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Travel Vaccines for Holiday

Tick Bites

Globally, ticks are second only to mosquitoes as carriers of human disease. Across Europe (including the UK), North & Central America, Australasia, parts of Asia (China, Korea and Japan) and sub-Saharan Africa, ticks may be common in wooded or heathland areas especially in Spring and Summer. 

Even city parks and gardens may contain ticks. Infections which can be transmitted via tick bites include Lyme Disease, tick typhus, tick borne encephalitis, Crimean–Congo haemorrhagic fever. Some tick species (in the USA and Australia mainly) secrete toxins causing tick paralysis. The main tick borne disease risk within the UK is Lyme Disease. Known Lyme disease areas in the UK are shown in blue on this map. The risk of infection can be reduced by avoiding tick bites and removing any ticks present are promptly.

Ticks are unable to fly or jump. They encounter hosts by climbing onto vegetation such as long grasses or small shrubs, and waiting for a potential host to brush past them. When the tick encounters clothing, fur or skin, it climbs onto the host and then crawls around in search of an appropriate location on which to attach and feed. The attachment bite is usually painless and goes unnoticed. The tick will stay firmly attached for many hours or days, then release and drop off. Over half of people with a tick borne illness do not recall having had a tick bite.

Ticks are usually found on the edge of wooded or shrubby areas and in clearings, long grass and hedgerows. Avoid these areas if possible, especially in late Spring and Summer, when ticks are most active. In regions where tick exposure is likely, people should wear long-sleeved shirts tucked into their trousers, long trousers tied at the ankle or tucked into boots or socks, and closed-toe shoes. Walking on cleared trails, away from vegetation, also decreases the opportunity for tick attachment. Walk in the centre of the trail to avoid contact with overgrown grass, shrubs, and leaf litter.

People who are in tick prone areas should check their clothing frequently for ticks, which can range in size from as small as a poppy seed to the size of a pea. (See photographs of ticks here). If multiple small ticks are seen on clothing, they are most easily removed by trapping them on a piece of sticky tape- avoid actually touching the tick. Spraying clothes with an insect repellent may provide an additional barrier of protection from ticks. Insect repellents containing diethyltoluamide (DEET) or lemon eucaltypus can be used on exposed skin areas, but only repel ticks without killing them. Permethrin is a long acting insecticide which kills ticks on contact. It can be used on clothes, but do not apply permethrin directly to the skin. When travelling in tick-infested areas, inspect all parts of the body closely at least twice daily, especially behind the knees, the armpits, scalp, and groin. Ticks can be very small so it is important to check thoroughly. Some ticks can be on the body for 1-2 hours before attaching so frequent checks will reduce the chance of an actual tick bite.

Even after a tick attaches, disease transmission may be prevented by prompt removal. Ticks should be removed as soon as they are seen. The best method is gentle steady traction using fine-tipped forceps or tweezers held flat to the skin surface as close as possible to the skin (technique here). Avoid squeezing or twisting the tick when removing it. If you don’t have tweezers, dental floss or a thick cotton thread can be used. Tie a single loop of thread around the tick’s mouthparts, as close to the skin as possible, then pull gently upwards and outwards, back over the body of the tick. Try to remove all of the tick if possible as the mouth parts can cause local infection if they are not fully removed. Methods like applying a hot match or smearing with petroleum jelly to make the tick let go are not recommended– they are not effective and can lead to the tick releasing more fluids into the bite area and increase the risk of illness.

Wash the bite site with soap and water, and apply antiseptic. If a tick has been touched with bare hands wash them thoroughly with soap and water.  Not all ticks carry disease, and not all bites will lead to infection, even from an infected tick, but anyone developing a rash spreading out from a tick bite, or flu like symptoms after a tick bite or being in a high risk area should consult their GP.

There is a vaccine available from specialist travel clinics for tick bite encephalitis (TBE). Long stay residents especially in rural areas, walkers, hikers and campers going to affected countries (see map) should consider having this immunisation, but tick avoidance is still necessary to avoid other tick borne illnesses. TBE can also be spread by drinking unpasteurised milk so travellers to these areas should avoid this.