The CDC reports illnesses from mosquito, tick, and flea bites have tripled in the U.S. Here's what you need to know to stay safe.
Photo: Pablo Calvo / Getty Images
In the middle-of-nowhere North Dakota, while hiking a 6-mile section of the iconic Maah Daah Hey trail system, I felt a small sting on my ankle. I looked down and was greeted by a large black bug with a white spot. An immediate rush of fear surged through me as I realized what it was—a tick. Did it bite me? Am I going to get Lyme disease? Did I just f*ck myself by aimlessly swatting it off, rather than pulling at it with tweezers like I've been told?
The thoughts swirled through my head as I tried to resist a full-blown freakout and my friends reassured me that the tick didn't latch. But in all honesty, each of us was a bit on edge: While we expected to see some ticks in the area—we were hiking through the Midwest after all, where ticks are prevalent—we were shocked by the number we encountered in just a few days. I was fortunate to only find one tick throughout our three-day trip, but one hiker found four, another three, and another spotted six. I asked one of the local hikers if this many was common in the area. "Absolutely not," he replied. "I expected one of us would find one, but this is unprecedented."
He's not wrong. According to the Centers for Disease Control and Prevention (CDC), illnesses from mosquito, tick, and flea bites have tripled in the U.S., with more than 640,000 cases reported from 2004 to 2016. What's more: Nine new germs spread by mosquitoes and ticks were either discovered or introduced to the U.S. in that time. (Related: Powassan Is a Tick-Borne Virus More Dangerous Than Lyme)
"Over the past 20 years, we've seen an increase in the number of Lyme disease cases reported each year, and cases have been reported over an expanding geographical region," says Candice Burns Hoffmann, press officer for the National Center for Emerging and Zoonotic Infectious Diseases at the CDC. "Some of these changes can be explained by geographic range expansion of the black-legged tick, which spreads Lyme disease bacteria, [as] the number of counties in which [they] have been reported has more than doubled." Areas that are particularly high-risk for ticks: the upper Midwest, Northeast, and mid-Atlantic. (Related: What You Need to Know About Chronic Lyme Disease)
That's why it's more important than ever to take caution when heading outdoors this summer. Here's what you need to know about ticks, including where they're found, how to prevent tick bites, and what to do if you find one getting a little too friendly with your skin.
What Ticks Look Like—and Where You're Most Likely to Find Them
As soon as my friends started spotting ticks, I realized that despite all the hiking I'd done, I'd never actually seen one myself. That freaked me out because, well, my mom always said knowledge is power. So I took to Google to find out what a tick truly looked like. And of course, the answer isn't totally straightforward.
"The appearance of ticks can differ based on the species," says Rafal Tokarz, Ph.D., an associate research scientist at the Center for Infection and Immunity at Columbia University and author of The Everything Guide to Lyme Disease. Some—like the black-legged or deer tick—can have a black upper half with a brown lower half, while the lone star tick is all brown save for the yellow spot right in its center. And there isn't always just one kind you'll run into. "Geographically, there is a lot of overlap of where different ticks are found, and in some places, there are three or more human-biting ticks present," says Tokarz.
In other words, you can't just familiarize yourself with one kind of tick. Check out these photos of different species from the CDC, so you'll know what unwanted bugs may be trying to find a new home in your skin.
And while it may be tempting to veer off the beaten path for that perfect 'gram, Timothy J. Sellati, Ph.D., chief scientific officer for the Global Lyme Alliance, says doing so is one of the easiest ways to welcome a tick into your life. "The best way to [avoid a tick bite] when you hike is to walk in the middle of trails, and avoid leaf litter and woodpiles," he explains. "Don't lean on rock walls or sit on fallen logs, and avoid wooded and brushy areas with high grass. Ticks thrive in damp, cool areas with plenty of shade, which is why large, open meadows receiving full sunlight are less likely areas to find ticks."
The Best Way to Dress for Avoiding Tick Bites
You may think it's NBD to pull on everyday gym apparel and hit the dirt. But if you're smart about your hiking attire, you'll be less likely to find a tick on you. Here are a few tips experts say you should follow to reduce your chances of a tick bite.
1. Skip the leggings. Yes, there are a ton in your closet, they're comfortable, and they're cute. But leggings usually leave a part of the ankle exposed, and cropped versions can stop just below the knee, meaning your entire lower leg is open to attack. "Ticks prey on creatures by latching onto them as they brush past tall grass or low plants, and then look for bare skin," says Janis Reed, Ph.D., an entomologist at Mosquito Squad. Opt for full-length hiking pants instead, and tuck them into your socks so no skin shows.
2. Wear light-colored clothes. Black and navy blue apparel may be flattering, but light pastels and neon options are the better way to go, per the CDC. They make ticks and other insects easier to spot, so you can get 'em off before they can do any real damage. (PS: Did You Know a Tick Bite Could Make You Allergic to Red Meat?)
3. Shop for permethrin-treated gear. We know: Workout gear can get expensive. But the CDC recommends splurging on clothes and gear that have been pre-treated with permethrin, an insecticide that kills bugs on contact, whenever possible (like these Eddie Bauer Freepellent Pants, which also have built-in UPF 50+ sun protection). You can also cover boots, pants, socks, and tents with products containing 0.5% permethrin, which lasts for multiple washes. (Here's how to figure out the right products for you.)
4. Put on bug spray... Don't fall prey to the myth—yes, it's a myth—that bug spray won't help you avoid tick bites. It absolutely will, says Sellati. "You can repel ticks on skin and clothing by using repellents that contain 20 percent or more DEET, picaridin, or IR3535 on exposed skin, which can [offer] protection that lasts several hours," he explains. "Don't forget to spray your shoes, as ticks can latch onto them and crawl up your leg."
5. ...but don't forget to apply sunscreen first. One thing people don't often think about when going through a "how to avoid tick bites" checklist: Sunscreen. But it's an important component because, if you put it on after bug spray, it may deactivate your repellent. "It's best to rub in the sunscreen first, let it absorb into the skin, and then apply the repellent on top," says Sellati. As always, carefully follow the instructions on the product label.
Other Ways to Avoid Tick Bites
Once you've wrapped your outdoor adventures, it's best to take extra precautions to ensure ticks don't come inside. These are the most important steps to take.
1. Check your clothes. The first place ticks go to try to sneak onto your skin? Clothes and gear, like your backpack and boots. If you have access to a dryer, immediately put your clothes in and tumble-dry on high for at least 15 minutes, says Sellati. If not, a thorough inspection is your best bet, and folds in fabric, flaps, pockets, and laces should all be checked. Spot a tick? Grab it with a tissue and flush it down the toilet. Don't try to crush it—it's unlikely to work—and definitely don't use your bare hands. (Remember, ticks like exposed skin.)
2. Check your body. Just because you haven't felt anything nibbling on your skin doesn't mean a tick isn't there. "Ticks release a mild anesthetic when they bite, camouflaging their presence and allowing them to stay for extended periods of time without being noticed," says Reed. Do regular self-checks throughout your time outside, and when you get home, strip to your birthday suit and do a thorough look from head to toe, ideally with a hand-held or full-length mirror. Sellati says ticks like to hide in warm, moist places where they're unlikely to be seen and removed, and are often found in or around the ears, belly button, and armpits, near the groin, behind the knees, and in your hair—so take extra time searching those areas. On top of that, he suggests a shower within two hours of finishing your hike, if possible, which will wash off and make it easier to find any ticks that may be crawling around.
3. Don't forget the pets. Ticks don't discriminate, so make sure your four-legged friend gets a thorough inspection, too. A new study from Merck Animal Health found that one-third of pet owners don't give their fur babies regular flea and tick medication, and more than a third admit they could not identify a tick on their pet. Study up so you can be confident no unwanted critters are entering the house.
How to Remove a Tick
Many people have heard that you need to pull a tick straight out—twisting or ripping it off can cause parts of the bug to stay in the skin—and if you don't have a pair of tweezers on hand, it may be tempting to wait until you're home to get it out. That's a big mistake. "If you discover a tick on yourself or your pet, don't wait for it to leave on its own; remove it immediately. In order for a tick to transmit Lyme disease onto its host successfully, it must stay attached for 36 to 48 hours," says Reed.
Don't know how to remove a tick? "Use fine-tipped tweezers to grasp the tick as close to the skin's surface as possible," says Sellati. "Pull upward with steady, even pressure. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water." (Hand sanitizer can work in a pinch until you can access soap and water.)
And on that note: It's an important reminder to always leave the house prepared. "You should never go hiking without at least a basic first-aid kit on hand, and that should include fine-tipped tweezers and alcohol to safely remove ticks and sterilize the area where you were bitten," says Sellati. (REI has a great option for taking on day hikes, BTW.)
What to Do If You Get Bit
"After a tick bite, people should look for an expanding rash around the [bitten area]," says Tokarz. "It doesn't always appear as a bullseye—most often it doesn't—[but] a large rash that expands daily is usually indicative of Lyme disease. This is usually accompanied by fever, muscle aches, and overall fatigue."
If you experience any of these symptoms, see a physician right away—preferably one who regularly sees patients with tick-borne diseases, as Sellati says Lyme is easy to misdiagnose, and other tick-borne diseases typically express similar symptoms. If you do get a rash, take a picture of it and measure the diameter, which can help your physician determine your best course of treatment.