Mosquitoes and ticks

Mosquitoes and ticks cause disease by transmitting parasites, bacteria, and viruses.

Malaria is a caused by a parasite transmitted by mosquitoes.  Mosquitoes also carry the West Nile virus, Zika virus*, and Yellow Fever virus.

Ticks transmit the bacteria that causes Lyme Disease, but Lyme Diseases is not the only disease that one needs to be concerned including infections from numerous pathogenic bacteria, viruses, and at least one parasite.

Please see webpage on Ticks & Parasites. 
 
Some of the most common tick-borne diseases in the United States include:
Bacterial

• Lyme disease AKA borreliosis (Borrelia burgdorferi) – from deer ticks a.k.a black-legged ticks (Ixodes scapularis).
• Anaplasmosis (Anaplasma phagocytophilum) – from deer ticks a.k.a. black-legged tick (Ixodes scapularis) in the Eastern and Midwestern U.S. and from western black-legged ticks (Ixodes pacificus).
• Ehrlichiosis (Ehrlichia chaffeensis and Ehrlichia ewingii) – from lone star ticks (Amblyomma americanum).
• Rocky Mountain Spotted Fever (Rickettsia rickettsia) – caused by many species of ticks & is the most lethal and most frequently reported rickettsial illness in the United States.
• Southern Tick-Associated Rash Illness (STARI) or Masters' disease (Bacterial Cause unknown) ­­– from lone star tick (Amblyomma americanum).
• Tick-Borne Relapsing Fever (Borrelia bacteria) ­­– from soft ticks in the genus Ornithodoro and family Argasidae. 
• Tularemia (Francisella tularensis) – from tick and deer fly bites, as well as from contact with infected animals (e.g., rabbits, hares, rodents, etc.).

Viral

• Colorado Tick Fever (Coltivirus) – from Rocky Mountain wood ticks (Dermacentor andersoni).
• Heartland Virus – believed to be spread by ticks.  Symptoms include fever, headaches, fatigue (being tired), muscle aches, and diarrhea.

• Powassan encephalitis AKA Deer Tick Virus (Powassan virus [POWV]) – from deer ticks AKA black-legged ticks (Ixodes scapularis) & common co-infection with Lyme Disease.
• Q fever (Coxiella burnetii) – from ticks of the family Ixodidae AKA hard ticks or scale ticks.  There are more 700 species in this family. 

Parasitic

• Babesiosis – from microscopic parasites that infect red blood cells.

Unknown (and unproven)

• Alpha-gal allergy –  An allergy to red meat (e.g., beef, pork, lamb, etc.) and, in some cases, (mostly whole fat) dairy that is linked to a bite from a lone star tick (Amblyomma americanum).  Symptoms include hives, redness, itching, lightheaded, swelling and intense gastrointestinal distress within hours of eating red meat.  NOTE: With the introduction of chemicals used in the food industry, this link is correlational not causal, as there are too many confounding factors that have not been isolated.   Also the symptoms that people are experiencing are also the same as observed from a parasitic or bacterial infection – both of which are acquired from eating red meat.  From NPR's the salt WHAT'S ON YOUR PLATE  "Red Meat Allergies Caused By Tick Bites Are On The Rise": We thought it was a parasite," Commins explains. But then he and his colleagues realized that many of the patients were outdoorsy types who spent time hiking. And eventually they pieced together the tick bite connection."  This is not science, this is speculation.  Hypotheses need to be tested.  This has not been done.  Regardless, ticks are a very serious health threat.  The lone star ticks is also believed to be responsible for transmitting the Heartland virus.

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Seasons of Highest Risk of Being Bitten:

• Spring
• Summer
• Fall
• Winter when temperatures above freezing

Thus, be prepared year round.
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These are some common ticks where I live in the Eastern United States.  See CDC link below to learn more about ticks where you live or where you are traveling.

American dog tick (Dermacentor variabilis)
NOTES: Also called wood ticks.  Adult females most likely to bite humans.
 here: Widely distributed east of the Rocky Mountains and in limited areas on the Pacific Coast.
Transmits:

• Tularemia
• Rocky Mountain spotted fever

Blacklegged tick (Ixodes scapularis)
NOTES: Also called deer ticks.  Adult females and nymphs most likely to bite humans.
Where: Widely distributed in the northeastern and upper Midwestern United States.
Transmits: 

• Lyme disease
• Anaplasmosis
• Ehrlichia muris eauclairensis (cause human ehrlichiosis)
• babesiosis
• Borrelia miyamotoi
• Powassan disease

Lone star tick (Amblyomma americanum)
NOTES: This is a very aggressive tick.  The adult female white dot or “lone star” on her back.  Adult females and nymphs most likely to bite humans.
Where: Widely distributed in the southeastern and eastern United States.
Transmits: 

• Ehrlichia chaffeensis (cause human ehrlichiosis)
• Ehrlichia ewingii (causes human ehrlichiosis)
• Heartland virus
• tularemia
• STARI

Reference:
Adapted from CDC - Geographic distribution of ticks that bite humans athttps://www.cdc.gov/ticks/geographic_distribution.html ∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞∞
My Tick Encounter:
Last year [2017], I was infected with anaplasmosis that is caused by deer ticks AKA black-legged ticks (Ixodes scapularis).  Deer ticks are very common in the northeast and upper mid-western United States.  Anaplasmosis can be a serious illness that can be fatal if not treated appropriately, even in previously healthy people. 

The tick was not attached and it would have been very easy for me to never have known that I was bitten.  When I saw the tick that morning, I easily knocked it off (never did find it again).  I had three bite marks that looked like small bruises and this was after the tick was on me for less than 8 hours.  

The mistakes that I made were numerous:
1. I wore no bug repellent.
2. I wore my clothes into the house, after being out in brushy areas taking pictures that evening. 
3. Not only did I bring my clothes into the house, but after showering, I put the same black (of course) hoodie on that I was wearing when out in the thickets taking wild plant photos.  The tick had hitched a ride home on my hoodie and I took this creature to bed with me, as I slept with the hoodie on. 

It does not take 24 hours to transmit bacteria that causes anaplasmosis from a tick bite. 

About 8 days later, I developed symptoms that included swollen lymph glands, flu-like symptoms, and the worst headache of my life.  I was treated with a 28-day course of doxycycline.  This infection – anaplasmosis – can resemble other tick-borne diseases, such as Rocky Mountain Spotted Fever and ehrlichiosis, as all are transmitted by rickettsia group bacteria.  The main difference between symptoms of Rocky Mountain Spotted Fever and both ehrlichiosis and anaplasmosis is that a rash is common for those infected with Rocky Mountain Spotted Fever, but not the other two infections.
Similar to anaplasmosis, these infections respond well to treatment with doxycycline.   Ehrlichiosis is more common in the southern United Stars and anaplasmosis is more common in the Northeastern U.S. and Mid-Atlantic states.  The deer tick that causes anaplasmosis also transmits Lyme Disease and babesiosis with co-infections being very likely. 

The Mayo Clinic states pertaining to ehrlichiosis that “[b]efore bacteria can be transmitted, a tick must be attached and feeding for at least 24 hours” and “[a]n attached tick with a swollen appearance may have been feeding long enough to have transmitted bacteria.”  I saw the tick and it was a deer tick not a lone star tick, but most people don’t ever see the tick.  Just keep in mind, it does not have to be embedded or attached to transmit bacteria that can cause very serious – even deadly – infections. Like ehrlichiosis, the first symptoms – typically are flu-like symptoms like mild body aches, fever, malaise, etc. – of anaplasmosis typically begin within 1-2 weeks after the bite of an infected tick.
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How to Avoid Ticks & Mosquitoes

• Apply insect repellents to skin surfaces and clothes EVERY TIME you are going outside.  Insect repellents come in lotions, liquids, gels, sprays, etc.
• Wear light colored clothes.  Dark colors attract mosquitoes and dark colors make it hard to spot a tick that has hitched a ride. 
• Wear closed shoes and socks.  Do not wear sandals or flip-flops. 
• If biting insects are around, cover a child’s crib, playpen, and stroller with a fine mesh netting.
• Use screens on windows and doors in your home and while camping.  Repair holes in screens to keep mosquitoes and other critters outside.
• Mosquitoes and ticks do not like cold environment, hence, sleeping in an air conditioned areas when possible, if the windows do not have screens.  
• Sleep under a bed net if air conditioned or screened rooms are not available or if sleeping outdoors.

How to Avoid Mosquitoes

• Avoid times outside when mosquitoes are most active.  According to the CDC, this varies by species with mosquitoes that transmit dengue, yellow fever, Zika, and chikungunya bite mainly from dawn to dusk, while mosquitoes that transmit malaria, West Nile, and Japanese encephalitis bite mainly from dusk to dawn.
• Mosquitoes breed – that is, lay eggs – in standing water, so try to avoid these places and do not allow water to accumulate in tires, planters, buckets, birdbaths, flowerpots, trash cans, pools, and barrels near where you live.  Once a week, empty and scrub these items that hold water that you cannot keep covered or turned over.   

How to Avoid Ticks

• Try to staying on paths and trails, which is not always practical.  Ticks live in grassy, brushy, and/or wooded areas, and are commonly found on animals.
• Also ticks bite more during the spring and fall, so be especially careful during these seasons. 
• It is recommend that one tucks their pants into boots or socks and that one wears long-sleeved shirts.  While this is not practical in hot weather, it is helpful in cooler months.  Ticks are especially problematic in the spring, because the young nymphs are too small to be easily seen and can go unnoticed. 
• Do not bring your clothes and shoes into the home after returning from being out in nature. 
• Place clothes in the clothes dryer on high for 10-15 minutes to kill any ticks that may have hitched a ride and then wash your clothes. 
• If you live in or visit an area where ticks are common, inspect yourself and your children thoroughly at least daily.  This includes the head, neck, behind the ears, belly button, and groin area.  Ticks like soft tissue, as it is easier to bite. 
• If a tick is found, remove it as soon as possible.  Save the tick in a sealed jar or sealed plastic bag, in case an infection develops. 

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Please refer to the EPA website for safety and use information, as well as information on use by pregnant and breastfeeding women, infants, and children at https://www.cdc.gov/zika/prevention/prevent-mosquito-bites.html

Basic Guidelines

• Do not put on hands (especially children), because you do not want to eat food with your hands or put hands in the mouth and consume any of these insect repellents.

• Do not get insect repellent in your eyes.    
• Do not put insect repellent on your face.  If you sweat or get wet, it may get in your eyes and/or mouth.    
• Do not apply insect repellent on cut, broken wounded, irritated, or sunburned skin.
• Apply sparingly – just enough insect repellent to cover clothing and exposed skin.
• Avoid insect repellent products combined with sunscreen. Sunscreen typically needs to be reapplied more often than insect repellent. If insect repellent and sunscreen are both required, apply the sunscreen first, allow to dry for 20 minutes, then apply insect repellent.
• Spray insect repellents in open, well-ventilated areas (not in a tent) and never near food or beverages. 
• Be mindful of those around you before spraying insect repellents on you or your gear.
• Do not inhale or breathe in.  Watch the wind.
• Do not apply insect repellent under clothing.
• Do not apply insect repellent to clothing, mosquito netting, bed nets, gear, etc. that a child or animal may suck or chew on.
• Reapply as needed, but not more than necessary.
• Once indoors for the day, wash the insect repellent off  with soap and water.
• Keep and store repellent safely out of the reach of children and animals. 

The synthetic compound DEET (N,N-diethyl-meta-toluamide) is the most effective and widely used insect repellent in the world.  The Mayo Clinic and CDC recommend using DEET containing products like Off!, Repel, and Cutter. DEET is a true repellent – that is, it does not kill insects, it just keeps them at bay.  Many scientists say it’s the gold standard for all repellents, but is it safe and how does it work?  DEET has been linked to neurological problems and does damage to plastic, from which a lot of camping and hiking gear is made.  Please click here to see the report by the EWG.  According to a 2014 report by the Canadian Paediatric Society, contact dermatitis and eye irritation are the most common side effects of DEET, but toxic encephalopathy - has been reported, usually with prolonged or excessive use, or accidental DEET ingestion.  Encephalopathy can present a very broad spectrum of symptoms that range from mild like some memory loss or subtle personality changes, to severe, including dementia, seizures, coma, or death.  {SIDEBAR: Hmm ... a lot of products that contain DEET are aerosol sprays.  It may be best to avoid products containing DEET or at least lotions or gels and not sprays, even non-aerosol.} NOTE: Effective for 4 to 10 hours.

According to the FDA, “DEET works by making it hard for these biting bugs to smell us” and “believe that the normal use of DEET does not present a health concern to the general population, including children.”  “Believe” is not the same as “know” – hence, I err on the side of caution and use tick and mosquito repellents made with essential oils that have been shown through both use and scientific research to be effective at repelling bugs.  I also would consider using one of the alternatives listed below that are effective as DEET without the issues associated with DEET, especially if I was traveling to an area that is known to be infested with mosquitoes and ticks.

Alternatives to DEET:

• Picaridin (hydroxy-ethyl isobutyl piperidine carboxylate) AKA Icaridin: synthetic compound introduced in the late 1990s in Europe and made available in the United States in 2005. It was created based on the natural compound piperine, which is a phytochemical found in black pepper. NOTE: Effective for 4 to 10 hours.
• Permethrin: Both an insecticide and a repellent.  Treating your clothes, footwear, and outdoor gear with products containing 0.5% permethrin that remains protective through several washings. Permethrin kill ticks that linger on treated fabric, and it deters mosquitoes from biting through clothing.                                                                                                                             Insect Shield® apparel: Clothing pre-treated with permethrin kills ticks that linger on treated fabric, and it deters mosquitoes from biting through clothing. NOTE: Effective up to 8 hours. WARNING: Permethrin cannot be used on skin.  Does it concern anyone that clothes comes pre-treeated with a chemical that is not safe for use on skin, but the clothes come into direct contact with your skin?  It does me. 
• IR3535:  A chemical (3-[N-Butyl-N-acetyl]-aminopropionic acid, ethyl ester) widely used in Europe for over 20 years and now in use in the United States.  IR3535 is known as can be very irritating to the eyes but poses few other safety risks.  It is solely a repellent has no killing action.  NOTE: Effective for 4 to 8 hours.
• Oil of lemon eucalyptus (OLE) or p-menthane 3,8-diol (PMD): Shown to be especially effective at concentrations of 30 percent PMD.  This is a synthesized plant oil.  "‘Oil of Lemon Eucalyptus" is not the same as "Lemon Eucalyptus Essential Oil."  OLE tree extract is refined to intensify the concentration of PMD and hence, OLE is high in PMD, but Lemon Eucalyptus essential oil is not.  PMD is the constituent that is effective at repelling insects.  NOTE: Effective up to 6 hours. 
• Blends of Essential Oils that include the following (not necessarily used all at once.  Find a blend that works for you).    Just because these are botanically based, there are risks involved.  Some people are allergic to ingredients in certain essential oils.  Some essential oils are not for direct application to the skin without dilution.  Also can be more effective with soybean oil or castor oil.  A 2% solution of soybean oil has been shown to be effective at repelling mosquitoes, but not necessarily ticks. This holds for citronella oil as well. {SIDEBAR: I wonder if the soybean oil is derived from GMO soy and if that would explain the effect.}  For use on skin, lawns, and gardens.  NOTE: Repellents using essential plant oils are likely only effective for only 30 minutes to about 2 hours.  In addition, most of these essential oils are highly volatile and need to be combined with a fixative like vanilla, atlas cedarwood, patchouli (serves a double function, as it is an effective insect repellent), and even butter can be used to slow down the rate of evaporation of the more volatile materials for longer lasting effects:

1. Common Juniper (Juniperus communis)
2. Rose Geranium AKA Sweet Scented Geranium (Pelargonium graveolens)
3. Lemon Eucalyptus (Corymbia citriodora)
4. Patchouli (Pogostemon cablin)
5. Citronella [Java Type] (Cymbopogon winterianus)
6. Lavender (Lavandula spp.)
7. Peppermint (Mentha × piperita)
8. Cedar (Cedrus spp.)
9. Lemongrass (Cymbopogon spp.)
10. Catnip (Nepeta cataria)
11. Palmarosa (Cymbopogon martinii)
12. Rosemary (Rosmarinus officinalis)
13. Thyme (Thymus vulgaris)
14. Lemon (Citrus limon)
15. Geranium (Pelargonium spp.)
16. Rose (Rosa spp.)

• Garlic Essential Oil: For use on lawns and gardens. 
• Wild tomato plant (Lycopersicon hirsutum): Essential oil from leaves and stems.  For use on skin, clothing, and gear.
• Insect repelling candles, mosquito coils, mosquito sticks, and diffusers:  Use around campsite, backyard patios, porches, etc. NOTE: These are most effective in windless conditions.
• Mosquito Netting and Bed Nets: Cover crib, stroller, and baby carrier, as well as use as a covering for tent and outside areas.  Use bed nets to cover beds. 
• The citrosa houseplant (Pelargonium citrosum) – a type of Geranium called the "mosquito plant – is claimed to deter mosquitoes, but has not been shown to be effective at deterring mosquitoes.  Other plants like Lemon Thyme (Thymus X citriodorus) and Lemon Balm (Melissa officinalis) have exponentially higher amounts of citronella, are easier to grow, and are less costly. 
• High doses of Vitamin B1 appears to produce a skin odor that female mosquitoes find offensive.

I use a homemade tick and bug repellent made with Rose Geranium and other essential oils.  Please click here for the recipe.  I have heard that regular Listerine is a cheap tick repellent in a pinch, but haven't tried it myself.
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*Thoughts on Zika Virus and Birth Defects like Microcephaly: 
Zika can be passed from a pregnant woman to her fetus. Infection during pregnancy can cause certain birth defects.  Microcephaly (my-kroh-SEF-uh-lee) is a rare neurological condition in which an infant's head is significantly smaller than expected.  Microcephaly is also caused by Toxoplasma gondii – a protozoan parasite transmitted by cats that is estimated by the World Health Organization [WHO] to infect over 50% of the world’s population.  The Mayo Clinic states that microcephaly may be caused by “infections passed to the fetus during pregnancy” that “include toxoplasmosis, cytomegalovirus, German measles (rubella), chickenpox (varicella) and Zika virus.”  During the Zika scare, the mainstream media failed to address the other causes of microcephaly and focused only on the Zika virus … more hype than substance, but that is the rule not the exception. 
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References:
Mayo Clinic – Patient Care & Health Information – Diseases & Conditions – Ehrlichiosis
https://www.mayoclinic.org/diseases-conditions/ehrlichiosis/symptoms-causes/syc-20372142

Merck Manual Online – Ehrlichiosis and Anaplasmosis
https://www.merckmanuals.com/professional/infectious-diseases/rickettsiae-and-related-organisms/ehrlichiosis-and-anaplasmosis

CDC [Centers for Disease Control and Prevention] – Ehrlichiosis
https://www.cdc.gov/ehrlichiosis/index.html

CDC [Centers for Disease Control and Prevention] – The National Institute for Occupational Safety and Health (NIOSH) – NIOSH Workplace Safety and Health Topics – TICK-BORNE DISEASES
https://www.cdc.gov/niosh/topics/tick-borne/default.html

CDC [Centers for Disease Control and Prevention] – West Nile Virus Home – Prevention
https://www.cdc.gov/westnile/prevention/index.html

CDC [Centers for Disease Control and Prevention] – Ticks Home – Avoiding ticks – Preventing tick bites
https://www.cdc.gov/ticks/avoid/on_people.html

CDC [Centers for Disease Control and Prevention] – Protection against Mosquitoes, Ticks, & Other Arthropods
https://wwwnc.cdc.gov/travel/yellowbook/2018/the-pre-travel-consultation/protection-against-mosquitoes-ticks-other-arthropods

EPA – United States Environmental Protection Agency – DEET
https://www.epa.gov/insect-repellents/deet

EPA – United States Environmental Protection Agency –Find the Repellent that is Right for You
https://www.epa.gov/insect-repellents/find-repellent-right-you

REI – Insect Repellents: How to Choose
https://www.rei.com/learn/expert-advice/insect-repellents.html

Onyett, H., & Canadian Paediatric Society, Infectious Diseases and Immunization Committee. (2014). Preventing mosquito and tick bites: A Canadian update. Paediatrics & Child Health, 19(6), 326–328.

EWG's Guide to Bug Repellents in the Age of Zika: Repellent Chemicals - April 1, 2016.  Accessed May 22, 2018.
https://www.ewg.org/research/ewgs-guide-bug-repellents/repellent chemicals#.WxUlaiAh3IU

CDC [Centers for Disease Control and Prevention] – Birth Defects – Facts about Microcephaly
https://www.cdc.gov/ncbddd/birthdefects/microcephaly.html

Nahmias AJ, Walls KW, Stewart JA et al (1971) The ToRCH complex-perinatal infections associated with toxoplasma and rubella, cytomegol- and herpes simplex viruses. Pediatr Res 5:405–406.  https://doi.org/10.1203/00006450-197108000-00144

Essential Oils:
Borg-Karlson, A.-K. (2017). Essential oils of aromatic Egyptian plants repel nymphs of the tick Ixodes ricinus (Acari: Ixodidae). Experimental & Applied Acarology, 73(1), 139–157. http://doi.org/10.1007/s10493-017-0165-3

Tabanca N, Wang M, Avonto C, Chittiboyina AG, Parcher JF, Carroll JF, Kramer M, Khan IA. Bioactivity-guided investigation of germanium essential oils as natural tick repellants. J Agric Food Chem. 2013;61:4101–4107. doi: 10.1021/jf400246a.

Jaenson TGT, Garboui S, Pålsson K. Repellency of oils of lemon eucalyptus, geranium, and lavender and the mosquito repellent MyggA natural to Ixodes ricinus (Acari: Ixodidae) in the laboratory and field. J Med Entomol. 2006;43:731–736. doi: 10.1093/jmedent/43.4.731.

CDC [Centers for Disease Control and Prevention] – Lyme Disease Home – Preventing tick bites – Natural Tick Repellents and Pesticides
https://www.cdc.gov/lyme/prev/natural-repellents.html

Hebe Botanicals –Mosquito repellents: ‘Lemon Eucalyptus Oil’ is not ‘Oil of Lemon Eucalyptus’!
http://www.hebebotanicals.co.nz/mosquito-repellents/

Eden Botanicals – Natural Perfumery Basics
https://www.edenbotanicals.com/natural-perfumery-basics.html

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