How You Can Prepare For This Spring's Tick Outbreak

Ask the Experts

Marcos Luis Marcos, MD
Director, Adult Lyme and Tick-Borne Disease Center 
Stony Brook Medicine
Due to this past mild winter, experts are predicting one of the worst tick seasons ever. Dr. Luis Marcos, Director of the Adult Lyme and Tick-Borne Disease Center at Stony Brook Medicine, offers advice on how to protect yourself and your children from tick-borne illnesses.

What are tick-borne illnesses?
Many people have heard about Lyme disease, a bacterial infection transmitted by the bite of the Ixodes scapularis tick. In acute infections, it can cause headaches, fevers, rash and muscle aches. More severe cases can progress to Bell’s Palsy (facial paralysis) or meningitis. Untreated, it can lead to heart problems, arthritis and even long-term neurologic and/or rheumatologic conditions. Other infectious illnesses transmitted by ticks locally include Babesiosis, Anaplasmosis, Ehrlichiosis, Rocky Mountain Spotted Fever, Tularemia, Powassan Virus, among others. Also, an increase in cases of alpha-gal meat allergy related to tick bites has been recently noted.

Is Lyme disease dangerous?
Lyme disease is a growing problem for Suffolk County, with thousands of cases a year. Unfortunately awareness is low and many cases go unreported. When Lyme disease goes undiagnosed, especially in children, there can be serious complications. However, if treatment is started early, it is often extremely effective. With Suffolk County in the heart of one of the country’s highest risk areas, everyone in our community needs to be aware of ways to prevent and detect tick bites, and when to seek medical treatment. 

Are some tick-borne diseases worse than others?
Different tick-borne illnesses have different symptoms and effects on the body. Recently Powassan Virus, or POW, has been in the news because it was reported that New York had the second-highest number of cases in the U.S. POW causes an encephalitis, which is an infection of the brain and central nervous system, and there is no treatment for it. Symptoms of Powassan are usually quite severe. But it’s important to keep in mind that Powassan is extremely rare. In recent surveys of the tick population on Long Island, the ticks don't seem to have a very high-level of infection with the Powassan virus at all, so that's a very good thing.

What should I do if I’m worried about tick-borne diseases?
The most important thing you can do is to practice ongoing prevention. Everyone should always wear long pants and long sleeves while outside in grass or wooded areas, where there’s leaf litter, or along lakes and streams and rivers, and you should apply insect/tick repellant containing 20 to 30 percent DEET. When you put DEET on your child, you should spray a little on your hands then rub it onto their clothes or their skin. Never spray a tick repellant directly on a child or near because you don’t want them to breathe it in or get it in their eyes, nose or mouth.

How often should I check for ticks?
If concerned about tick bites or you’ve been in a high-risk area, check yourself and your children every day. Ticks like moisture, so it’s important to look in the creases of the body such as the underarms, in the groin area, behind the knees, in the hair and between the toes. If you or your child is bitten by a tick, remove it promptly with tweezers. Grasp it at the head and pull directly up. Do not grasp or squeeze the tick by the body since it will force germs into your body. If the head remains, it will gradually work itself out.

Wouldn’t I know if my child or I was bitten by a tick?
Not always. Ticks are very small and their bites are painless. You won’t even get itchy because ticks release an antihistamine when they bite which prevent an allergic reaction. Unless you actually see a tick on you, or have symptoms, you may not even realize that you were bitten. 

If I get bitten by a tick am I likely to get Lyme disease?
Not necessarily. The good news is that the number of patients that have tick bites that go on to develop a Lyme disease is very small. A tick carrying Lyme disease has to stay attached to you for 24-48 hours for the infection to transmit. If you do notice a tick and remove it quickly, you may want to mark the spot and keep an eye on it just to see if a rash develops, or if you have other symptoms. Not every tick bite transmits infection so that’s why we tend to watch it rather than immediately test or treat.

When should I see a doctor about a possible tick-borne illness?
Fever, rash, headache and muscle aches can be symptoms of early Lyme disease infection. Other tick-borne diseases may have different symptoms. If you notice any unusual or severe symptoms, especially if you know you’ve been bitten by a tick or have been in an area where ticks might be present, you should contact your doctor immediately. If Lyme disease or other tick-borne infections are suspected, you should consult an expert. If you’ve removed a tick you can seal it in a plastic bag and bring it with you to your doctor’s appointment so the doctor can examine the tick and get a better idea of what type of infection could be transmitted.

What type of tick-borne disease research are you conducting?
A main focus of our research is to recruit people on Long Island who are at high risk for acquiring tick-borne diseases. These high-risk individuals usually have outdoor work, such as at vineyards, on farms, on golf courses and in landscaping, that makes them susceptible to getting a tick bite on a daily basis from May to October every year. In about 10 percent of the patients who are effectively treated for Lyme disease, there are residual symptoms such as generalized pain, fatigue, attention deficits, brain fog, etc., which are not changed by antibiotics. So, in our research, which involves using the sophisticated neuroimaging technologies available at Stony Brook, we’re trying to identify where the problem exists in the brain. If we are able to pinpoint this pathway, we may be able to treat the devastating chronic symptoms caused by Lyme disease. 

Where can I find experts in Lyme disease?
Stony Brook Medicine has a very extensive program for adults, which includes a laboratory program as well as a clinical program. At the Lyme and Tick-Borne Disease Center at Stony Brook Children’s Hospital, members of the Division of Pediatric Infectious Diseases, provide multidisciplinary, comprehensive diagnosis, treatment and management of Lyme and other diseases transmitted by ticks to children.

All of our infectious disease specialists are board-certified with expertise in treating Lyme disease, and are up to date on all relevant tick disease-related treatments and research. They remain current on the latest guidelines, and bring a level of experience to their patients that can make a difference in both common and hard-to-diagnose cases.

Fortunately there are excellent resources available to Suffolk County residents. For information about Stony Brook Medicine resources for adults call (631) 444-3490, and for children call (631) 444-7692. Farther east, the Tick-Borne Disease Resource Center at Southampton Hospital ( offers education and facilitates access to diagnosis and treatment of tick-borne diseases.

All health and health-related information contained in this article is intended to be general and/or educational in nature and should not be used as a substitute for a visit with a healthcare professional for help, diagnosis, guidance, and treatment. The information is intended to offer only general information for individuals to discuss with their healthcare provider. It is not intended to constitute a medical diagnosis or treatment or endorsement of any particular test, treatment, procedure, service, etc. Reliance on information provided is at the user's risk. Your healthcare provider should be consulted regarding matters concerning the medical condition, treatment, and needs of you and your family. Stony Brook University/SUNY is an affirmative action, equal opportunity educator and employer.