May is Tick-Borne Disease Awareness Month

As more people head to the outdoors for recreation, so will ticks. Though ticks are active year-round, the warmer months mean “tick season” and the need for increased awareness. 

“Both residents and visitors are exposed to ticks and tick-borne diseases through work, play, outdoor recreation and travel,” said Chaffee County Public Health in a press release on April 25. “Pets, horses, and other livestock are also at risk for tick-borne diseases and can put humans at greater risk, as well.”

Rates of Lyme disease and other tick-borne infections and illnesses continue to spread across the country. The U.S. Environmental Protection Agency uses Lyme disease incidence as a monitor for climate change, and the Centers for Disease Control and Prevention now estimates there to be more than 500,000 cases across the U.S. annually. 

Monica White, co-founder and president of the Colorado Tick-Borne Disease Awareness Association, said that while many may think they’re safe from ticks or Lyme disease in Colorado, the risk is on the rise. She worked with the U.S. Forest Service in college. Later, when she reached out to peers in the USFS and Bureau of Land Management, she “started hearing more from people that have been in the field for 20, 30 years that they had never run into ticks until these last 5 or 10 years,” she said. “Unfortunately, we don’t have much of a baseline in Colorado.

“It’s kind of a vicious cycle, being considered a low-risk state for tick-borne diseases in general,” she said. “Because we’re considered a low-risk state, there hasn’t been active surveillance, and that just perpetuates. With no surveillance, you can continue to say, ‘Oh, we don’t have a problem.’”

Of the 20 tick-borne diseases nationwide, only 7 are tracked in Colorado. Many tick-borne diseases (TBDs) are not “reportable” for humans at the state level, leaving rates of local infections and risk for many other tick-borne diseases unknown. 

“If you acquired a Babesiosis infection or an infection with Anaplasmosis, it wouldn’t be a reportable condition in our state,” White said. 

The Companion Animal Parasite Council has reported an upward trend for Lyme disease, ehrlichiosis and anaplasmosis cases in Colorado dogs since 2012.

“There’s actually better surveillance data for our dogs than for humans,” White said. “It’s really hard to get people to take the issue seriously when the data just isn't there.”

It can also be difficult to get endemic cases identified and diagnosed quickly. 

“In eastern states, if you show up with a discernible bull’s eye rash, it’s good enough to be diagnosed with Lyme and have it reported,” she said. “If you show up in a low-incidence state like Colorado with what looks to be a bull’s eye rash, that’s not good enough to be reported as a verified case.”

This long-standing resistance to surveillance, White said, is in part due to the controversy around TBDs and a status quo “that you can’t get Lyme in Colorado.”

“There are different ticks in Colorado in the same genus (as the black-legged tick),” she said, “two other very competent vectors of borrelia bacteria that can cause Lyme disease.”

Colorado is home to nearly 30 species of ticks, including endemic populations of Ixodes species known to carry borrelia. Though they are not well-known human biters, White says there is evidence they can still transmit infections to humans. 

Colorado also has “soft-body” ticks, which act differently from hard-body ticks. They’re common, White said, in “rustic lodging conditions” that may have had rodent infestations.

“The soft-body ticks can live for up to 20 years in a building, even if their host has been eradicated,” White said. “They feed for a very short time and then scurry back to their nest.”

In addition to Lyme disease, ticks can transmit many other germs (bacteria, viruses and protozoan) that can cause many serious and sometimes fatal diseases. Colorado Tick Fever, Spotted Fever Rickettsiosis (such as Rocky Mountain Spotted Fever), Tularemia, Babesiosis, Ehrlichiosis, Anaplasmosis, Tick-Borne Relapsing Fever and others can be acquired across the country and the world. 

Ticks can also transfer substances that can cause tick paralysis and alpha-gal syndrome (red meat allergy). One tick bite can cause multiple co-infections. According to a 2018 CDC study, tick-borne disease cases more than doubled in the United States in 13 years and were 77 percent of all vector-borne disease reports. Lyme disease accounted for 82 percent of those reports. 

Prevention is key. White recommends treating clothing and outdoor gear with permethrin, a long-lasting repellent toxic to ticks but safe for humans and dogs. It should not be applied to the skin. 

“We have a lot of opportunity for exposure here in Colorado with climate change, milder winters, migration of birds, people, dogs and wildlife,” she said. “Nationwide, it's a growing issue and Colorado is not going to be immune to that.”

She also recommends wearing long pants tucked into socks or donning gaiters. 

“They usually attach lower on the body as you’re walking by…and then crawl upwards,” White said. “So if you’re protected on your lower half, you have a better chance of finding one crawling on you before it finds skin.”

Other repellent options include products with DEET or oil of lemon eucalyptus. There is also ongoing research about more natural options. 

White also advises recreators to stay toward the center of trails, put a barrier on the ground before sitting and be aware of the environment and surroundings. 

“Be knowledgeable about the habitats you’re heading into,” she said. “If you’re in areas that have higher humidity microhabitats, ticks will gravitate toward those.”

Even in your backyard, White said, check pets and kids for ticks. 

“I consider tick checks the best and last defense because if you can remove a tick from clothing before it touches the skin or remove a tick as early as possible, the less chance there is for disease transmission,” she said. “It’s not foolproof, but…it lowers the risk.”

Outdoor workers, recreators, travelers and those who have close contact with domestic animals or wildlife are at higher risk. Children are also at higher risk, and symptoms of Lyme and other tick-borne diseases can appear differently, sometimes manifesting solely as neuropsychiatric symptoms.

Diagnosis of tick-borne diseases is often difficult. Nearly 50 percent of people who develop Lyme disease don’t recall a tick bite. For children, it’s less than 20 percent. Manifestation and recognition of a bull’s eye rash on darker skin tones can further delay diagnosis and treatment for people with brown or black skin. 

Other symptoms of tickborne diseases may appear as flu-like in the early stages, including fever, severe headache and neck stiffness, fatigue, muscle/joint pain, nausea, diarrhea, vomiting, rashes of various presentations (spotted, streaked), swollen lymph nodes and other symptoms. This can make diagnosis difficult, especially when there is no history of a tick bite. 

The COTBDAA and CCPH are partnering in a month-long awareness campaign. Kicking off the month is Moonlight Monday on May 6, with donations going to support COTBDAA and the

awareness campaign in Chaffee County. Prevention education resources will be available from 5-7 p.m. at their table at Moonlight Pizza and Brewpub.

On May 8, CCPH and COTBDAA will host a community conversation and screening of  “The Quiet Epidemic,” a documentary on the impact of Lyme disease nationwide. This screening is part of the CCPH Age Strong Film Club at the Stardust Theater from 2-4:30 p.m. White and CCPH director Andrea Carlstrom will be on hand to answer questions.