Prevention
and Control of Lyme Disease
Avoidance
of Tick Habitat
Whenever possible, persons should avoid entering areas that are
likely to be infested with ticks, particularly in spring and
summer when nymphal ticks feed. Ticks favor a moist, shaded environment,
especially that provided by leaf litter and low-lying vegetation
in wooded, brushy or overgrown grassy habitat. Both deer and
rodent hosts must be abundant to maintain the enzootic cycle
of B. burgdorferi.. Sources for information on the distribution
of ticks in an area include state and local health departments,
park personnel, and agricultural extension services.
Personal Protection
Individuals who are exposed to tick infested areas should wear
light-colored clothing so that ticks can be spotted more easily
and removed before becoming attached. Wearing long sleeved shirts
and tucking pants into socks or boot tops may help keep ticks
from reaching the skin. Ticks are usually located close to the
ground, so wearing high rubber boots may provide additional protection.
Application of insect repellents containing DEET (n,n-diethyl-m-toluamide)
to clothes and exposed skin, and permethrin (which kills ticks
on contact) to clothes, should also help reduce the risk of tick
attachment. DEET can be used safely on children and adults but
should be applied according to Environmental Protection Agency
guidelines to reduce the possibility of toxicity (58).
Tick Check
and Removal
Since transmission of B. burgdorferi from an infected
tick is unlikely to occur before 36 hours of tick attachment
(27, 59), daily checks for ticks and their prompt removal will
help prevent infection.
Prophylaxis
after Tick Bite
The relative cost-effectiveness of post-exposure treatment of
tick bites to avoid Lyme disease in endemic areas is dependent
on the probability of B. burgdorferi infection after a
tick bite (60). In most circumstances, treating persons with
tick bite alone is not recommended (6, 61). Individuals who are
bitten by a deer tick should remove the tick and seek medical
attention if any signs or symptoms of early Lyme disease, ehrlichiosis,
or babesiosis develop over the ensuing weeks.
Strategies
to Reduce Tick Abundance
The number of ticks in endemic residential areas may be reduced
by removing leaf litter, brush- and wood-piles around houses
and at the edges of yards, and by clearing trees and brush to
admit more sunlight and reduce the amount of suitable habitats
for deer, rodents, and ticks (62). Tick populations have also
been effectively suppressed through the application of pesticides
to residential properties (63, 64). Community based interventions
to reduce deer populations or to kill ticks on deer and rodents
have not been extensively implemented, but may be effective in
reducing community wide risk of Lyme disease (65). The effectiveness
of deer feeding stations equipped with pesticide applicators
to kill ticks on deer, and other baited devices to kill ticks
on rodents, is currently under evaluation.
Early Diagnosis
and Treatment
Lyme disease in its early stages is a readily treatable disease
(5, 6). The early diagnosis and proper antibiotic treatment of
Lyme disease is an important strategy to avoid morbidity and
costs of complicated and late-stage illness.
