Hylton I Lightman, MD, DCH (SA), FAAP

It’s confirmed. The number of people infected with diseases which have been transmitted by mosquito, tick and flea bites has tripled in the United States over the last decade.

The study, conducted by the CDC and released on May 4 2018, looked at vector-borne diseases, or illnesses transmitted to humans by blood-sucking ticks and other insects, from 2004 through 2016. Of the 642,602 total cases reported to the CDC during the 13-year study, the number of cases rose most years, more than tripling from start to finish.  In 2004, there were 27,388 total cases of vector-borne diseases reported, compared with 96,075 in 2016,

Lyme disease, West Nile Virus, and other established infections are growing.  There are also new tick-borne diseases like Heartland virus which have debuted in the continental United States.  There is an unexpected resurgence of Chikungunya (which I saw often in Africa).  Zika seems quiescent at the present time.  The efficacy of mosquito control through sprayings is dubious.  They are costly and almost never stop outbreaks.  Global warming is believed to be a significant factor in increasing the number of mosquito-borne illnesses.  But that’s not what this article is about.

Total Family Care is focusing on prevention and, if needed, treatment.

With the weather warming up, a time when mosquitoes and ticks breed and transmit disease faster, let’s discuss PREVENTION.

For most of these diseases, there are no magic pills, vaccines or treatment.  However, EDUCATION is important so please continue reading.

Cover up.  Even when it’s hot out  

Call it Tznius.

Thank G-d, our Torah and Mesorah is onto something fundamental and important that we should dress modestly.  Here, it means building a protective shield around yourself.

• When you take the family hiking in tick country or send your children off to camps there, make sure they have long pants and/or leggings, long sleeves, and shoes and socks.

• Tuck pants into the socks or pull up socks over the end of the leggings so no skin is exposed.

• Wear a hat on your head (you should anyways for protection from the sun) and a bandanna around your neck to cover up even more skins.

• Consider pulling back long hair into a ponytail or braids.

Spray clothes and shoes with Permethrin 

Permethrin is a medicine and insecticide and is sold under the name “Nix.”

• As a medication, it treats lice and scabies by being applied to the skin as a ream or lotion. As an insecticide, it can be sprayed on clothing or mosquito nets; when insects touch them, they die.

• Spraying Permethrin in shoes has been shown to be effective. Think about it:  Ticks are low on the ground because they live on grass.  Also, they don’t fly or jump.  Their “entry point” then is often climbing onto shoes.

• When hiking then, stay in the center of the trail in woods and avoid bushy areas and grasslands.

• Don’t sit on downed logs as they are nestling places for ticks.

• Side effects of Permethrin may include rash or irritated skin around the areas of use.

• Pregnant women should consult their obstetricians about use.

Use insect repellent on exposed skin

• When purchasing insect repellents, read the packages carefully.

• Only DEET, picaridin and IR3535 are effective against ticks.

• Higher concentrations are required when used against mosquitoes.   Reapply as needed.

• DO NOT apply insect repellent to babies under 2 months old.

• OLE and PMD should not be used on children under the age of 3.

• For all children, avoid putting repellent on their hands or near their eyes and mouths (often stings or can irritate as they play, move, swim and perspire)

• Always use sunscreen. Apply the sunscreen first and then mosquito repellent.

• Download a YouTube to learn how to properly apply repellent.

The post-hike check list

• After the hike, shower. Check yourself for ticks in front of a full body mirror.  Feel your scalp under your hair.  Check the folds of skin, your belly button and private parts, behind your ears and knees.  Have another person check your back.

• Parents should check their children, including their backs.

• What’s the protocol if you find a tick embedded in the skin?

• Use pointy tweezers to pull it out. Grasp it and then pull it straight out, slowly but firmly.  Consult YouTube for a video on how-to (there are many)

• Call your pediatrician or physician to inform him and ask for the next step, if there is one.

• Are you a dog owner? If yes, please check your dog when he comes in from the outside.  Dogs, especially those with long hair, can be hiding ticks.

Reducing exposure in your home and yard

“Bug proof” your homes. Mosquitoes love fresh water and don’t need much of it in order to reproduce.  They also enter when doors are open for long periods and when lights are on.

• Windows should have screens without any tears.

• Cover gaps in the walls.

• Use weather stripping under doors.

• Check bathroom exhausts and chimneys to ensure proper screens

• Remove piles of wet leaves from yards and roof eaves.

• Make sure your flower pots and beds and other areas where water tends to accumulate are water-free. Perhaps the community should speak to the local health department to eliminate standing water in the neighborhood.  Notify them about standing water in empty lots, parking lots and near uninhabited houses.

• Keep the grass short, real short. Be “leaf-free” and keep those trees and bushes pruned.

• When sitting outside, keep a low-cost electric fan going. The breeze disperses the human scents that attract female mosquitoes.  Also, it’s difficult for mosquitoes to fly into the wind.

• Speaking of scents, avoid scented soaps, perfumes and hair spray as they attract biting insects. Citronella is touted as a scent that wards off mosquitoes.  Citronella plants are available.

• When camping outdoors, use mosquito nets around your sleeping area. Think about placing nets over strollers and playpen areas.

If you’re thinking about spraying in large area, consult the website of your local health department or your community association where you reside. Trying to rid your neighborhood of mosquitoes is one line of defense.

According to the US Environmental Protection Agency, “The chemicals used in approved insecticides, when used correctly, do not pose unreasonable risk to public health and the environment.  Insecticides do not cause asthma.  Rarely, they may cause mild, temporary eye infection.”  Please do your due diligence here is an article from Healthy Children on Protecting Your Children from Pesticides.

As always, daven.