Lyme disease primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]Ilan Dock, B.S.


Primary prevention of Lyme disease involves tick control and reducing exposure to ticks. The tick should be removed with proper technique so as to decrease the risk of infection. A Lyme disease vaccine used in the past is no longer available.

Primary Prevention

Tick control

Minimizing tick exposure

The best way to prevent Lyme disease is to avoid tick infested areas, but it is unreasonable to assume that a person can completely eliminate activities that may result in tick exposure. Therefore, preventive measures should emphasize personal protection when exposed to natural areas where ticks are present:[9]

  • Frequently check skin and clothes to identify ticks and remove before infection can be transmitted.
  • Wear light-colored clothing that allows you to see ticks that are crawling on clothing.
  • Use long sleeved shirts tucked into pants and tuck pant legs into socks so that ticks cannot crawl up the inside the pant legs.
  • Apply repellents to discourage tick attachment.[10]
    • Permethrin
      • Repellents containing permethrin can be sprayed on boots and clothing, and will last for several days.
    • N,N-diethyl-3-methylbenzamide (DEET)
      • Repellents containing DEET can be applied to the skin, but will last only a few hours before reapplication is necessary.
      • Use DEET with caution on children. DEET is appears to be safe when used as directed.[11]
      • Application of large amounts of DEET on children has been associated with adverse reactions.[12]
      • DEET should be avoided on face, hands, and irritated or abraded skin.
      • DEET should be washed off with soap and water upon returning indoors.
  • Conduct a body check upon return from potentially tick-infested areas by searching the entire body for ticks. Use a hand-held or full-length mirror to view all parts of the body. Remove any tick found on the body.
  • Parents should check their children for ticks, especially in the hair, when returning from potentially tick-infested areas.
  • Ticks may also be carried into the household on clothing and pets and only attach later, so both should be examined carefully to exclude ticks.[13]

The best way to remove a tick

  1. Use fine-tipped tweezers or notched tick extractor, and protect fingers with a tissue, paper towel, or latex gloves. Persons should avoid removing ticks with bare hands.
  2. Grasp the tick as close to the skin surface as possible and pull upward with steady, even pressure. Do not twist or jerk the tick; this may cause the mouth-parts to break off and remain in the skin (If this happens, remove mouth-parts with tweezers. Consult your health care provider if illness occurs).
  3. After removing the tick, thoroughly disinfect the bite site and wash your hands with soap and water.


  • Do not squeeze, crush, or puncture the body of the tick because its fluids may contain infectious organisms. Skin accidentally exposed to tick fluids can be disinfected with iodine scrub, rubbing alcohol, or water containing detergents.
  • Save the tick for identification in case you become ill. This may help your doctor to make an accurate diagnosis. Place the tick in a sealable plastic bag and put it in your freezer. Write the date of the bite on a piece of paper with a pencil and place it in the bag.[14]
Tick removal process -



  1. 1.0 1.1 Curran KL, Fish D, Piesman J (1993). "Reduction of nymphal Ixodes dammini (Acari: Ixodidae) in a residential suburban landscape by area application of insecticides". J Med Entomol. 30 (1): 107–13. PMID 8433317.
  2. Stafford KC (1991). "Effectiveness of carbaryl applications for the control of Ixodes dammini (Acari: Ixodidae) nymphs in an endemic residential area". J Med Entomol. 28 (1): 32–6. PMID 1903451.
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  4. Stafford KC, Ward JS, Magnarelli LA (1998). "Impact of controlled burns on the abundance of Ixodes scapularis (Acari: Ixodidae)". J Med Entomol. 35 (4): 510–3. PMID 9701937.
  5. Schulze TL, Jordan RA, Hung RW (1995). "Suppression of subadult Ixodes scapularis (Acari: Ixodidae) following removal of leaf litter". J Med Entomol. 32 (5): 730–3. PMID 7473629.
  6. Deblinger RD, Rimmer DW (1991). "Efficacy of a permethrin-based acaricide to reduce the abundance of Ixodes dammini (Acari: Ixodidae)". J Med Entomol. 28 (5): 708–11. PMID 1941940.
  7. Daniels TJ, Fish D, Falco RC (1991). "Evaluation of host-targeted acaricide for reducing risk of Lyme disease in southern New York state". J Med Entomol. 28 (4): 537–43. PMID 1941916.
  8. Stafford KC (1992). "Third-year evaluation of host-targeted permethrin for the control of Ixodes dammini (Acari: Ixodidae) in southeastern Connecticut". J Med Entomol. 29 (4): 717–20. PMID 1495085.
  9. Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS; et al. (2006). "The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America". Clin Infect Dis. 43 (9): 1089–134. doi:10.1086/508667. PMID 17029130.
  10. Fradin MS (1998). "Mosquitoes and mosquito repellents: a clinician's guide". Ann Intern Med. 128 (11): 931–40. PMID 9634433.
  11. Carroll JF, Klun JA, Debboun M (2005). "Repellency of deet and SS220 applied to skin involves olfactory sensing by two species of ticks". Med Vet Entomol. 19 (1): 101–6. doi:10.1111/j.0269-283X.2005.00559.x. PMID 15752184.
  12. Centers for Disease Control (CDC) (1989). "Seizures temporally associated with use of DEET insect repellent--New York and Connecticut". MMWR Morb Mortal Wkly Rep. 38 (39): 678–80. PMID 2506420.
  13. General Tick Disease Information. Centers for Disease Control and Prevention (2015). Accessed on December 30, 2015
  14. Tick Removal. Centers for Disease Control and Prevention (2015). Accessed on December 30, 2015
  15. Safety/Efficacy concerns re: Lyme vaccine: LYMErix Controversy
  16. Willett TA, Meyer AL, Brown EL, Huber BT (2004). "An effective second-generation outer surface protein A-derived Lyme vaccine that eliminates a potentially autoreactive T cell epitope". Proc. Natl. Acad. Sci. U.S.A. 101 (5): 1303–8. doi:10.1073/pnas.0305680101. PMID 14742868.
  17. Earnhart CG, Marconi RT (2007). "OspC phylogenetic analyses support the feasibility of a broadly protective polyvalent chimeric Lyme disease vaccine". Clin. Vaccine Immunol. 14 (5): 628–34. doi:10.1128/CVI.00409-06. PMID 17360854.
  18. Pozsgay V, Kubler-Kielb J (2007). "Synthesis of an experimental glycolipoprotein vaccine against Lyme disease". Carbohydr. Res. 342 (3–4): 621–6. doi:10.1016/j.carres.2006.11.014. PMID 17182019.