Treatment

In the early stages of infection Lyme disease is completely curable with antibiotics such as:

The treatment during later stages of Lyme disease is more difficult, and some patients may still experience symptoms up to three months

after treatment. An intravenous drug, such as Ceftriaxone (Rocephin), is recommended for the later stages.  Pain killers, such as Ibuprofen, can also be prescribed along with antibiotics to relieve joint pain.

Link to guidelines for treatment of Lyme disease

Prevention

Who is at Risk?

Individuals who spend a lot of time outdoors should be more careful about following precautionary measures. An individual doesn't necessarily have to be hiking or live in an extremely wooded area to contract the disease, since deer and mice have brought the disease to residential neighborhoods. Children under the age of 10 and adults over age 50 are at highest risk of contracting the disease, but anyone living in an area with infected deer ticks is at risk of contracting the illness. Individuals traveling to other endemic areas of the country are also at risk of infection.

 

Risk of Lyme Disease by Age and Gender (2001-2011)

Source: http://www.cdc.gov/lyme/stats/graphs.html

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Personal Protection

The single most effective method for preventing Lyme disease is personal protection:

  1. Wear long pants and long sleeves when spending time outdoors. Be sure to tuck pant legs into boots or socks to minimize skin exposure to tick bites.
  2. Apply insect repellent with DEET to skin before spending time outdoors. DEET is not recommended for children under 2 months of age, and children older than 2 months should use concentrations of DEET 30% or less. DEET concentrations over 50% do not provide much additional protection. Permethrin, found in hardware and outdoor equipment stores, can also be applied to clothing to repel ticks.
  3. Wear light colored clothing, which allows ticks to be more easily noticed.
  4. When hiking, try to stay in the middle of trails and avoid areas of dense brush.
  5. Perform tick checks after spending time outdoors, even after gardening or cutting the lawn.
  6. Check children and pets for ticks, and remove them promptly, as illustrated below.

This short video summarizes personal protective measures.

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Local Health Departments Should Promote Awareness and Personal Prevention

Since personal protection is the most effective method of preventing Lyme disease, strategies aimed at promoting awareness and adoption of personal protection measures are the most important intervention that a community health department can pursue.

Environmental Approaches

Personal prevention measures are the most effective. Environmental approaches have also been suggested, but their effectiveness is controversial. This short video summarizes environmental approaches that may supplement personal protective measures.

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Landscape Modification

Ticks are more likely to establish a habitat in close proximity to wooded areas as well as in areas with an abundance of groundcover vegetation, including leaf litter. They prefer dark, damp, and cool areas, especially in so called "transition areas" between the woods and the lawn. Keeping grass short and free of debris will make the environment less suitable for ticks to survive on.

Link to more information

Chemical Pesticide and Acaricides Application

Some authors have recommended the use of pesticides and acaricides for control. MDPH does not strongly encourage this as a prevention strategy, because of concerns related to pesticide exposures. While this can decrease the abundance of ticks in an area, pesticide application can have adverse consequences for the macro-environment.

Management of Deer Populations

Deer do not get infected with the bacterium that causes Lyme disease. However, deer are a main source of the blood adult ticks need to reproduce. Some have proposed that culling deer populations through increased hunting will reduce the incidence of Lyme disease.The impact of deer reduction on tick abundance or Lyme disease has been examined in several studies with mixed results. Studies on islands indicate that culling deer populations reduces the tick population, but this approach is not practical or realistic in the contiguous United States, since deer are constantly migrating. Even if one town in Massachusetts were to increase hunting of deer, it would prevent immigration of deer from adjacent towns, and the impact of this strategy in decreasing human disease remains unproven. For more information on deer management strategies see MassWildlife.

Chemically Targeting Reservoirs with Insecticides

Another approach is to reduce tick populations by passive application of chemicals to deer and mice, although there is little evidence for the effectiveness of this approach. At present, these approaches are only experimental. For example, a 4-poster bait station can be used to passively apply insecticide to the neck and head of the deer in order to decrease the number of ticks attached to the deer as shown in the photograph below.

Source: http://www.deerfriendly.com/lyme-disease/4-poster-system-for-tick-control

While this may be a very effective method, the display can be expensive and a licensed insecticide applicator needs to replenish the display frequently, making it a less popular option. For more information about four posters, follow this link: American Lyme Disease Foundation.htm.

Another method is to use "tick tubes," shown below, which contain cotton treated with Permethrin, which kills ticks. Mice will enter the tube to retrieve cotton for their nests, and the Permethrin will adhere to the mice. For more information see the Damminix Tick Tube Fact Sheet.

      

Biological and Natural Control

Use of fungal pathogens and plants as biological control agents have been proposed to control tick populations. One area of research has focused on using the natural enemies of ticks native to the same areas. By increasing the numbers of these fungi found in the area, tick abundance would decrease through the process of "augmentative bio control."  The use of natural enemies could potentially provide a more environmentally friendly and effective way to control the spread of pathogens. Further research on this and other methods of biological control are currently in progress.


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