Protecting yourself from ticks, mosquitoes and the diseases they can spread

Host Amber Smith: Upstate Medical University in Syracuse, New York invites you to be The Informed Patient with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. As the weather in Central New York gets warmer, ticks and mosquitoes become more active, and so do humans and their pets. Because ticks and mosquitoes can transmit disease, it's important to know how to protect yourself and your loved ones. I'm talking with Dr. Saravanan Thangamani. He's a professor of microbiology at Upstate who specializes in medical entymology and vector-borne diseases, and he leads a very popular laboratory devoted to tick testing. Welcome to The Informed Patient, Dr. Thangamani.

Saravanan Thangamani, PhD: Oh, thank you, Amber.

Host Amber Smith: Why is it that ticks and mosquitoes are likely to be more prevalent in Central New York this season?

Saravanan Thangamani, PhD: Well, there are two things I want to mention: Mosquitoes are active in our area from April to October. And during this time mosquitoes look to lay eggs in slow-moving and standing water. And as far as the ticks are concerned, they are active throughout the year. You have different types of ticks that can be active even winter as well. It's just that they lay under the leaf litter, shielded from harsh winter, but as soon as the ground thaws, they come out. So, that actually segues to the next thing -- why we are seeing more ticks and mosquitoes, or why we will be seeing more ticks and mosquitoes this season is that the first culprit is the climate change.

You know, climate change impacts human health by increasing the vector-borne diseases. So when I say vector, vector is an organism such as ticks or mosquitoes that can transmit a pathogen that can cause disease to human or animals. The climate changes, in a way, alter the condition of the biology of the vector biology of the tick or a mosquito, and also the pathogen they carry. For example, the development and survival of ticks, and the animal hosts such as deer, and the bacteria that causes Lyme disease are strongly influenced by climatic factors, especially temperature, precipitation and humidity. And also the rising global temperatures can lengthen the season and the geographic range of these vectors. The reason being is that warmer average temperature means longer warm season. So when I say longer warm season, it means earlier spring, shorter, milder winters, and hotter summers. These conditions are perfectly suitable for mosquitoes and ticks and the pathogens they transmit to perpetuate. And so overall, we are seeing rising temperatures, and that's one reason why I'm actually thinking that this year, we will see more tick and mosquito-borne disease emergence in New York.

Host Amber Smith: Do they prefer warm and dry weather, or warm and wet weather, or does it matter that much?

Saravanan Thangamani, PhD: That's a very good question. Warm and dry are good for ticks. Warm and wet is good for mosquitoes. So it is a caveat. You know, mosquitoes like to lay eggs near the water bodies, so they require more moist, wet environments. And ticks on the other hand, they like to have more humidity, but they don't want it to be too overtly wet. So that is a little bit of biology there, but at the end of the day, the climate change impacts are in increases in the abundance of both mosquitoes and ticks.

Host Amber Smith: Are there things that people can do around their homes to reduce ticks and mosquitoes?

Saravanan Thangamani, PhD: Absolutely. These are all preventable diseases. Personal protective measures are important to prevent us from getting mosquito bites or tick bites. But obviously you have to take different measures for mosquitoes and different measures for ticks. In the case of mosquitoes, I would recommend that they should use screens on windows and doors. Repair holes in the screens to keep mosquitoes outdoors. So you don't want any mosquitoes to come inside your house. And also use air conditioning if it's available, so that's not conducive for the mosquitoes. And also the most important thing is to stop mosquitoes from laying eggs in or near the water. So my recommendation would be to once a week empty or scrub or turn over items that hold water, such as tires and buckets, planters, toys, pools, bird baths, flower pots and trash containers. And I would always check for water-holding containers, both indoor and outdoor, and then all you have to do is to flip it upside down so that the water doesn't stay there. If the water is there, the mosquitoes would like to land on it and lay eggs on it. And the eggs will then hatch into larvae inside the water because they have perfect organic material in that water. And the larvae become pupae. Pupae will emerge into adult, and they will start to fly around and probably feed on the humans that are in the house. Those are the easy things for the mosquitoes, in terms of how we can prevent mosquito bites, considering the way we live.

For the ticks, again, we have to create a tick safe zone to reduce particularly deer ticks. We have to remove the leaf litter, clear tall grasses and brush around homes and at the edge of the lawns. It would be best to provide a three-feet wide barrier of white chips or gravel between lawns and wooded areas to restrict tick migration into recreational areas. Mow the lawn frequently. There are multiple other things that if you go to www.CDC/ticks, they provide a lot of information on how one can actually keep their yard tick free. But there are chemicals available that one can use to prevent the mosquito or tick bites. The most common ones are the use of tick or mosquito repellents. They can apply on themselves or on their clothing material before they actually go out. There are several chemical based repellents are available. The most popular ones are the DEET-based or the oil of lemon eucalyptus- based.

Host Amber Smith: Let me ask you, are there pesticide products to put on the yard, though? So that a person doesn't have to put the chemical on their body? Is there something you can spray on your yard that works to get rid of ticks?

Saravanan Thangamani, PhD: Yes, they are available. So you can use permethrin- based products to spray your yard. And so that will actually keep the mosquitoes and ticks away, and upon contact, they will die. You can do that, but again, permethrin products are sensitive for skin, so one has to be careful when applying to the yard.

Host Amber Smith: And I've also heard that bats like to eat mosquitoes -- I don't know if that's really true, -- but if it is, would it work to put a bat house in your yard to attract bats?

Saravanan Thangamani, PhD: It's a partially true. So bat houses are good to provide a safe environment for bats. Insect-eating bats, or insectivore bats, when they roost in these bat houses, they can protect the yard from pest insects, like mosquitoes, moths and beetles. However, they are less effective at reducing the mosquito burden on a daily basis. On the other hand, we need to be careful about having bats in our back yard because they can carry deadly pathogens that can cause disease to humans.

Host Amber Smith: Well, I appreciate the tips that you gave about making the yard a little safer. If someone has dogs, are they going to be at higher risk of getting ticks in their home, if the dog goes outside and brings the ticks in with them?

Saravanan Thangamani, PhD: Pets and dogs, I consider them as tick magnets, so we have to be more vigilant. If we have a dog that goes into the yard and plays, or goes off the trail and comes back, they always bring ticks on themselves. So we have to do tick checks on the dogs and probably shower on a regular basis on the dog to look for any ticks that are crawling or attached to them.

Host Amber Smith: All right. If a human makes it a habit, when they come indoors, to shower, wash their hair, after they've been out hiking or something, is that going to be enough to dislodge the ticks or do they still need to go through their hair carefully?

Saravanan Thangamani, PhD: They have to go through their hair carefully because if the ticks are crawling on them, showering is great. But if the tick is already attached to the skin, then the shower is not going to help. They still have to look, and they still have to go manually, use some fine tweezers to pull the ticks. They still have to do tick check on their body.

Host Amber Smith: Do ticks attach themselves to clothing? Because I wonder how important it is to shake the clothing off once you come in, or maybe you shouldn't do that cause you may be shaking ticks off.

Saravanan Thangamani, PhD: Well, I think that if you want to shake, you can shake it outside the home. I would say, not inside, because whatever ticks that are crawling on the surface of the clothing material will drop off there. So you don't want to have ticks in your home. So the best thing is, I tell people, don't shake off the dress, just take off the dress, put directly into the dryer or washer. So if any ticks are still crawling or are hiding in the seams they will die when you put them into the washer or dryer.

Host Amber Smith: This is Upstate's The Informed Patient podcast. I'm your host, Amber Smith talking with Dr. Saravanan Thangamani. He's a professor of microbiology at Upstate and an expert in ticks. If you have a tick you want to send in for analysis, go to his website, NYticks.Org. That's N Y T I C K S dot O R G.

So there are instructions on your website, but let me ask you to go over with us, how people need to submit a tick that they pull from themselves or their dog. What are the steps they need to take?

Saravanan Thangamani, PhD: The first step is that, pull the tick very carefully, and use blunt-tip tweezers. I know sometimes people use sharp-tip tweezers, but depending on the location where the tick is attached, you may want to use a blunt-tip tweezer. Just go right underneath where the tick is attached onto the skin, and then gently pull upwards with gentle pressure. Once you pull the tick, then you sanitize the area where the tick was attached and then put the tick on a moist towel. Fold it, and then put it inside a Ziploc bag and send it to us. Our lab is providing free Ziploc bags with printed information on how to ship it, how to pack it and send it to the lab.

So once you put the tick inside the Ziploc bag, go to our website NYticks.org, click on the tick submission tab and provide the information about where you found the tick and what date you found the tick, because we use that information for scientific analysis. So once you provide that information and you complete the form, we then give you a unique tick ID for the tick that you submitted. And we advise you to submit this form -- one tick per form and also one tick per Ziploc bag -- so that we can actually track which tick carry which pathogens. And then, we provide information on our Ziploc bags where to send it. Once you send it to the lab, we then send an acknowledgement email to you as soon as we receive the tick in the lab. And then it takes about three to five days for us to process each tick. And once tick processing is done, tick testing is done, we then send a results email to the submitter. So for that reason, if anyone wants the results to be sent back to them, they need to provide an email address to us because we do not send results via post. We only send by email.

Host Amber Smith: So can someone obtain your Ziploc bags by visiting your website?

If anyone wants Ziploc bags from our lab, all they have to do is to send us a regular self addressed stamped envelope to my lab, and we'll be more than happy to fill 10 or 20 bags in that envelope and send it back to whoever wants it, and they can use that to send it. So we are providing this for free to all New Yorkers.

Host Amber Smith: Now, what percentage of the ticks that you receive are found to be carrying a pathogen?

Saravanan Thangamani, PhD: So, between 35 and 40% of the ticks carry at least one pathogen. And it is, depending on the season, During the spring season, which is the highest that I would say, nearly 45 to 50% of the ticks carry at least one disease-causing agent. Of that, the Lyme disease agent is the dominant factor.

Host Amber Smith: And so people would, perhaps, receive an email back telling them that they had this particular pathogen?

Saravanan Thangamani, PhD: So we send out what type of tick it is, and what life stage it is, and do they carry a disease-causing agent or not? If it is yes, then we provide the name of the pathogen.

Host Amber Smith: And then what determines if the pathogen has been transmitted to the person? Because just because you found it in the tick, does that mean that they got it?

Saravanan Thangamani, PhD: No, that's a very good point. Just because the tick that you sent to us was positive, it doesn't mean that you got that agent as well. So that needs to be verified in a clinical setting with your primary care provider. But if a tick that is positive from our testing, if it stays attached on your human skin or in a pet's skin for a good number of hours, that determines that what is the chance of someone getting a pathogen or not? So, for example, for the Lyme disease agent, the tick needs to be attached on a human or a pet for at least 24 to 48 hours for the Borrelia to successfully transmit to a human. That is a qualitative measure. So one needs to know how long the tick stayed attached. It's very difficult to tell that. My advice to the public is that if they receive a result from us saying that it is positive for a particular agent, and if they thought that it stayed attached on the skin for a good number of hours, they should take that information to the clinician, and the clinician will make a proper decision based on the information. So we are providing additional set of information for the clinician to make a differential diagnosis.

Host Amber Smith: Now their protective measures we've talked about sound like kind of a lot of work, really, but I'd like to talk a little bit more about why it's important because some of the diseases that can be transmitted, I mean, you mentioned Lyme disease. What's the other one? Borelia?

Saravanan Thangamani, PhD: Borrelia burgdorferi is the causative agent of Lyme disease. It is the bacterium that causes the Lyme disease.

Host Amber Smith: And then what are some of the other tick-transmitted diseases or pathogens that we should be aware of? Because you're finding more than just Lyme, right?

Saravanan Thangamani, PhD: Exactly. The deer ticks that are most commonly presenting in our part of New York carry multiple disease causing agents. The Lyme disease agent is the dominant one, followed by anaplasmosis agent and babesiosis the agent, Babesia microti. These three are the major ones that we detect in our testing program. And they all are acute febrile illnesses. If detected early, in the health care setting, they can be treated. However, if it is not detected early, it can have lifelong consequences as well.

Host Amber Smith: But again, if you find one of these pathogens and the person gets the report back from your lab, they can at least be alert to the common symptoms and see if they develop them.

Saravanan Thangamani, PhD: Exactly. So what I advise to people is that if they get the result from us to be a positive tick, I tell them, watch out symptoms for the following 30 days. Do you develop a rash? A fever? Or fatigue? A headache or muscle pain? If you have one of those symptoms within the first 30 days of a tick bite, I would then recommend them to visit their healthcare provider. Take the tick results that came from the lab. It's up to the discretion of the health care provider to use our data or not because we are not a clinically certified laboratory. We are a research laboratory. It is up to the discretion of health care provider, but it is important for them to actually monitor symptoms for at least 30 days for, like, an acute febrile illness. If they find, if they observe anything, then maybe they should visit the doctor immediately.

Host Amber Smith: We've talked a lot about the tick-borne diseases, but what mosquito born diseases do we need to be aware of or concerned about in Central New York?

There are two major things that we need to be concerned in Central New York for mosquito-borne diseases, which is the most common one that everybody aware is the West Nile virus that causes West Nile encephalitis. The other important one that we should know about is the Eastern Equine Encephalitis virus -- which is otherwise called triple E virus -- which is caused by Culiseta malanura. Both the West Nile virus and the triple E virus are transmitted by bird-feeding mosquitoes, and humans accidentally come in contact with those mosquitoes, and we get exposed and we succumb to the disease. But I must mention that both triple E and West Nile are neuroinvasive encephalitis viruses with deadly outcomes, and we don't have vaccine or any therapeutics, so, not getting a mosquito bite is only prevention at this time. It's the same thing with the tick-borne diseases, you know, minimizing the exposure is the only prevention we have at this time.

Host Amber Smith: And of course with the mosquitoes, the mosquito bites and flies away or get slapped. If you smash it, there's nothing left to test, I guess, right?

Saravanan Thangamani, PhD: No, but there is nothing left to test exactly. However, county health departments and state health departments, they collect mosquitoes throughout the state, and they monitor for rate of prevalence. So they do have a robust mosquito surveillance program that county health departments are participating in.

Host Amber Smith: Well, Dr. Thangamani, once again, I thank you for making time for this interview. And I'll remind listeners that your website is NYticks.Org.

Saravanan Thangamani, PhD: Thank you. Appreciate it.

Host Amber Smith: My guest has been Dr. Saravanan Thangamani. He's a professor of microbiology at Upstate. The Informed Patient is a podcast covering health, science and medicine brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at upstate.edu/Informed. This is your host, Amber Smith, thanking you for listening.