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Outdoors enthusiasts urged to practice tick bite prevention [Grand Forks Herald :: BC-OTD-TICK-PREVENTION:GF]

Rick Horton of Grand Rapids, Minn., was just back from a spring turkey when he noticed the ticks, about a dozen of them, dug into his skin.

"They were several on my back, between my shoulder blades. And several in places I can't mention," said Horton, who spent three days crawling around in Kansas prairie grass to shoot a tom turkey. "I was camping out. No shower. I was literally crawling on top of ticks for three days. And I didn't do anything to prevent it."

Horton and his wife eventually pulled them all out. But soon after, Horton's lymph nodes started to rapidly swell. He went to his doctor, who immediately prescribed a dose of the antibiotic doxycycline.

"It cleared it right up," Horton said. "I got lucky. I've never had Lyme disease and most every other wildlife biologist I know has had it once. Some have had it multiple times."

Horton, a biologist with the National Wild Turkey Federation, now takes tick precautions very seriously.

"Now, I soak my hunting pants with permethrin. And I have a (turkey hunting face mask) that's designed to keep them off," he said. "I'm not taking chances anymore."

With Lyme disease on the increase in Minnesota for more than 20 years, it would seem everyone who spends time outdoors in spring and summer should know to take precautions. But many people still don't, experts say, even as the number of nasty tick-borne disease increases.

Last week, the Centers for Disease Control said reported cases of insect-borne illnesses - ticks and mosquitoes, mostly - more than tripled from 27,000 per year in 2004 to nearly 100,000 by 2016.

The CDC says about 35,000 cases of Lyme disease alone are reported annually, but as many as 300,000 people in the U.S contact the disease each year, with most going unreported.

May through July are the most likely months to get bitten by a tick in the Northland. Right now, spring turkey hunters, kids outside playing on warm days, shed antler hunters, morel mushroom seekers, bird watchers, hikers and even ATV riders are susceptible as the last snow melts away and ticks get active.

"But it can happen as late as deer season, in November, and in a warm winter it can start up in February," said Dr. Kevin Stephan, infectious disease specialist with Essentia Health in Duluth, Minn.

Stephan strongly encourages anyone who spends time outdoors this time of year to take precautions with a clothing repellent like permethrin and a skin replant like DEET, even if you may not like the feel or smell of chemicals on your skin. He notes studies show the repellents are safe, in commercially available doses, and proven effective in test after test.

"It's weighing risk against benefit," Stephan said. "If you can prevent serious or even potentially lethal infection, why not do it?"

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New ticks, new diseases

The worst offender in the Northland is the blacklegged tick, formerly called the deer tick, which spreads Lyme disease, by far the most common and still most serious tick-borne illness in the region and nationwide. The blacklegged tick also can carry babesiosis, anaplasmosis and the emergent Powassan virus.

Blacklegged ticks like a few warm days before they get really active in spring. But they also like humidity, and can be found in damp grass and leaves.

Horton's nemesis in Kansas was the lesser-known lone star tick, which in recent years has moved north into Minnesota. Named for the single white dot on the back of the female tick - the ones that bite - the lone star tick carries several pathogens, including tularemia, southern tick-associated rash illness and ehrlichiosis. New research, published in the journal Emerging Infectious Diseases from the Centers for Disease Control, suggests that disease caused by the lone star tick is increasing and seriously underdiagnosed.

The lone star tick also carries the bizarre alpha-gal bacteria that can spur a severe allergic reaction to meat. It first surfaced in the southeastern U.S. and was only as far north as Iowa just a few year ago. But in recent years, cases have been popping up in Minnesota, even as far north as Duluth.

Victims of Lyme and other tick-borne illness report myriad symptoms, from the common bullseye rash, fever, aches and pain, to fatigue and flu-like symptoms, to full-body rashes, mood changes, vision problems, cognitive issues and even sleep disorder and heart problems.

Stephan says he sees more tick bites and more tick disease every year. When Stephan first started seeing Lyme and other tick cases, they were almost all from south of Duluth, Minn. Now, he said, St. Louis County has among the highest Lyme disease rates per capita of any in the state.

"Whether you call it global warming or climate change or whatever, we are seeing more ticks moving further north. We have Lyme all the way to the Canadian border now and we just didn't see that when I first got here" in 2003, Stephan said. "It's not going away. ... It's getting worse."

Stephan said he's not sure if he's seeing so many more tick-related cases because more people are being bitten and infected or because more people are aware of the possibility and are seeking help if they suspect a problem.

"Probably a little of both," he said.

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More ticks carrying disease

Stephan said that a concerning development is the increasing percentage of ticks now carrying disease. When he first started tacking tracking Lyme disease, only about 2 percent of female blacklegged ticks carried the disease. So even if you got bit, chances are you wouldn't be infected.

Now, more than 30 percent of female ticks are infected on average, and in same areas its 40 or even 50 percent.

"The odds used to be in your favor. Now, it's one-in-three or even one-in-two. Those aren't good odds," Stephan said.

That's one reason he's suggesting that people who spend a lot of time outdoors in tick country get an advance prescription for a one-time, 200 mg dose of doxycycline, the go-to antibiotic for tickborne diseases. If any small tick become embedded in your skin, first, properly pull the tick out. Then take the antibiotic.

The precautionary dose "is something like 90 to 95 percent effective. In medicine, that's pretty good prevention," Stephan said, urging people to get that prescription in advance of being bitten. "You can wait for it to happen. But if it's a Friday night it might be Monday before you get to your doctor" and time is of the essence.

"If your doctor doesn't know about this, they should," Stephan said, noting the dose is small enough to allay concerns about antibiotic resistance.

Stephan also suggests seeing your doctor as soon as possible after tick bites. Because he's a specialist, Stephan often gets the most difficult cases, sometimes patients who went months without seeking medical attention, or months being misdiagnosed by other doctors.

"Take precautions. ... And if you still get symptoms, don't delay," he said. "The earlier the treatment, the better the outcome."

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