‘Tis the Season for Tick-borne Diseases in Nebraska

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News Release
 
For Immediate Release: 5/27/2021
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CONTACT
Olga Dack, Office of Communications (402) 471-9356
Olga.dack@nebraska.gov

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The spring and summer months are the primary tick season in Nebraska, so we ask all residents to be mindful of ticks. Although some species can be active year round, the highest levels of tick activity correspond to the season when outdoor activities such as trail running, hiking, camping, and morel mushroom hunting begin to take place.

Ticks and Tick-Borne Disease Prevention

Ticks are small arachnids that feed on blood and have the potential to transmit and spread serious diseases to both people and pets. They are typically found in or along brushy, wooded, or grassy areas. Ticks need blood meals to develop into adults and specifically for adult females to subsequently produce eggs. Contrary to popular belief, ticks do not jump or fall onto hosts from above. Ticks find their hosts by a process called questing. They wait patiently with their front legs extended from the tip of a leaf or grass blade and when an unsuspecting host brushes against the plant, the tick grabs on with its claws and begins to crawl upward. Once a tick has found a host, it will find a spot to insert its mouthparts into the skin. The tick's mouthparts securely anchor the tick in place while feeding. Ticks may feed and remain embedded for several days (7–10) if undisturbed. The longer the tick remains attached, the higher the risk it can potentially transmit pathogens if infected. Quick removal of any attached ticks (particularly within 24 hours) greatly reduces the chances for a tick to transmit disease.

The two most common ticks in Nebraska are the American dog tick and the lone star tick. American dog ticks are found throughout Nebraska while lone star ticks are primarily found in the southeastern part of the state. However, there is growing evidence suggesting lone star tick distribution is moving further north and west in the state. In 2019, officials identified established populations of the black-legged tick in Nebraska for the first time in Douglas, Sarpy, and Saunders counties. Additional tick surveillance activities are presently taking place in collaboration between state agencies and universities to better identify the distribution of different tick species within the state.

It is important to prevent and remove ticks before they get a chance to transmit disease. Here are some actions you can take to protect yourself.

Before you go outdoors:

  • Know where to expect ticks. Ticks live in brushy, wooded, or grassy areas.
  • Treat clothing and gear with products containing 0.5% permethrin. Permethrin can be used to treat boots, clothing, and camping gear to remain protective through several washings. Alternatively you can buy permethrin treated clothing and gear.
  • Use an Environmental Protection Agency (EPA) registered insect repellent. Make sure to follow the manufacturer's label directions and understand the limitations of DEET repellents against ticks when applied to the skin. Products with >30% DEET do not offer greater protection and thus such high levels are unnecessary. DEET repellents with 20–30% DEET provide the best protection.  
  • Wear long pants, tucked into white socks for quick detection and removal.
  • Avoid brushy, wooded, or grassy areas and walk in the center of trails.

After you come indoors:

  • Check your clothing for ticks. Any ticks that are found should be removed. Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing. If clothes are damp, additional time may be needed. If clothes require washing first, hot water is recommended. Cold and medium temperature water will not kill ticks.
  • Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later. Protect your pets using a tick prevention program through your veterinarian. If your dog is on a flea and tick program, continue to perform regular tick checks. Ticks are most often found on the dog's head, in and around the ears, neck, armpits, and between the toes. Use fine tipped tweezers to remove attached ticks, collect and discard ticks in a way they cannot escape. https://www.avma.org/resources/pet-owners/petcare/lyme-disease-pet-owners-guide
  • Check yourself and children for ticks after being outdoors. Conduct a full body check upon return from potentially tick-infested areas, including your own backyard. Check under the arms, in and around the ears, inside the belly button, back of the knees, in and around the hair, groin, and around the waist.
  • Showering within two hours of coming indoors might help wash off unattached ticks and it is a good opportunity to do a tick check.
  • Remove embedded ticks as soon as possible using fine-tipped tweezers, grasping the tick as close to the skin's surface and pulling straight out. If the mouthparts break off and remain in the skin, try and remove them with the tweezers. If you are unable to remove the mouthparts easily, leave them alone and let the skin heal. After removing the tick, clean the bite area and your hands with soap and water or rubbing alcohol. Removed ticks may be disposed of by putting it in alcohol, placing it in a sealed bag or container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers. Additionally, testing of removed ticks is not generally recommended. https://www.cdc.gov/ticks/removing_a_tick.html
  • Avoid folklore remedies such as “painting" the tick with nail polish or petroleum jelly, or using heat to make the tick detach from the skin. Such methods are not effective and might actually increase the risk of disease transmission.

Tick-Borne Diseases

Jeff Hamik, Vector-Borne Epidemiologist/Entomologist for Public Health, reminds people that different tick species carry and transmit different pathogens and not all ticks can transmit Lyme disease. https://www.cdc.gov/ticks/tickbornediseases/tickID.html. If a person develops symptoms of a tick-borne illness (e.g. fever/chill, aches and pains, fatigue or malaise, rash) within a few weeks of being in known tick habitat or having a known tick bite, they should visit with a health care provider for evaluation of a potential tick-borne disease. Information regarding the tick-borne diseases most often reported in Nebraska are present below.

Spotted fever rickettsia (SFR) including Rocky Mountain spotted fever (RMSF):

SFR are illnesses caused by bacteria that are transmitted through the bite of an infected tick. American dog ticks are the primary vector for SFR illnesses. It is the most commonly reported tick-borne disease in Nebraska. Since 2016, Nebraska has recorded an average of 26 cases annually. Symptoms include fever, headache, muscle and joint pain, followed by the development of a rash. RMSF is the most severe tick-borne illness in the U.S. and if left untreated can have a high fatality rate. Nebraska has reported two RMSF-associated deaths since 2015.

Tularemia:

Tularemia is caused by the bacteria Francisella tularensis. This pathogen is found in nature in rabbits, muskrats, prairie dogs, and other rodents. Human infections occur through several routes with tick bites being the most common transmission route in Nebraska for this illness. American dog ticks are the primary vector for tularemia in the state while lone star ticks are also considered a potential vector. Symptoms for this disease vary depending on how the bacteria entered the body. The illness can range from mild to life-threatening. The most common form, occurring via tick bites, typically present with fever, skin ulcer at the site of the bite, and swelling of lymph glands usually in the armpit or groin. On average, Nebraska has recorded approximately nine cases per year.

Ehrlichiosis:

Ehrlichiosis is caused by several bacterial species that are closely related to the SFR bacteria. Ehrlichia chaffeensis, and less commonly, Ehrlichia ewingii are transmitted via the bite of the lone star tick. Symptoms included severe malaise, fever, and headache. Although rare, severe outcomes including death are possible. Nebraska reported its first ehrlichiosis-associated death in 2019. An average of six cases are reported annually within the state, however with recent expansion of the lone star tick in Nebraska, this disease is likely underdiagnosed. 

Lyme disease:

Lyme disease is caused by the bacteria Borrelia burgdorferi. Recently, another closely related species found more abundantly elsewhere in the upper Midwest (e.g. Minnesota and Wisconsin), Borrelia mayonii has also been discovered to cause Lyme disease in people. Both bacterial species are transmitted through the bite of infected black-legged ticks. In 2019, established populations of the black-legged tick were detected for the first time in Nebraska in Douglas, Sarpy, and Saunders counties. This local identification of the vector of Lyme disease increases the suspicion that Borrelia burgdorferi might be acquired in eastern Nebraska. However, even with these established populations, Nebraska is a low prevalence state for Lyme disease. Presently, local human health risk is unknown, but of increased concern. Broadened tick surveillance efforts through collaboration with several state agencies and universities is currently on going. Symptoms of Lyme disease can produce a wide range of symptoms, depending on the stage of infections. Early stage disease often presents with fever, chills, headache, fatigue, muscle and joint pain, and a rash. This rash is often referred to as a “bulls-eye" rash. However, the rash does not always appear as the classic “bulls-eye" nor does it appear in every case of illness. Later stages of the disease can see severe headaches, neck stiffness, facial palsy, arthritis, heart palpitations or irregular heartbeat, inflammation of the brain and spinal cord, and nerve pain. In Nebraska, an average of 12 cases are reported annually with nearly all cases reporting likely out-of-state acquisition of the disease.

Alpha-gal Syndrome (Red meat allergy):

Alpha-gal syndrome is an allergy first described in 2009 to the alpha-gal molecule. Alpha-gal is a sugar molecule found in most mammals (except in humans, great apes, and monkeys) and can be found in products made from mammals (including some medications, cosmetics, vaccines, gelatin, and milk products). Allergic reactions typically occur after people eat meat from mammals that have alpha-gal or are exposed to products containing alpha-gal, may not occur after every exposure, and may vary from person to person. Common symptoms include rash, hives, difficulty breathing, a drop in blood pressure, dizziness, nausea, or vomiting. Alpha-gal allergies can be severe, and even life-threatening. Both children and adults can develop alpha-gal allergy; however, most cases appear to be in people >50 years of age. Growing evidence suggests that alpha-gal syndrome may be triggered by the bite from a lone star or black-legged tick. It is thought that these ticks carry the alpha-gal molecule in their saliva after feeding on mammalian blood. People that are bitten by these ticks, especially those that are bitten repeatedly, are at risk of becoming sensitized and developing the allergy. However, with both lone star and black-legged ticks present in the state, the development of this allergy is plausible.

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