WSJ Article > TICKing Time Bomb

They can wait for months, clinging to the edge of a blade of grass or a bush, for the whiff of an animal's breath or vibration telling them a host approaches.

Around the country, state and federal health officials are battling a continued rise in tick-borne diseases including Lyme, babeosis, and Rocky Mountain spotted fever. Laura Landro has details on Lunch Break.

They are ticks—and when they attach to your skin and feed on your blood over many days, they can transmit diseases. Often hard to diagnose and tricky to treat, tick-borne illnesses—led by Lyme disease—can cause symptoms ranging from headache and muscle aches, to serious and long-term complications that affect the brain, joints, heart, nerves and muscles. Preventing bites to head off illness is particularly important, experts say, because the complex interaction between ticks, their hosts, bacteria and habitats isn't completely understood.

Warmer temperatures are leading some experts to warn that tick activity is starting earlier than usual this year, putting more people at risk.

"This is going to be a horrific season, especially for Lyme," says Leo J. Shea III, a clinical assistant professor at the Rusk Institute of Rehabilitation Medicine, part of New York University Langone Medical Center. He is also president of the International Lyme and Associated Diseases Society.

Lyme may be identified after a tick bite, for example, by an expanding rash that looks like a bull's-eye. But that doesn't always happen, and even after a tick bite, antibodies against Lyme may not show up for weeks, so early blood tests can turn up false negatives. Symptoms such as fatigue, chills, fever, headache and swollen lymph nodes may be misdiagnosed. Some infections can go undetected for months or even years. When caught early, tick-borne diseases can be treated successfully with two weeks of antibiotics, but doctors and researchers still argue about whether a chronic form of Lyme exists, and whether it should be treated with longer courses of the drugs.

To Fight Ticks

Several steps to reduce the chance of picking up disease bearing ticks.

Between 1992 and 2010, reported cases of Lyme doubled, to nearly 23,000, and there were another 7,600 probable cases in 2010, according to the Centers for Disease Control and Prevention. But CDC officials say the true incidence of Lyme may be three times higher. Other infections, including babesiosis, Rocky Mountain spotted fever, and anaplasmosis are steadily increasing, too. While not all ticks carry disease, some may spread two or three types of infections in a single bite.

Researchers say the primary reasons for the global rise of tick-borne illness include the movement of people into areas where animal hosts and tick populations are abundant, and growth in the population of animals that carry ticks, including deer, squirrels and mice.

"We haven't even begun to scratch the surface of the type of pathogens ticks can be harboring and transmitting," says Kristy K. Bradley, state epidemiologist and public health veterinarian for the Oklahoma State Department of Health.

Animals "are a traveling tick parade," Dr. Bradley adds, with pet dogs "bringing them into the home and onto furniture and carpets."

Photo Researchers, Inc.

The brown dog tick, pictured, can transmit Rocky Mountain spotted fever.

Regularly checking the body for ticks can reduce exposure, because removing them quickly can prevent transmission of disease, says Kirby C. Stafford III, chief entomologist at the Connecticut Agricultural Experiment Station, or CAES, in New Haven.

Showering or bathing quickly after being outdoors can also help wash off crawling ticks or make it easier to find them. What won't work: simply jumping in the pool or lake, because ticks can hide in bathing suits and don't quickly drown in water. There are tick-repellent sprays for clothes, but it is wise to immediately launder and dry garments at high temperatures after hiking or golfing in areas where ticks are present.

The CDC is conducting the first study of its kind to determine whether spraying the yard for ticks can not only kill pests, but also reduce human disease. Participating households agreed to be randomly assigned a single spray with a common pesticide, bifenthrin, or one that contained water, without knowing which they would receive.

Paul Mead, chief of epidemiology and surveillance activity at CDC's bacterial-illness branch, says preliminary results from about 1,500 households indicate that a spray reduced the tick population by 60%.

"But there was far less of a reduction in tick encounters and illness," indicating that even a sharp drop in tick populations leaves infected ones behind. "We may have to completely wipe out ticks to get an effect on human illness," he says. The CDC is enrolling households for a second arm of the study and expects final results late in the fall. Organic repellents such as Alaska cedar are also being tested in other studies.

Sometimes fire is the only solution: Wildlife biologist Scott C. Williams roams Connecticut's woods armed with a propane torch to incinerate clumps of Japanese barberry, an invasive plant species that chokes off native vegetation and provides a favorite habitat for ticks.

The CAES program to control the red-berried shrub—once cultivated as decorative—is part of the growing, multifaceted effort around the country to prevent the spread of infections like Lyme, which Dr. Williams has been treated for twice since beginning the project in 2007.

Dr. Bradley's home state of Oklahoma is one of several working with the One Health Initiative, a global program to improve communication between physicians and veterinarians to prevent the spread of infectious disease from animals to people, such as recommending tick collars, sprays or topical treatments with pesticides for dogs.

One problem, says Laura Kahn, a founder of One Health, is that "vets don't like to advise people on human health and physicians don't typically think about these things, so it falls through the cracks." About 75% of new diseases that have emerged globally in the last 30 years are spread from animals to people, many of them through ticks, says Dr. Kahn, who is also a science-and-global-security researcher at Princeton University.

Jason Lipsett, 21 years old, was diagnosed with Lyme in November, after suffering for three years with symptoms including problems with his jaw, recurring sinus infections, migraines and trouble sleeping. He had to give up playing tennis and take a medical leave from Bentley University in Waltham Mass., where he was a senior. He doesn't remember being bitten by a tick but had been camping in the woods in New Hampshire and often spent time outdoors during the summers at a family home in Cape Cod.

Doctors told him he might have chronic fatigue syndrome or fibromyalgia. Depressed about his health, he began seeing a therapist who knew about the symptoms of Lyme and referred him to another physician. That doctor determined he had Lyme—and babesiosis, caused by a parasite that destroys red blood cells.

Mr. Lipsett has been on an antibiotic regimen for four months. He says he has felt better each month and that he is prepared to stay on the drugs until he and his doctor are confident the disease is under control. He is making up courses and hopes to graduate next year. He plans to participate in a 5K run on April 29 to raise money for Time for Lyme, a Stamford, Conn. nonprofit that supports research into Lyme and other tick-borne illnesses.

"I may not be able to run, but I'm going to try to walk it," he says.

Write to Laura Landro at laura.landro@wsj.com

A version of this article appeared Mar. 27, 2012, on page D1 in some U.S. editions of The Wall Street Journal, with the headline: This Season's Ticking Bomb.

That dreaded Lyme disease & those damned ticks

From The Wall Street Journal. Written by Laura Landro.

While most people worry about tick bites after outdoor activities like camping, hiking and golf, the majority of bites happen close to home.

The federal Centers for Disease Control and Prevention and the National Institute of Allergy and Infectious Diseases are investigating an alarming rise in several different types of tick-borne infections including Lyme disease, Rocky Mountain spotted fever and ehrlichiosis. Not only are more diseases being spread by ticks, but more species of ticks are transmitting disease, including some, like brown dog ticks, not previously considered a danger to humans. The blood-sucking parasites are the leading carriers of disease in the U.S. and second only to mosquitoes worldwide.

The CDC is promoting "integrated tick management," which includes the use of landscaping to discourage ticks and recommending people treat yards in affected areas with pesticides. Studies by Kirby Stafford, chief entomologist at the Connecticut Agricultural Experiment Station, show that 82% of ticks on a property are within three yards of the lawn perimeter, particularly along woodlands, stone walls, and ornamental plantings.

Dr. Stafford's recommendations include making a barrier of wood chips made of cedar—a natural tick repellent—between wooded areas or stone walls and lawns heavily used by the family, keeping pets out of woods, and avoiding vegetation that attracts deer. As an alternative to chemical pesticides, Dr. Stafford is also working with the CDC to field-test the effectiveness of new organic repellent products that use such substances as rosemary oil, Alaskan cedar and garlic. Some are already on the market.

Often victims aren't aware they've been bitten. Most ticks are hard-backed and can be the size of a pinhead. They may not be noticed until they have embedded themselves in the skin, growing larger as they gorge themselves on blood. Disease can often be avoided if ticks are removed within 24 hours.

To combat the spread of ticks on animals, the CDC and the U.S. Department of Agriculture have been working with state and local officials to study applying insecticides directly to animals in the wild. For deer ticks, which carry three types of disease including Lyme, studies show that feeding stations armed with pesticide can sharply reduce ticks on deer. When the deer eat corn in the feeders, four paint rollers filled with pesticide brush against their ears, neck, head and shoulders. Bait boxes that apply pesticides to mice have also worked. In Arizona, the CDC has been fighting an outbreak of Rocky Mountain spotted fever spread by brown dog ticks by going door-to-door to place tick collars on dogs.

Behind the rise in ticks and the diseases they carry: More homes are being built near wooded areas and on land once used for farming that has reverted to secondary forests. The deer population around the country has exploded. Infectious disease experts also cite warming temperatures and increasing humidity.

"The more people study ticks, the more new pathogens are discovered," says Joseph Piesman, who oversees tick-borne diseases at the CDC.

While some tick-borne infections cause only mild illness that can be treated with antibiotics, others can require hospitalization and cause serious long-term health issues. There are few vaccines for tick-borne diseases.

Reported cases of Lyme, the most prevalent of tick-borne diseases, have risen sharply over the last decade, with 35,198 cases in 2008 compared with 13,000 cases in 2000. The CDC says because of under-reporting, the actual number of cases may be three times as high. Though still largely a problem in the Northeast and upper Midwest, Lyme is turning up all over the U.S. If not correctly diagnosed and treated, Lyme can cause chronic joint inflammation, neurological symptoms such as facial palsy, impaired memory and heart-rhythm irregularities.

Other tick-borne illnesses, though less widespread, are also on the rise. In 2008, there were 2,563 reported cases of Rocky Mountain spotted fever , compared with 579 in 1999. The fever can be quickly fatal unless treated with a powerful antibiotic. Last May, Wisconsin and Minnesota warned about a new species of the tick-borne bacteria ehrlichia, not previously found in North America, which can cause flu-like illness. The disease is transmitted by lone star ticks, which have spread to more states in recent years and are also linked to a new illness, called STARI, for southern tick-associated rash illness.

Tick-borne diseases often exhibit symptoms that look like something else. Without rapid or reliable tests for some diseases, it can be hard for doctors to suspect and diagnose, says David Davenport, an infectious disease specialist at the Michigan State University Center for Medical Studies. "These are rare diseases most physicians don't know much about, or they learned in medical school that the diseases only occur in certain areas," says Dr. Davenport. "But these patterns are rapidly changing and a whole lot of what we are trying to control is a moving target."

Connie Sargent, a nurse at Bronson Methodist Hospital in Kalamazoo, Mich., was admitted to the hospital as a patient last summer after she spiked a fever of 104, became sick to her stomach, and a red rash spread all over her body. Dr. Davenport diagnosed Rocky Mountain spotted fever.

Ms. Sargent did notice some bites, but wasn't sure if she got them gardening in her yard or while at her lake cottage in Traverse City. She was successfully treated with the antibiotic Doxycycline. It took her several weeks to recover. Now, she uses tick repellent when gardening, dons long sleeves and examines herself when she comes inside.

On Wild Horse Island in Montana's Flathead Lake, soft-backed ticks bite quietly in the night, typically inside cabins in wooded areas, leaving people infected with relapsing fever that can cause repeated illness over years. Scott MacDonald, whose family developed the island and sold part of it to the state as a park, was infected with relapsing fever along with several relativesin a 2002 outbreak. Everyone recovered after treatment, he says.

Tom Schwan, an expert in tick-borne diseases at the National Institute of Allergy and Infectious Diseases' Rocky Mountain Laboratories, who first identified the outbreak on the island, has helped property owners rid cabins of ticks with pesticides and remove rodents' nests that harbor ticks. He is now studying how animals and birds may be spreading the disease in Western states.