Hylton I Lightman, MD, DCH (SA), FAAP

The number is up.

62,551 Lyme disease cases were reported to the CDC in 2022.  This was a 68.5% increase from the annual average of 37,118 cases reported between 2017 and 2019.  The CDC estimates that nearly 500,000 Americans are diagnosed and treated annually for Lyme disease but only a small fraction of cases are actually reported.

We are focusing on prevention and, if needed, treatment.

Cover up.  Even when it’s hot out.  

Thank G-d, our Torah and Mesorah is onto something fundamental and important that we should dress modestly.  Here, it means building a protective shield around yourself.  When you take the family hiking or send your children off to camp, make sure they have long pants and/or leggings, long sleeves, and shoes and socks.  Tuck pants into the socks or pull up socks over the end of the leggings so no skin is exposed.

Wear a hat on your head (you should anyways for protection from the sun) and a bandanna around your neck to cover up even more skin.  Consider pulling back long hair into a ponytail or braids.

Spray clothes and shoes with Permethrin

Permethrin is a medicine and insecticide and is sold under the name “Nix.”  As a medication, it treats lice and scabies by being applied to the skin as a cream or lotion.  As an insecticide, it can be sprayed on clothing or mosquito nets; when insects touch them, they die.

Spraying Permethrin in shoes is effective.  Think about it:  Ticks are low on the ground because they live on grass.  They don’t fly or jump.  Their “entry point” then is often climbing onto shoes.  When hiking, stay in the center of the trail in the woods.  Avoid bushy areas and grasslands. Don’t sit on downed logs; they are nesting places for ticks.

Side effects of Permethrin may include rash or irritated skin around the areas of use.  Pregnant women should consult their obstetricians about the use.

Use insect repellent on exposed skin

When purchasing insect repellents, read the packages carefully.  Only DEET, picardin and IR3535 are effective against ticks.  Higher concentrations are required when used against mosquitoes.  Apply.  Reapply as needed.

Do NOT apply insect repellent to babies under 2 months old.  OLE and PMD should not be used on children under the age of 3.

For all children, avoid putting repellent on their hands or near their eyes and mouths.

Always use sunscreen.  Apply the sunscreen first and then mosquito repellent.

Watch a YouTube to learn how to properly apply repellent.

The post-hike check list

After the hike, shower.  Check yourself for ticks in front of a full body mirror.  Feel your scalp under your hair.  Check the folds of skin, your belly button and private parts, behind your ears and knees.  Have another person check your back.

Parents should check their children, including their backs.

What’s the protocol if you find a tick embedded in the skin?

Prepare a Zip Lock bag and write the child’s name on it with a Sharpie.  Use fine-tipped tweezers to pull it out.  Grasp it and then pull upward, slowly but firmly.  Consult YouTube for a video on how to.  Clean the bite area with soap and water.

Place the tic in the prepared bag and seal it.  Call your pediatrician or physician to inform them and ask for the next step, if there is one.

Are you a dog owner?  Check your dog when he comes in from the outside.  Dogs, especially those with long hair, can hide ticks.

Monitoring for symptoms

Early symptoms, meaning within a few weeks, include a rash (especially a bullseye rash), fever, headache, fatigue, muscle aches and swollen lymph nodes.

Later symptoms, meaning months later, include severe headaches, neck stiffness, facial paralysis, arthritis and heart palpitations.

When to seek medical attention

• If the tic was attached for more than 24 hours
• If you see a rash, especially a bullseye rash
• If your child develops any of the symptoms above
• In some cases, a doctor may prescribe a preventative dose of antibiotics if your child

As always, daven.