usually just climb up from the ground, so you can just focus your repellent use below the knees.

Doug: You can? ok.

Melissa: There are some other things you can do as well. Wearing long pants will route ticks up on the outside of your clothing so you have more time to just spot them and remove them before they start biting. If you wear light colored clothing it helps you see them. In addition, when you’re in the woods, stay in the center of trails away from the brush, away from the wooded area. That can limit the number of blacklegged ticks that you encounter since they do tend to be more common in the thicker areas or the brush.
Once you get inside, do a very thorough tick check. Check your back, check the back of your legs. If you have a spouse, or someone else who can help check your head or other hard to see areas of your body, get their help as well. And of course parents should always check their kids.

Doug: Ok, what about reducing the numbers of ticks themselves?

Melissa: We get that question a lot. Especially from people who have properties or cabins, right in the middle of the woods. And really it would be nearly impossible to eliminate all of Minnesota’s ticks—unless we cut down all of our woods. And I don’t think that’d be a very popular option. But people who live on wooded property do have some options to reduce the number of blacklegged ticks right on their property. In certain conditions, they can use a pesticide carefully applied to the perimeter of their lawn where it meets the woods. And that could reduce the tick numbers. Keep in mind blacklegged ticks need shaded, brushy areas with a thick layer of leaves to live. And so if you keep your yard very free of leaves, keep it free of brush. Do your activities in sunnier areas of the yard, that will also limit your exposure to these ticks.

Doug: Ok, as long as we’re talking about where ticks hang out. From a bigger picture, are there certain areas of the state these ticks are more common than others.

Melissa: Yes. Indeed they are. They’re not found in every single county of Minnesota. They do best in hardwood forests. Those are forests like Oaks and Basswoods and those kind of broadleafed forests. They do best in a forest with a thick layer of leaves at the ground with a lot of shade, with a lot of brush at the forest floor. And these kind of forests are most common in east central Minnesota. In north central MN and in SE counties. We have seen a shift of the tick range into counties north and west of the historical range, however.

Doug: And do you know, excuse me, do we know why the diseases seem to be spreading or expanding?

Melissa: There’s probably a lot of factors in that. Ticks could be brought into new areas. Possibly by mammals such as um well, ourselves, or our pets, possibly deer. Probably they’re being brought in by birds, because the immature stage feeds on birds. Once they get to an area, whether or not they become established depends on whether or not there’s suitable habitat in those areas. Again, those hardwood forests. And where there’s, whether or not, their natural animal host to feed on.
And of course, other things could play a part too. If Minnesotans are going to areas that they didn’t used to go to. New popular areas, in northern Minnesota. Or if they’re building more second homes in those areas that could just be more people are just putting themselves at risk.

Doug: So, let’s say someone forgets the insect repellent and they’re at their second home up north. They go into the woods anyway and they suspect they may have been bitten. What should they be looking for? What are the signs and symptoms of Lyme disease?

Melissa: Well, if you got bit by a blacklegged tick but didn’t get it off in time, or if you never noticed the tick bite, you could develop Lyme disease or another tick borne illness. Within a month of the infectious tick bite, between 60-80% of people who develop Lyme disease will have a rash at the site of the tick bite. This tends to be circular or oval shaped It’s at least 2 inches wide, and it expands in size over time. The larger it becomes, the more likely it is to develop a “bulls-eye” appearance that you sometimes hear about with Lyme disease. It doesn’t always have that ring-like bulls eye appearance, but it does expand in size. People may also have a fever or swollen lymph nodes.
Now if these signs and symptoms go undiagnosed or untreated, later signs and symptoms of Lyme disease can include rashes that spread to other parts of the body, uh facial droop, arthritis, that involves joint swelling, fatigue, problems with the nervous system, or problems with the heart.
Fortunately, Lyme disease is treatable with antibiotics. Now, if it’s caught later on in the course of Lyme Disease, it might take longer for signs and symptoms to go away after being treated. So, it is important to catch any any signs of the illness, After getting a tick bite or spending time, in the, in the woods, so that you can start treatment as soon as possible.

Doug: Can, and we did talk about the diseases being you know, treatable, or cured. Anything else that you can think of that we haven’t talked about?

Melissa:
Well, I wanted to mention that it’s, it’s important to start treatment as soon as possible.

Doug: Ok

Melissa: Wwith Lyme disease, the later it’s caught, the more, the longer the signs and symptoms can last. Even after they’re adequately treated. It just can take awhile for those signs and symptoms to go away.
So, the, it’s very important to catch it early, and to get it treated as soon as possible.
And again, I wanna, really, really emphasize here that anaplasmosis and babesiosis can be severe.

Doug: Right, what are some numbers, there?

Melissa: Well, in recent years, about 40 percent of our anaplasmosis cases and ¾ of the babesiosis cases do end up being hospitalized. So, that’s pretty major. That could be expensive. That could be time away from work and home. And people get very, very ill. And a few cases, um over the years, have died from these infections.

Doug: Ok. So. Again, to kinda wrap things up. Take away message would be. Know when you’re gonna be in tick habitat. Bring the repellent. Use it. And then, check yourself later and watch for any signs or symptoms.

Melissa: Absolutely. You know, there are so many reasons that we should go outdoors and enjoy our great state. Get fresh air, get exercise. Enjoy our family and friends in the great out of doors. But you do have to be thinking about ticks in, in many areas of Minnesota. So, a late spring to, to mid summer, be, just bring that repellent with you and use it. Ssave days or, or weeks worth of illness later, by taking just a few minutes to use that repellent. And then of course, be aware of any signs of illness in the month or so, after you’ve been outside.

Doug: Great. Thanks for, for being with us Melissa.

Melissa: Thank you.

Doug: We, invite our listeners to check back regularly for other podcasts on important health topics.

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Updated Tuesday, November 16, 2010 at 12:31PM