Lyme Disease on the Rise
Lyme disease became a familiar term in Canadian households when pop star Avril Lavigne was diagnosed with the disease in 2014. As reported by CTV news Lavigne said, “she would wake up with night sweats and felt so exhausted she couldn’t get out of bed.” Canadian country singer Shania Twain, who contracted Lyme disease in 2003, said it affected her vocal cords and left her unable to sing for a time. Lyme disease has been frequently featured in news stories across Canada, as cases of the disease have been on the rise over the last several years.
The trouble with ticks
Lyme disease is spread by the bacteria Borrelia burgdorferi which is carried by the Ixodes species of ticks. In Canada, Lyme disease is spread by two types of ticks: The blacklegged, or deer tick, in southeastern and southcentral regions of Canada; and the western blacklegged tick in BC.
Ticks become infected with Lyme disease when they feed on infected animals such as rodents and birds. The infected ticks can then spread the disease to humans when the tick attaches itself to a person to feed on their blood. Most people are infected by immature ticks about the size of a poppy seed. Adult ticks are about the size of a sesame seed and can also spread Lyme disease. As ticks are very small their bites are often painless, so it is possible to be bitten by a tick and not know it. Luckily most tick bites don’t result in disease.
Blacklegged ticks are usually found in tall grass and wooded or forested areas. Ticks can be found year-round but are most likely to bite in the spring and summer months. People at risk of tick bites include those participating in outdoor activities in wooded or semi-wooded areas, such as camping, hiking, hunting, fishing, gardening, golfing, or dog walking. Dogs may increase human risk by bringing ticks indoors.
On the rise in Canada
The Public Health Agency of Canada reports an increase in cases of Lyme disease in Canada, from 144 cases in 2009 to 2025 cases in 2017. The BCCDC reports that these rates have been increasing with climate change. While cases of Lyme disease have been on the rise in eastern Canada, the risk has remained low in BC. Fortunately, in BC less than 1% of tested ticks carry the bacteria that causes Lyme disease. The risk is highest in eastern and central Canada. In 2016, 88% of reported cases were from Ontario, Quebec, and Nova Scotia.
Is Lyme disease a risk for travellers?
Lyme disease is also a risk outside of Canada. In the United States the risk is highest in the northeastern and north-central part of the country. It is also a risk in Europe, with the highest number of cases occurring in central and eastern European countries, but there is also risk from southern Scandinavia into the northern Mediterranean countries of Spain, Italy and Greece. Infected ticks are also present in Asia, from western Russia through Mongolia and northeastern China and Japan, but human infection in these areas is usually uncommon.
Symptoms of Lyme Disease
Lyme disease is often associated with the classic “bulls-eye” rash, known as erythema migrans, which occurs in >80% of cases. This is usually the first symptom of Lyme disease and begins 3-30 days after exposure as a red rash at the site of the tick bite and slowly expands over several days up to 30cm in diameter. The rash is often accompanied by fever, headache, muscle and joint aches, and swollen lymph nodes.
Classic erythema migrans rash. Source: CDC
If left untreated, people can experience multiple erythema migrans rashes, severe joint pain and swelling,a facial droop, irregular heartbeat, dizziness, shortness of breath, tingling or numbness of the hands and feet, or problems with short-term memory.
Long term complications lasting months to years can occur, even after treatment. Post-treatment Lyme disease usually involves persistent joint and muscle pain, fatigue, difficulty sleeping, and cognitive defects.
People treated early with antibiotics usually recover quickly.
There is no vaccine available to prevent Lyme disease. The best way to prevent it is to avoid being bitten by ticks:
- Avoid tick habitats by walking on well-cleared trails in forested or tall, grassy areas
- Wear light coloured clothing to see ticks better
- Tuck your shirt into your pants, and your pants into your socks
- Use an insect repellent with DEET or Icaridin
- Check daily for ticks when in a risk area
- Perform a full-body check, especially on neck, scalp, groin, armpits, and belly button
- Take a bath or shower to remove lightly attached ticks
- Put clothing in a hot dryer for 10 minutes to kill any ticks on clothing
- Remove ticks on your body right away (see below)
You discovered a tick on your body! – now what?
If you find a tick on your body remove it right away. The most important thing is to remove the entire tick, including any parts of the head that might be buried under your skin. Use a tick removal device or a pair of fine-tipped tweezers:
- Grasp the tick as close to the skin as possible. Avoid touching the tick with your hands.
- Without squeezing the tick, pull directly and steadily upward. Avoid twisting or jerking the tick while pulling.
- Once removed, clean the bite area with soap and water, then disinfect the wound with antiseptic cream.
If the tick has been on your body for several hours or days, it may have buried itself deep into your skin. It can be very difficult to remove the entire tick without leaving some mouth parts, which can cause infection. When a tick is buried very deep under the skin it is best to see a doctor to remove it.
What NOT to do when removing a tick!
There are several remedies and folklores about how to remove a tick from your body. Here’s what to avoid:
- Avoid putting nail polish, petroleum jelly, grease, or other substances on the tick to suffocate it, or using heat to make it detach. These methods can increase the chance of infection
- Avoid squeezing the body of the tick which can force out its stomach contents into the wound and increase the chance of infection
If you’ve been bitten by a tick and would like to have it tested, it can be submitted to a BCCDC Public Health Laboratory. For further details visit the BCCDC website.
TravelSafe Clinical Educator – Kristin Cain, RN, BSc, MSc(A)