Tick Check: A Guide for Running in Tick Country

Growing up, my dad wouldn’t let us bring our shoes inside during the spring and summer. It wasn’t because of how terrible they smelled, but rather because they had hitchhikers lurking! I grew up in Northern Wisconsin, as the daughter of two physicians, and in a hot bed for a variety of ticks. Along with shoes that never came in the house, “tick checks” were not just lyrics in a country song, they were a real thing.

For much of my life, ticks have been a problem in certain areas of North America, Europe, and Asia. Because of their regional geographic limitations, ticks were a vector for diseases that many did not have to worry about. However, as the climate warms, not only does tick population control in their traditional regions become increasingly difficult but they are also finding new habitats to thrive in.

What do we know about these creepy crawlies, what should we be on the lookout for, and what should you do for your own health and safety when running in tick country?

Tiny Vector, Big Problem

What’s a vector? A vector is an organism that can transmit a disease or parasite from one animal or plant to another. Along with ticks, other biting insects such as mosquitoes are excellent vectors. Not all ticks are actively carrying infectious pathogens that they can pass onto you, but when they are, they are capable of causing a wide range of viral and bacterial diseases.

Most ticks belong to one of two families, Ixodidae the hard ticks or Argasidae the soft ticks. Of the 950-plus species of ticks found throughout the world, only about 60 species are known to bite and transmit diseases to humans (1).

That brings up an interesting point. If only 60 species are disease-spreading vectors in humans, then what else do they do and are they good for something? They seem to have two important roles for the ecosystem more broadly. First, they are an important food source for reptiles, amphibians, and bird. And second, through being a disease vector in animals like deer, rabbits, and mice, they help control wildlife populations (9). Ticks can also be used as an ecosystem indicator, meaning that researchers monitor tick populations and their predators to get a sense of the general health and wellbeing of the ecosystem from a diversity perspective.

For the purpose of this article–and knowing that that this shouldn’t take more than one cup of coffee to read–let’s focus on the few most common types of ticks and the specific diseases they carry. In North American those are the blacklegged tick (also known as the deer tick), the lone star tick, and the American dog tick (also known as a wood tick) (3). Ticks are not a uniquely North American problem. The European relative to the blacklegged tick is the castor bean tick (sometimes called the sheep tick). Similar to the blacklegged tick, the castor bean tick is the leading cause of Lyme disease in Europe. In Asia, the longhorned tick is known to carry similar strains of bacteria found in blacklegged and lone star ticks (4). Ah, creepy crawlies!

Three common North American ticks at various life stages, including their actual size. Image: Sunycccthecrier.com/fall-2019/ticks-aka-minions-of-lucifer

Where Do These Critters Live?

I grew up in one of the hot beds for ticks in the Upper Midwest of the U.S., but over the past 30 years the real estate for ticks has grown exponentially. A warming climate has made winter survival and migratory animal hosts more plentiful, allowing ticks to travel into previously tick-void regions, and we as humans overlap more and more in the spaces (natural grass and woodlands) where those animals and their hitchhikers reside (5).

What that means is that tick populations are now fairly widespread, particularly over the U.S.’s Northeast, Midwest, South, and throughout the Rocky Mountains. There is a growing tick population (of western blacklegged ticks) in the Pacific Northwest. Curiously enough, one of their main and preferred hosts, is the western fence lizard which carries a specific protein in their blood that neutralizes the bacteria that is responsible for Lyme disease. Essentially, after feeding on this lizard, the tick becomes “cured” of its Lyme disease and so cannot spread it when it meets its next host. So cool!

In Europe, the castor bean tick is widespread and found in much of Western, Eastern, and Northern Europe. The taiga tick has a more limited-to-Northern-Europe range.

A look at where five different tick species make their homes in the U.S. Image: Cdc.gov/ticks/geographic_distribution.html

The range of the castor bean tick (top) and taiga tick (bottom) in Europe. Image: Ecdc.europa.eu/en/disease-vectors/surveillance-and-disease-data/tick-maps

How Do Ticks Spread Disease?  

Most species of ticks live on a two to three-year life cycle that passes through four distinct life stages: egg, larva, nymph–baby ticks, how cute!–and adult. Even at the larva stage, ticks must have a blood meal in order to survive. Although ticks cannot fly or jump, they can detect a potential host by smell, body heat, moisture, vibrations, and even shadows (3). Once on a host, ticks transmit pathogens–generally bacteria–through the process of feeding. Depending on the tick, feeding can last as little as 10 minutes and as much as two hours, after this blood meal–maybe the creepiest thing I have ever typed–the tick will drop off the host to prepare for its next life stage where it will then transmit any acquired disease to its new host. When a tick bites you, it may secrete saliva that has an anesthetic property, numbing you to its presence. Unfortunately that saliva may also contain any pathogen the tick is infected with that it then transmits to you.

Different species of ticks have different-length life cycles generally lasting two to three years. They go through four stages including egg, larva, nymph, and adult, and feed on mammals (like us), birds, reptiles, and even amphibians, using a different host in each of the four life stages. Image: Cdc.gov/ticks/life_cycle_and_hosts.html

The most common tick-borne diseases in the U.S. are Lyme disease, ehrilichiosis, Rocky Mountain spotted fever, tick-borne relapsing fever, and babesiosis. In Europe, the castor bean tick is responsible for two tick-borne diseases, Lyme disease and tick-borne encephalitis (TBE) (7). TBE is a viral infection that affects the central nervous system, encephalitis means inflammation of the brain, and can be fatal if left untreated. In Asia (and Russia), the taiga tick is known to be a vector for TBE. Finally, the most common tick-borne diseases in Asia (carried by the longhorned tick) include Lyme disease, TBE, Crimean-Congo hemorrhagic fever, and a disease known as severe fever with thrombocytopenia syndrome (8).

If left untreated, Lyme disease seems to include a long list of varying secondary symptoms and conditions such as cardiac problems (Lyme carditis), arthritis, severe joint swelling, and facial paralysis or weakness on one side of face. Interestingly, and not a common trait among tick bites, is that some people bitten by the lone star tick will develop an allergy to red meat called Alpha-gal syndrome (6). Most of these tick-borne diseases (aside from babesiosis which is a parasitic infection and requires treatment with antiparasitic drugs and TBE which is a viral infection and has no effective treatment but does have a vaccine in countries where it is endemic) can be treated with a course of antibiotics. Several different antibiotics are effective but deciding the right antibiotic for you (that takes into account your age, gender, other medical conditions, allergies, sun exposure, and more) is an important decision for your physician and care team.

A blacklegged tick and a human host followed by a common (seen in about 70% of patients) rash known as erythema migrans, often referred to as a bullseye rash. Image: Samhealth.org/about-samaritan/news-search/2018/06/04/lyme-disease-in-oregon

How to Protect Yourself From Hitchhiking Ticks

So, should you never leave your house again? That’s definitely not my suggestion, but there are some things you can do to limit your risk of being bitten by one of these little guys and what to do in case it does happen.

  • Know Before You Go. Find out what kind of ticks are prevalent in the area in which you will be running. Know that they love tall grass, bushes, and overhanging foliage as a way to meet their new host, so use care to avoid these areas when possible.
  • Cover Up. Although not always easy when running, consider clothing garments that make identifying ticks easier and that serve as a protective barrier from your skin. This includes tall socks, long sleeves, and light-colored gear.
  • Add Repellent. If you are running or racing in a high-tick environment, use a tick repellent on your skin and clothing (containing about 20% DEET). Consider pre-treating your clothes with the repellent permethrin for an extended backpacking or camping trip in tick country.
  • Do a Tick Check. Once inside after your run, examine your gear, pets (ticks love dogs!), and clothing for any hitchhikers. Leave your shoes outside and tumble dry your clothes in the dryer on high for 10 minutes to kill any ticks that have made the journey onto them. Shower as soon as you can to help remove unattached ticks. Finally, perform a standard tick check in high-risk areas such as under the arms, in and around the ears, on the backs of the knees, throughout your scalp and hairline, between your legs, and around your waist.
  • But What If It’s Attached? If you find a tick that has managed to burrow, you want to remove it, in its entirety, as soon as possible. Using fine-tipped tweezers, pinch the tick as closely to your skin as you can and pull upward with steady pressure. Next, clean the bite area with soap and water. Dispose of the tick by flushing it down the toilet, or you can put it in a jar of rubbing alcohol (my dad’s favorite method). Watch for symptoms of tick-borne disease for the next 30 days, and contact your primary-care provider if you experience a rash, fever, headache, muscle pain, fatigue, or joint pain and swelling.

The four steps to carefully removing an embedded tick. Image: Cdc.gov/ticks/pdfs/FS_TickBite-508.pdf

Call for Comments

  • Do you live in tick country? What tips can you share for safely preventing tick bites?
  • Have you been sick with a tick-borne disease? If so, feel free to share your story in the comments section.

References

  1. Types of Ticks. (n.d.). Retrieved July 12, 2020, from https://www.lymedisease.org/types-of-ticks/
  2. Smith, M. (2019, November 13). Ticks, aka Minions of Lucifer. Retrieved July 12, 2020, from https://www.sunycccthecrier.com/fall-2019/ticks-aka-minions-of-lucifer
  3. Tick ID. (2019, January 10). Retrieved July 12, 2020, from https://www.cdc.gov/ticks/tickbornediseases/tickID.html
  4. What you need to know about Asian longhorned ticks – A new tick in the United States. (2020, April 30). Retrieved July 17, 2020, from https://www.cdc.gov/ticks/longhorned-tick/index.html
  5. Madison-Antenucci S, Kramer LD, Gebhardt LL, Kauffman E. 2020. Emerging tick-borne diseases. Clinical Microbioly Reviews 33 :e00083-18. https://doi.org/10.1128/CMR.00083-18.
  6. Alpha-gal syndrome. (2020, June 30). Retrieved July 17, 2020, from https://www.mayoclinic.org/diseases-conditions/alpha-gal-syndrome/symptoms-causes/syc-20428608
  7. Key messages about tick-borne encephalitis and tick-borne diseases. (2017, June 18). Retrieved July 20, 2020, from https://www.ecdc.europa.eu/en/tick-borne-encephalitis/facts/key-messages
  8. Zhang, L., Fu, Y., Wang, H., Guan, Y., Zhu, W., Guo, M., . . . Wu, Z. (2019). Severe Fever With Thrombocytopenia Syndrome Virus-Induced Macrophage Differentiation Is Regulated by miR-146.Frontiers in Immunology, 10. doi:10.3389/fimmu.2019.01095
  9. Cairoli, S. (2019, November 18). What Purpose Do Ticks Serve in the Ecosystem? Retrieved July 20, 2020, from https://sciencing.com/what-purpose-do-ticks-serve-in-the-ecosystem-12192945.html

There are 14 comments

  1. Katherine

    I live in the Seattle area and while ticks are around, people getting bit aren’t super common and there’s no known Lyme disease. A few years back on a trip through California, three of the buggers got me on my leg. Never saw or felt them, but two days after we got home from a trip I developed the bullseye rashes. Thing was, we weren’t hiking or running or camping or even walking through the woods or grasslands. I got nailed probably while sitting on the porch of our b&b which was on the outskirts of Mt Shasta in Northern California. I knew about Lymes Disease so I headed to the clinic where I was fortunate enough to get a doctor who’d just arrived from Ohio. She knew what it was as soon as she saw the rashes. I got to show them to the other clinic staff, none of which had ever seen real life presentations before. Got put on the antibiotics regimen and so far it appears that I’ve not suffered any after affects. I called public health for the village of Mt Shasta, they apparently contacted the b&b to remind them to clean their deck chairs daily and to spray for ticks near the house…

    1. Corrine Malcolm

      Hi Katherine,
      Thank you so much for sharing your story! I’m so glad you got a doctor who was familiar with Lyme disease and tick borne illnesses, I’ve heard so many stories of it being missed in regions less familiar with the disease and vector. I distinctly remember being super worried “sitting on the lawn” when I moved from the midwest to the Adirondacks in college (ticks were not a huge problem there yet). Properties can be made less “tick friendly” by removing brush close to buildings, and some of our friends in the midwest even have a few Guineafowl to help naturally thin their tick population.

    1. Corrine Malcolm

      Hey Matt,
      Yes you’re totally right! Initially the article was skewed to the US tick population and I missed changing the treatment note. Similar to ticks causing babesiosis that require an antiparasitic drug (similar to Malaria treatment), ticks that cause TBE (virus) require an antiviral treatment (which basically don’t exist) so happy that there is a vaccine for it! Ticks in the US are not currently known to carry the specific virus that causes TBE, so as you suggested it might not be available in the US because we don’t readily have to treat it.

  2. Hangdog

    “Dispose of the tick by flushing it down the toilet, or you can put it in a jar of rubbing alcohol (my dad’s favorite method)”

    here’s another thought:
    Some county health departments /city/municipal public health labs will test tick bodies for Lyme disease presence. One methodology: Indirect Fluorescent Antibody (IFA). Some labs might even accept a tick that has been sent in by mail. The lab in my local area charges $35 per test; cheap peace of mind.

    Retain the tick carcass and wrap it in a moist paper towel or cotton ball. Then put the moist paper towel inside a ziplock sandwich bag and seal the ziplock. Presto. Your tick is ready for transport to testing.

    1. Corrine Malcolm

      Hi Hangdog,
      Great input! I do realize some city health/public health departments will do this, I also know that in many regions where the tick population is endemic that can be a really complicated task. The testing (like all testing I suppose) is not always reliable, a positive tick does not always transmit disease to you the host, a negative tick you found might be different than the tick that bit you (it’s possible to completely miss a tick bite). Growing up (n of 1 here) it was not uncommon to have multiple tick bites at the end of the day. So while yes for some this might be an option, it’s not for the majority, and I would still encourage people to monitor for symptoms (taking a picture of the tick to ID its species can be helpful) and talk with their primary care provider.

  3. Wade N

    I was bitten by a tick on a run in New Jersey (Highlands Trail!) and it hid behind my glasses next to my nose all the way home to Oregon. It was probably attached at least 24 to 48 hours. I finally saw it by luck and extracted it. The wound didn’t heal over weeks and slowly opened into a little crater threatening to take over my nose. When I finally went to a dermatologist, the festering crater was diagnosed as a basal cell carcinoma, a form of skin cancer. So if your bite wound doesn’t heal, get it checked out! And especially beware of NJ ticks….

    1. Corrine Malcolm

      Wade, that is terrifying! I hope you and your nose are both okay, I’m wondering if the tick helped (words I didn’t think I’d type) bring about the skin cancer diagnosis that you wouldn’t have otherwise known was there? So bizarre!

  4. Beth

    As a child growing up in the Carolinas, I was told not to tweezer ticks in case they were still feeding, in which case the head would stay attached and the body come off. The advice I was given was light a match or lighter near it so it would release and drop off of its own accord. I’ve no idea of the efficacy of this method though as I have been fortunate so far to be tick free.

    1. Corrine Malcolm

      Hi Beth,
      You are right, you do have to be very careful to try to remove the tick intact. We personally never used tweezers growing up and instead would use our fingers or a Q-tip to gently and slowly twist the tick (still important to do this as close to the skin as possible). Growing up we’d often find ticks had bitten in or near our hair lines so I fear a match or lighter would have caused some really bad haircuts growing up ;)

  5. Delia

    The idea of removing ticks with a match is pretty dangerous. Doing that will increase the likelihood of the tick regurgitating its stomach contents into the bite, potentially causing more problems. (to say nothing of accidental burns) Just use tweezers and remove it as carefully as you can, getting the tweezers as close to the skin as possible. Harder to do when it’s your dog squirming, but you do the best you can.

    Living in upstate NY, ticks are ever present. I’ve had great success using permethrin-treated clothing, though. I treat our running shoes, hiking boots, gaiters, and a couple pairs of socks (tall ones that I can tuck pant legs into) every spring. If I plan on bushwhacking, I’ll treat a pair of pants, too. That has been enough to obviate using DEET on my skin, at least for ticks (mosquitos are another matter). The greatest threat comes from ticks riding in on our dog. I feel like tick-checks are the most practical reason to teach a dog the trick “roll over” – then you can check their belly, armpits, etc.

    The nice thing (?) about ticks is that they don’t usually latch on right away – they seem to crawl around for a while, weighing their options. So you have a bit of time to deal with the problem.

  6. J Scott Kang

    Fantastic article, Corrine. I live in the south and work outside most of the summer and have been literally bitten hundreds of times in the last fifteen years with no diseases. I say this to let people know to not panic when they find a tick embedded. The chances of getting a serious disease are still incredibly low. I’ve had deeply embedded ticks in places that are nearly unimaginable! Both my wife and I have been in public places when we felt ticks crawling on our faces. It’s a little embarrassing, but that’s life in the country! DEET on the skin (if you don’t mind it) does work if you are running on trails, unless you are running through waist-high pastures, in which case all bets are off. If the trail just has pretty low grass, spraying DEET all over your shoes and on your socks will do the trick. Getting the clothes off immediately is the key and showering as soon as possible. But note that ticks don’t just wash off with water. A crawling tick on your back won’t be swished away. And an embedded tick on your skin doesn’t come off with soap either.

    A Massachusetts girl won a science fair contest by showing that putting your clothes in the dryer on low for just five minutes will kill all ticks (proving the CDC’s recommendation of one hour on high was overkill). This has been our strategy for de-ticking clothes that aren’t sweat-soaked (Spring and Fall). Whip off the jeans, socks, shirt, and jacket and toss them in the dryer while you take a quick shower.

    I want to note that almost every tick bite we now get is the result of either not removing clothes when we’re done with the outside activity or from being out in the woods 4-8 hours without the chance to remove clothes. If you’re running fifty miles or more in the deep woods, you’re probably going to get bit, although I’m happy to report that I got no tick bites on a 90 degree day at the Barkley Classic with just one pre-race spray of my socks. Even the ticks can’t handle Rat Jaw!

    1. Corrine Malcolm

      Hi J Scott Kang, thank you for your thoughtful comment. I’ve had essentially an identical experience growing up in Northern Wisconsin I was bitten by ticks (found embedded) multiple times every summer but never got sick with a tick-borne illness. There’s atleast two, maybe even three, reasons for that. First, not all ticks (even the ‘bad ones’) are carrying the bacteria that may cause Lyme disease etc. Second not all infected ticks will pass the bacteria onto their host –> which I feel leads to the third reason, luck! But you’re right, there is no reason to panic unless you become symptomatic. I have had one experience with Lyme disease when I was bitten during a 50mile race in Ithaca, NY. When I became symptomatic a few weeks later my parents both said, “how did you survive growing up in Wisconsin, and NOW you get Lyme!” ;)

  7. Jason

    My mother lives in coastal Maine, and Lyme disease is a huge problem. She’s had at least two rounds of it over the years. Made much worse by not seeking immediate treatment. She described a vicious throbbing neck/headache as one of the first symptoms.
    Shortly after hearing that (about 10 or 12 years ago) I was doing yard work in my then home of Mississippi… I found a very small deer tick on me, but never felt a bite.
    Shortly afterward (two days??) I came down with the same terrible neck pain, and a bullseye rash. My doctor insisted that there was no Lyme in Mississippi despite the obvious and perfectly described symptoms and rash. I insisted on the antibiotic treatment and within hours the neck pain dissipated and eventually all symptoms went away.

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