Archive

Peter Troell : Good Afternoon.  Thank you for joining us for this live discussion on Lyme disease, West Nile virus and the measures you can take to protect yourself and your family members.  We appreciate all of the excellent questions you have submitted, and look forward to answering any additional questions.

Joanne : I've heard that the symptoms of Lyme Disease mimic many other illnesses - how can one be sure if what they have is Lyme and when should you consult a doctor?

Peter Troell :

Thanks for this important question.  Lyme disease is reported in all areas of Fairfax County and all Fairfax residents with possible exposure to ticks could develop Lyme disease and should know what symptoms to look for and when to seek medical care. 

In many cases, individuals with Lyme disease will develop an expanding bullseye or target-shaped rash, also known as an erythema migrans (EM) rash, at the site of the tickbite.  This rash usually develops within 3-30 days following the bite.  If you develop a rash like this, you should consult a healthcare provider; even if you do not remember being bitten by a tick.  Lyme carrying ticks can be very small and bites can go unnoticed.  In some people exposed to Lyme disease, this rash does not develop (about 30% of the time) or goes unnoticed due to the location of the rash.  In these cases, knowing whether you might have Lyme disease can be more difficult.  Other early symptoms to watch for include fever, chills, fatigue, headache, muscle and joint aches, and swollen lymph nodes. Anyone experiencing these symptoms, with or without the rash described above, should consult their health care provider. 

If Lyme disease is not recognized early, other symptoms may develop, such as additional EM rashes on other parts of the body, loss of muscle tone on the face, severe headaches and neck stiffness, pain and swelling of large joints, and heart palpitations or dizziness.  Anyone experiencing these symptoms should consult with their healthcare provider.  For more information on Lyme disease signs and symptoms, visit http://www.cdc.gov/lyme/signs_symptoms/index.html

shane : Does Fairfax County have a proactive program of mosquito control? For example, in Colorado, teams go into mosquito habitat area, check for larvae, and treat accordingly. This lessens the need for harmful and disruptive spraying for adult mosquitoes, and, if tracked in great enough detail, controls mosquitoes most efficaciously.

Jorge Arias : Yes, we have a proactive program; we treat catch basins and known breeding sites on County property. We encourage residents to tip and toss standing water around their home.  Learn more:  http://www.fairfaxcounty.gov/hd/westnile/wnveliminate.htm 

Joan : Is it true that if a person doesn't get treatment for lyme disease early on then it will be too late for the antibiotics to work and cure the person?

Peter Troell : Treatment for Lyme disease can be effective at all stages of the disease process.  However, treatment is easiest and most effective when given early in the disease process, so knowing the signs and symptoms of Lyme disease and seeking healthcare early are very important.

Patients treated with appropriate oral antibiotics in the early stages of Lyme disease usually recover quickly and completely.  For people not diagnosed until the later stages of disease (for example, those with heart or nervous system forms), treatment with 2-4 weeks of IV antibiotics may be necessary.  About 10-20% of people, particular those diagnosed later, may have lingering symptoms after treatment, including fatigue, pain, joint or muscle aches that can last more than 6 months.  Many experts believe these symptoms are due to damage caused during the disease process and not by ongoing infection.  Therefore, further treatment with antibiotics is not recommended for these lingering symptoms. 

Anonymous User : I found a tick on my back, and I think I may have been bitten. What should I do now? How can I tell if I have Lyme disease or not?

Jorge Arias : You should get the tick identified (you can bring it to the Health Department for ID service: http://www.fairfaxcounty.gov/hd/westnile/tick-id.htm). If it is not a deer tick you won’t get Lyme disease from it.

Refer to the response to Question #1 for information about how you can tell if you have symptoms of Lyme disease.

Anonymous User : If one is traveling to an area for vacation that has a high rate of tick borne mosquito disease is it a good idea to take antibiotics as a preventive measure? If you get a tick bite should you always go to the dr or just if you get the red rings? Do ticks in this area carry Rocky Mountain Spotted Fever?

Peter Troell :

International travelers to countries known to have yellow fever should be, and in many cases are required to be, vaccinated.  Similarly, preventive antibiotics is recommended for individuals traveling internationally to countries known to have malaria.   To my knowledge, there are no similar recommendations for tickborne diseases or other mosquito borne diseases and antibiotics are not recommended on a preventive basis in other situations (for example, travel within the U.S.).  However, it is very important to always use the following measures whenever you may be exposed to mosquitos or ticks: dressing properly, wearing insect repellent, conducting frequent and thorough tick checks, and watching for signs and symptoms of disease. 

As I mentioned in previous answers, not everyone develops the characteristic rash associated with Lyme disease.  Other early symptoms to watch for include fever, chills, fatigue, headache, muscle and joint aches, and swollen lymph nodes. Anyone experiencing these symptoms, with or without the rash described above, should consult their health care provider. 

In Fairfax County, we do have the tick that transmits Rocky Mountain spotted fever, but we haven’t found the bacteria that causes this disease in the thousands of ticks that we have examined in the last 3 years.

Anonymous User : Can you tell immediately by looking at the location of the bite if the mosquito that bit you was infected with Lyme Disease?

Jorge Arias : Mosquitoes don't transmit Lyme disease, black-legged ticks do.  However, all insects bites may look alike to the naked eye.  In any case, you cannot tell by the appearance of the bite whether the bacteria that causes Lyme disease or the virus that causes West Nile virus was transmitted.

Shannon : If I find a tick on me and I remove it myself, should I have the tick tested for Lyme disease? If so where do I take it and does health insurance pay for that?

Jorge Arias :

If you find a tick on your body, you can bring it to the Health Department for, but the Health Department does not test for the Lyme bacteria. Even though there are private labs that test ticks, the CDC does not recommend it. Instead, have the tick identified by the Health Department to determine if it is a black-legged tick.  If it is, we recommend you consult you health care provider.  Each health insurance policy is different, you should check with your provider for information about coverage.

Anonymous User : My son found a tick in his armpit four weeks ago, he was out camping and it may have been on him as long as three days. He didn't show any signs of Lyme disease but now he feels achy and tired. Is there a test the dr can do for Lyme disease? This tick seemed large for a deer tick, it was about the size of the end of pencil engorged with blood.

Peter Troell : Identifying ticks based on the size can be very difficult, as ticks go through various stages of development and all tick species have smaller and larger forms.  They can look particularly large when engorged with blood. Therefore, it is difficult to say what type of tick this might have been.  Deer ticks that are attached for as long as 3 days are capable of having passed Lyme disease (usually, the bacteria is usually passed within 36 hours).  In addition, there are other, much less common tickborne diseases that are carried by other tick species.  Not everyone who gets Lyme disease develops the classic bulls-eye rash.  Early symptoms of Lyme disease (and other tickborne illnesses) also include fever, chills, fatigue, headache, muscle and joint aches, and swollen lymph nodes.  Anyone experiencing these symptoms following a tick bite should consult with their healthcare provider.  For Lyme disease, there are blood tests available which can aid a physician in diagnosing the disease. 

Eric : Is there anything beyond the standard Lyme disease shot that I should protect my dog with? Do the collars work?

Jorge Arias : Yes, there are "spot on" topical treatments which can be used.  You should consult a veterinarian.  Yes, dog collars are effective - again, your vet can advise you.

Erica : I began treatment for what was believed to be lyme disease on Memorial Day. I was put on a course of antibiotic after I presented to the ER with multiple symptoms, including a sustained fever over 101, headaches, night chills, jaw pain, scalp pain, muscle and joint aches, and what appeared to be the bulls eye rash on the back of my leg. The ER had blood tests taken and the results showed that I did not produce any lyme antibodies, but my doctor suggested I go back in 6 weeks to see if antibodies were produced by that point. Will the fact that I started the antibiotics so soon after I exhibited symptoms inhibit the production of lyme antibodies? If there are still no lyme antibodies produced after 6 weeks could it be possible that I had/have something other than lyme disease?

Peter Troell : Given that you are currently under care, I suggest that you follow-up with your healthcare provider regarding the specifics of your situation and your laboratory test results.  In general, I can say that people who develop Lyme disease may not test positive by antibody blood tests during the first few weeks after infection, as it takes some time for the bodies immune response to build.  Most individuals who have been infected for at lest 4-6 weeks will test positive when using appropriate antibody tests.  For more information on lab testing for Lyme disease, you can visit http://www.cdc.gov/lyme/diagnosistreatment/index.html

Anonymous User : What's the best way to protect myself from ticks? Are there alternatives to bug spray (e.g., Off) to ward off mosquitos.

Jorge Arias :

Naturally, you can avoid tick-infested areas such as places where tall grass grows, etc.  As the best way to protect yourself from tick bites, we recommend:  Avoid direct contact with ticks; Use a repellent containing DEET; Wear long, loose-fitting, light-colored clothing; and use permethrin on clothing.  Also, when coming in from outdoor activity, always check for ticks, and promptly remove any attached ticks, and examine gear such as backpacks and your pets.

When it comes to mosquitoes, we recommend using an insect repellent. However, if you choose not to use a repellent, you can limit mosquito bites by wearing long, loose-fitting, light-colored clothing, and avoiding areas where there are mosquitoes.  Also, you can consider using Oil of Lemon Eucalyptus (chemical name: p-menthance 3,8-diol or PMD), which is a more natural product.  Finally, you can impregnate your clothing with permethrin.

Anonymous User : If Lyme disease is so hard to diagnose, how does my doctor know to test me for it if I feel like I have it? Is there a blood test?

Peter Troell : There are blood tests available to aid physicians with the diagnosis of Lyme disease.  However, it is important to note that these tests are not recommended for patients who do not have signs and symptoms that suggest Lyme disease (which I have described in previous answers).  In patients who don't have such symptoms, interpreting the test results is difficult as these tests may produce false positive results (meaning the test is positive even if the individual does not have the disease).  A false positive result can lead to misdiagnosis with Lyme disease when the patient actually has something else. This can delay treatment for that other disease.

Burke Centre Resident : Fairfax County recently completed new trails in Burke Centre leading to and the Burke VRE station. There are many places of standing water along the new trails, is there a plan to treat these areas for mosquitos? There are already mosquites present along the trails. Is the treatment safe for local wildlife and pets if they get in the treated water? There are also several deer that live in this area, is there any plan to treat the deer for ticks in Burke Centre? Now that the county has opened up this area with new trails the human traffic has increased quite a bit.

Jorge Arias : The Health Department routinely treats known mosquito breeding sites that we have identified based on larval production.  On an on-going basis, we evaluate the community for new mosquito breeding sites.  There are many places throughout our community where there is standing water after a rain, for example, but not all of them will produce mosquitoes.  It is not possible to treat every body of standing water on County property.  However, the treatments used by the Health Department are safe to wildlife and pets.

At present, there are no plans to treat deer for ticks in the County other than an experimental use of 4-poster feeding stations by the County Biologist; more info here: http://www.fairfaxcounty.gov/police/news-releases/2012/032612pinkdeeralert.htm 

Anonymous User : What is the best topical tick and mosquito repellent for dogs? Can products for humans be used on dogs? Is there a topical repellent that is safe for outdoor cats? What is the best way to prevent pets from bringing ticks inside the house with them?

Jorge Arias : There are several products to for dogs, your veterinarian can advise which one is best; however, you should not use some products designed for humans, such as those that contain DEET, on your pets.  There is a dog vaccine against Lyme disease, again, you vet can advise you.  To limit the number of ticks on pets, use a topical repellent designed for pets and do a tick check when pets come indoors.

Anonymous User : All the talk is about west nile but can we get malaria here?

Peter Troell : Interesting question.  This year, the Health Department confirmed 29 cases of internationally-acquired malaria (malaria in travelers returning from countries known to have malaria).  However, there have been no  reported locally-acqured malaria cases in Fairfax County for many years.  The risk for malaria is considered to be in international travelers.  It is strongly recommended that travelers visiting malaria endemic countries consult with a healthcare provider prior to travel and take appropriate preventive antimalarial drugs during their time in known malaria areas.    

Ticked off in Clifton : We have had many encounters(over 25 occasions) with Ticks on my front steps of my home this spring. It seems to be a common area for them to jump on my family members. How can we rid this area of ticks? It seems to be a nesting area for them.

Jorge Arias :

To kill ticks in your yard, you can spray the yard with a product called permethrin. Always follow label instructions.  You can learn more about spraying your yard on page 5 of this booklet:  http://www.fairfaxcounty.gov/hd/westnile/wnvpdf/dciguide.pdf

You can learn more about creating a tick-free yard on our website: http://www.fairfaxcounty.gov/hd/westnile/tickfreeyard.htm 

Carole : I live by the cameron creek and we get a lot of mosquitos. Is there anything being done without calling in. I had to report it last September right before the flood of 2011.

Jorge Arias : The Health Department will respond to complaints about mosquito problems.  You can submit a complaint online here:  http://fido.fairfaxcounty.gov/DP1/Metroplex/FairfaxCounty/customerservice/wiz_csr.asp

Ellen : Has west nile virus been identified in the county yet? When in the summer has it shown up in past years? Where can we look up hte symptons of west nile? I heard it is similar to a flu. Should we have kids tested for Lyme disease when they have their regular checkup?

Peter Troell : Each year, West Nile virus is identified in mosquitos around starting around late June.  So far this year, no West Nile virus has been found in mosquitos tested in the County, but it is still early.  The Health Department usually confirms 1-2 human West Nile virus infections and these usually occur in the late summer and early fall months. 

More information on the symptoms of West Nile virus infection is available at http://www.cdc.gov/ncidod/dvbid/westnile/clinicians/clindesc.htm.  A fact sheet on West Nile virus is available at http://www.cdc.gov/ncidod/dvbid/westnile/wnv_factsheet.htm  It should be noted that most people infected with West Nile virus do not show any symptoms. 

With regard to testing kids for Lyme disease regularly, screening with laboratory tests for Lyme disease is not recommended.  There are blood tests available to aid physicians with the diagnosis of Lyme disease.  However, it is important to note that these tests are not recommended for patients who do not have signs and symptoms that suggest Lyme disease (which I have described in previous answers).  In patients who don't have such symptoms, interpreting the test results is difficult as these tests may produce false positive results (meaning the test is positive even if the individual does not have the disease). 

The best preventive measures for Lyme disease in children include wearing insect repellent, dressing appropriately, wearing permethrin treated clothes, and conducting frequent tick checks (by parent for younger children), and watching for the signs and symptoms of the disease (described earlier).   

Cathy : What do you think about the safety of using acaricide in preventing or killing ticks and other insects. Will this hurt wildlife such as birds.

Jorge Arias : The Health Department recommends using permethrin as an acaricide for preventing and killing ticks.  While permethrin is safe for most wild life, cat-owners should avoid using permethrin on your clothes and in your yards, because cats, in particular, will have adverse reactions to permethrin.

Jorge Arias : On behalf of Dr. Troell and myself, thank you to everyone for sending in your questions.  We regret that we didnt' have more time to answer all of them.  However, you can learn more about how to Fight the Bite! on our website, www.fairfaxcounty.gov/FightTheBite.