1. What You Should Know About Lyme Disease and Other Tick-Borne Diseases
Minnesota Department of Health Disease Prevention & Control
625 Robert St N
PO Box 64975
Saint Paul, MN
(651)
Welcome.  We are pleased to present you with information about Lyme disease and other tick-borne diseases. 
This slide presentation and script is part of a public education initiative that is occurring in Minnesota. 
It was originally funded by the Centers for Disease Control and Prevention and was developed by the Minnesota Department of Health. 
Permission was granted from various sources to use photographs.
Revised October 2009

2. Goal
“Minnesota residents and visitors will take action to prevent exposure to ticks which may carry Borrelia burgdorferi; will know the signs and symptoms of Lyme disease and other tick-borne diseases; and if present, will seek early diagnosis and treatment.”
Our goal for Lyme disease prevention is:
“Minnesota residents and visitors will take action to prevent exposure to ticks which may carry Borrelia burgdorferi; will know the signs and symptoms of Lyme disease and other tick-borne diseases; and if present, will seek early diagnosis and treatment.”
1995 Minnesota Lyme Disease Public Education Plan

3. Goals of presentation
Be aware of Lyme disease and other tick-borne diseases
Recognize basic signs and symptoms
Seek early diagnosis and treatment
Know whether you live, work or play in endemic areas
Practice prevention activities
Know whom to contact for more information
By the end of this presentation, you will:
Be aware of Lyme disease and other tick-borne diseases,
Recognize basic signs and symptoms,
Know to seek early diagnosis and treatment,
Know if you live, work or play in an area that has deer ticks,
Practice preventive actions, and
Know who to contact for more information.

4. LYME DISEASE Borrelia burgdorferi,
Lyme disease is the most common tick-borne disease in the United States.
Borrelia burgdorferi is the agent of Lyme disease.  The bacteria have a flexible helical shape and are called spirochetes.
Borrelia burgdorferi,
the bacteria that cause Lyme disease

5. History 1975 Juvenile cases of arthritis found in Connecticut
Disease named Lyme disease
1985 Lyme disease became reportable in Minnesota
Lyme disease was named in 1975, when a group of children in Connecticut were reported to have juvenile arthritis.
The Minnesota Department of Health began collecting information on people diagnosed with Lyme disease in 1982.  In 1985, Lyme disease became a reportable disease in the state.
During the 1980s, the Minnesota Department of Natural Resources, Metropolitan Mosquito Control District and other organizations were also participating in Lyme disease activities.
From 1986 to 2008, 9,727 confirmed cases of Lyme disease have been reported in Minnesota.

6. Lyme Disease Signs & Symptoms
3 to 30 days after deer tick bite
Rash (often “bulls-eye”)
Fever
Chills
Headache
Muscle and joint pain
Fatigue
The signs and symptoms of Lyme disease can vary among individuals. 
Three to 30 days after a bite from an infected deer tick, look for:
A distinctive rash (“bulls-eye” or erythema migrans)                     
Fever
Chills
Headache
Muscle and joint pain
Fatigue
Swollen lymph nodes
A person may not have all of these symptoms. People often feel like they have the “flu.”

7. Erythema migrans (EM) rash characteristic of Lyme disease
The most common early sign of Lyme disease is a skin rash that has a “bull’s eye” appearance.  It begins as a reddened area near the tick bite.  As the rash increases in size, it clears in the middle and develops a red ring around the outside. 
This rash:
May expand to a very large size,
Is usually not painful or itchy, and
Often appears on the thighs, groin, trunk, armpit, or back.
The rash has been reported in about 60 to 80 percent of adults and 50 percent of children.  
The classic rash has central clearing as shown here, but not all rashes have this presentation.

8. Lyme disease rash without central clearing
Sometimes the rash does not have a bull’s eye appearance.  It may appear as a reddened area without an outer ring.
Lyme disease is not transmitted from person to person.
Not everyone gets a rash with Lyme disease.
The early signs and symptoms of Lyme disease (fever, chills, headache, muscle/joint pain and fatigue) are similar to other ailments.   Therefore, it may be difficult to diagnose Lyme disease if a person does not have the rash. 
Lyme disease rash without central clearing

9. Lyme Disease Signs & Symptoms
Days to weeks after illness onset
Multiple rashes
Facial paralysis on one side
Fever, stiff neck, headache
Weakness, numbness, arm/leg pain
Irregular heart beat
Persistent weakness and fatigue
If the early stage is absent, undetected, or undiagnosed, one or more of these signs and symptoms may occur days to weeks after onset of illness :
Multiple rashes (result of spirochetal dissemination, not multiple tick bites)
Facial paralysis on one side of the face (Bell’s Palsy)
Fever, stiff neck, headache
Weakness, numbness or pain in arms or legs
Irregular heart beat (heart block)
Persistent weakness and fatigue

10. Multiple Rashes Reaction as bacteria move through body
Not caused by multiple tick bites
A person may experience multiple rashes, such as you see here.  The rash is not caused from multiple tick bites, but occurs as a reaction when the bacteria move through the body.

11. Multiple Rashes This is another example of a multiple rash.

12. Lyme Disease Signs & Symptoms
Weeks to months after illness onset
Fatigue
Chronic arthritis
Nervous system problems
If earlier stages of Lyme disease are undetected or undiagnosed, these signs or symptoms may appear weeks to months after onset of illness:
Arthritis involving joint swelling in one or more joints, usually a large joint such as the knees
Problems with the nervous system (subtle encephalitis resulting in memory problems)
Persistent weakness and fatigue
Individual reactions to Lyme disease will vary with the individual
Lyme disease can be difficult to diagnose and treat at this stage. Any stage of Lyme disease that doesn’t involve a classic rash can be difficult to differentiate from other diseases or conditions with similar symptoms.

13. Joint Swelling
Joint swelling and pain may occur weeks to months after onset of illness if left untreated.
This is an example of Lyme arthritis in the knee.  Joints may become red, swollen, and painful.  Lyme arthritis is generally periodic, but may become chronic in about 10 percent of people if untreated.

14. Diagnosis of Lyme Disease
Physical examination
History of possible exposure to deer ticks
Blood tests may be performed
A screening test is done first, followed by a confirmatory test for antibodies to Lyme disease bacteria
If a person suspects Lyme disease, he or she should contact a doctor immediately. 
Diagnosis includes:
Physical examination (signs and symptoms, presence of a rash),
History of possible exposure to deer ticks, and
Blood tests may be performed.
A thorough physical examination and history of exposure are required for proper diagnosis and treatment.  A blood test alone is not diagnostic of Lyme disease.

15. Remember
Early recognition of signs and symptoms of Lyme disease is very important for prompt diagnosis and treatment.
Remember, early recognition of signs and symptoms of Lyme disease is very important for prompt diagnosis and treatment.
Early diagnosis and treatment can reduce the time a person is ill and the severity of the disease.

16. Treatment Lyme disease can be treated
Antibiotics are used to treat Lyme disease
Talk to your doctor about specific treatment
Here are a few general statements about the treatment of Lyme disease:
The disease is treated with antibiotics.
Antibiotics are very effective in killing the bacteria.
Treatment is most effective early in the course of Lyme disease.
Lyme disease detected later may be more difficult to treat.
Specific questions about treatment should be discussed with your health care provider.

17. Questions about Diagnosis or Treatment of Lyme Disease?
Call your doctor or
Minnesota Department of Health at
If you have questions about the diagnosis and treatment of Lyme disease, call your health care provider or the Minnesota Department of Health at

18. TICKS Blacklegged Tick (deer tick) American dog tick (wood tick)
(spreads Lyme disease)
American dog tick
(wood tick)
(does not spread Lyme disease)
The tick that carries Lyme disease is called the blacklegged tick. It is also commonly known as the deer tick. You may also hear it called the bear tick.  They are all the same tick. The scientific name is Ixodes scapularis.
Now we’re going to describe the blacklegged tick, its life cycle, habitat, transmission of the bacteria and specific actions you can take to reduce your risk of exposure to blacklegged ticks. 
The deer tick is much smaller than the wood (or dog) tick.  On the left of this slide is the adult male blacklegged tick (deer tick), which is dark in color.  In the middle is the adult female, which is red and dark brown. On the right is a wood tick.  Notice the wood tick’s white markings, which are not present on the blacklegged tick.
adult male
adult female

19. Blacklegged Ticks (Deer Ticks)
Blacklegged ticks have three life stages
Nymph
Blacklegged ticks live for two years and have three blood meals.  The life cycle begins when the female lays eggs.  As the eggs mature, they develop into a larva (bottom), then a nymph (left) and finally, adult male or female (adult female shown on right).
Adult
(female)
Larva

20. Blacklegged Tick Larvae
Size of period at end of sentence
Initially does not have Lyme disease bacteria, so does not transmit the bacteria to a host
May get the bacteria from a host who has the bacteria
Larval blacklegged tick
From May through September, eggs hatch into larvae (plural). 
The larva (singular):
is the size of a period at end of sentence
initially does not have Lyme disease bacteria
may get the bacteria during its first meal from a host that carries the bacteria
Molts into a nymph after the first blood meal and goes dormant

21. Collecting Immature Blacklegged Ticks
Lyme disease researchers often live-trap small mammals to collect blacklegged ticks. Here is a small mammal trap set up in the woods.
Lyme disease researchers often live-trap small mammals to collect blacklegged ticks.

22. Natural Host for Immature Blacklegged Ticks
Larvae first feed on white-footed mice or other small mammals. Notice the ticks on this mouse’s ear.
If the mouse is infected with the bacteria that causes Lyme disease, the larva will become infected and transmit the bacteria during its second feeding. The tick may also feed on a small mammal or bird that is not infected, so the tick will not get the bacteria at this time. After this feeding, the larvae become inactive until the following spring.
Immature blacklegged ticks can be infected by feeding on mice that are carrying Lyme disease bacteria.
Transmission can also occur from the ticks to mice.

23. Blacklegged Tick Nymph
In the spring and summer of the tick’s second year, primarily from May through August, the nymph becomes active and takes its second feeding from a mammal.  If the tick received the bacteria from its first feeding in the larva stage, it can transmit the bacteria during this second feeding.  
Nymph stage ticks often look like a speck of dirt or a freckle on a person’s skin.

24. Blacklegged Tick Nymph
Size of a poppy seed
Transmits most cases of disease because they are so difficult to detect
Seeks a blood meal from mid-May to mid-July
The nymph is about the size of a poppy seed.
Ticks in the nymph stage are mainly responsible for transmitting infections to humans or domestic mammals because they are difficult to detect.

25. Blacklegged Tick Adults
Adult female
Adult
male
In the fall of the second year, nymphs molt into the reddish female (shown on the left) or the smaller male adult tick.  These ticks are next to a common pin.
Male ticks attach, but do not feed.  Because the males do not take a blood meal, they do not transmit Lyme disease.

26. Blacklegged Tick Engorgement
A third feeding generally occurs in late fall.  As ticks feed over the course of several days, their bodies slowly enlarge with blood.
Blacklegged ticks become engorged with blood after feeding. This picture shows an adult female who has been feeding at least a few days. She is approximately the length and width of a watermelon seed.
Male ticks attach, but do not feed.  Because the males do not take a blood meal, they do not transmit disease agents.

27. Male and Female Adult Blacklegged Tick
Feed and mate on large animals in the fall or early spring
After feeding, females lay eggs, then die
Ticks that did not feed or mate go dormant
The adult ticks feed and mate on large animals in the fall or early spring.  The female lays her eggs, then dies.
If the ticks did not get a blood meal in the fall, they go dormant over winter and seek a meal in the spring.  Remember, a frost does not kill deer ticks.

28. Two-Year Life Cycle of Blacklegged Tick
MEAL 1
Mouse
Bird
EGGS
LARVAE
NYMPHS
MEAL 2
(peak feeding
time May-mid July)
Person
Mouse
Dog
Eggs laid,
adults die
Nymphs molt into adults
MEAL 3
For adults that did not feed in fall
Person
Deer
Dog
SPRING
SUMMER
Larvae molt into nymph stage
WINTER
FALL
ADULTS
To summarize, in the spring of year one, eggs hatch into larvae, have one feeding, molt into nymphs, and go dormant.  In year 2, nymphs take their second feeding.  At this time, the nymph may transmit bacteria to humans, or to wild or domestic mammals.
In the fall, nymphs molt into adult male and female ticks.  The females feed, mate, lay eggs, and die. 
MEAL 3
Person
Deer
Dog
Nymphs dormant

29. Blacklegged Tick Habitat
Where do we find blacklegged ticks? 
Blacklegged ticks live in wooded areas and/or along the fringe of grass and woods. They are most common in woods with broadleaf trees (oaks, maples, elms, etc) and less common in coniferous (pine, spruce, etc) forests.
White-tailed deer live throughout Minnesota, but blacklegged ticks (“deer ticks”) are not found everywhere that deer live.  Therefore, it is important to know when you are in a county where blacklegged ticks have been found.

30. Trails and Edge Habitat
Blacklegged ticks live in woody, brushy areas that provide food and cover for hosts such as mice and deer
Exposure to these ticks can be greatest along trails and edges of woods
Blacklegged ticks live in wooded, brushy areas that provide food and cover for white-footed mice, deer and other small or large mammals.
Exposure to ticks may be greatest in the woods (especially along trails) and the fringe area between the woods and border.

31. Blacklegged Tick Questing
Blacklegged ticks search for a host from the tips of low-growing vegetation, generally climbing onto a person or animal near ground level.
Blacklegged ticks search for a host from the tips of low-growing vegetation, not from trees.  Generally, ticks climb onto a person or animal near ground level.
Blacklegged ticks crawl, they do not jump or fly. 
They grab onto people or animals who brush against vegetation they are sitting on and crawl upward.

32. Blacklegged Tick Feeding
Blacklegged ticks feed on blood by inserting their mouth parts into the skin.
They are slow feeders and will feed for 3-5 days.
If the blacklegged tick is infected, it must be attached for hours before it transmits the bacteria.

33. To Get Lyme Disease
Blacklegged tick must be infected with Lyme disease bacteria
Only the nymphs and adult females can transmit the Lyme disease bacteria
Tick must be attached hours before it passes bacteria to host
In order to get Lyme disease, a person must be bitten by a blacklegged tick that is infected with the Lyme disease bacteria.
Remember– not all blacklegged ticks are infected with the bacteria, so not all deer ticks transmit disease.  The tick must be attached for at least hours to transmit the bacteria.
The chance of getting Lyme disease increases the longer the tick is attached.

34. Lyme Disease Cases by State, 2002 (n = 23,763)
In 2002, nearly 24,000 cases of Lyme disease were reported to the Centers for Disease Control and Prevention.  While dated, this map continues to represent current distribution of cases on a national level.
This map shows reported cases by state of residence – that is, where people live who have this disease.  The map does not necessarily demonstrate where people were exposed to blacklegged ticks, since some people are exposed to ticks when they travel.
Lyme disease occurs primarily in three regions of the United States:
in the Northeast (from Massachusetts to Maryland),
in the Midwest (Wisconsin and Minnesota), and
in the West (northern California and Oregon).     
Lyme disease is also widespread throughout much of Eurasia.

35. Lyme Disease Areas of Highest Risk in Minnesota
Wadena
Hennepin
Murray
Pine
Aitkin
Cass
Hubbard
Wilkin
Itasca
St. Louis
Cook
Wash- ing- ton
Lake
Le Sueur
Rice
Goodhue
Nobles
Rock
Jackson
Martin
Faribault
Freeborn
Mower
Fillmore
Houston
Winona
Olmsted
Dodge
Steele
Waseca
Blue Earth
Watonwan
Cottonwood
Pipestone
Nicollet
Wabasha
Dakota
Scott
Chisago
Isanti
Brown
Sibley
Carver
Wright
Meeker
Kandiyohi
Renville
Redwood
Sherburne
Lyon
Lincoln
Yellow Medicine
Lac Qui Parle
Swift
Big Stone
Pope
Stevens
Traverse
Chippewa
Stearns
Benton
Carlton
Kanabec
Mille Lacs
Crow Wing
Morrison
Todd
Douglas
Grant
Ottertail
Becker
Clay
Clear Water
Mahnomen
Norman
Red Lake
Pennington
Polk
Beltrami
Marshall
Koochiching
Lake of the Woods
Roseau
Kittson
McLeod
Ram- sey
Anoka
Tick-borne disease risk in Minnesota is highest in forested areas within the shaded zones.
Blacklegged ticks may also be found at lower levels in some forested areas outside this zone.
Lyme disease is endemic in northern central Minnesota and in counties bordering the Mississippi and St Croix rivers, in wooded or brushy areas. Some of the endemic areas have expanded in recent years, especially in northern Minnesota. It is important to know if you live, work or play in an area known to have blacklegged ticks, so you can take preventive measures.
In recent years, three quarters of cases were exposed to a blacklegged tick in the shaded areas of this map.  Around twenty percent of Minnesota Lyme disease cases were exposed to deer ticks in western Wisconsin or other states.  The remaining cases were exposed to deer ticks in several other Minnesota counties.
Minnesota Department of Health
May 2008

36. Reported Cases of Lyme Disease in Minnesota, 1986-2008 (n = 9,726)
This bar graph shows reported cases of Lyme disease since the Minnesota Department of Health first began systematically counting cases in 1986.
Since about 2000, the incidence of Lyme disease in Minnesota has increased dramatically. The frequency of reported cases in recent years is triple that of the late 1990s. MDH surveillance efforts have not changed since 1994, suggesting that other reasons account for this large increase.
The number of cases decreased in 2003 compared to surrounding years. This may have been due to a relatively hot, dry July compared to previous years.

37. Reported Cases of Lyme Disease in Minnesota by Location of Residence, 1998-2007 (n=6,905)
This bar graph shows reported cases of Lyme disease by area of residence over the past decade.  The blue bars show residents of the Twin Cities Metropolitan Area, and the green bars show people who live in greater Minnesota.
About one-half of the Lyme disease cases occurred in people who live in the Twin Cities metropolitan area. Most of the metro residents, however, were exposed to blacklegged ticks in Greater Minnesota. 

38. Reported Cases of Lyme Disease by County of Exposure, Twin Cities Metropolitan Area, 1998-2007
Anoka
Washington
Ramsey
Dakota
Hennepin
Scott
Carver
Total
County
187
183 38 32 18 6 5
469
No. of Cases
From 1998 to 2007, 469 reported cases who were able to identify a single county of exposure were likely exposed to infected deer ticks and Lyme disease in the Twin Cities Metropolitan Area. Anoka County has the highest number of exposures, followed by parts of Washington and Ramsey counties.

39. Top Ten Counties of Exposure for Reported Cases of Lyme Disease, 1998-2007
County
No. (%) of Cases
1. Crow Wing
2. Cass
3. Pine
4. Aitkin
5. Anoka
6. Washington
7. Houston
8. Morrison
9. Hubbard
10. Itasca
Wisconsin
Other
966 (20%)
370 (8%)
302 (6%)
207 (4%)
187 (4%)
183 (4%)
125 (3%)
124 (3%)
103 (2%)
940 (20%)
1,120 (24%)
4,730
From 1998 to 2007, the majority of people with Lyme disease who reported one likely county of exposure were likely exposed to an infected blacklegged tick and Lyme disease in Greater Minnesota or the northern metro. Most people are exposed to ticks while visiting recreational property in east-central, north-central, or southeast Minnesota or western Wisconsin.
Total Cases with Known Exposure

40. Reported Cases of Lyme Disease by Month of Onset, Minnesota, 1999-2008 (n = 6,277*)
Exposure to blacklegged ticks and Lyme disease occurs in Minnesota primarily from March to November. The majority of cases occur in June, July and August, when people are outdoors and ticks are actively feeding.  However, people also get Lyme disease in the later months of the year. 
Onset of disease peaks just after the mid-May to mid-July time period when the nymphal deer tick is feeding.  This lag is due to 3 to 30 days when signs and symptoms of Lyme disease first occur.
* Excluding 1,415 cases without erythema migrans or with unknown onset dates

41. Reported Cases of Lyme Disease by Age at Onset, Minnesota, 1999-2008 (n=7,610*)
People of any age can get Lyme disease. People diagnosed with Lyme disease in Minnesota range in age from less than one year old to 98 years of age.  We see an especially high percentage of cases in children 12 years and younger.
* Excluding cases with unknown age at time of onset

42. Reported Cases of Lyme Disease in Minnesota by Sex, 1999-2008
Male
Female
Total
4,732 (62%)
2,960 (38%)
7,692
More males (62%) than females (38%) were reported to have Lyme disease in Minnesota from 1998 to 2007.

43. Human Anaplasmosis Signs and Symptoms
Fever (over 102 degrees)
Chills and shaking
Severe headache
Muscle aches
Earlier, we mentioned the blacklegged tick (deer tick) can also cause two other diseases—human anaplasmosis (previously known as human granulocytic ehrlichiosis) and babesiosis.  Both diseases appear to be less common than Lyme disease.
Human anaplasmosis was first described in the early 1990s in patients from Minnesota and Wisconsin. The signs and symptoms of human anaplasmosis may include:
Fever (over 102°)            
Severe headache        
Muscle aches                
Chills and shaking
If human anaplasmosis is suspected, see your doctor immediately.  Human anaplasmosis is treated with antibiotics.

44. Reported Cases of Human Anaplasmosis in Minnesota by Year, 1995-2008 (n = 1,602)
During 2007, a record number of 322 cases of human anaplasmosis were reported. Like Lyme disease, the frequency of human anaplasmosis reports has dramatically increased since the year 2000.

45. Reported Cases of Human Anaplasmosis by Age at Onset, Minnesota, 1999-2008 (n = 1,530)
Most human anaplasmosis cases are over 40 years of age….unlike Lyme disease, which is often diagnosed in children
* Excluding cases with unknown age

46. Human Anaplasmosis Sex Distribution, 1999-2008
Male Female Total
980 (64%) (36%) ,534
More males (64%) than females (36%) were reported with human anaplasmosis from 1999 to 2008, similar to the distribution of Lyme disease.

47. Reported Cases of Human Anaplasmosis by Month of Onset, Minnesota, 1999-2008 (n = 1,519*)
Most human anaplasmosis transmission in Minnesota occurs from May through August. This corresponds to the peak activity of the nymph stage of the deer tick.
Unlike Lyme disease, a secondary, small peak also occurs in the fall, when adult ticks are questing. We probably see this difference because adult ticks are easier to detect than nymphal ticks. However, since they don’t need to be attached as long to transmit the HA bacteria as the Lyme bacteria, a greater proportion of HA cases occur in the fall than LD cases
* Excluding 15 cases with unknown onset

48. Reported Cases of Human Anaplasmosis in Minnesota by County of Exposure, 1995-2007 (n = 1,323)
Hennepin
Murray
Pine
Aitkin
Cass
Hubbard
Wilkin
Itasca
St. Louis
Cook
Wash- ing- ton
Lake
Le Sueur
Rice
Goodhue
Nobles
Rock
Jackson
Martin
Faribault
Freeborn
Mower
Fillmore
Houston
Winona
Olmsted
Dodge
Steele
Waseca
Blue Earth
Watonwan
Cottonwood
Pipestone
Nicollet
Wabasha
Dakota
Scott
Chisago
Isanti
Brown
Sibley
Carver
Wright
Meeker
Kandiyohi
Renville
Redwood
Sherburne
Lyon
Lincoln
Yellow Medicine
Lac Qui Parle
Swift
Big Stone
Pope
Stevens
Traverse
Chippewa
Stearns
Benton
Carlton
Kanabec
Mille Lacs
Crow Wing
Morrison
Wadena
Todd
Douglas
Grant
Ottertail
Becker
Clay
Clear Water
Mahnomen
Norman
Red Lake
Pennington
Polk
Beltrami
Marshall
Koochiching
Lake of the Woods
Roseau
Kittson
McLeod
Ram- sey
Anoka 1 12 1 1 7 22 9 4 41
155 7
Cases with unknown exposure = 266
Cases with known exposure = 1,057
Minnesota = 722
Wisconsin = 99
Other State = 7 1
100 15
368 1 65 5 39 12 2 6 1 4 9 9 3
From 1995 to 2007, the majority of human anaplasmosis cases were exposed to an infected deer tick in north-central and east-central Minnesota.  This is consistent with the area of highest risk for Lyme disease, since the two diseases are spread by the same tick species, the blacklegged tick (deer tick). 14 3 7 1 1 2 5 1 1 1 2 1 2 1 10
* Includes confirmed and probable cases

49. Babesiosis Signs & Symptoms
High fever
Chills
Headache
Muscle aches
Fatigue
Loss of appetite
Babesiosis is a protozoan infection. 
Signs and symptoms may include:
High fever
Muscle aches
Chills
Fatigue
Headache
Loss of appetite
Signs and symptoms may go away without treatment, but some cases may be severe.  If babesiosis is suspected, see your doctor immediately.  Babesiosis is treated with antimicrobial drugs. 
Some people may be infected with two or more tick-borne infections at the same time, which can make diagnosis and treatment difficult.

50. Summary of Tick-Borne Diseases, Minnesota, 1999-2008 (n = 9,333)
Lyme disease is the most common of three tick-borne diseases in Minnesota, followed by human anaplasmosis.
Babesiosis remains rare in Minnesota, although the number of people with aysmptomatic infections is likely much higher than the number of detected cases.

51. Prevention Actions
Campers, hikers, hunters, people in outdoor occupations, and people who live near the woods may be at risk in the counties known to have blacklegged ticks.
Know whether you live, work or play in an area that has blacklegged ticks
Take precautions when in blacklegged tick habitat, especially from May through July
Remember, preventing exposure to blacklegged ticks requires diligence
Now we’ll focus on ways to prevent exposure to blacklegged ticks (deer ticks) and tick-borne diseases.
You should know whether you live, work, or play in an area that has blacklegged ticks.  Some people have been exposed to a blacklegged tick in their yard.  Campers, hunters, farmers, and people in outdoor occupations may be at risk in the counties known to have blacklegged ticks. People in these counties who live in or adjacent to the woods may also be at risk.
Be aware of tick habitat, especially from May through July in Minnesota, when ticks are most actively feeding.  But also remember that adult blacklegged ticks may feed as early as March and as late as November. Remember that deer ticks are most often found in thick woods or brush.
Preventing exposure to blacklegged ticks requires diligence.

52. Lyme Disease Vaccine Discontinued in 2002
The Lyme disease vaccine for humans was discontinued in February 2002.  We do not expect any other Lyme disease vaccines for humans in the near future.
Discontinued in 2002

53. Prevention
Use repellents (DEET or permethrin), according to label directions.
Tucking pants into socks creates a barrier to ticks.
Wearing light-colored clothing helps to more easily spot ticks.
Take preventive actions to protect yourself from tick bites, especially from May through July in Minnesota.
Wear long pants and long-sleeved shirts.
Tuck pants into boots or socks and shirt into pants to create a barrier to ticks.
Wear light-colored pants and shirt so ticks can be easily seen.
We also recommend the use of repellents containing DEET (up to 30% for children and adults) or permethrin.

54. Checking for Ticks
Check thoroughly for attached ticks after you’ve been in a wooded area. Ticks can attach anywhere on the body, but are often found in areas such as behind knees, between legs, around the waist, and under arms.
It is a good idea to check yourself and your children for ticks after spending time in a wooded or brushy area.

55. Pets Check your dog or cat for ticks before bringing them inside.
There is a Lyme disease vaccine for dogs, but it does not prevent them from bringing ticks into the home.
A vaccine to prevent Lyme disease is available for dogs.  However, the vaccine will not stop your dog from bringing ticks into the home. 
Check your dog or cat for ticks before allowing them inside
Check often for ticks on yourself, children, and pets.

56. Avoid Deer Tick Bites Be aware of high-risk times and places
Walk in the center of trails to avoid picking up ticks from brush
Wear long pants, light-colored clothing, and repellent
Walk in the center of the trail to avoid picking up ticks from grass and brush.
Carefully use repellents and other chemicals on your body, clothes or property.  Use repellents according to instructions on the container. DEET and permethrin are the most effective products currently available. Since ticks usually climb onto people at or near ground level, concentrate repellent use from knee-height down.

57. Avoiding Blacklegged Ticks at Home
If you live in an area with blacklegged ticks (deer ticks):
You may be exposed to blacklegged ticks in your own yard. Typically, ticks are located along the fringe of your yard and a wooded area.
Keep your lawn mowed short.
Remove leaves and clear the brush around your house and at the edges of the yard.
Create a landscape barrier between your lawn and the woods; for example, a 3-foot wide border of wood chips.
If you live in area with ticks, they are usually located around the fringe of your yard and a wooded area.

58. Removing Attached Ticks
Ticks have barbed mouth parts. This means that ticks attached to the skin should be pulled out slowly and steadily.
Prompt tick removal is important.   First of all, if you find a deer tick on you, another person or your pet, don’t panic. 
Notice the barbed mouth part on this tick. 
The earlier you remove the tick, the less likely it can transmit the Lyme disease bacteria, if it has the bacteria.

59. To Remove a Deer Tick Use tick forceps or tweezers
Grasp the tick close to the skin
Pull outward S-L-O-W-L-Y, gently, and steadily
Do not squeeze the tick
Use an antiseptic on the bite
Use these steps to remove a tick:
Use forceps or tweezers,
Grasp the tick close to the skin,
Pull the tick outward slowly, gently and steadily,
Do not squeeze the tick, and
Use an antiseptic on the bite.
Do not use Vaseline to smother the tick; you can’t smother ticks that way. Also, don’t try to burn the tick with a match; this will not cause the tick to pull out and you could get burned.

60. Important Messages
Know whether you live, work or play in an area that has deer ticks
Take preventive actions
Seek early diagnosis and treatment
Know if you live, work or play in an area with deer ticks.
Take preventive measures.
Seek early diagnosis and treatment.

61. Whom to Contact Minnesota Department of Health
Metropolitan Mosquito Control District
For more information about:
Signs and symptoms, diagnosis, treatment and prevention of Lyme disease, human anaplasmosis and babesiosis, call the Minnesota Department of Health at (651)
Blacklegged ticks in the Twin Cities Metropolitan Area, call the Metropolitan Mosquito Control District (MMCD) at (651) MMCD can also provide homeowner consultations to reduce ticks at your home property.

62. Minnesota Department of Health’s Lyme Disease Web Site
Scroll down to “Diseases and Conditions” and click on “Diseases A to Z”
Click on “Lyme Disease”
Minnesota Department of Health’s Lyme Disease Web Site