Abstract
Occupational and environmental health nurses should educate workers about ways to prevent tick bites, which can cause Lyme disease.
Lyme disease is the most commonly reported vector-borne illness in the United States with more than 300,000 new cases diagnosed each year (Centers for Disease Control and Prevention [CDC], 2015a). In 2013, 96% of confirmed cases were reported from 13 states, the majority of them in the Northeast and upper Midwest (CDC, 2015a). Ticks are active in the months of April through October and peak in the summer months of June through August.
Lyme disease is caused by the bacterium Borrelia burgdorferi carried by infected ticks such as the blacklegged deer tick. Most humans are infected by bites of immature ticks called nymphs which are less than 2 mm and difficult to see (Mayo Clinic, 2012). Outdoor workers, whose jobs are in grassy or wooded areas where the infected ticks live, may be at risk for Lyme disease. Forestry workers, construction workers, landscapers, land surveyors, utility line workers, farmers, veterinarians, military recruits, orienteers, and park/wildlife management workers are at risk (Occupational Safety and Health Administration [OSHA], n.d.; Piacentino & Schwartz, 2002). Non-occupational exposure to infected ticks also occurs while performing property maintenance, hiking, camping, fishing, and hunting.
When infected ticks attach to the human body, they feed slowly and must be attached for 36 to 48 hours to transmit disease (Mayo Clinic, 2012). Typical symptoms are fever, headache, chills, fatigue, lymph node swelling, and a “bulls-eye” rash at the site of a tick bite. The rash, called erythema migrans, is one of the hallmarks of Lyme disease which occurs in 70% to 80% of infected individuals. The rash will gradually expand over several days and can reach up to 12 inches (CDC, 2015b). Joint pain and swelling, particularly in the knees, may also develop. Weeks, months, or even years after being infected, individuals can experience meningitis, Bell’s palsy, numbness or weakness in limbs, and impaired muscle movement.
Awareness of Lyme disease and its symptoms are essential for diagnosis and treatment. Laboratory tests, such as enzyme-linked immunosorbent assay (ELISA) test, can detect antibodies to B. burgdorferi. The Western blot test is usually done to confirm the diagnosis of Lyme disease. If recognized early, it can be effectively treated with oral antibiotics such as doxycycline, amoxicillin, or cefuroxime axetil. About 10% to 20% of individuals can have symptoms last for more than 6 months after antibiotic treatment. Untreated, Lyme disease can become a debilitating disease affecting joints, the heart, brain, and the central nervous system.
Occupational and environmental health nurses should educate workers and supervisors about ways to prevent tick bites. Workers should cover their bodies as much as possible when working outside. Light-colored clothing should be worn so ticks can be easily seen. Workers should wear a hat, a long-sleeved shirt, and tuck pant legs into socks or boots to prevent ticks from reaching the skin. Clothing can be treated with permethrin, which stays effective through several washings, to kill ticks on contact. Insect repellents with 20% or higher concentration of DEET (N,N-diethyl-meta-toluamide) can also be applied to exposed skin.
After being outdoors, workers should conduct a full-body tick check, paying close attention to hairy areas of the body such as underarms, groin areas, and scalp. Any ticks discovered should be removed immediately using tweezers followed by cleansing the area with soap and water. Workers should shower immediately with hot water to remove ticks that may be on the body and place clothes in a dryer on high heat for 1 hour to kill any ticks clinging to the fabric.