As our patients and families celebrate Passover, Easter, Opening Day and warmer weather, we have begun to receive phone calls about tick bites. Westwood-Mansfield Pediatrics treated 90 children last year for Lyme Disease (1/3 of whom live in Westwood or Medfield) and we expect even more this year. Interestingly, while most of the cases occurred between May and September, we diagnosed 5 cases of Lyme Disease between November 1st and April 1st indicating that Lyme has truly become a year-round concern.
We would like to use this e-mail to dispel 4 Myths about Lyme Disease, as well as answer 1 Question about post tick bite prevention of Lyme with antibiotics. Additionally, we will talk a little about lawn care and prevention.
Myth #1: I need to remove the entire tick to prevent Lyme Disease. FALSE.
When removing a tick, it is common for a piece of the mouth or head to be left imbedded in the skin - this doesn't contain the Lyme bacteria! The Lyme bacteria resides in the stomach of the deer tick and, once it is removed, the risk of transmission of Lyme Disease is over. To learn how to properly remove ticks, visit www.tickencounter.org. It is important not to try to dig the head out as doing so can actually cause a skin infection. If the bite area gets inflamed or red in the first two days following the bite, we recommend using a topical antibiotic (ie: triple antibiotic, Neosporin, bacitracin) mixed with hydrocortisone cream. Both of these are available over the counter and should be applied twice daily for three days.
Myth #2:
I need to test a tick that was found attached on my child for Lyme. FALSE.
Numerous studies have shown that ticks must remain attached for at least 36 hours in order to transmit the Lyme bacteria. Ticks that are attached for less than 36 hours will not cause infection in children. In general, testing a tick for the Lyme Disease will not influence whether or not we decide to treat for Lyme Disease. It is important to check the site of attachment for any rash occurring 3-30 days after the tick bite (most commonly it will be seen 3-7 days after the bite).
Myth #3: Most kids who get Lyme Disease never have a rash. FALSE.
The vast majority (almost 80%) of children diagnosed with Lyme Disease develop rashes. We suspect that the other 20% also get the rash, only it is never noticed (rashes on the scalp and back can be easy to miss). It is important to remember that all secondary Lyme Disease (arthritis, meningitis, and heart disease) are curable with no prolonged effects (although treatment may require intravenous antibiotics, however).
I live in an area with a lot of Lyme Disease and have heard many horrible stories about Lyme Disease. I just saw an unattached tick on my child and think he should be treated with antibiotics. FALSE.
We will not treat a child who has an unattached and unengorged tick on them regardless of where you live (go to www.tickencounter.org to see the picture of stages of engorgement of a tick). If the tick has not been attached for at least 36 hours, it is unable to transmit Lyme Disease and therefore there is no reason to give antibiotics. We must continue to remember that antibiotics, while generally safe and well-tolerated are not without risk, and unnecessary use is not encouraged. Children in our practice have been hospitalized for allergic reactions to antibiotics. Please do not call us for an antibiotic for an unattached or unengorged tick.
Question: I live in an area with a high incidence of Lyme Disease and have just found a tick attached to my child. Can a single dose of an antibiotic prevent Lyme Disease?
Answer: Maybe.
The answer to this question comes in many parts.
For children younger than 9 years of age, there is no antibiotic regimen that can prevent the transmission of Lyme Disease. Amoxicillin has been studied and found not to be effective as prophylaxis - it is only effective in a 21-28 days regimen. Children under 9 years old should only receive antibiotics if they have the symptoms of Lyme Disease - either the classic "bullseye" rash, or the constellation of flu-like symptoms (fever, headache, AND body aches) in the spring, summer or fall in a high-risk town (Medfield, Sharon, Norfolk, Easton, Norton , parts of Walpole , Westwood and Mansfield).
In children 9 years of age and older, the antibiotic doxycycline may be effective for prevention of Lyme Disease. In one study, a single dose of doxycycline following a tick bite decreased the likelihood of developing Lyme Disease from 1 in 30 to 1 in 250 exposures (approximately an 8-fold decrease). Patients receiving the doxycycline have significantly more side effects, however, with nausea and vomiting commonly seen.
We at Westwood-Mansfield Pediatrics believe that if you are aware of the tick bite, Lyme Disease is unlikely to be missed (and complications are almost unheard of). Being on the lookout for the classic rash, as well as fever and flu-like symptoms in the 3-30 days following a bite should make Lyme Disease easy to find. Once diagnosed, Lyme Disease is easily treated in the early stages with oral antibiotics with complete resolution and no long-term effects (treatment = cure).
In light of this (and given the side effects of antibiotics), our recommendation is not to preventively administer antibiotics following a tick exposure.
Each family, however, has its own level of tolerance of risk. If your child is older than 9 years of age and has had a deer tick attached for over 24-36 hours, he or she may be eligible for preventive antibiotics. Remember, Lyme Disease is not a life threatening disease- if you choose to treat your child 9 years of age or older please call us during business hours - NOT AFTER HOURS PLEASE.
For questions about Lyme Disease go to: www.mass.gov/dph.
For questions about deer ticks go to: www.tickencounter.org.
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