1. Ridgefield Health Department
The BLAST Tick-borne Disease Prevention Program is a community-based health initiative designed to teach tick-borne disease prevention strategies and encourage early symptom identification. The program was created in by a team of researchers, educators and community members in partnership with the Ridgefield Health Department. Funding was provided by the Connecticut Department of Public Health.
Ridgefield Health Department
Ridgefield, CT 06877
Blastlyme.org

2. What is BLAST?
BLAST is the easy to remember acronym which represents the 5 most effective prevention measures that YOU can take to avoid getting a tick-borne disease.
BLAST is an easy to remember acronym highlighting five of the most effective prevention measures for avoiding all tick-borne diseases. The recommendations included are based on a Peridomestic Lyme Disease Prevention Study conducted at the Yale School of Public Health.

3. What are Tick-borne Diseases?
There are many diseases carried by different ticks. In Connecticut, we are most concerned with the illnesses spread by blacklegged ticks (a.k.a. Deer Ticks). Our #1 concern is Lyme Disease
There are approximately 20 tick species of major public health or veterinary importance in the United States and over a dozen human tick-borne diseases that affect humans. We know that several disease can be acquired from the bite of an infected blacklegged tick , often referred to as a deer tick. Lyme Disease is still most common, but health departments are monitoring the rise of Babesiosis and Anaplasmosis. Borrelia miyamotoi and Powassan disease are less common, but can have serious health consequences. It is possible to acquire multiple infections from one tick attachment. While there are other types of ticks in our area, which may carry other diseases, the blacklegged ticks and Lyme disease continue to be our greatest health threat.

4. What is Lyme Disease?
Lyme disease, the most common tick-borne illness in our state, is a bacterial infection that attacks various organ systems in the body:
Nervous System (Bell’s palsy, meningitis, jabbing pain)
Activity System (arthritis, migratory, joint pain, swelling)
Circulatory System (heart block, rhythm abnormalities)
Lyme disease is a bacterial infection caused by the spirochete Borrelia burgdorferi. This organism attacks various organ systems in the body, including the:
Nervous System (Bell’s palsy, meningitis, jabbing pain)
Activity System (arthritis, migratory, joint pain, swelling)
Circulatory System (heart block, rhythm abnormalities)

5. What are the symptoms?
Symptoms typically appear 2 – 30 days after the bite of an infected tick.
Early symptoms:
Expanding "bull's-eye" rash
Flu-like Symptoms
Fever
Malaise
Fatigue
Headache
Muscle aches
Joint aches
Lyme disease symptoms are often described as “early” and “late”. Early symptoms typically appear two to 30 days after the bite of an infected tick. The Lyme disease bacterium can infect several parts of the body, producing different symptoms at different times.  Not all patients with Lyme disease will have all symptoms, and many of the symptoms can occur with other diseases as well.  Early symptoms may include an expanding rash, often presenting as a “bulls-eye”, flu-like symptoms, fever, malaise, fatigue, headaches, muscle aches and joint aches, chills and swollen lymph nodes.  Individuals who recognize these early symptoms and receive timely treatment often recover without any further complications

6. *Photos provided by Pfizer
A rash is very common
Examples of the characteristic "bull's-eye" rash:
L. Zemel
S. Luger
The first sign of Lyme infection is usually a circular rash called erythema migrans or EM.  This rash generally begins at the site of a tick bite after a delay of 3-30 days.  A distinctive feature of the rash is that it gradually expands over a period of several days, reaching up to 12 inches (30 cm) across. The center of the rash may clear as it enlarges, resulting in a bull's-eye appearance.  It may be warm but is not usually painful or itchy. Some patients develop additional EM lesions in other areas of the body after several days.   It is important to note that not everyone with Lyme disease gets a rash, so it is important that you consult your health care provider for proper diagnosis.
J. Stratton
A. McDonald
*Photos provided by Pfizer

7. More Lyme Disease Symptoms
Late symptoms of Lyme may include:
Nerve damage
Encephalopathy (brain disease)
Meningitis symptoms
Heart abnormalities
Severe joint pain or swelling
Untreated, the infection may spread to other parts of the body within a few days to weeks, producing an array of discrete symptoms.  These include loss of muscle tone on one or both sides of the face (called facial or "Bell's palsy), severe headaches and neck stiffness due to meningitis, shooting pains that may interfere with sleep, heart palpitations and dizziness due to changes in heartbeat, and pain that moves from joint to joint.  Many of these symptoms will resolve, even without treatment.
After several months, approximately 60% of patients with untreated infection will begin to have intermittent bouts of arthritis, with severe joint pain and swelling.  Large joints are most often affected, particularly the knees. In addition, up to 5% of untreated patients may develop chronic neurological complaints months to years after infection.  These include shooting pains, numbness or tingling in the hands or feet, and problems with concentration and short term memory.
Most cases of Lyme disease can be cured with antibiotics, especially if treatment is begun early in the course of illness.  However, a small percentage of patients with Lyme disease have symptoms that last months to years after treatment with antibiotics.  These symptoms can include muscle and joint pains, arthritis, cognitive defects, sleep disturbance, or fatigue.  The cause of these symptoms is not known.  There is some evidence that they result from an autoimmune response, in which a person's immune system continues to respond even after the infection has been cleared.
Source: National Library of Medicine

8. How common is Lyme disease?
According to the CDC, there are over 320,000 new cases of Lyme disease each year. In this map from the Centers for Disease Control (CDC) and Prevention, each dot represents one case of Lyme disease and is placed randomly in the patient’s county of residence. The presence of a dot in a state does not necessarily mean that Lyme disease was acquired in that state. People travel between states, and the place of residence is sometimes different from the place where the patient became infected. Most cases are contracted in the North East where we live. According to the Centers for Disease Control and Prevention (CDC), Lyme disease is the most commonly reported vector borne illness in the United States.
There are over 320,000 new cases of Lyme disease each year in the US.

9. And it’s on the rise…
Reported Cases of Lyme Disease by Year, United States,
The number of Lyme Disease cases has increased steadily over the past 20 years. While the criteria for reporting Lyme disease cases has varied over the years, we see a clear upward trend since 1995.

10. When am I most likely to get bitten by a tick?
Confirmed Lyme disease cases by month of disease onset–United States,
You are at risk for Lyme disease year-round. However, ticks are most active in the spring and summer months. Lyme disease patients are most likely to have illness onset in June, July, or August and less likely to have illness onset from December through March. The blacklegged tick (deer tick) does not die or hibernate in the winter, so it’s still important to be on the lookout whenever the ground isn’t covered by snow.

11. What do Blacklegged Ticks Look Like?
Tick is the common name for the small arachnids in superfamily Ixodoidea that, along with other mites, constitute the Acarina. Ticks are ectoparasites (external parasites), living on the blood of mammals, birds, and occasionally reptiles and amphibians.

12. It depends on their stage in the life cycle
Adult Female: Reddish body size comparable to a sesame seed
Adult Male: Slightly smaller than female, completely dark brown
Nymphs: Size comparable to that of a poppy seed
Larva: Size smaller than that of a pin head
Larva cannot transmit Lyme Disease!
Ixodes Scapularis, known as the black-legged tick or deer tick, is common to the eastern part of North America and is known for spreading Lyme disease.
Notice the eight black legs, long mouthparts and the black dorsal shield. The nymph is less than ¼ the size of the adult female. The adult female is about the size of a sesame seed; the nymph is about the size of a poppy seed. As the female feeds, its body becomes engorged with blood and eventually plumps up to be more than 4 times it’s original size. Keep in mind that both the nymph and the adult female can transmit disease.
From left to right: Adult female, adult male, nymph, larva

13. The Tick Life Cycle Year One Year Two larvae nymphs adults eggs
Spring Summer Autumn Winter Spring Summer Autumn Winter
larvae
nymphs
adults
Adults mate,
produce eggs & die
eggs
Source: Center for Vector-Borne Disease, University of Rhode Island
Tick eggs hatch in the Spring. The ticks feed 3 times in their 2 year life cycle. Tick larvae feed on mice, moles or birds (known as hosts) in late Summer. Larvae and nymphs can acquire the bacteria which causes Lyme disease (B. burgdorferi) when feeding on an infected host. The white footed mouse is the principle reservoir for B. burgdorferi. Nymphal ticks feed in the early Spring, and Adult ticks feed in the Fall and Winter (on deer, pets, or humans.) Lyme disease is acquired through the bite of an infected nymph or adult tick. Larval ticks can not transmit the infection. Adult ticks feed and reproduce on deer in the Fall and Winter. Adult ticks lay eggs (approximately eggs per tick) in leaf litter in the Spring.
Meal 3
Meal 1
Meal 2

14. Ticks filled with blood are “engorged”
Ticks can be difficult to identify once they are engorged with blood from feeding. This graphic shows different levels of engorgement. Regardless of the type of tick, the removal procedure is the same.

15. How does a tick give you a disease?

16. Ticks attach with a unique mouthpart.
The term tick bite may be misleading as ticks do not bite like a mosquito. Ticks attach and feed gradually. Once a tick has found a place to feed, it grasps and begins to cut into the skin. The hypostome penetrates and the tick secretes a “cement” which holds the mouthparts in place while the tick feeds. This cement is one of the reasons ticks may be hard to remove. Irritation may occur at the site of the bite and should not be mistaken for the EM rash.

17. Tick Removal We recommend asking an adult for help.
Use fine tipped tweezers.
Grasp the tick by the mouthparts close to the skin.
Pull straight back with a slow, steady force.
Avoid crushing the tick’s body.
Wash area and disinfect the bite site.
Record the date and location of the bite.
Watch for any early symptoms!
Remove a tick from your skin as soon as you notice it. Use fine-tipped tweezers to firmly grasp the tick very close to your skin. With a steady motion, pull the tick’s body away from your skin. Then clean your skin with soap and warm water.
Avoid crushing the tick’s body. Do not be alarmed if the tick’s mouthparts remain in the skin. Once the mouthparts are removed from the rest of the tick, it can no longer transmit the Lyme disease bacteria. If you accidentally crush the tick, clean your skin with soap and warm water or alcohol.
Don’t use petroleum jelly, a hot match, nail polish, or other products to remove a tick.
Place the tick in a zip-lock bag and bring it to your local health department if they send them for identification and testing.

18. Tick Removal DON’Ts Don’t squeeze or rupture the tick.
Don’t rub Vaseline or Petroleum Jelly on the tick.
Don’t rub dish detergent on it.
Don’t do ANYTHING that might otherwise traumatize the tick.
These methods are not effective and may actually increase the risk of bacteria transmission.

19. Bring the tick to your Health Department
Health departments identify ticks and submit ticks for free testing.
Results will be ed to you.
If a tick is infected, it DOES NOT mean that the person it was attached to has contracted disease.
It DOES mean that you should watch for early symptoms and discuss the options with your doctor.
Your town health department will mail blacklegged ticks removed from residents (not pets) to the Agricultural Experiment Station.
Their lab will check any blacklegged tick that contains blood for disease and the results to your family.
If a tick is infected, it DOES NOT mean that the person it was attached to has contracted disease.
It does mean that you should watch for early symptoms and discuss the safest options with your doctor.

20. Where do ticks live? Ticks thrive in shady, moist areas
Ticks like damp shady areas under ground covering plants such as pachysandra, myrtle and ivy. They can be found near stone walls – note that the ticks often hitch a ride on a small rodent such as the white-footed mouse, so you will find ticks in areas that mice find attractive. Dead tree trunks and branches, tall grasses and the wooded edge of your property are also places that you may encounter ticks. Stay away from leaf litter, too. Ticks spend 95% of their life in the leaf litter on the forest floor during their 2 year life cycle! Tick populations can also be abundant in areas where deer live (wooded areas.) Deer supply ticks with a place to mate and a blood meal. Be wary of ticks in places where you see a lot of deer, or deer droppings.

21. How do you avoid getting a tick bite?

22. BLAST

23. Bathe or shower soon after coming indoors
The “B” in BLAST reminds us to bathe or shower soon after coming indoors. Research shows that bathing or showering within 2 hours of coming indoors helps to remove ticks that have not yet attached themselves to you.

24. Place clothes in a dryer to kill ticks
10 minutes on high heat to kill ticks on dry clothing
60 minutes on high heat to kill ticks on wet clothing
Washing clothes alone doesn’t kill ticks.
Once you’ve undressed, be careful where you leave your clothing. Ticks could be attached to your shirt or pants. Ticks don’t die in the washing machine. They are killed by high heat in the dryer. 10 minutes for ticks on dry clothing and 60 for ticks on wet clothing.

25. BLAST

26. Look for ticks and rashes
Tick bites are usually painless, therefore most people are unaware when they have a tick attached to them.
Do a tick check every night!
Ticks are very small, and may feed anywhere on the body so check thoroughly.
L reminds everyone to look for ticks and rashes on your body after coming indoors. Finding and removing an attached tick as soon as possible may reduce your risk of getting the disease… so the sooner the better! Check under your arms, in your ears, the belly button, behind your knees and in other places where a tick may go undetected. Ticks are very small, and may feed anywhere on the body so check thoroughly. Tick bites are usually painless. That’s why people are surprised when they find a tick attached to them. Do a tick check every night…and while you’re looking…check for expanding rashes too.

27. BLAST

28. Apply repellents
SKIN
If you choose to use a tick repellent on your skin, the CDC recommends using a product that contains DEET at a concentration of > 20%.
CLOTHING
A permethrin based product is recommended for clothing and gear. It provides great protection against ticks! Spray when not wearing or buy factory treated clothing.
…applying repellents to skin and/or clothing. The CDC recommends using repellents that contain 20% to 30% DEET (N, N-diethyl-m-toluamide) on exposed skin and clothing for protection that lasts up to several hours. Always follow product instructions. Parents should apply this product to their children, avoiding hands, eyes, and mouth.
Another option is to use products that contain permethrin on clothing and gear. Treat shirts, pants, socks and shoes when you are not wearing them. Spray outdoors in a well ventilated area and allow them to dry before putting these items on. Permethrin remains protective through several washings. Pre-treated clothing is available and may provide longer-lasting protection.
Photos CDC

29. Dress for Success
Wearing clothing that covers as much skin as possible can be very protective. Consider spraying clothing and shoes and your hat with a permethrin-based repellent that will kill ticks. You will spot ticks more easily on light colored clothing. Wear closed toe shoes, socks and tuck pants in to your socks. Put clothes in to the dryer for a ten minute spin on high heat after outdoor activity to kill ticks.

30. BLAST

31. Spray and maintain the yard
Spray tick habitat areas
Clear tall grasses and brush.
Add a 3-ft wide barrier of wood chips or gravel between lawns and wooded areas.
Mow the lawn frequently.
Keep leaves raked.
Stack wood neatly in a dry area.
Keep playground equipment and patio furniture away from yard edges and in a sunny location.
Choose deer resistant plants.
Avoid feeding wild animals & birds.
Recognizing that most people become infected with tick-borne diseases close to home, researchers have focused on understanding all of the effective ways to reduce the number of ticks in your own backyard.
These include:
Spraying tick habitat areas at least once a year. These include the yard edge, leaf litter, wood piles, ground cover and stone walls.
Clearing tall grasses and brush
Adding a 3-ft wide barrier of wood chips or gravel between lawns and wooded areas
Mowing the lawn frequently and raking leaves.
Stacking wood neatly in a dry area
Keeping playground equipment and patio furniture away from yard edges and in a sunny location.
Choosing deer resistant plants
Removing plants that harbor ticks
Not feeding wild animals & birds
Westport/Weston Health District

32. BLAST

33. Treat your pets Check your pets for ticks after coming indoors.
Ask your vet what you can put on your pet to repel ticks.
Don’t sleep with your pet because ticks on your pet may crawl onto you.
Pet owners are more likely to get tick-borne diseases, so be extra careful when it comes to your own tick checks and prevention practices.
Pets, especially dogs, can be seriously impacted by tick-borne diseases. Unfortunately, vaccines are not available for all the illnesses dogs can get from ticks, and they don’t keep your pet from bringing ticks into the house. For these reasons, it’s important to use a tick prevention product for your dog or cat and to check your pets daily for ticks, especially after coming indoors.
Ask your veterinarian about the ticks found in your area, vaccines, topical products, collars, and other prevention methods available. Don’t allow pets to sleep on your bed as ticks may crawl off the dog or cat and on to a family member. Cats are extremely sensitive to a variety of chemicals so don’t apply any insect acaricides or repellents to your cats without first consulting your veterinarian!
Tick bites on pets may be hard to detect. Signs of tick-borne disease may not appear for 7-21 days or longer after a tick bite, so watch your dog closely for changes in behavior or appetite if you suspect that your pet has been bitten by a tick. Symptoms may include fever, lack of appetite, lameness and joint swelling.
Recent research has shown that pet owners are at greater risk for tick-borne diseases. Everyone with indoor-outdoor pets should be extra careful when it comes to tick checks and prevention practices.

34. Quiz Time!
Let’s review what each letter in the BLAST acronym stand for!

35. B
Bathe or Shower soon after coming indoors

36. L
Look for Ticks & Rashes

37. A
Apply Repellents

38. S
Spray and maintain your yard

39. T
Treat your pets

40. Be a LYME Fighter!
Teach your friends and family the BLAST message so they will avoid tick bites and the possibility of Lyme and other tick-borne diseases!
In conclusion, we are asking you to become a Lyme Fighter!
Please share what you have learned about Lyme Disease Prevention with at least 5 of your family members, friends or neighbors.

41. Information sources include:
Centers for Disease Control and Prevention (CDC)
CT Agricultural Experiment Station
Tick Management Handbook
CT Department of Public Health
Westport/Weston Health District
 Yale School of Public Health  
Peridomestic Lyme Disease Prevention:
Results of a Population-Based Case–Control Study
Questions? Contact the Ridgefield Health Department at or
Information in the BLAST program is based on recommendations and research from the following sources:
Centers for Disease Control and Prevention (CDC)
Connecticut Agricultural Experiment Station Tick Management Handbook
Connecticut Department of Public Health
Westport/Weston Health District
Emerging Infections Program/Yale School of Public Health 
If you have additional questions you can contact us at the Ridgefield Health Department at or