With Lyme disease running nearly four times the statewide average in Bennington County, health officials are advising residents to be aware and take precautions.
Vermont had the highest rate of Lyme disease per capita in the nation in 2017, with 103.6 per 100,000, according to the Vermont Department of Health. This includes confirmed and probable cases. Bennington County's rate was 396.1 per 100,000, the highest in Vermont.
"Tickborne illness is highly prevalent, and that includes both Lyme, anaplasmosis and others," said Dr. Trey Dobson, chief medical officer at Southwestern Vermont Medical Center.
"Our region is a hot spot, but the prevalence over time is heading north," Dobson said. "We know that it's very important for the life cycle of the tick to have both the whitefoot mouse and deer as a part of their life cycle."
Deer, humans and mice are now living in closer proximity, he said, leading to increased prevalence of tickborne diseases.
Lyme disease is caused by an infection with a bacterium called Borrelia burgdorferi. In the eastern United States, Borrelia burgdorferi is transmitted to humans by the bite of a black-legged tick, Ixodes scapularis. Since 2015, Vermont has also had the highest annual incidence of anaplasmosis in the U.S, according to the Vermont Department of Health. Anaplasmosis is a curable disease caused by bacteria, but it can be serious and sometimes fatal. It is spread by the same type of tick that transmits Lyme disease.
Lyme disease and anaplasmosis are both treated with antibiotics.
"We really are talking about prevention," said Dobson. "Signs are very similar among all the illnesses. What we're really focused on is how to prevent. As with most diseases, earlier treatment leads to higher rates of full resolution of the disease."
Kathleen O'Reilly, a public health nurse with the Office of Local Health for Bennington County, identified three common tickborne illnesses in the area: Lyme disease, anaplasmosis and babesiosis, which is caused by "a tiny little micro-parasite," she said.
"We're seeing more and more babesiosis," she said. "I think the message that people need to get is: it's really important to protect yourself against tickborne illness, against being bitten."
A lot of people, she said, will say they don't even remember being bitten by a tick.
When ticks first come out in late April and early May, they're quite small, she said.
"They're nymphs," she said. "They're tiny. They're the size of a freckle, or a poppyseed. They're not easy to see sometimes."
It's important to wear protective clothing and check yourself thoroughly after being in areas with ticks, she said. It's also important to wear light-colored clothing in areas with ticks, as dark-legged ticks aren't as visible on darker clothing, she said.
"Nothing is 100 percent effective," she said. "The odds with this many ticks are pretty good that you could get bitten by a tick."
But it's important to also realize that not every tick is necessarily carrying a disease, she said.
"When you find a tick on yourself, or you pull a tick off yourself, you watch yourself," she said. And if you start feeling sick, see a doctor.
Doctors in the area tend to be "generally very good" at recognizing tickborne illnesses, she said.
O'Reilly said her office has a short booklet for the public, available at the office, about tickborne illnesses and how to prevent them.
"These are not complicated things," she said of prevention steps. "They're actually pretty doable."
Early symptoms of Lyme disease typically begin three to 30 days after a tick bite, and can include headache, fever, chills, muscle pain, joint pain and fatigue.
A characteristic symptom is a bulls-eye rash that often — but not always — begins at the site of the tick bite and gradually expands. The center of the rash may clear as it enlarges, giving the appearance of a bull's eye, or a target.
The rash usually appears within seven to 14 days after the tick bite. The rash may be warm, but it is usually not painful or itchy, according to the Department of Health.
While the rash is commonly associated with Lyme disease, not everyone with the disease will develop a rash.
Awareness has increased among physicians to look for symptoms of Lyme disease that are "not classic," like nausea and vomiting Dobson said.
A small percentage of people that contract tickborne illnesses will suffer long-term effects, like chronic joint pain or neurologic symptoms, he said.
"We know that people that get treatment early have a much less likely chance of having long-term effects," he said.
A common misconception, Dobson said, is that a person will definitely have long-term problems if they contract Lyme disease.
"And that's just simply not true," he said. "The vast majority of people do not have long-term problems."
Controversy also surrounds Lyme disease and other tickborne illnesses, he said.
"There's a huge section of people who believe that the testing is not sufficient, that there's things being held back from the public, which is not true, that doctors don't want to treat it, which is not true," he said. "We're becoming more and more aware of it, and diagnosing it at a more frequent level. And it's also increasing in prevalence."
The severity of Lyme disease symptoms can also vary widely, he said. Some people are somewhat symptomatic, but their body fights off the illness.
"The other extreme is that people can be very sick, and need to be hospitalized, with high fevers, neurologic symptoms and bad pain," he said. "It really doesn't have too much of a [predilection] for how it presents."
According to the federal Centers for Disease Control and Prevention, there were 42,743 reported cases of Lyme disease in the United States in 2017, over 17 percent more than in 2016. Vermont had 1,093 confirmed and probable cases in 2017, said Natalie Kwit, state public health veterinarian.
In 2017, state and local health departments also reported a record number of cases of tickborne diseases to the CDC, according to the center's website. The reported numbers of cases of Lyme disease, anaplasmosis/ehrlichiosis, spotted fever rickettsiosis (including Rocky Mountain spotted fever), babesiosis, tularemia, and Powassan virus disease all increased—from a total of 48,610 reported cases in 2016 to a total of 59,349 reported cases in 2017.
Reported cases capture only a fraction of the overall number of people with tickborne illnesses, according to the CDC. Even so, the number of reported cases of Lyme disease in the United States has tripled since the late 1990s.
This increase follows an accelerating trend of tickborne diseases reported in the United States. Between 2004 and 2016, the number of reported cases of tickborne disease doubled, and researchers discovered seven new tickborne pathogens that infect people, according to the CDC.
The reason for the increase is unclear, but various factors can affect tick numbers each year, including things like rainfall, humidity and populations of host organisms like mice and other animals. Tick densities in any year vary by region, state, and county, according to the CDC.
Anyone who spends time outdoors can be at risk for Lyme disease.
The tick that transmits Lyme disease in Vermont, the black-legged tick, can live in a variety of habitats such as wooded areas or fields with tall grass and brush. People who frequent these settings, like hikers, campers, hunters, farmers, gardeners and landscapers, may be at increased risk of contracting Lyme disease.
One of those people who spend a lot of time outside is Jared Newell, who sits on the board of directors for the Bennington Area Trail System (BATS).
In the past five years or so, a couple of BATS' members have contracted Lyme disease, he said. They were treated and recovered.
The potential for tickborne illness doesn't keep Newell off the trails.
"Take precautions," he said. "It's something that we all deal with here. It's a reality, and if you go in the woods, you're going to get ticks on you. You just need to take precautions."
Some people have misconceptions about how long a tick needs to be attached to a person's body to transmit a disease, said Kwit of the state Department of Health.
For instance, a tick must be attached for 48 hours to transmit Lyme disease, she said.
"If you remove ticks properly, they don't have a chance to transmit Lyme disease to you," she said. "I think sometimes people think it can be transmitted immediately."
Others also are so concerned, they feel like they can't go outside at all, she said.
"And we don't want anyone to feel that way," she said. "It is preventable."
Patricia LeBoeuf can be reached at email@example.com, at @BAN_pleboeuf on Twitter and 802-447-7567, ext. 118.
Lyme disease prevention tips
- Examine clothing, gear, and pets before going indoors.
- Put your clothes in the dryer on high heat for 10 minutes.
- Check your body and your child's body after being outdoors. Use a mirror to look at all parts of your body (under arms, behind ears, around waist, between legs, etc.) and remove any ticks you find.
- Shower soon after being outdoors to wash off unattached ticks and more easily check for ticks.
If you see a tick on your body:
- Remove the tick as soon as you can.
- Use fine-tipped tweezers, or one of the many available tick removal tools, and firmly grasp the tick as close to the skin as possible.
- With a steady motion, pull straight up until all parts of the tick are removed. Do not twist or jerk the tick. Do not be alarmed if the tick's mouthparts remain in the skin.
- Dispose of a live tick by putting it in alcohol, placing it in a sealed bag/container, flushing it down the toilet or wrapping it tightly in tape.
- Never crush a tick with your fingers.
- Clean your hands and the bite area with rubbing alcohol or soap and water.
- Watch for symptoms of tickborne illness for three days to 30 days after a tick bite.
- Symptoms may include fever/chills, rash, headache, joint pain, muscle aches or fatigue. Not all people with Lyme disease report a rash.
— Vermont Department of Health