The Centers for Disease Control and Prevention (CDC) reported in May of 2018 that the number of illnesses caused by mosquito, tick, and flea bites more than tripled in the United States between 2004 and 2016.
Nine new germs spread by mosquitoes and ticks were discovered or introduced into the United States during this time. “Zika, West Nile, Lyme, and chikungunya—a growing list of diseases caused by the bite of an infected mosquito, tick, or flea—have confronted the U.S. in recent years, making a lot of people sick. And we don’t know what will threaten Americans next,” said CDC Director Robert R. Redfield, M.D. 1
As runners, athletes and active people, we cannot simply stay inside with the windows locked tight and fear in our hearts.
Most of us grew up with mosquitoes, black flies and ticks. When I was a kid running around the Maine woods I rarely heard about ticks but black flies and mosquitoes were a common topic of conversation.
We knew that these insects were most active from dusk to dawn in the cool evening air. It was not unusual to see these insects during the day, but you could be eaten alive by them at night.
Ask anyone who has camped out in the Maine woods what it’s like to try and get to sleep with all of that buzzing, hopefully just outside of your tent.
Tick and Mosquito Season
Tick season is generally April through December and peaks from May to August in Massachusetts. During these months you should be particularly aware of the symptoms of tick born diseases.
It should be noted that ticks do not die in the winter. When it is below freezing they take cover in leaf litter and possibly your yard under the snow.
If it is over 40° ticks can be active and you should take the same precautions that you would in peak season.
Mosquito season generally begins when the temperature approaches 50°F.
As the temperature rises, so does the population of mosquitoes. It should be noted that some mosquitoes hibernate during the winter and some can winter-over in your house.
Closets are a common place to find mosquitoes in your home during the winter months. 2
In general, you should be safe from mosquito bites most of the winter in North America.
Tick Born Diseases
The most common tick-borne disease in Massachusetts is Lyme Disease. Much less common are Babesiosis, and Anaplasmosis. Rarer still are Tularemia, Rocky Mountain spotted fever, Borrelia miyamotoi, and Powassan virus.
All diseases carried by ticks start out the same way according to Massachusetts Deputy State Epidemiologist and State Public Health Veterinarian Dr. Catherine Brown.
The four most common symptoms are fever, chills, headaches and muscle aches. More specific symptoms related to each illness develop as they progress, but they all start with these four symptoms. With Lyme Disease you may also see a rash around the bite location.
Lyme Disease is wide-spread in Massachusetts, most of the Northeast and in Michigan and Minnesota. Lyme disease appears to be spreading to any area with ticks.
Lyme Disease is named after Lyme and Old Lyme, CT where the disease was first discovered.
Lyme disease came into public view when an epidemic of what appeared to be rheumatoid arthritis began afflicting children in Lyme, Connecticut.
A young rheumatologist at Yale named Allen Steere, who now conducts research at Massachusetts General Hospital, in Boston, studied the children.
In 1976 he named the mysterious illness after its locale and described its main symptoms more fully: a bull’s-eye rash; fevers and aches; Bell’s palsy, or partial paralysis of the face, and other neurological issues; and rheumatological manifestations such as swelling of the knees.
After much study, Steere realized that the black-legged ticks that live on mice and deer (among other mammals) might be harboring a pathogen responsible for the outbreak. In 1981, the medical entomologist Willy Burgdorfer finally identified the bacterium that causes Lyme, and it was named after him: Borrelia burgdorferi. 12
Nantucket and Martha’s Vineyard in Massachusetts are hotbeds for Lyme Disease in the US.
40% of Nantucket’s 10,000 year-round residents have had the disease or are currently being treated for it! 3
It is so bad that they are considering the release into the wild of mice genetically modified to be immune to the disease. A team from MIT lead by Kevin Esvelt wants to use a gene editing technology called CRISPR and Gene Drive to make the mice immune to Lyme Disease. 4
White-footed mice carry the disease and ticks get it when they bite the mice and then humans. Research and discussions continue but many people on Nantucket are ready to try anything to deal with this problem.
The most common early symptom of Lyme is a rash which can look like a ring around the bite site. Flu-like symptoms, such as fever, headache, stiff neck, sore and aching muscles and joints, fatigue and swollen glands may also occur.
Early treatment is crucial to prevent more serious problems as the disease progresses.
The joints, nervous system and heart are most commonly affected as the disease progresses.
• About 60% of people with untreated Lyme disease get arthritis in their knees, elbows and/or wrists. The arthritis can move from joint to joint and become chronic.
• Many people who don’t get treatment develop nervous system problems. These problems include meningitis (an inflammation of the membranes covering the brain and spinal cord), facial weakness (Bell’s palsy) or other problems with nerves of the head, and weakness or pain (or both) in the hands, arms, feet and/or legs. These symptoms can last for months, often shifting between mild and severe.
• The heart also can be affected in Lyme disease, with slowing down of the heart rate and fainting. The effect on the heart can be early or late.
Prompt treatment with antibiotics prevents later, more serious symptoms. 5
Lyme Disease is nothing to fool with. If you are in an infested area you need to check yourself often and take precautions to protect yourself.
The other tick born diseases are less common and generally less dangerous to your health. If you have been in a tick infested area and develop flu-like symptoms or develop a rash call your doctor right away.
Mosquito Born Diseases
The most common diseases carried by mosquitoes are West Nile Virus (WNV) and Eastern Equine Encephalitis (EEE). Less common in the US are Zika, Chikungunya and Dengue.
The majority of people who are infected with WNV (approximately 80%) will have no symptoms.
A smaller number of people who become infected (~ 20%) will have symptoms such as fever, headache, body aches, nausea, vomiting, and sometimes swollen lymph glands. They may also develop a skin rash on the chest, stomach and back.
Less than 1% of people infected with WNV will develop severe illness, including encephalitis or meningitis. The symptoms of severe illness can include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis. Persons older than 50 years of age have a higher risk of developing severe illness.
Since most people exposed to WNV have no symptoms it is difficult to say how many people actually become infected each year.
Between 2000 and 2010, 67 people were reported infected with WNV in Massachusetts. Six of these people died. There is no specific treatment for this virus so we are fortunate that most of us have little to no reaction from the infection. 6
The first symptoms of EEE are fever (often 103º to 106ºF), stiff neck, headache, and lack of energy. These symptoms show up three to ten days after a bite from an infected mosquito. Inflammation and swelling of the brain, called encephalitis, is the most dangerous and frequent serious complication. The disease gets worse quickly and some patients may go into a coma within a week.
There is no treatment for EEE. In Massachusetts, about half of the people identified with EEE died from the infection. People who survive this disease will often be permanently disabled. Few people recover completely.
Since 1938 fewer than 100 cases have been reported in Massachusetts, with 60% of cases in Plymouth and Norfolk counties. Outbreaks of EEE occur about every 10 to 20 years with the most recent Massachusetts outbreak starting in 2004 and ending in 2006. Of 13 reported cases, six were fatalities. 7
Zika is a relatively new disease to North America. 80% of people exposed to Zika report no symptoms. Those who do react to the virus report symptoms 2-7 days after being bitten by an infected mosquito. Symptoms include fever, rash, joint pain and conjunctivitis. If a woman is pregnant and contracts Zika the disease may spread to the fetus.
It is extremely unlikely that anyone could become infected with Zika virus from a mosquito bite in Massachusetts. The kinds of mosquitoes that are known to carry Zika virus are generally not found in Massachusetts. 8
Most people contract Zika when they travel to areas where it is prevalent. Zika has been reported in Texas and Florida in the past with a few neighborhoods in Miami listed as active transmission areas.
Zika can also be transmitted through unprotected sex and can be transmitted by a pregnant woman to her baby during pregnancy.
Tick and Mosquito Bite Prevention
As the old saying goes an ounce of prevention is worth a pound of cure. Here is what you need to know.
Preventing Tick Bites
Ticks are most active in warmer weather and can be found in tall grass, brush and wooded areas. Ticks do not fly or jump. They latch onto passing mammals when they brush up against grass or a plant where the tick is clinging.
DEET and permethrin are both recommended to repel ticks. You can buy clothing infused with permethrin and permethrin actually kill ticks, not just repel them.
Permethrin should be applied carefully and according to the manufacturers directions.
Long-sleeved shirts and light colored pants tucked into your socks or boots are also recommended. This doesn’t work very well for runners who typically have a great deal of exposed skin.
Staying on cleared trails while running and avoiding the brush and grass along the trail is also recommended. Ticks are literally hanging out on the vegetation next to trails and clearings waiting for a mammal to come by.
For runners the best advice is to put on some DEET or permethrin and to stay on the trails. Since it’s almost impossible to avoid brushing up against foliage while running, you need to do a post run tick check.
Ticks like warm and moist areas of the body. Areas to check include:
- Inside and behind the ears
- Along your hairline
- Back of your neck
- Behind your knees
- Between your toes
You should also check your skin for new freckles which could be a tick.
The best way to remove a tick is with fine point tweezers. Do not use a hot match, petroleum jelly or any other home remedy. 10
You should save the removed tick and make note of the date and where on your body the tick was removed from. Ticks can be analyzed in a lab to discover if and what they are infected with. This can be crucial to your diagnosis if you end up with an infection.
Save the removed tick in a tightly sealed container.
Notify your doctor if you develop flu like symptoms or a rash.
If you run with your dog, this article from YourDogAdvisor.com has some good information for you.
Preventing Mosquito Bites
DEET and permethrin are recommended to repel mosquitoes. Since mosquitoes are active 24 hours a day, it is a good idea to use repellant if you are in an area active with mosquitoes any time of day.
You are more likely to find mosquitoes near bodies of water such as ponds or streams. Mosquitoes can lay their eggs in a table spoon of water, so anywhere near any standing water could have a high concentration of insects.
Dusk to dawn are peak hours for mosquito activity, so using repellent at these times is highly encouraged.
Long-sleeved shirts, long pants and socks are also recommended. Since these are generally impractical for runners it is best to use repellent, avoid high mosquito activity hours and locations.
Unlike ticks, mosquitoes do fly. While running, you are probably safe from getting a bite. But when you stop running the little buggers are sure to find you and all of that exposed skin!
How to Choose a Repellent
The EPA has a great site where you can select a repellent based on your needs. You can specify how long you need protection for, what you need protection from and which ingredients you are interested in.
You can also look up specific products, companies and EPA registration numbers.
Click HERE and scroll to the bottom of the page to look for your repellent.
Tick and Mosquito Season Running Go Bag
I always keep a bag of running gear in my car. In the winter this is often just a pair of gloves and a winter hat that I’ve picked up as swag at a race. Why leave them in a pile at home when they could literally be a life saver in the winter?
In the summer time it is easier to spontaneously go for a run after work with friends. So in addition to keeping some running gear in my go bag I also keep sun screen and a can of insect repellent.
If you are running after work in the summer, it is likely you will be out at dusk. While you are running you will probably be okay. But when you stop for a drink or to hang out after your run, you could be swarmed by mosquitoes, black flies and possibly horse flies.
Having a DEET based repellent in your car is a great idea. I’ve been at races along The Charles River in Boston and seen runners freely passing around a can of bug spray. Stranger or no, no one can stand by and watch others suffer. Hanging out next to the river before a race can literally suck!
I hope you have a great summer running season and stay healthy.