by What could be more delightful than collaborating with nature in a glorious landscape, far from the crowds, enjoying fires and the peace of summer? It is the perfect holiday scene. But unfortunately, ticks may be ready to spoil the fun, sensing your presence, easily latching onto clothes in search of their next meal.
Ticks are not insects. Like spiders, they have four pairs of legs and no wings or antennae, but are obligate parasites. Around the world, hundreds of species of blood-sucking creatures can be found wherever animals are eaten. And unfortunately, a small number of these also transmit infections to humans, the best known being Lyme disease and tick-borne encephalitis.
But with proper precautions and prompt medical treatment if needed, a sick bite doesn’t have to ruin your vacation – apart from the obvious sick factor – if you stay aware of the risks.
Lyme disease
High risk areas
Ticks that carry Lyme disease are found in the US, Canada, across Europe and the UK – particularly grasslands and woodlands in England and the Scottish Highlands.
What is Lyme disease?
Lyme disease is caused by bacteria present in the salivary glands of certain tick species. The infection is named after the town of Lyme in Connecticut, where it was first described in 1975. Since then, it has spread geographically to include most of the United States of America, where an estimated the Centers for Disease Control (CDC) that there could be so many. as 476,000 cases every year. However, it can be found widely throughout the northern hemisphere (causing around 3,000 cases per year in the UK). Small mammals and birds create a reservoir of infection that makes Lyme disease impossible to eradicate.
The most visible feature of Lyme disease is an increasing rash, sometimes seen as a red ring with a lighter inner area and a red center. The rash is often accompanied by headache, muscle and joint pain, fever and feeling sick. More serious complications can occur, with longer-term effects on the nervous system, heart or joints.
How to treat Lyme disease
Treatment is with antibiotics – usually doxycycline, or amoxicillin for children. Sometimes treatment can cause an initial worsening of symptoms, a sensitivity reaction to the dying bacteria. Blood tests for Lyme disease sometimes give confusing results and may require specialist interpretation.
There is currently no vaccine but clinical trials for a promising new vaccine are at an advanced stage – perhaps only a year or two away. (A vaccine was previously approved in the US in 1998 but withdrawn in 2002.)
Tick-borne encephalitis
High risk areas
Countries affected include Austria, Germany, Switzerland, Sweden, Finland, Czech Republic, Slovakia, Slovenia, Hungary, Poland, Romania, Croatia – and a wide belt that stretches across of Eurasia to Korea, China and Japan.
What is tick-borne encephalitis?
It is a severe, untreatable viral illness, with flu-like symptoms, fever, headache, inflammation of the heart, pancreas, brain and spinal cord, and death, paralysis or permanent neurological damage in about 10 percent of cases After that. Tick-borne encephalitis is on the rise, and recently, there have been a small number of locally acquired cases in the UK.
People don’t always think about health precautions when traveling to destinations such as Switzerland or Austria, which are popular for camping, hiking and hill walking holidays, and so many visitors arrive unprotected. The risk is seasonal from March to December, with two-thirds of cases occurring during the peak summer season between June and September.
The tick-borne encephalitis vaccine
A safe vaccine is available and widely used in many of the affected areas, and visitors at potential risk are strongly advised. In countries such as Austria, the entire population is regularly vaccinated. Two doses are required, ideally at least three weeks before travel. These can be given 14 days apart, with a dose five to 12 months later to complete the course.
Other tick-borne infections
Ticks can also spread other diseases, including tick fever, typhus and Rocky Mountain spotted fever. These are uncommon among travelers from the UK, but are easily treated with the right antibiotics. The important precautions are to prevent bites where possible, and to seek medical advice promptly for symptoms such as fever or rash.
How to prevent tick bites
Avoid tall grass and vegetation – don’t let children play in it – and stick to the center of paths and sidewalks. Deny tick access by wearing closed shoes, long pants tucked into socks, and long-sleeved shirts tucked into pants (light-colored clothing can help them find them more easily). Use DEET repellents on exposed skin, and permethrin on clothing, backpacks or other fabrics.
After your outdoor adventure, check yourself thoroughly: Have a bath or shower, then check your entire skin with the help of a mirror or a friend, including ears, hair, navel, armpits and skin creases. Wash, dry or iron clothes at a high temperature to kill any lurking passengers.
What to do if you are bitten
If you find a tick, grasp it with fine tweezers (ideally tweezers tweezers) close to the skin and not on its body, pulling up gently. Wash and apply alcohol or antiseptic. It may help to keep the tick in a sealed container for future reference (or send it to the UKHSA tick surveillance scheme, which monitors the risks of tick-borne diseases).
Ticks can take hours to attach, feed and transmit disease, so the sooner you remove them, the lower your risk. Bites are painless and up to 40 percent of people diagnosed with tick-borne infections have no memory of ever being bitten.
The likelihood of infection from any bite is low, so the current advice in the UK is not to take antibiotics or other treatment after a bite. However, in a high-risk area for Lyme disease – such as some parts of the US – recommendations may be different, so seek local advice. You can find more information at travelhealthpro.org.uk and fitfortravel.nhs.uk; for the US, cdc.gov/lyme, for the EU, ecdc.europa.eu/en/tick-borne-encephalitis.
However, always be alert for symptoms such as rash, fever, headache, body aches, in which case prompt treatment should be sought. And don’t forget to tell your doctor about any recent travel if you feel sick when you return.
Dr Richard Dawood is a specialist in Travel Medicine at Fleet Street Clinic (020 7353 5678, fleetstreetclinic.com)
