BUSINESS

Tick-Borne Diseases Roam the Countryside

By Simone Kozuharov

Staff Writer

Alexander Belenky / The St. Petersburg Times Even brief exposure to the tick's habitat, such as country houses, forests and fields, invites a chance for a bite.

Long the thorn in the Russian side, tick season has officially arrived bringing with it diseases for dacha, or country house, enthusiasts and the like.

"In Russia, ticks are particularly active in early May, peak throughout June and taper off in August and September," said Yulia Koshcheeva, an epidemiologist at EuroMed Clinic.

Alexander Routchenkov, a family practitioner at International MEDEM Clinic and Hospital, said that there are "two periods of high tick activity in the St. Petersburg region: April through June and August through September."

Risk of infection for those who never visit forests, fields or pastures is low, but beware not just the die-hard dachniki, but those who plan to take at least one trip to the dacha this summer for a little rest, relaxation and shashliki. Even brief exposure to the tick's habitat invites a bite and later, possible infection.

Tick-borne diseases include "Lyme disease, tick-borne encephalitis, Q Fever, Tularemia, Rocky Mountain and Spotted Fever," Routchenkov said.

"According to the statistics for 2003 in St. Petersburg, there were 691 registered cases of Lyme disease and 134 cases of tick-borne encephalitis - no registered cases of Tularimea [or] Q Fever, though they are a potential threat in the area," he said. "The other tick-borne diseases do not occur in the [Leningrad] region."

Lyme disease, also occurring in North America, is an inflammatory disease affecting the skin in its initial onset and then spreads to affect the joints and nervous system in more advanced stages. It can also affect internal organs, although not as severely, in these stages, Koshcheeva said.

"The first symptom is usually an expanding rash," she said.

The area bitten usually serves as the rash's epicenter, is often solid red or blotchy "or a central spot surrounded by clear skin that is in turn ringed by an expanding red rash - [it] looks like a bull's eye," she said.

The rash occurs on average one week after infection, but has a range of one to 30 days. The average diameter of a tick bite is about 12 to 15 centimeters, could be warm to the touch and is not usually itchy or painful, Koshcheeva said.

"Other symptoms such as joint pains, chills, fever and fatigue are common, but they may not seem serious enough to require medical attention," Koshcheeva said. "These symptoms may be brief, only to recur as a broader spectrum of symptoms as the disease progresses.

"Untreated, the bacterium travels through the bloodstream and other symptoms including severe fatigue, a stiff, aching neck and peripheral nervous system involvement such as tingling or numbness in the extremities of facial palsy [paralysis] can occur," she said.

Tick-borne encephalitis, while more dangerous, is less infectious and far less likely to be contracted from a single tick bite.

It is a "virus maintained in nature in small mammals, domestic livestock and certain species of birds. The disease is transmitted to humans by the bite of an infected tick or, less commonly, by ingestion of un-boiled milk from infected animals, especially goats," Koshcheeva said.

Unpasteurized milk from friends' and loved ones' dachas might seem like a fresh alternative to the store bought, packaged variety, but it may be dangerous if it comes from an infected animal.

Infection risk areas include parts of western and central Europe, Scandinavia and the former Soviet Union, according to the U.S. Centers for Disease Control and Prevention's Health Information for International Travel.

"The severity of disease, incidence of sequelae (after effects) and case-fatality rates are higher in the Far East and eastern regions of Russia than in western or central Europe," the advisory said.

There is an existing vaccine against tick-borne encephalitis, but it should only be administered until the beginning of April in order to be affective.

"It has to be done before the beginning of tick season," Routchenkov said. "If you are planning to stay here for the next season, you should get the first series of the vaccine starting next November."

If vaccination has not been done by April 1, it is important to take other precautionary steps.

"You can prevent all of the tick-borne diseases by avoiding areas of high risk, wearing long-sleeved shirts and pants," Routchenkov said. "It helps to use repellents with DEET, which you can buy at the pharmacy."

Other preventive measures should not be overlooked, like avoiding ticks in the places they often hide.

Such places included shady, moist ground coverings, in tall grass and other shrubbery.

"They also inhabit lawns and gardens, especially at the edges of woodlands," Koshcheeva said.

"Potential hosts, which include all wild birds and mammals, domestic animals and humans, acquire ticks only by direct contact with them; an infected tick can transmit the infection to the humans and animals it bites," she said.

The disease often manifests itself as a vague form of flu-like illness that lasts about a week.

"It may also present as a benign, aseptic meningitis," Koshcheeva said. "There is an abrupt onset of signs of encephalitis such as tremor, dizziness and altered sensorium."

Only about 1 percent to 5 percent of cases result in death.

"If you find a tick - don't remove it yourself - visit your doctor immediately," Routchenkov said.

Immediately is the operative word because, according to Koshcheeva, ticks can be attached to skin for 36-48 hours before transmission of Lyme disease occurs. "If you find a tick attached to your skin, there is no need to panic," she said. "Therefore, your chances of contracting Lyme disease are greatly reduced if you remove a tick within the first 24 hours.

"Remember, too, that the majority of early Lyme disease cases are easily treated and cured."

Koshcheeva also noted that not all ticks are infected with disease.

"Inspect yourself after a visit to the countryside," Routchenkov said.

Dr. Koshcheeva's words on prevention:

. Wear enclosed shoes and light-colored clothing with a tight weave to spot ticks easily.

. Stay on clear, well-traveled trails

. Avoid sitting directly on the ground or on stone walls [which are] havens for ticks and their hosts.

. Keep long hair tied back, especially when gardening.

. If you tuck long pants into socks and shirts into pants, be aware that ticks that contact your clothes will climb upward in search of exposed skin. This means they may climb to hidden areas of the head and neck if not intercepted first; spot-check clothes frequently.

. Clothes can be sprayed with either DEET or Permethrin. Only DEET can be used on exposed skin, but never in high concentrations; follow the manufacturer's directions.

. Upon returning home, clothes can be spun in the dryer for 20 minutes to kill any unseen ticks.

. A shower and shampoo may help to dislodge crawling ticks, but is only somewhat effective. Inspect yourself and your children carefully after a shower.

. Any contact with vegetation, even playing in the yard, can result in exposure to ticks, so careful daily self-inspection is necessary whenever you engage in outdoor activities and the temperature exceeds 4 degrees Celsius - the temperature above which deer ticks are active.

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