Authors:
Eiyu Matsumoto, MB, and Jennifer R. Carlson, PA-C
Citation:
Matsumoto E, Carlson JR. Vector-borne diseases on the rise: 4 tips for prevention [published online July 20, 2018]. Consultant360.
People who enjoy summertime activities such as camping, fishing, and hiking are at greater risk for exposure to vector-borne diseases from ticks and mosquitos.
According to the May 2018 report by the Centers for Disease Control and Prevention (CDC), disease cases from mosquito, flea, and tick bites in the United States have tripled from 2004 to 2016.1 Tickborne illnesses are particularly concerning. Ticks can transmit Lyme disease, anaplasmosis, ehrlichiosis, rocky mountain spotted fever, babesiosis, and more. Reported cases of Lyme disease account for 82% of tickborne disease and have doubled from 19,804 in 2004 to 36,429.1 More recently, a study published in July 2018 suggests that disease-bearing ticks are more widespread in the United States than previously thought.2
What can we do about this? Prevention of vector-borne diseases starts with education. Here are some tips you can use for your patients.3
- Assess the risk
Geographic location, time of the day, and type of activity all affect the likelihood of insect bites. Awareness of a higher possibility of insect bites should trigger use of physical barriers such as long-sleeves, pants, and chemical barriers.
- Chemical barriers: Two types for insect prevention
DEET (N, N-Diethyl-3-methylbenzamide) is most commonly used and is effective against mosquitoes, biting flies, chiggers, fleas, and ticks. No other compound has the broad coverage against arthropods or offers the extended duration of action as DEET. DEET should be applied on the skin. Serious adverse reactions to DEET are extremely uncommon.
Permethrin is a synthetic compound that is not a repellent but causes nervous system toxicity to insects. Although its toxicity in humans is low, it should not be applied to the skin. Permethrin should be applied to clothing, gear, or bedding for prevention of insect bites. Both sides of the fabric should be sprayed for 30 to 45 seconds and should be allowed to dry completely before wearing or use. One application maintains potency for at least 2 weeks, even after several washings. Clothing and gear impregnated with permethrin are also available.
- Tick check and bathing
Although the evidence is limited, checking for and removing ticks after outdoor activities as well as bathing after outdoor activities where ticks are abundant may be important points to educate your patients.
- Antibiotic prophylaxis for Lyme disease
Antibiotic prophylaxis with a single dose of doxycycline has been demonstrated to be effective. Its use is indicated only if specific criteria are met: initiating prophylaxis within 72 hours of tick removal when tick attachment is more than 36 hours, and the exposure is in a geographic location where the infection rate of Borrelia burgdorferi is 20% or more. Pre-exposure education may be helpful for certain patient groups in endemic areas.
Eiyu Matsumoto, MB, is a clinical assistant professor in the Department of Internal Medicine, Division of Infectious Diseases, at the University of Iowa Carver College of Medicine in Iowa City, Iowa.
Jennifer R. Carlson, PA-C, is a physician assistant at the Iowa City Veterans Affairs Health Care System in Iowa City, Iowa.
References:
- Rosenberg R, Lindsey NP, Fischer M, et al. Vital signs: trends in reported vectorborne disease cases — United States and territories, 2004-2016. MMWR. 2018;67(17):496-501. http://dx.doi.org/10.15585/mmwr.mm6717e1.
- Nieto NC, Porter WT, Wachara JC, et al. Using citizen science to describe the prevalence and distribution of tick bite and exposure to tick-borne diseases in the United States [published online July 12, 2018]. PLoS ONE. https://doi.org/10.1371/journal.pone.0199644.
- Biggs HM, Behravesh CB, Bradley KK, et al. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis — United States. MMWR. 2016;65(No. RR-2):1-44. http://dx.doi.org/10.15585/mmwr.rr6502a1.
