Ticks are small, but by no means harmless. These tiny bloodsuckers are found not only in the woods, but also in gardens, parks and on playgrounds. They are particularly active during the warmer months and can pose a danger to both humans and animals. A tick bite is not only unpleasant, but can also transmit serious diseases such as Lyme disease or TBE (tick-borne encephalitis).
But what are the most important first steps to take, and what should you look out for if it does happen? In our interview with an expert, we explain the health risks involved and what you absolutely must bear in mind after a bite – our expert is regarded as a leading authority on ticks and speaks plainly in the interview.
BIKE: Prof. Dr Jelinek, we’ve all been there: you spot a tick, but you don’t have a tick removal card or tweezers to hand. What should you do?
Prof. Dr Jelinek: The aim is to remove the tick as close to the skin as possible – in other words, near the skin’s surface. This is because the dangerous part is not the mouthparts, but the tick’s body, including its intestinal contents. That is where the pathogens are found, not at the front in the mouthparts. So it is not a problem if the mouthparts – which many people mistakenly take to be the tick’s head – remain embedded in the skin. The pathogens are not located there. The body will expel this foreign body on its own. In this case, no further action is required.
So don’t wait until the evening to remove the tick calmly with the Tweezers or Map to remove it – or would you rather take immediate action?
If you are able to clip the tick cleanly at the front, then yes. Important to know: the dangerous Borrelia bacteria are usually only transmitted after about 12 hours. This is because it is only the blood sucked from the human host that activates the Borrelia bacteria within the tick’s body. However, if the tick is squeezed and empties its contents, the pathogens can enter the body sooner. So if it’s only been a few hours, you should try to remove the tick straight away – it’s better to do a temporary job on the spot than not at all.
It’s a different story with TBE, isn’t it?
Exactly. Unlike Borrelia bacteria, TBE viruses are transmitted directly at the moment of the bite. The time factor is irrelevant.
Fiddling about for too long can stress the tick
Many ticks are tiny. That makes it difficult to grip them properly. How important is it to be careful so as not to ‘stress’ them?
It doesn’t happen that quickly, but fiddling about and squeezing it for too long can stress the tick – and, in the worst case, cause it to regurgitate its intestinal contents. The ‘trick’ of using a drop of glue or oil to pull it out isn’t a good idea either. If the tick is very small and difficult to grip, you can carefully try to cut off the proboscis using a sharp knife.
Sometimes you don’t even realise when you’ve been bitten – and only discover the tick much later. Should you go straight to the doctor then to get treatment to prevent Lyme disease?
A bite often continues to itch for days or even weeks after the tick has been removed – this is simply the body’s reaction to the tick’s saliva and is completely harmless. It is important to keep an eye on the bite site. A sure sign of Lyme disease is what is known as ‘erythema migrans’: a red rash that spreads in a ring-shaped pattern around the bite site days or weeks after the bite.
This redness is non-itchy and causes no discomfort whatsoever – which is precisely why it is so characteristic. No other condition causes exactly this type of rash. The only problem is that this migratory erythema occurs in only about half of those infected – the other half do not develop it at all.
One in five ticks carries Borrelia bacteria. What should you do if you suspect the tick has been attached for more than 12 hours – and no erythema migrans has appeared?
A US study has shown that taking a single tablet of doxycycline reduces the risk of infection by around 87 per cent, provided it is taken within the first 72 hours of the bite.
Doxycycline is a conventional antibiotic that is also used to treat conditions such as acne. In such cases, it is a sensible preventive measure – provided it is taken early on.
The symptoms of Lyme disease may not appear until weeks or months later – and are often non-specific. When should you start to be wary?
That is the problem: the symptoms are often vague and non-specific – tiredness, exhaustion, joint or soft-tissue pain, and even neurological symptoms. More typical are fluctuating joint pain or wandering soft-tissue pain that moves from one part of the body to another. In children, we sometimes see a swollen earlobe – this is caused by an accumulation of white blood cells. Ultimately, only a blood test can provide a definitive diagnosis.
Editor’s note: Health insurance usually only covers the cost of this blood test if erythema migrans has developed or if symptoms are present which usually only appear later, such as facial paralysis, meningitis, burning nerve pain or signs of arthritis.
Lyme disease is insidious
How many cases of Lyme disease are there each year in Germany?
It is difficult to say, because Lyme disease is not a notifiable illness and many cases go undiagnosed. We estimate the figure to be around 60,000 to 100,000 per year. In short: Lyme disease is insidious. The migratory rash is a sure sign – but it fails to appear in about half of all cases. A single doxycycline tablet taken upon discovery can effectively prevent the disease. Ultimately, only a blood test can provide certainty. And contrary to what is often claimed online, Lyme disease is easily treatable – the earlier it is treated, the better. If it goes undiagnosed for a long time, treatment becomes more complex, but it is generally still possible.
There is no vaccine for Lyme disease – but there is one for TBE. How effective is this vaccine?
It makes a lot of sense – and it’s very safe. I don’t know of a single documented case where someone has become infected despite being vaccinated. There have been a few exceptions in Sweden, but these are absolutely isolated cases. Anyone living in southern Germany should definitely get vaccinated. Unlike Lyme disease, TBE cannot be treated. It is a serious inflammation of the meninges and the brain.
How common are TBE infections in Germany?
Significantly less common than Lyme disease. We record around 600 to 800 cases a year.
Since the COVID-19 vaccinations, many people have become more sceptical about vaccinations. What about the side effects of the TBE vaccine?
The TBE vaccine has been available for decades – and has been continuously improved. Today, there are virtually no significant side effects. In the 1990s, there was a vaccine in France that was less well tolerated – but that is long since history. In short: the vaccine is safe.
How often do you need to be vaccinated?
First, two doses, then a booster after one year. According to studies, the protection then lasts for at least ten years. Although the information in the manufacturers’ regulatory documents mentions a booster every two to three years, I do not consider this necessary.
>> For more information, visit: www.impfen.de
Laurin Lehner
Editor
