Frequently Asked Questions

Frequently Asked Questions About Ticks and Tickborne Illness on Martha’s Vineyard: 

What You Need to Know and Do

 

What are ticks? 

• ticks are small bugs in the arachnid (or spider) family that attach themselves by biting humans and other animals to obtain a blood meal (feed).

 

Where are they found?

• on Martha’s Vineyard, ticks are found in in wooded areas, dune grasses, fields and meadows, lawns, leaf litter

 

Why should I worry about tick bites?

• ticks can spread bacteria, viruses and parasites that can make humans—and other animals, including pets—sick.

 

What tick species exist on Martha’s Vineyard and what diseases do they carry?

• 4 species of tick live on Martha’s Vineyard, 3 of which pose a disease or illness risk to humans 

  • Deer ticks:

    • Lyme Disease, Babesia, Anaplasmosis, Ehrlichiosis, Powassan Virus, Borrelia Miyamotoi

  • Lone Star ticks

    • Ehrlichiosis, Tularemia, STARI, and confer a risk of Alpha Gal Syndrome 

  • Dog ticks

    • Rocky Mountain Spotted Fever (even here!), Tularemia

  • Asian Longhorned Ticks

    • Not currently known to transmit disease to humans in the United States, prefer animal hosts

 

Do different tick species prefer different habitats?

• Deer ticks thrive where yards and trails border wooded areas, among ornamental plantings and prefer shady, more humid areas including among leaf litter

• Dog ticks don’t mind sunny areas, thrive in dune grasses can even be seen on your patio or deck

• Lone Star ticks are very robust and can tolerate higher temperatures and dryer conditions than Deer ticks and can be found in all of the above habitats as well as in lawns and parks

 

What do ticks look like and how do I identify them?

• unlike insects (which have 6 legs), ticks are arachnids (which have 8 legs).

• different species look generally similar and can usually be readily recognized by their 8 legs (not 6), but identifying the specific species of tick can be difficult by patients and even clinicians. 

• additionally, a tick’s appearance varies with its life stage and engorgement status (whether it is filled with blood). 

• newly hatched ticks can be as small or smaller than poppy seeds and almost translucent. 

• adult ticks often have specific patterns that help indicate their species 

• males and females of a given species can have different patterns and be different sizes

• engorged ticks (those filled with blood) can expand to (XX) their size and make them harder to identify. 

• Definitively identifying which kind of tick bit you can be helpful, but is not imperative

 

Photos of Local Tick Species +/- Various Stages and Degrees of Engorgement (can have on site or click out to a different link at MVBOH)

 

LONE STAR TICK

 

ENGORGED FEMALE LONE STAR TICK

 

LONE STAR TICK LARVA (“SEED TICKS”)

 

BLACKLEGGED or DEER TICK

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ENGORGED FEMALE BLACKLEGGED or DEER TICK

 

DOG TICK

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ENGORGED FEMALE DOG TICK

 

What time of year do I need to worry about tick bites?

• ticks are active when temperatures are above 39 degrees F.

• given warmer winters, this means that avoiding tick bites is important YEAR ROUND

• ticks are MOST active, however, in warmer months, beginning around March and extending through October. 

• different species and stages of ticks (e.g, adults, nymphs and larvae) are prevalent during different periods. For example, Lone Star Tick larvae are most active in June through October. 

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What are the symptoms of tickborne illnesses?

• Many tickborne illnesses have similar, flu-like symptoms. These symptoms are often vague and non-specific. The most common of these are:

  • fever and chills

  • body aches

  • rashes 

  • headache

  • fatigue

• Some have more specific symptoms in addition to the above. For example:

  • Lyme Disease can cause a “bull’s eye rash” known as “Erythema Migrans”

 

https://lymediseaseuk.com/lyme-rash/ PHOTO

 

• Rocky Mountain Spotted Fever causes a distinctive rash that often involves the palms and soles, often begins as small, flat, pinkish or red spots or bumps before becoming more purplish due to bleeding under the skin. It is usually accompanied by a very high fever. 

 

https://www.cdc.gov/rocky-mountain-spotted-fever/about/index.html PHOTO

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• Tularemia (when associated with tick bites as opposed to other means of infection) can involve skin ulcers and swollen glands near the bite site

• Ehrlichiosis is often associated with gastrointestinal symptoms like nausea, vomiting or diarrhea

• Some tickborne illnesses can cause symptoms so mild they are not noticed and resolve on their own, without medical intervention

• Others resolve fully after proper treatment

• In severe cases, tickborne infections can result in significant and life-threatening illness involving the heart, brain, kidneys or liver, chronic health issues / long-term organ damage post treatment, or even death

• Individuals with compromised immune systems, the elderly and the very young may be particularly at risk of severe tickborne illness

• With prompt recognition and treatment, most people recover fully from tickborne infections

 

What is Alpha-Gal Syndrome (AGS)?

• AGS is an allergy to the alpha-gal sugar, a molecule found in all non-primate mammalian products including meats, dairy and gelatin, as well as many medications and food additives

• AGS is not an infectious disease and therefore not treatable by antibiotics like most other tickborne illnesses

• AGS can result from the bite of a Lone Star tick which carries the substance that causes the allergy in its saliva

• not everyone develops this allergy after a tick bite

• many more people test positive for the antibody that causes the allergy than have symptoms. For this reason, testing without symptoms is NOT recommended

• when a person has AGS, they may experience gastrointestinal, allergic or a combination of these symptoms after ingesting food or other substances containing the alpha-gal sugar

• for some people, this means they must avoid mammalian meats only

• for those with more severe AGS, they must avoid ALL mammalian substances including meat, dairy and other products that contain the alpha-gal sugar. 

• for some the allergy is more significant than for others

• symptoms can range from gastrointestinal distress (nausea, vomiting, cramping, diarrhea) to more classic allergic reactions including hives, itching, facial swelling, wheezing, and even anaphylaxis. 

• Anaphylaxis is a medical emergency

 

What are the Symptoms of Alpha-Gal Syndrome (AGS)?

• The symptoms of AGS are unique from other typical food allergies in that they typically occur 2-8 hours after ingestion of mammalian products

• With most other food allergies, reactions occur within minutes to a half-hour

• This can make diagnosis complicated as patients and clinicians often do not make a connection between the substance causing the reaction and the reaction itself. 

• It is important that patients and clinicians think about and document the pattern of symptoms 

•  

 

• Symptoms of Classical AGS (roughly 80% of cases) can include:

  • Itching, hives, other rashes, swelling of the lips, face, tongue, airway, shortness of breath, wheezing, cough, nausea, vomiting, diarrhea, abdominal pain, lightheadedness, low blood pressure, racing heart or a combination of these symptoms.  These symptoms are typical of many other allergic responses. 

• Symptoms of Non-Classical AGS (roughly 20% of cases) generally include:

  • GI symptoms such as abdominal pain and cramping, nausea, vomiting, indigestion, diarrhea IN ISOLATION of other symptoms that commonly occur with typical allergic responses

  • They can also include joint aches and arthritis and isolated chronic itching

  • Are often misdiagnosed as IBS

 

How long do ticks need to be attached to transmit disease?

• Simply put, depends on the tick species AND the disease

• Some tickborne illnesses come from the tick’s gut. In these cases, ticks generally needs to be attached long enough to be “engorged” or full of blood. 

  • For example, deer ticks need to be attached for at least 24 hrs to transmit Lyme disease. 

  • In the case of Alpha Gal Syndrome and Powassan Virus, the substance that imparts the risk is in the tick’s saliva, which means that transmission may be near immediate to within 15 minutes

• In short, quick recognition of a tick bite and immediate removal of the tick is key

 

What activities increase my risk of tick bites?

• many outdoor activities can increase your risk of tick bites including camping, hiking in woods or fields, walking through dunes and even just sitting in your back yard.

• ticks generally climb on to and up humans and other animals when we brush past them in tall grasses or brush or walk through leaf litter

• others crawl on to or towards us in lawns or when sitting near beach dunes

• ticks do not fly or jump

• they do not move quickly

• they are not typically found in trees

 

How do reduce my risk of these tickborne illness?

• prevention of tickborne illness including AGS begins with prevention of tick bites as well as early recognition of tick bites followed by prompt removal

  • find and remove ticks quickly by performing frequent “tick checks” (SEE BELOW), including each time you come in from outdoor activities.

 

How do I prevent getting bitten by ticks?

•  Limit your exposure to tick habitats

  • Stay on well-groomed trails

  • Walk in the center of trails, avoiding brushing up against tall grasses or brush

• When tick habitats cannot be avoided:

  • Wear light-colored, long sleeves and pants with cuffs tucked into your pants

  • Consider treating your clothing with Permethrin sprays (many last several washes)

  • Consider wearing insect repellants containing 20% or greater DEET, picardin, or IR IR3535 on exposed skin

  • Organic sprays are also available but have not been shown to be as effective as chemical sprays

• Take off your outdoor clothes immediately upon returning home from outdoor activities and dry them on HIGH for 10 minutes. This will kill all ticks on your clothing. 

• Perform a tick check immediately upon returning home from outdoor activities (SEE BELOW)

• Reduce tick habitats in your yard:

  • Remove leaf litter and clear tall grasses and brush around your home and the edges of your yard

  • Control deer (ticks’ primary breeding ground)

    • with deterrent sprays

    • by planting greenery deer do not eat

    • by putting up deer fencing

    • don’t actively feed deer

  • Reduce the tick population

    • Consider application of insecticides to your yard and its perimeter 

    • There are both organic and non-organic options

    • Mow your lawn regularly

    • Create borders of woodchips or stone between lawns and wooded/brushy areas

    • Consider plantings that may deter ticks, such as lavender, rosemary, mint, citronella, marigold, garlic and other alliums, and lemongrass

  • Discourage rodents (which carry the diseases ticks transmit to humans):

    • Remove wood piles and other areas where small rodents nest

    • Use traps

    • Consider repellant sprays around stonewalls, sheds, woodpiles and other areas rodents prefer

    • Avoid leaving out seeds for birds that rodents also feed on

• Check your pets for ticks regularly as they, too, can contract tickborne illnesses AND they can bring ticks into your home. 

  • Use veterinarian-approved products (sprays, oral or topical medications, shampoos, collars) to prevent ticks on your pets and to treat their bedding

  • Permethrin sprays can be used on dog beds but is TOXIC to cats

  • Perform a full-body tick check after removing all clothing; have someone help you or use a mirror for hard to reach/see areas

  • Shower as soon as possible and comb through your hair

  • Consider throwing your clothing on “high” for 0 minutes which will kill all ticks

 

How do I Perform a “Tick Check” on myself, my partner, and my children?

• “Tick Checks” should be performed regularly when you live in or are visiting an area where ticks are present and immediately after you spend time in tick habitats (yards, fields, woods, dunes, trails). 

• Ticks can bite you anywhere but prefer areas that are warm and hidden. See the diagram below. 

• Undress completely when performing a tick check; consider checking while showering

 

• Consider having a mirror in your shower to look at those hard-to-see places. 

• If possible, have someone help you if there are areas you cannot see

 

What do tick bites feel like?

• Unlike the bites and stings of other arachnids or insects, tick bites don’t cause pain

• Ticks have a substance in their saliva that numbs the skin at the bite site

• As a result, most bites are noted by looking for them or as a result of mild itching at the bite site

 

What if I am bitten? 

• remove tick and clean the area with rubbing alcohol or soap (see below)

• in the case of a deer tick bite (or if the tick species is unknown) AND if the tick has been attached for more than 24 hrs or is filled with blood (or “engorged”), taking a 200 mg dose of doxycycline may be recommended as doing so can help prevent a person from developing Lyme Disease. 

• Monitor the bite site for any signs of infection, including increased, redness, pain, swelling or surrounding rash

• Consider taping the tick to a piece of paper to show your doctor in the event you develop symptoms or if you have questions about what to do next

• Ticks can be disposed of by flushing them down the toilet or enclosing them in tape and throwing them away

 

How do I remove a tick? 

• ticks can be removed using tweezers, fingertips and a variety of specialized tick removal tools available online or in local pharmacies

• grab firmly by the head, not the body, and pull steadily 

• do not yank, twist or squeeze

• don’t worry about small remaining mouth pieces; your body will push them out over time and they cannot transmit disease

• for Lone Star tick larvae, consider use of packing tape, exfoliants, tweezers

• the area may remain red or purplish, raised and possibly itchy for days to weeks

• do not use petroleum jelly, matches, nail polish; these methods don’t work and/or can be dangerous

 

 

https://ticksafety.com/removal-prevention/proper-tick-removal/

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https://www.vdh.virginia.gov/ticks/tick-removal/

 

What if I can’t remove it myself? 

• Most ticks are easy to remove with gentle traction and the right tool

• In some cases you may need assistance from someone else or to see a medical professional to help with tick removal

• don’t worry about small remaining mouth pieces; your body will push them out over time and they cannot transmit disease

 

Is there a medication I can take to prevent getting sick AFTER a tick bite?

• In the case of a Deer Tick bite, if the tick has been attached for > 24 hrs or is engorged (filled with blood), your clinician may offer you a single 200 mg dose of doxycycline which according to some research can reduce the transmission of Lyme disease by ~87%

• There is not yet evidence to show that this dose of doxycycline prevents the transmission of tickborne illness other than Lyme

  • Because Lyme Disease is only carried by Deer Tick, this prophylactic dose of Doxycycline is NOT recommended after bites from other tick species

• Doxycycline does not prevent Alpha-Gal Syndrome; again this is not an infectious condition, it is an allergy not treated with antibiotics

 

When do I need testing for tick borne illnesses and where is this done?

• Testing for infectious tickborne illnesses is indicated when you live in or have visited an area where ticks are endemic OR have had a known tick bite AND have symptoms of tickborne infectious diseases. Some of these symptoms are vague and similar to viral syndromes, and others are more specific to a certain disease. See “What are the Symptoms of Tickborne Illness” above for more details. Testing for tickborne infections is not recommended or useful in the absence of symptoms. 

• Testing for Alpha-Gal Syndrome is recommended when you live in or have visited an area where Lone Star ticks are endemic OR have had a known Lone Star tick bite or bite from an unknown tick species AND have symptoms of Alpha-Gal Syndrome. Because a large number of people test positive for the antibody for the Alpha-Gal Sugar and DON’T have any symptoms, testing is not recommended simply because you have been bitten by a Lone Star tick. People who test positive who do not have symptoms are “sensitized” to the Alpha-Gal sugar. Those who test positive AND have symptoms are considered to have Alpha-Gal Syndrome. 

• 20-30% of the adult population test positive for the antibody for the Alpha-Gal sugar and DO NOT have any symptoms. 

• Getting tested for either Alpha-Gal Syndrome OR tickborne illness at the time of a bite is not recommended; it is too soon for tests to be positive. In these cases, monitor for symptoms and consider testing if they develop. 

• Testing can be done via your PCP, other clinical specialists, local urgent cares and ERs. The cost of testing can vary with your insurance. 

 

When should I go to an ER? 

• Many of the symptoms of tickborne infections can be managed non-emergently by your PCP. 

• Symptoms of tickborne infections that should prompt you go to immediately to an ER include confusion/behavior changes noted by others, severe headache or neck pain, neck stiffness, severe abdominal pain, chest pain, shortness of breath, vomiting such that you cannot tolerate any food or fluids, lightheadedness or feeling you are going to pass out, bruise-like, purplish rashes, rashes on the palms of the hands or soles of the feet, bleeding from the gums, blood in your stool or urine, facial droop, joint swelling with redness, or decreased range of motion, skin ulcers, 

• With regard to Alpha-Gal Syndrome, any signs or symptoms of ANAPHYLAXIS should be evaluated in the ER immediately. 

• Anaphylaxis can include feeling like your throat is closing, difficulty breathing, chest pain, racing heart, lightheadedness, vomiting, diarrhea and abdominal pain, rashes including hives, flushing of the skin, facial or oral swelling, and a feeling of impending doom. 

• If you experience any of these symptoms, please call 911 or go immediately to a local ER. 

 

How are tickborne illnesses treated?

• Most tickborne infections are treatable with oral doxycycline, an antibiotic, when recognized early. Sometimes oral antibiotics or IV medications are needed. 

• Babesia, which is a parasite, requires a different treatment

• Unfortunately, there is no treatment for viruses—like Powassan Virus—transmitted by ticks other than for symptom management

• Alpha-Gal Syndrome is an allergy for which the mainstay of management is prevention of allergic responses by avoiding eating mammalian products and management of symptoms such as itching/hives or GI upset. 

  • In some cases, your clinician may recommend medications that block the allergic response, such as Xolair. 

  • In the event of anaphylaxis, Epinephrin combined with antihistamines, IV fluids, inhaled breathing treatments, steroids and close monitoring for several hours are needed in an ER setting to abort the allergic response and ensure it is over.

  • AGS can resolve over time, but prevention of additional Lone Star tick bites is critical as these bites can make the allergy worse and last longer

 

How do I know what kind of tick bit me and is this important?

• Ticks can be hard to identify if you are not an expert. 

• Knowing what kind of tick bit you can be helpful in terms knowing what tickborne illnesses you are at risk for

• If you are NOT able to identify the tick, that’s ok. There are general signs and symptoms you can watch for that might need you should seek care from a health care professional. Being aware of these symptoms is the best way to catch infections early. 

 

Should I have the tick that bit me tested for infectious diseases?

• There are companies that do tests ticks to see what species they are and what diseases they are carrying

• Many professionals feel that doing this is not necessary and simply costs money as even if the tick that bit you is carrying an infectious agent, that does not mean the disease has been transmitted to you

• Pros of testing ticks that bit you

  • Knowing specifically what diseases this tick might have transmitted to you and what specific symptoms to watch for

  • Data collection for public health

• Cons of testing ticks that bit you

  • Cost

  • Finding out that a particular tick that bit you is not carrying certain diseases may cause you to be less vigilant about monitoring for signs and symptoms of tickborne illness and give a false sense of security. Remember, often people are unaware of or miss tick bites. It is important if you live in an area where ticks are present that having a tick test test negative for disease does not give you a false sense of security

  • Even if a tick tests positive for a disease this does NOT mean it was attached long enough to transmit this disease to you or that you will become sick

• REMEMBER, not all ticks carry bacteria that make you sick!

 

What Percentage of Ticks Carry Infectious Diseases on Martha’s Vineyard?

• Based on a study from 2021-2024, on Martha’s Vineyard, an estimated:

  • ~34% of adult and ~26% of nymphal Deer ticks carry the pathogen that causes Lyme Disease

  • ~6% of Deer ticks carry the pathogen that causes Anaplasmosis

  • 1.58% of Deer ticks carry the pathogen that causes Borrelia miyamotoi Disease

  • 1.15% of Dog ticks carry the pathogen that causes tularemia

  • 2.13% of adult and 2.08% of nymphal Lone Star ticks carry the pathogens that cause Ehrlichiosis

  • ~11% of larval Lone Star ticks carry the pathogen associated with STARI (Southern Tick Associated Rash Illness)

 

Is there anything I need to tell my doctor if I’m not from Martha’s Vineyard but have visited and have had a tick bite or develop symptoms of tickborne illness or allergy when I return home?

• While ticks—and thus tickborne illness—are present in many places throughout the US and the world, some areas are not highly effected. 

• Additionally, because the symptoms of tickborne illness can be nonspecific, clinicians in areas where tickborne illness is NOT routinely seen may not consider these conditions as the cause of your symptoms thereby potentially delaying diagnosis and treatment

• For these reasons, it is important to tell your clinicians where you have traveled if you become ill and if you have had tick bites regardless of whether you have any symptoms at present

 

Where can I go for additional science-based information on ticks and tickborne illness?

 

Alpha Gal Syndrome: 

https://alphagalinformation.org

 

About Ticks and Tickborne Illness in the United States

https://www.cdc.gov/ticks/about/index.html

 

Martha’s Vineyard Board of Health:

https://www.mvboh.com/tickborneillness