Tick-borne Diseases

The following was adapted from the CDC's Tick Removal page (https://www.cdc.gov/ticks/removing_a_tick.html)

1. Use clean, fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible.
2. Pull upward with steady, even pressure. Don’t twist or jerk the tick; this can cause the mouth parts to break off and remain in the skin. If this happens, remove the mouth parts with tweezers. If you cannot remove the mouth easily with tweezers, leave it alone and let the skin heal.
3. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol or soap and water. If you are interested in Georgia's free tick identification, please submit a form through Georgia'sTick ID Program.
4. Never crush a tick with your fingers. Dispose of a live tick by:
   • Putting it in alcohol,
   • Placing it in a sealed bag/container,
   • Wrapping it tightly in tape, or
   • Flushing it down the toilet.
5. If you develop a rash or fever within several weeks of removing a tick, see your doctor:
   • Tell the doctor about your recent tick bite,
   • When the bite occurred, and
   • Where you most likely acquired the tick.

If you recently removed a tick from your body, getting it tested for diseases might be tempting. While this seems like an ideal solution, public health does not generally recommend testing ticks for pathogens for the following reasons:

• Laboratories that conduct tick testing are not required to have the high standards of quality control used by clinical diagnostic laboratories. Results of tick testing should not be used for treatment decisions.
• Positive results showing that the tick contains a disease-causing organism do not necessarily mean that you have been infected.
• Negative results can lead to false assurance. You may have been unknowingly bitten by a different tick that was infected.
• If you have been infected, you will probably develop symptoms before the tick test results are available. If you become ill, you should not wait for tick testing results before beginning appropriate treatment.

Public health does recommend tick ID and telling your provider the species of tick if you develop symptoms. If you would like to have a tick identified by one of our entomologists, please submit it to Georgia'sTick ID Program. 

What is Spotted Fever Rickettsiosis?
Spotted fever rickettsioses (SFR) are a group of diseases caused by closely related bacteria transmitted to humans by the bite of an infected tick. Rocky Mountain Spotted Fever is the most severe and most frequently reported Rickettsial illness in the United States and is the most commonly reported tickborne disease in Georgia.

Who gets SFR?
Infection with SFR is directly related to exposure to tick‐infested habitats. Although not all ticks carry SFR, anyone bitten by a tick (most commonly the brown dog tick) can get SFR.

How is SFR spread?
SFR is spread by the bite of an infected tick or by contamination of breaks in the skin or mucus membranes with crushed tissue or feces from ticks, which may occur when removing ticks from pets. Person‐to‐person spread of SFR does not happen.

What are the symptoms of SFR?
SFR is characterized by a sudden onset of moderate to high fever, severe headache, fatigue, deep muscle pain, chills, and rash. The rash begins on the legs or arms, may include the soles of the feet or palms of the hands, and may spread rapidly to the trunk or rest of the body.

How soon do symptoms appear?
Symptoms usually appear within two weeks (3-12 days) after the bite of an infected tick.

Does past infection with SFR make a person immune?
One attack probably provides permanent immunity.

What is the treatment for SFR?
Doxycycline is the treatment of chose for SFR and all other tickborne rickettsial diseases. Providers should not wait for confirmatory testing to treat if there is an index of suspicion for SFR.

What can be done to prevent the spread of SFR?
Limiting exposure to ticks is the best way to prevent tick‐borne disease. When spending time
outdoors in places where contact with ticks may occur, take the following precautions:

• Wear light‐colored clothing so that crawling ticks can be easily seen.
• Wear pants and long sleeves to reduce skin exposure to ticks.
• Tuck pants into socks and shirts into pants to prevent ticks from crawling up pants legs.
• Apply insect repellent containing DEET to exposed skin and permethrin to clothing.
• After spending time outdoors, thoroughly inspect your body for crawling or attached ticks. Pay particular attention to the head and scalp, as ticks may be hidden in the hair.
• Populations of American dog ticks may be effectively controlled with pesticides along trails and by keeping grass mowed.

How should a tick be removed?
To remove an attached tick, grasp with fine‐tipped tweezers as close to the skin surface as possible, and pull upward and out with firm, steady pressure. If tweezers are unavailable, use fingers shielded with tissue paper or rubber gloves. Do not handle the tick with bare hands. Do not use petroleum jelly, fire, or other home remedies; these methods may increase the risk of infection. Be careful not to squeeze, crush, or puncture the tick’s body, which may contain infectious fluids. After removing the tick, thoroughly disinfect the bite area and wash your hands. Consult with a physician if there is concern about incomplete tick removal.

Where can I get additional information about SFR?
If you believe you have SFR, please consult your physician to screen for risk factors and begin treatment, if appropriate. Additional information for healthcare providers can be found on the CDC’s Rocky Mountain Spotted Fever (RMSF) website (https://www.cdc.gov/rmsf/healthcare-providers/index.html).

What is Lyme disease?
Lyme disease is caused by a bacterial infection transmitted by the bite of a black-legged tick. Lyme disease may cause symptoms affecting the skin, nervous system, heart, and joints.

Who gets Lyme disease?
Infection with Lyme disease is directly related to exposure to tick‐infested habitats. Although not all ticks carry Lyme disease, anyone bitten by a tick (most commonly the black-legged tick) can get Lyme disease. Traveling to the Northeast, upper Midwest, and parts of California can increase the risk of exposure to black-legged ticks and Lyme disease.

How is Lyme disease spread?
The bacterium that causes Lyme disease is part of a natural cycle of the black-legged tick feeding on animals such as mice, opossums, dogs, and deer. If an infected tick feeds on humans, it can transmit the infection to them. Person‐to‐person spread of Lyme disease does not occur.

What are the symptoms of Lyme disease?
The illness usually occurs during the summer months. Generally, it starts as a large circular reddish rash, which expands around or near the tick bite site. Multiple rashes may occur. Other symptoms, such as fever, headache, fatigue, stiff neck, muscle pain, and joint pain, may last for several weeks. If untreated, complications such as meningitis, facial palsy, or heart abnormalities may occur within a few weeks. In addition, swelling and pain in the large joints may recur over many years.

How soon do symptoms occur?
Symptoms usually begin within a month (3-30 days) of exposure (tick bite). 

What is the treatment for Lyme disease?
Current therapy includes the use of antibiotics. 

What can be done to prevent the spread of Lyme disease?
Limiting exposure to ticks is the best way to prevent tick‐borne disease. When spending time outdoors in places where contact with ticks may occur, take the following precautions:

• Wear light‐colored clothing so that crawling ticks can be easily seen.
• Wear pants and long sleeves to reduce skin exposure to ticks.
• Tuck pants into socks and shirts into pants to prevent ticks from crawling up pants legs.
• Apply insect repellent containing DEET to exposed skin and permethrin to clothing.
• After spending time outdoors, thoroughly inspect your body for crawling or attached ticks. Pay particular attention to the head and scalp, as ticks may be hidden in the hair.
• Populations of ticks may be effectively controlled with pesticides along trails and by keeping grass mowed.

How should a tick be removed?
To remove an attached tick, grasp with fine‐tipped tweezers as close to the skin surface as possible, and pull upward and out with firm, steady pressure. If tweezers are unavailable, use fingers shielded with tissue paper or rubber gloves. Do not handle the tick with bare hands. Do not use petroleum jelly, fire, or other home remedies; these methods may increase the risk of infection. Be careful not to squeeze, crush, or puncture the tick’s body, which may contain infectious fluids. After removing the tick, thoroughly disinfect the bite area and wash your hands. Consult with a physician if there is concern about incomplete tick removal.

Where can I get additional information about Lyme disease?
If you believe you have Lyme disease, please consult your physician to screen for risk factors and begin treatment, if appropriate. Additional information for healthcare providers can be found on the CDC’s Lyme Disease website (https://www.cdc.gov/lyme/healthcare/index.html). 

What is Alpha-Gal Syndrome?

Alpha-gal syndrome (AGS) (also called alpha-gal allergy, red meat allergy, or tick bite meat allergy) is an allergic reaction to alpha-gal. Alpha-gal (galactose-α-1,3-galactose) is a sugar molecule found in meat and products made from mammals.

Who gets AGS?

Since AGS is spread through the bite of a (lone star) tick, anyone who has been bitten may be at risk for developing symptoms.

How is AGS spread?

More research is needed to understand which ticks can spread AGS, but evidence suggests lone star ticks may be the culprit in the US.

What are the symptoms of AGS?

AGS reactions can be different from person to person. Persons suffering from AGS may experience the following symptoms after eating meat or dairy products:

• Hives or itchy rash
• Nausea or vomiting
• Heartburn or indigestion
• Diarrhea
• Cough, shortness of breath, or difficulty breathing
• Drop in blood pressure
• Swelling of the lips, throat, tongue, or eyelids
• Dizziness or faintness
• Severe stomach pain

AGS can be severe and even life-threatening. Seek immediate emergency care if you are having a severe allergic reaction.

How soon do symptoms occur?

Symptoms commonly appear 2-6 hours after exposure.

What is the treatment for AGS?

There is no medical treatment for Alpha-Gal except supportive care. Like any allergy, avoiding the triggering food is the best way to prevent symptoms.

What can be done to prevent the spread of AGS?

Limiting exposure to ticks is the best way to prevent tick‐borne disease. When spending time outdoors in places where contact with ticks may occur, take the following precautions:

• Wear light‐colored clothing so that crawling ticks can be easily seen.
• Wear pants and long sleeves to reduce skin exposure to ticks.
• Tuck pants into socks and shirts into pants to prevent ticks from crawling up pants legs.
• Apply insect repellent containing DEET to exposed skin and permethrin to clothing.
• After spending time outdoors, thoroughly inspect your body for crawling or attached ticks. Pay particular attention to the head and scalp, as ticks may be hidden in the hair.
• Populations of ticks may be effectively controlled with pesticides along trails and by keeping grass mowed.

How should a tick be removed?

To remove an attached tick, grasp with fine‐tipped tweezers as close to the skin surface as possible, and pull upward and out with firm, steady pressure. If tweezers are unavailable, use fingers shielded with tissue paper or rubber gloves. Do not handle the tick with bare hands. Do not use petroleum jelly, fire, or other home remedies; these methods may increase the risk of infection. Be careful not to squeeze, crush, or puncture the tick’s body, which may contain infectious fluids. After removing the tick, thoroughly disinfect the bite area and wash your hands. Consult with a physician if there is concern about incomplete tick removal.

Where can I get additional information about AGS?

If you believe you have Alpha Gal Syndrome, please consult your allergist or primary physician. Additional information can be found on the CDC’s AGS website (https://www.cdc.gov/ticks/alpha-gal/index.html). 

Local (Georgia) Data

National Data

Rocky Mountain Spotted Fever - National Epidemiology and Statistics (CDC)  [external link]
National Lyme Disease Surveillance Data (CDC) [external link]

Case Surveillance

What is Case Surveillance? (CSTE) [external link]