Tick-Borne Diseases

NIOSH Safety and Health Topic:

Overview Tick-borne pathogens can be passed to humans by the bite of infected ticks. Ticks can be infected with bacteria, viruses, or parasites. Some of the most common tick-borne diseases in the United States include: Lyme disease, babesiosis, ehrlichiosis, Rocky Mountain Spotted Fever, anaplasmosis, Southern Tick-Associated Rash Illness, Tick-Borne Relapsing Fever, and tularemia. Other tick-borne diseases in the United States include: Colorado tick fever, Powassan encephalitis, and Q fever. Lyme disease is the most commonly reported tick-borne disease in the United States. In 2005, more than 23,000 cases of Lyme disease were reported to the Centers for Disease Control and Prevention (CDC). Outdoor workers are at risk of exposure to tick-borne diseases if they work at sites with ticks. Worksites with woods, bushes, high grass, or leaf litter are likely to have more ticks. Outdoor workers in most regions of the United States should be extra careful to protect themselves in the spring, summer, and fall when ticks are most active. Ticks may be active all year in some regions with warmer weather. Frequently Asked Questions Which workers are at risk of infection? All outdoor workers should check with their supervisor if they have questions about possible exposure to ticks. Workers at risk of tick-borne diseases include, but are not limited to, those working in the following: Construction Landscaping Forestry Brush clearing Land surveying Farming Railroad work Oil field work Utility line work Park or wildlife management Other outdoor work What diseases are transmitted by ticks in the United States? Diseases caused by tick-borne pathogens in the United States include: Lyme disease Babesiosis Ehrlichiosis Rocky Mountain Spotted Fever Southern Tick-Associated Rash Illness Tick-Borne Relapsing Fever Tularemia Anaplasmosis Colorado tick fever Powassan encephalitis Q fever Where are infected ticks found in the United States? Tick-Borne Disease Common US Regions Lyme disease Northeast, North Central, Pacific Coast Babesiosis Northeast, Midwest, Northwest Ehrlichiosis East, Southeast, Central Rocky Mountain Spotted Fever Southeast, Atlantic Coast Southern Tick-Associated Rash Illness Southeast, Atlantic Coast Tick-Borne Relapsing Fever Rocky Mountains, Pacific Coast Tularemia All States except Hawaii Anaplasmosis Northeast, North Central, Pacific Coast Colorado Tick Fever Northwest, Rocky Mountains Powassan Encephalitis Northeast Q fever Throughout the United States When are workers at risk of infection? Ticks are usually more active in the months of April through October and peak in the summer months of June through August. The time of year when ticks are active may vary with the geographic region and climate. Outdoor workers should be extra careful to protect themselves in the late spring and summer when immature ticks are most active. What are the symptoms of infection with a tick-borne disease? There are many symptoms associated with tick-borne diseases. Infected workers may not have all of these symptoms and many of these symptoms can occur with other diseases as well. Some common symptoms of infection with tick-borne diseases include: Body/muscle aches Fever Headaches Fatigue Joint pain Rash Stiff neck Facial paralysis What is the diagnosis and treatment for tick-borne diseases? Tick-borne diseases are diagnosed based on symptoms and the possibility that the worker has been exposed to infected ticks. Most cases can be successfully treated with specific types of antibiotics, especially if treatment is started early. However, some workers may have symptoms such as arthritis, muscle and joint pain, or fatigue for an extended period of time. Recommendations for Employers Employers should protect their workers from tick-borne diseases by taking these steps: Provide training for workers that includes information about the following: How tick-borne diseases are spread The risks of exposure and infection How workers can protect themselves from ticks The importance of the timely reporting of workplace illnesses and injuries Recommend that workers wear light-colored long-sleeved shirts, long pants, socks, and hat when possible. If worker uniforms are provided, provide long-sleeved shirts and long pants as options. Provide workers with repellents (containing 20% to 30% DEET) to use on their skin and clothing for protection against tick bites. Provide workers with repellents (such as Permethrin) to provide greater protection. Permethrin kills ticks on contact. It can be used on clothing but not skin. When possible, have workers avoid working at sites with woods, bushes, tall grass, and leaf litter. When avoiding these sites is not possible, personal protective measures are of particular importance. If work in these higher-risk sites must occur, take the following steps to reduce tick populations: Remove leaf litter. Remove, mow, or cut back tall grass and brush. Discourage deer activity. Images courtesy of CDC Public Health Image Library, CDC Division of Viral and Rickettsial Diseases and the CDC Division of Vector-Borne Infectious Diseases Recommendations for Workers Take the following steps to protect yourself from tick bites: Wear a hat and light-colored clothing, including long-sleeved shirts and long pants tucked into boots or socks. Use insect repellents that provide protection for the amount of time you will be outdoors: Follow repellent label directions for use. Use repellents containing 20%-30% DEET on your exposed skin and clothing to prevent tick bites. Reapply repellents as needed. Use repellents such as Permethrin for greater protection. Permethrin kills ticks on contact. Permethrin can be used on clothing but should not be used on skin. One application of permethrin to pants, socks, and shoes typically stays effective through several washings. Check your skin and clothes for ticks every day. The immature forms of these ticks are very small and may be hard to see. Remember to check your hair, underarms, and groin for ticks. Immediately remove ticks from your body using fine-tipped tweezers. Grasp the tick firmly and as close to your skin as possible. Pull the tick's body away from your skin with a steady motion. Clean the area with soap and water. Wash and dry work clothes in a hot dryer to kill any ticks present. Learn the symptoms of tick-borne diseases. If you develop symptoms of a tick-borne disease seek medical attention promptly. Be sure to tell your health care provider that you work outdoors in an area where ticks may be present.