2017’s growing tick problem: How to protect yourself

We’re reminded every spring and summer to beware the return of the tick. These tiny, bloodsucking parasites carry a wide range of infections they can pass on to the humans they bite.

But ticks have cropped up more in the news in spring and summer 2017 than in years past. This is thanks to a couple milder-than-normal winters leading to a rise in the tick population and increased awareness of a tick bite-induced meat allergy.

I’ve yet to see a patient who has developed an allergy to red meat after a bite by the lone star tick, but we do treat plenty of patients every year for Lyme disease – the most common tick-borne illness. In 2015, the most recent year for which we have stats, 2,429 cases of Lyme disease were reported in the District of Columbia, Maryland and Virginia. In fact, 95 percent of Lyme disease cases are reported in 14 states, including Maryland and Virginia.

Even if you live in the city, you are not safe from ticks. While they are more common in rural areas, they can still be found in city parks and your yard. Ticks also can hitch a ride into your home on the backs of pets. Let’s look at the infections that ticks in our area can spread, how to remove ticks correctly and how to prevent getting bitten in the first place.

Tick-borne infections in our area

Three main types of ticks found in our area are deer ticks (also known as black-legged ticks), lone star ticks and brown dog ticks. Each type of tick can spread various diseases.

Lyme disease

This illness is transmitted by deer ticks. The first sign often is a rash at the site of the bite. This angular or oval rash can expand to the size of your hand and take on a “bullseye” appearance. You’ll also likely experience flu-like symptoms such as fever, chills, headache, and muscle and joint aches.

Close up view of a tick

Lyme disease bullseye rash

Rocky Mountain spotted fever

The first symptoms of Rocky Mountain spotted fever, spread by the brown dog tick, appear a couple days after the bite and include fever, headache, vomiting and muscle pain. A rash also may develop later in the disease. It will look like small pink spots on the arms and legs.

Ehrlichiosis

Ehrlichiosis, transmitted by the lone star tick, is a name for several less-common bacterial diseases and can cause fever, headache, fatigue and muscle aches. While a rash may develop, it’s not common.

Babesiosis

Some people with this rare deer tick-borne disease don’t experience any symptoms. Others may develop fever, headache, nausea, vomiting and loss of appetite. Babesiosis also can cause a type of anemia that leads to your skin turning yellow (known as jaundice) and dark urine.

Powassan

This virus spread by the deer tick is rare but very serious, as it can cause inflammation of the brain. About 10 percent of people who develop it will die, and half of survivors will have permanent neurological symptoms, such as frequent headaches or memory problems. Early symptoms include fever, headache, weakness and vomiting. Later symptoms can include confusion, loss of coordination or speech difficulties and seizures. There are no medications to treat Powassan directly, and patients may need respiratory support or treatment to reduce swelling in the brain.  

While most tick-borne diseases are easily treated with oral antibiotics if caught early, you can become very ill if treatment is delayed. Let your doctor know you’ve spent time outdoors even if you don’t remember being bitten.

You likely won’t feel a tick bite, and the tick may fall off before you spot it, so it’s important to know the symptoms of these illnesses and seek treatment as soon as possible.

How to remove ticks from your skin

If you find a tick on yourself or on your child, don’t panic. There’s likely no need to race to the emergency room. A tick needs to be attached to the body at least 24 hours to transmit most diseases. So if you remove it the same day, you’ll likely be fine.  

The best way to remove a tick is to use tweezers to grab it as close to the skin as possible and pull straight out. Don’t twist as you pull, because it can cause the tick’s mouth parts to break off and remain in the skin. Then clean the area with rubbing alcohol or soap and water.  

There are a few methods you shouldn’t use:

  • Don’t use your fingers: If you crush the tick, you run the risk of the juices spreading on your hands.
  • Don’t burn it off: I’ve seen people try to use cigarettes to kill the tick, but they usually just end up with a burn and a tick bite.
  • Don’t use Vaseline to smother it: This is a myth. It doesn’t work.  

How to prevent tick bites

The best way to prevent illnesses such as Lyme disease is to avoid exposure to ticks. If possible, stay out of wooded or brushy areas. If this isn’t possible, here are some tips to protect yourself and your loved ones.

Tips to repel ticks: 

  • Use repellent that contains 20 percent or more DEET or picaridin on any exposed skin. The Environmental Protection Agency has a tool to help you find the best repellent for you and your family.
  • Treat clothes with products that contain permethrin, an insecticide.
  • Wear long sleeves and pants.
  • Tuck your pants legs into your socks.
  • Treat your pets with flea and tick collars, sprays or topical treatments to avoid them bringing ticks home with them.  

Tips to find ticks on your body and clothing:

  • Check every inch of your body after spending time outdoors. Don’t forget around your ears, the backs of knees and elbows, armpits and hairlines. Do the same for your pets.
  • Take a shower within a couple hours of spending time outside. Ticks tend to wander around a bit before attaching, and you may be able to wash them off before they attach. This is also a good time to do a tick check.
  • Don’t forget about your clothes. Throw them in the dryer on high heat for 10 minutes to kill any hiding ticks. 

Ticks will return every year. And we must remain vigilant to prevent tick bites and notice the symptoms of tick-borne diseases as soon as they appear.

 

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Going abroad? See your doctor first

Your plane tickets are purchased, accommodations are organized, and passport is squared away. You’re almost ready for a trip abroad. But depending on where you’re traveling, your health, and your planned activities, you may want to see a doctor before you take off.  

Every destination has unique health risks and may be home to infections that your immune system hasn’t encountered before.  

A 2016 review in the New England Journal of Medicine said depending on the destination, 22 percent to 64 percent of people report some illness during international travel. Most of these illnesses were mild, such as diarrhea, respiratory infections and skin disorders. But some returned with potentially life-threatening infections. 

Depending on the destination, up to 64% of travelers return with some illness. via @MedStarWHC

But you can prevent much of this discomfort with a pre-international travel consultation with a travel medicine specialist. The appointment usually takes 30 minutes, during which time we’ll:

  • Discuss where you’re going, the length of the trip and the activities in which you’ll participate  
  • Evaluate your health, including whether you’re up-to-date with all vaccinations
  • Provide education on topics such as insect, food and water safety.  

Based on this information, we can advise you on how to prevent illnesses specific to your destination. This may include travel vaccinations or preventive antibiotics.  

Who should get a pre-international travel consultation?

Not everyone leaving the country needs a pre-international travel consultation with a travel medicine specialist. Many factors come into play, but in general, see your doctor if you are: 

  • Going to a developing country 
  • Taking part in high-risk or adventure activities 
  • Are pregnant or planning to become pregnant
  • Have pre-existing conditions or are immunocompromised
  • Traveling with children  

If you grew up in an area, moved away, and return for a visit, be aware that your childhood immunity may not protect you anymore. For example, malaria immunity wanes after a few years after exposure, so when you go back, you may need a prescription for an anti-malaria drug. Researchers who authored an April 2017 study suspect a number of fatal bouts of malaria in the United States may be due to immigrants who returned to their home countries without taking proper precautions.  

To learn about the specific health risks of your destination, go to the Centers for Disease Control and Prevention (CDC) and select the country you plan to visit.  

See your doctor four to six weeks before your trip to ensure there is enough time to get any necessary vaccines or medications. Request an appointment for a pre-international travel consultation in our Travel Clinic or call 202-877-DOCS.

Illnesses we’re often concerned about during travel

With preparation, medication, vaccinations and some common sense, you can prevent many illnesses present in different parts of the world. Examples available vaccines that can reduce your risk of infection include Hepatitis A, Hepatitis B, typhoid and the meningitis vaccine. Depending on where you’re traveling, some of these vaccines may be recommended for you.  

Malaria

Malaria is a mosquito-borne illness that causes flu-like symptoms and can be life-threatening if not treated. Malaria is found in parts of Africa, Asia and South and Central America. Depending on your destination and what you plan to do there, we can give you an antimalarial drug to prevent the illness.  

If you become sick while away from home, medical facilities could be scarce depending on where you are. It’s better to prevent malaria before it strikes.

Yellow fever

Yellow fever also is a mosquito-borne virus. It’s found in tropical areas of South America and Africa and can range from a mild illness to causing severe liver disease.  

You can get a vaccine to prevent yellow fever, and it may be required to enter certain countries. This vaccine is only available at designated vaccination centers, such as our Travel Clinic.  

Other mosquito-borne illnesses

Zika virus, while not a big threat to most people, can cause devastating birth defects in unborn children. It’s been spreading through South and Central America and turned up in mosquitoes in Texas and Florida in 2016. There is no cure for Zika virus, although researchers are working on a vaccine. In the meantime, women who plan to become pregnant should avoid visiting these areas.

Check out the CDC map of areas with Zika risk.  

Japanese encephalitis, a rare but serious condition found in agricultural areas in Asia and parts of the western Pacific, also is transmitted through mosquito bites. You can get a vaccine for this disease before your trip.  

Other illnesses that can be passed on by mosquitoes include dengue and chikungunya. Travelers should take steps to prevent mosquito bites, including:

  • Using insect repellents that contain DEET.  
  • Wearing long-sleeved shirts and long pants in the evening.
  • Sleeping under a mosquito bed net if window screens aren’t available.  

Altitude sickness

Altitude sickness symptoms can start at 8,000 feet. That’s the elevation of the north rim of the Grand Canyon.  

Altitude sickness is a result of exposure to low levels of oxygen and can cause symptoms such as headaches, loss of appetite, fatigue and poor sleep. Severe altitude sickness can be dangerous, affecting your lungs and brain.

If you plan to go above a certain altitude, we can give you medications to help prevent altitude sickness. It would be awful to spend a lot of money to travel somewhere and then spend most of the time with a headache.  

You also can prevent or limit altitude sickness by drinking plenty of water, avoiding alcohol, resting often, and gaining elevation slowly to better adjust to the altitude.  

How to avoid food-borne illnesses while traveling

Traveler’s diarrhea is a common gastrointestinal infection known by many names around the world, including Montezuma’s revenge and Delhi belly. Along with diarrhea, it can cause fever, abdominal cramps and bloating. Traveler’s diarrhea causes up to 40 percent of travelers to change their plans during a trip.  

During your pre-international travel consultation, we’ll talk about how to avoid food-borne illnesses and maybe prescribe a short course of antibiotics to take in case you get sick. These medications usually can knock the illness out in about 12 hours. 

Up to 40% of travelers change plans during a trip due to traveler’s diarrhea. via @MedStarWHC

I know part of the allure of traveling is trying local cuisine, and in general, this is fine. But there are a few things to think about regarding food, especially when visiting developing countries.  

Food to avoid: 

  • Raw fruits and vegetables, such as salad. They may have been washed with unsafe water. If you can peel it yourself, it’s safe. This includes bananas and oranges.
  • Raw or undercooked meat, seafood and eggs.
  • Unpasteurized milk and cheeses.
  • Food from street vendors.  

Tips to ensure you drink safe water:  

In developing countries, water may be contaminated by bacteria, parasites or viruses:  

  • Don’t drink tap water. Stick to bottled water.
    • Ice often is made with tap water, so don’t use it in your drinks.
    • Use bottled water when you brush your teeth.  
  • If bottled water is not available, boil your water for up to three minutes or use commercial iodine or chlorine tablets before drinking.

Contrary to popular belief, alcohol does not kill bacteria, so avoid alcoholic drinks with ice in them or throwing a splash of gin in your water to kill the germs.  

People often have changes in bowel habits when they travel due to unfamiliar food and spices. However, we do want to avoid dysentery, which is characterized by bloody stool. If you have a fever, severe cramping and bloody stool, see a medical professional.  

What to be aware of when you return from your trip

Just because you return home healthy doesn’t mean you can let your guard down. Symptoms for some illnesses, such as malaria and tuberculosis, can take several weeks to months to occur after returning from travel.    

If you experience fever, weight loss or other abnormal symptoms, tell your doctor about your travel history. If symptoms persist, you may want to consider seeing an infectious disease doctor.

One last topic I like to discuss during pre-international travel consultations is behavioral risks. Vacation makes you feel uninhibited and relaxed, as it should. But some travelers may not take certain precautions that they normally would at home. They feel like they’re in a bubble and invincible.  

It’s not uncommon to see people return from a trip with a sexually transmitted infection. Be careful and use condoms during sexual activity. Safety and health rules still apply no matter where your travels take you.

We want you to have the trip of a lifetime, and staying healthy is important. Before you get on the plane, check “pre-international travel consultation” off your to-do list. 

HIV: Get Tested. Get Treated.

In the United States, there are 1.2 million people living with Human Immunodeficiency Virus (HIV), but the Centers for Disease Control (CDC) estimates that 13 percent of those people are unaware of their diagnosis. Washington, D.C. has been hit particularly hard by HIV. Approximately 2.7 percent of the District’s population is living with the disease.

“Unfortunately, many people do not know that they are infected with HIV, and don’t present for medical care until the infection has severely damaged their immune system,” says Glenn Wortmann, MD, section director of Infectious Diseases at MedStar Washington Hospital Center. “In order to help people get diagnosed earlier, the CDC now recommends that all people aged 15-65 get an HIV test at least once in their life, and those with risk factors for HIV get tested more frequently.”

The only way to know if you have HIV is to get tested. Your primary care physician or other healthcare provider can test for the disease with a simple oral swab or finger prick blood test. Many medical clinics, hospitals, and community health centers also offer testing.

Most insurance covers the cost of HIV/AIDS testing and treatment. If you do not have insurance, some facilities have resources to help patients pay for the cost of treatment. MedStar Washington Hospital Center is the recipient of Ryan White HIV/AIDS Program funding, the largest federal program designed specifically for people with HIV/AIDS. Through this grant, the outpatient clinic provides medical care, case management, social work and peer navigator services to individuals and families affected by HIV/AIDS.

Evolving Treatment and Care

HIV is most commonly spread through sexual contact, contaminated needles, or from mothers to their children during pregnancy, birth or breastfeeding. The virus attacks the body’s immune system and makes it difficult to fight infections and certain cancers. If left untreated, HIV can lead to AIDS (acquired immune deficiency syndrome).

There is no cure for HIV, but early testing and revolutionary treatment options can dramatically improve the quality and length of life for those living with the virus.

“Over the past 30 years, advances in treatment have seen HIV evolve from a uniformly fatal condition to an infection which can be managed with medications.  However, the control of infection requires taking a pill every day, and regular adherence is critical,” says Dr. Wortmann.

The treatment is typically a combination of drugs called antiretroviral therapy (ART). The use of ART to treat HIV has drastically reduced the number of infections and deaths from the disease.

Before the introduction of ART in the mid-1990s, HIV could progress to AIDS in a matter of years. Now, with early diagnosis and treatment, people with HIV can live nearly as long as those without it. Taken regularly, ART can help control the disease, keep immune system healthy and even decrease the risk of infecting others. The World Health Organization estimates that there are approximately 17 million people currently using these life-saving medications.

“By getting tested and linked into care, patients can start life-saving medications, and can expect to live a normal lifespan,” Dr. Wortmann concludes.