It’s a dangerous world out there. That’s why we wear seatbelts, look both ways, store foods properly, stay off the roof, and generally don’t hang out with lions and tigers and bears. One danger we face at this time of the year are the diseases carried by mosquitoes and ticks. Who ever heard of West Nile virus, Zika, or Lyme disease a few years ago? Today we worry about them.
The good news is that we can take steps to avoid harm by these and other pests. Yes, dangers exist, but so do precautions. There’s no need to spend our lives in bed, under the covers. Indeed, the first piece of advice I hear in my quest for information is from pediatrician Dr. Rochelle Kushner (who happens to be my daughter-in-law). “Don’t be afraid to go outside,” she says. “Don’t expect the worst, but do take precautions to protect yourself and your family.”
Sholom Rosenbloom, of Rosenbloom Pest Control, reaffirms this stance: “People should not make themselves crazy. They should be as calm as possible and not worry that their child will pick up a tick. Just make sure the play area is sufficiently groomed so that you are not providing a haven for insects to attack your family.”
How does one do that? It helps to know what makes these insects thrive so as to avoid providing them with a “friendly” environment. Let’s start with mosquitoes.
Aside from their itchy, scourge-of-the-summer bites, mosquitoes carry the West Nile and Zika viruses. Formerly limited to the tropics, these diseases have made their appearance in the United States. What’s important for us to know is that the Asian tiger mosquito (Aedes albopictus), the most common type in our area, is attracted to standing water, where it lays its eggs after a delicious blood meal.
Mr. Rosenbloom advises to look out for “poorly draining gutters, trashcans and lids, buckets, potted plants, children’s toys, kiddy pools, tires, tarps, and bird baths.” Even a capful of water can become a breeding ground. There are also products that allow you to keep your birdbath but not the mosquitoes. A water agitator, like the Water Wiggler, keeps the water moving so that mosquitoes can’t use it as a breeding ground. The sound of splashing water will also entice birds. Another method is to add a mosquito “dunk” to the water. This chemical kills mosquitoes but is said to be harmless to birds. It must be replaced every 30 days. (It is also important to change the water every five to seven days.)
The female tiger mosquitoes lay 40 to 150 eggs at a time and will lay about 300 eggs in their lifespan. (It is only the female mosquito that bites as it needs blood to produce offspring.) The eggs are deposited along the sides of a container just above the water surface. When the conditions are right and the water level rises, the eggs will hatch. But even if it is too cold, the eggs can survive the winter and hatch when it is warm enough. After hatching, mosquito larvae live in the water for one to several weeks, depending on water temperature and the amount of food present.
“This is why it is so important to empty kiddy pools when not in use,” says Levi Brody, of Brody Brothers Pest Control. “Did you ever see a dirt ring on a kids’ pool after the water has been spilled out? Those are thousands of mosquito eggs, which will hatch at different times, because they were not laid at the same time. They can stay dormant up to five years! When the water hits that edge again, they will hatch.” Mr. Brody also emphasizes the importance of keeping the pools clean and dry, when not in use. “Never let the water get dirty. Those little mosquitoes feed on algae and bacteria in the water.” Mr. Brody also notes that, “a big source of water is the black corrugated pipes at the end of gutters. You should cut the bottom of the pipe lengthwise with a razor blade, so that water will flow out and not build up between the little corrugations.”
Mosquitoes thrive in forests, marshes, tall grasses and weeds, and ground that is wet at least part of the year. They often hide under leaves and behind tree bark. Most adult mosquitoes spend their lives within a few hundred yards of the breeding container from which they hatched.
How to Avoid Becoming a Bug’s “Dinner”
“The two most important reasons a mosquito is attracted to you have to do with sight and smell,” says Jonathan Day, a professor of medical entomology at the University of Florida in Vero Beach.
Your breath, with its output of carbon monoxide, attracts mosquitoes, and so do movement and body heat. Mosquitoes can see their victims from within 30 feet by locating the changes in waves of light around them caused by moving objects. Early morning and late afternoon are peak biting times.
Harry Savage, chief research entomologist at the CDC, said carbon dioxide and heat are the biggest draws for mosquitoes. Scent can also play a role. Ingredients in your sweat and other skin secretions, which are often genetically determined, make one person more attractive to a mosquito than another. He wasn’t very enthusiastic about the use of citronella candles to repel mosquitoes, calling it a weak repellent at best, which only works temporarily. “To me, citronella only protects the candle,” Savage said.
There is a widely-held belief that wearing dark clothes or eating certain foods attracts mosquitoes, but this is refuted by Joseph M. Conlon, a retired U.S. Navy entomologist and a technical adviser to the American Mosquito Control Association. Of course, covering up as much skin area as possible with long sleeves and long pants can be helpful. As Mr. Rosenbloom quipped, “Who ever said wearing tzniut clothing does not get rewarded in this world?”
You may have heard reports that some blood types are more attractive to mosquitoes than others. Mr. Conlon, however, says this is unlikely. He said that a study on mosquitoes’ attraction to Type O blood was later refuted due to bad statistics. But it is probably true that the larger you are, the more body heat and carbon dioxide you produce, making you more of a target. (As if we needed another excuse to lose weight!)
In an article in the University of Arizona newsletter, Roger Miesfeld, a professor in UA’s department of chemistry and biochemistry, said “During a blood meal, a mosquito ingests its body weight in blood. It’s the equivalent of a 125-pound human consuming a 12-gallon smoothie made from 25 pounds of hamburger meat plus a half pound of butter and two tablespoons of sugar.” For us, of course, that meal would need a pareve substitute for the butter, but it still seems like an awful lot to consume.
The best protection against mosquitoes (and ticks) is the application of DEET or products containing the active ingredients picaridin and IR 3535. The artist Avraham Cohen, an avid gardener, mentioned that he heard putting a box fan outside to blow the mosquitoes away might help. It turns out he is correct. Mr. Brody says, “Mosquitoes are extremely poor flyers. So if you aim a big box fan toward all the people on the deck, that will keep the mosquitoes away.” And no less an expert than Mr. Conlon agrees with him: “Plus, the breeze tends to dissipate the body odors and the carbon dioxide that people give off that attract mosquitoes, so the mosquitoes have a much more difficult time trying to find their hosts. It’s low-tech but very effective.”
Deer Ticks or Rodent Ticks? Story of a Misnomer
Like mosquitoes, ticks, the infamous carriers of Lyme disease, love tall grass, wooded areas, underbrush, leaf litter, rock piles – the same places rodents (such as deer mice) hang out. As a matter of fact, although we associate Lyme disease with deer, it is really the rodents and other small animals that are in the front line of spreading Lyme. Deer play a part, but those small animals begin the cycle since they are the ones carrying the spirochete that cause Lyme.
Ticks have four life stages: egg, larva, nymph, and adult. The larva and nymph phases require a blood meal to grow to the next stage. The adult tick also needs a blood meal, but this is for reproduction purposes, not to grow. Ticks cannot jump or fly. They do not fall out of trees and land on people or other animals. Rather, even in the larval stages, they cling to the tips of grass blades, other vegetation, or leaf litter with their hind legs, in what is called the “questing position.” Holding their front legs outstretched, they wait for a suitable host to brush by so they can grab on to it. The smallest ticks generally attach themselves to field mice or other small animals, even birds. It is these animals that may carry Lyme. That is why rodent control and yard grooming is very important. (Mr. Brody told me that house mice do not spread Lyme, because the home environment is far too dry for the ticks to survive.)
This does not let deer off the hook. Deer play an important role in tick reproduction. The adult ticks need a large mammal for the final blood meal. Not only do they commonly get this meal from deer but they may mate at the same time. It’s the deer that then carry the fertilized female ticks around until they climb down. Ticks don’t jump off deer and latch onto humans or any other mammal. Rather, humans, like mice and deer, become tick victims by walking through their grassy habitat.
Adult ticks that survive the winter lay eggs in the spring. The main tick season in our area is from early spring through fall, but ticks may become active in winter if the weather is warm enough. Both nymph and adult ticks can attach to humans (or pets). The good news is that if the tick has never had a blood meal or its blood meal was from an animal without Lyme, that tick will not spread Lyme to its human blood meal victim.
The first step in preventing ticks is to be careful about yard grooming. Ticks are unlikely to lurk in trimmed grass in the middle of a sunny yard. Needing moisture, the sun will dry them out. Make sure your grass is cut regularly and your yard is well trimmed in areas where you or your kids walk or play. “If there is debris from grass clippings and sticks, there is more area to retain moisture and more of a place for rodents to hang out. Making your property uninviting to rodents helps tremendously,” says Mr. Brody, who also suggests that the swing set should be as far away as possible from the wooded edge, “so kids aren’t playing around near that brush.”
Because of their role in the tick lifecycle, preventing deer from accessing your property is also important. Any type of fence will discourage deer from entering, says Avraham Cohen. He sprays his yard with Liquid Fence, one of several deer repellent sprays on the market, including sachets you can hang on your bushes. They repel deer, but “the problem is the deer get used to it.” Another solution that has worked for him is putting out compact, solar-powered motion-sensor LED lights. He hangs them up with zip ties throughout his backyard and around its perimeters for the summer months. When the deer wander into range, they are blasted with the very strong beams of light. “Ever hear the expression, ‘deer in the headlights’?” he quips. The problem is on Shabbos (he disables the offending lights during Succos), but Mr. Cohen has warned his neighbors, so they all know not to walk through the backyard at night on Shabbos.
Both Mr. Rosenbloom and Mr. Brody told me that tick and mosquito treatments are not a one-size-fits-all proposition. Each home is unique, not only because of the conditions surrounding the yard but also on how/whether the yard is used. Advice regarding a rarely used yard and no pets, for example, would be quite different from advice for a family with many children and a yard bordering a wooded area. Mr. Brody emphasized that a “common sense approach” is needed. Dr. Kushner advises parents, especially in the summer months, to check their kids for ticks every night after coming in from outside. It’s a good idea to check yourself as well!
Yikes! What to Do if You Find a Tick
If you find a tick, first of all, don’t panic. Not all ticks carry Lyme, and of those that do, not all are infected with Lyme. Moreover, the CDC (Centers for Disease Control) says that a tick bite does not spread Lyme unless it has been on your body for at least 24 to 48 hours.
The important thing to do is remove the tick from your body. Most sources advise using a fine-tipped tweezers to remove the attached tick by grasping it as close to the skin as possible, without squeezing the tick, and pulling it straight out, perpendicular to the skin, without twisting. The Brody Brothers give out a handy “tick-spoon” to facilitate tick removal. Mr. Brody says he often uses it to remove ticks for his neighbors. They suggest that you pick one up for kids to bring to camp.
Avoid touching the tick with your fingers, and wash them off if you do. Also, once you’ve removed the tick, it’s best not to wash it down the drain or the toilet, since it could crawl back up. Killing it with rubbing alcohol is said to be effective.
If your dogs or other pets play in the yard, they should also be checked, as they can get Lyme disease. Pet products are available for them.
If you find a tick on yourself or your child, you should obviously remove it as soon as possible. However, it is reassuring to know that, according to Dr. Kushner, “Not every tick is infected with Lyme. Your chances of contracting Lyme depends where you are in the U.S. According to the CDC, ‘In 2015, 95% of confirmed Lyme disease cases were reported from 14 states.’ Maryland is on that list. And to contract Lyme, the tick would have to be on the body unnoticed for at least 24 hours.”
If you find a tick and don’t know how long it was attached to you, you may want to ask a physician for advice as it is important to treat diagnosed Lyme as soon as possible with antibiotics. It is also important to recognize the symptoms that might indicate Lyme and contact your doctor if they are present. Although the bull’s-eye rash is most commonly thought of, many people never get this rash or do not notice it if it appears on a part of the body they don’t see, such as the back of the head. Other symptoms include other types of rashes, pain, fatigue, or generally feeling sick. (For a fuller list, see https://www.cdc.gov/lyme/signs_symptoms/) Dr. Kushner says, “No matter what the season, if a patient presents with fatigue, Lyme disease is always on my differential.” Lyme is often called “the great pretender” because so many other illnesses present the same way.
The Lyme Controversy
As is true of many medical conditions with vague symptoms and unclear prognoses, a great deal of controversy surrounds the treatment of Lyme disease. Two schools of thought exist.
The CDC and the vast majority of “mainstream” doctors maintain that there is no such thing as “chronic Lyme disease.” They treat Lyme with antibiotics, for varying periods of time, most commonly between two to four weeks. They acknowledge the lingering symptoms of fatigue, pain, or joint and muscle aches that many people experience, but rather than referring to this as chronic Lyme, they say this is a condition properly known as “post-treatment Lyme disease syndrome” (PTLDS). The CDC says, “Most medical experts believe that the lingering symptoms are the result of residual damage to tissues and the immune system that occurred during the infection…. Studies have not shown that patients who received prolonged courses of antibiotics do better in the long run than patients treated with placebo.” [Emphasis mine]
This is a main point of contention for the other camp, a small but vocal opposition that disputes these conclusions with its own studies. This group believes that the lingering symptoms reflect persistent infection with Borrelia burgdorferi, the Lyme causing spirochete, and often recommend long-term antibiotic treatment. Mainstream doctors (and the CDC) feel such treatment can be harmful to patients. Moreover, “Lyme-literate” doctor visits and consultations cost a fortune, as do the medications and blood tests. “Going rogue” is not an easy path to take.
Which camp is right? The position you follow really depends on what doctor or medical association you trust more, but here are some sources to check out: Dr. Kushner, who practices evidence-based medicine – supported by the guidelines published in The Red Book: Report of the Committee on Infectious Diseases and backed by well-known organizations, such as the American Academy of Pediatrics – recommends the websites www.healthychildren.org and www.cdc.gov. The “chronic Lyme” supporters suggest www.ILADS.org and www.yeshtickva.com/home/lyme, a Jewish non-profit organization.
I spoke with a few people who have been treated for Lyme. Two cases were successfully (at least so far) treated with the standard antibiotic treatment recommended by the CDC and mainstream doctors. Of those, one case was not diagnosed for several months but still responded well. Two other people who shared their stories with me are firm believers in chronic Lyme and long-term antibiotic treatment. One person’s child has been on antibiotics (along with strong probiotics) for at least eight months.
For people who have a Lyme diagnosis, it is important to have a frank discussion with their doctors to decide on the best course of treatment. The bad news is that it can take months or even years to feel completely well. The good news is that, according to the CDC, patients with PTLDS almost always get better with time.
by Eta Kushner
Here are some of the lawn-grooming tips I found:
- Get rid of tall grass and brush, especially at the edge of your lawn, to eliminate ticks’ favorite hangout spots.
- Place a gravel or woodchip buffer zone between lawns and wooded areas. Ticks find these surfaces irritating and aren’t likely to cross over them to your property.
- If you have a wood pile, keep it stacked neatly in a sunny area.
- American beauty-berry bushes are said to repel ticks. Some advise planting them around the lawn edges as a barrier as well.
Of course, we don’t stay in our own backyards all summer. Here are the CDC’s recommendations to avoid tick bites while hiking in wooded areas:
- Walk in the center of trails, avoiding wooded and brushy areas with high grass and leaf litter.
- Use a repellent that contains 20 percent or more DEET, picaridin, or IR3535 on exposed skin for protection that lasts several hours. Parents should apply this product to their children, avoiding hands, eyes, and mouth. Always follow product instructions.
- Treat clothing and gear, such as boots, pants, socks and tents with products containing 0.5% permethrin. It remains protective through several washings. Pre-treated clothing is available and may be protective longer.
- Bathe or shower as soon as possible after coming indoors (preferably within two hours) to wash off and more easily find ticks that are crawling on you.
- Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair.
- Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and backpacks.
- Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors. If the clothes are damp, additional time may be needed.
- If the clothes require washing first, hot water is recommended. Cold and medium temperature water will not kill ticks effectively. If the clothes cannot be washed in hot water, tumble dry on low heat for 90 minutes or high heat for 60 minutes. The clothes should be warm and completely dry.