Planning a trip outdoors when the weather warms up?

20 May 2009

If you intend to make the most of the great outdoors at home or abroad during late spring and summer make sure you go prepared and are aware of the risk of tick bites.

According to provisional figures just released by the Health Protection Agency, there was a slight increase to 813 reported cases of Lyme disease in 2008, compared with 794 cases reported in England and Wales for 2007. As in previous years, the majority of cases were acquired in the UK, although infections contracted abroad have increased significantly over recent years, particularly from Central and Eastern Europe and Southern Scandinavia. In 2007, nearly one fifth of all infections (148 cases) were known to have been acquired overseas and in 2008 a similar ratio of cases is expected.

Over half the reports for 2008 came from the southern counties of England, especially the south-east and south-west health regions, a pattern reflected in reports in previous years. However, any habitat, large or small, in which ticks are present should be regarded as having a potential risk.

The age groups with the highest number of cases were the 25-44 and 45-64 year age groups, probably reflecting the ages of visitors to areas where the infected ticks are endemic.

Case numbers have increased annually since 2003, due in part to an increase in awareness and improvements in reporting and case ascertainment.

Many of the infections, which are more likely to occur during late spring, early summer and autumn, are contracted while people are participating in outdoor activities such as walking, mountain biking, trekking or camping. Areas which tend to be more affected include Exmoor, the New Forest, the Lake District, Yorkshire Moors, and other National Parks, although smaller wooded and heathland areas in many other parts of the country can also harbour infected ticks.

Professor Mike Catchpole, Deputy Director of the Health Protection Agency's Centre for Infections, said:

"Ticks are very small - about the size of a poppy seed - and can easily be overlooked, so it is important to be aware of the risk from their bites. Check for attached ticks regularly and remove them promptly. Most ticks do not carry the infection and infected ticks are very unlikely to transmit the organism if they are removed within a few hours of attachment.

 "The most common symptom of Lyme disease is a slowly expanding rash which spreads out from a tick bite, usually becoming noticeable after about three to fourteen days. It is not usually significantly painful or itchy and may gradually enlarge over many weeks if not treated with antibiotics, but will eventually disappear even without treatment. Other symptoms, including tiredness, headaches, aches and pains in muscles and joints may also be present.

"If the infection is untreated the bugs may spread in the bloodstream and to other parts of the body, including the nervous system, joints and other organs, and some patients may develop complications caused by tissue damage. It is important that infections are recognised and treated at an early stage to avoid the risk of developing these more serious complications."

Lyme disease infections cannot be passed person-to person, nor from other animals. The main feeding hosts for ticks are small mammals such as field mice and voles, and birds including blackbirds and pheasants. Areas inhabited by deer are particularly suitable habitats for ticks, but not every tick infested area has a high risk of Lyme disease.

To minimise the risk of being bitten by an infected tick the Health Protection Agency advises people to:

• Keep to paths and away from long grass or overgrown vegetation if possible, as ticks crawl up long grass in their search for a feed.
• Wear appropriate clothing in tick-infested areas (long sleeved shirt and long trousers tucked into socks). Light coloured fabrics are useful, as it is easier to see ticks against a light background
• Consider using a DEET-containing insect repellent
• Inspect skin frequently and remove any attached ticks
• At the end of the day, check again for ticks, especially in skin folds
• Make sure that children's head and neck areas, including scalps, are properly checked
• Check that ticks are not brought home on clothes
• Check that pets do not bring ticks into the home on their fur

Ticks can be removed by gently gripping them as close to the skin as possible, preferably using fine-toothed tweezers or similar implements, and pulling steadily away from the skin. Some veterinary surgeries and pet supply shops sell inexpensive tick removal devices, which are useful for people frequently exposed to ticks. Do not use lighted cigarette ends or match heads to remove ticks.

Notes for editors

For further information please contact the Health Protection Agency's Centre for Infections press office on:

Kate Swan   020 8327 7097
David Daley  020 8327 6647
Alexandra Baker   020 8327 7098
Georgina Fletcher  020 8327 6690
Louise Brown  020 8327 7080    

For further information about Lyme borreliosis and tick bite prevention visit our website:

http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListName/Page/1191942149546?p=1191942149546

Members of the public should seek advice about their specific travel health needs from their GP or local travel clinic.

Last reviewed: 20 May 2009