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Ticks - advice on prevention, protection and removal

What are ticks?
Ticks are small, spider-like creatures that feed on the blood of mammals, including people.  There are about 20 species in the UK. The species of tick most frequently found on people are sheep or deer ticks.  Tick numbers, and hence the chance of being bitten by one, are on the increase across the globe. 

Where are they found?
Ticks are present worldwide. They can be found mainly in the countryside.  They prefer moist areas with dense vegetation or long grass. Their preferred habitat usually includes woodlands, grassland, moorland, heathland and some urban parks and gardens, including in inner cities – all areas where scouting activities occur.

How do they get on people?
Ticks don’t jump or fly. They wait until an animal or person brushes past the vegetation they are on and transfer by walking. Once on their subject they bite and bury their head in the host’s skin.

Is it obvious that you have been bitten?
No. They secrete a pain killing substance in their saliva which helps them go undetected. Some people are unaware that they have been bitten by a tick, but may exhibit local redness, itching or burning, before or after the tick drops off.

On what parts of the body can they be found?
Ticks prefer warm, moist places on your body, especially the groin area, waist, arm pits, behind the knee and along hair lines, but they can occur anywhere on the body

What time of year are they active?
They may be present throughout the year but, in the UK, are particularly active between May and October and especially at times of warm weather.

How to recognise them
The size of a tick varies, depending on the stage of its life cycle, gender, species and whether it has fed recently. Nymphs (young ticks) are about the size of a poppy seed, while adult ticks look more like tiny spiders. You are likely to only see a tick once it has bitten a host and buried its head so that only the abdomen is protruding.

Tick                                                                Tick attached to skin

Are they harmful?
Tick bites are usually harmless and may produce no symptoms, however, if left can cause Lyme disease. People can also be allergic to tick bites and may experience pain or swelling at the bite site, a rash, burning sensation, blisters, or even difficulty breathing.

Public Health England

Conditions, Signs and Symptoms caused by ticks

Lyme disease
This is probably the most commonly known disease to be passed on by ticks but not the only one.
NHS England

This NHS site states ”It's estimated there are 2,000 to 3,000 new cases of Lyme disease in England and Wales each year.  About 15% of cases occur while people are abroad.”

Signs and symptoms of Lyme disease

Rashes occurring within a few hours of a bite are not caused by Lyme disease and are likely to be simple allergic reactions or infections.

The most easily recognised symptom of Lyme disease is a bull’s eye / ‘Polo mint’ rash (as pictured).  It may be very faint or vivid in colour.  The colour can be shades of brown, red and pink.  The rash gradually spreads from the bite site.  It appears anything between a few days to several weeks after being bitten and is the only sure-fire symptom of Lyme disease.  It is present in most but not all cases.  It may disappear quickly so take a photograph so that the doctor has evidence of it and the site of the bite.

Other symptoms of Lyme disease can include:
•    flulike symptoms
•    fatigue
•    muscle and joint pain
•    partial paralysis of the face
•    tingling or loss of sensation in the limbs.

’Polo mint’ rash
If any of the above signs or symptoms appear, seek a doctor’s advice, immediately.

Lyme disease can be treated with a course of antibiotics.

Tick-borne encephalitis (TBE)
TBE is a viral infection that can be spread to humans by the bite of tick.  It is a rare infection that is only acquired abroad in some European and Asian countries.  Scouting activities planned for these areas should factor this into their training and in their risk assessments.  For NHS advice.

Initial symptoms of TBE are similar to flu and can include:
•    A high temperature (fever)
•    A headache
•    Tiredness
•    Muscle pain

These symptoms usually last for up to eight days, after which point most people make a full recovery. However, some people go on to develop more serious symptoms caused by the virus spreading to the protective layer of tissue that covers the brain and spinal cord (meningitis) or the brain itself (encephalitis).

These 'second-stage' symptoms can include:
•    Changes in mental state, such as confusion, drowsiness or disorientation
•    Seizures (fits)
•    Sensitivity to bright light (photophobia)
•    Being unable to speak
•    Paralysis (inability to move certain body parts)

These symptoms tend to get slowly better over a few weeks, but it may take several months or years to make a full recovery and there is a risk you could experience long-term complications.

If any of the above signs or symptoms appear, seek a doctor’s advice, immediately.

There are now confirmed cases of Britons who have suffered severe reactions as a result of suffering a tick bite and then later eating meat.

The allergy is caused when a tick bites deer, sheep, cattle, horses and pigs, and then bites a human.  A substance in the tick's saliva triggers our immune system to overreact to meat, which contains the same substance.

Reported symptoms include:
•    Itching
•    Swelling of the mouth
•    Wheezing

If any of the above signs or symptoms appear, seek a doctor’s advice, immediately.

How to avoid ticks
The most common advice is to:

•    Stay on paths
•    Stay out of deep vegetation
•    Light coloured clothing will make ticks more visible before they move onto the skin
•    Wear long sleeved garments and long trousers tucked into your socks.
•    Be aware of them and get everyone to inspect themselves after activities in the countryside.
•    Application of an insect repellent that is effective against ticks, before the activity, may help (always follow the manufacturers’ guidance when applying).

Please note:
•    DEET insect repellents are available in various forms and concentrations.  Users should check with their pharmacy for advice before use. Some people are allergic to DEET. 
•    When sunscreen and DEET are used together, DEET should be applied after the sunscreen. The effectiveness of repellent reduces more rapidly than sunscreen, therefore, repellent may have to be reapplied on top of sunscreen.  DEET also reduces the effectiveness of sun cream and so a higher sun protection factor (SPF) should be used.
•    DEET can damage plastics so take care near to spectacles and waterproof clothing.
•    Nb. There are insect repellents available that do not contain DEET.

Health Protection Scotland.

Some US websites suggest impregnating clothing with Permethrin, however in the UK, this is only used on prescription by a doctor

What to do if you find a tick on the skin
Do not panic. Ticks do not normally feed for about 12-24 hours after attaching themselves during which time infection risk is small.  Remove the tick as soon as possible.

How to remove Ticks
The safest way to remove a tick is to use one of the proprietary tools available, carefully following their guidance.  If you use tweezers use only a pair of fine-tipped tweezers (not flat ended ones).  Get the tool between the skin and the abdomen of the tick.  Pull upwards, slowly and consistently without squeezing the tick, until it lets go. 

A video, “Watch out ticks about”, which shows tick removal, is available from Public Health England.

Do not crush or squeeze the tick since this may leave mouth parts and debris remaining in the skin which could cause infection later. Take your time; there is no need to rush or panic.  Do not attempt to remove the ticks by burning (i.e. do not apply hot matches, cigarette ends, etc.) and do not use such chemicals as nail polish remover, alcohol or petroleum jelly, etc. 

Once the tick has been removed, dispose of it safely.  Do not squash them between your finger nails.  Avoid touching removed ticks.  Disinfect and clean the bite area with antiseptic and wash your hands as well as the tool used to extract the tick. So long as you remove and dispose of all ticks from both skin and clothing that should be the end of the problem.  Washing clothing at 30OC - 40OC does not kill ticks.  A temperature in excess of 54OC is required.

Is it necessary to go to a doctor?
Unless any unusual symptoms or any of the symptoms outlined occur there should be no need to visit the doctor.
However if in any doubt seek medical advice.

Further Advice to members venturing in to high risk areas:
•    Consider ticks in your risk assessment.
•    Make parents aware of the need to check their child for ticks on return from any activity in high risk areas.  Use this factsheet to help inform them.
•    Train leaders and young people in tick awareness and removal.  Adult members may need to check for, and remove, ticks from young people in their care. Safeguarding practices must be followed at all times.
•    Carry a tick extraction tool in your first aid kit and consider adding tick training to First Aid training.


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