Tick Talk with Dr. Jonathan Ross

As Nova Scotians enjoy the outdoors this summer, the awareness of ticks is looming larger as we hike, garden and explore our beautiful natural environments. The rising tick population in Nova Scotia has led to increased risk and cases of tick-borne illnesses. 

Dr. Jonathan Ross, associate regional medical officer of health with Public Health, has spent much of this summer helping Nova Scotians better understand tick-borne illnesses, including how to prevent bites, recognize symptoms and know when to seek care.  

Dr. Ross has answered some common questions about ticks in Nova Scotia to help us protect ourselves while enjoying our time outside. 

How concerned should Nova Scotians be about ticks? 

The black-legged tick is the primary tick responsible for tick-borne disease transmission in Nova Scotia. These ticks are well-established and can be encountered anywhere in the province.  

People should continue to enjoy the outdoors, which brings many health benefits, but just be aware of ticks and know how to protect themselves. 

What diseases transmitted by ticks are most common in Nova Scotia? 

The most common disease transmitted by black-legged ticks in Nova Scotia is Lyme disease. Case numbers have increased significantly since Lyme was first diagnosed here in the early 2000s. Last year, Nova Scotia recorded over 2,700 lab confirmed cases. Another disease being increasingly seen is Anaplasmosis, with over 650 cases documented last year. 

Babesiosis and Powassan virus have also been seen in Nova Scotia, but they are rare.  

Another condition associated with ticks is Alpha Gal Syndrome (AGS). AGS is thought to be associated mainly with the Lone Star tick. This tick arrives through migrating birds or human travel, but it is not currently established in Nova Scotia. AGS results from the body’s immune system reacting to a molecule in the tick’s saliva and can cause allergies to red meat, pork or dairy. Cases of AGS are rare in Canada. 

What activities increase risk of tick bites? 

Since ticks are active anytime the temperature is consistently above 4 degrees, spending time outdoors in Nova Scotia during those conditions poses an exposure risk. They are especially active in warm, humid conditions. They are found in long grass, under leaf litter and foliage, in leafy tree forests and among shrubs and low-lying plants.  

Activities with higher risk for exposure include: 

• Spending time in forests, long grass, off established trails. 
• Gardening and yard work. 
• Outdoor occupations like forestry, landscaping, wildlife management, or farming. 

How can people protect themselves from tick bites? 

• Wear Health Canada-approved insect repellent. DEET and icaridin-based products are preferred for those over 6 months old.  
• Wear light-coloured clothing to spot ticks easily. 
• Wear long pants tucked into socks. 
• Tuck shirts into pants. 
• Wear closed shoes. 
• Enjoy areas less at risk for tick exposure, like established paths, short grass or playgrounds.  
• Shower after being outdoors.  
• Wash clothes worn outdoors. Dry on high heat for at least 10 minutes to kill any remaining ticks. 
• Check pets for ticks regularly and carefully and keep up to date on tick prevention treatments. 
• Keep grass short. Check out the Landscape Management Handbook for tips. 

How do I do an effective tick check? 

You should do a thorough tick check whenever you have been outside in an area that presents a high risk of tick exposure. Check your body from head to toe including your scalp and hair, behind ears, back of the neck, armpits, groin and behind knees. It can be helpful to have another person check these areas.   

Watch this video for more tips: Top 10 tick hiding spots 

How do I safely remove an attached tick? 

You can see a healthcare provider to have a tick removed, or you can remove it yourself at home. 

To remove a tick: 

• Carefully grasp the tick with fine-point tweezers as close to the skin as possible. 
• Gently and slowly pull the tick straight out of the skin. Don’t jerk, twist or squeeze it. 
• Once removed, clean the area with soap and water or alcohol-based hand sanitizer. 
• If you aren’t able to fully remove the tick, do not excessively attempt removal if it doesn’t come out easily. The body will naturally push out the remaining parts over time.  

Watch this video: How to properly remove a tick 

How long does a tick need to be attached to be concerning?  

The majority of tick bites will not lead to illness. In most cases, a tick needs to be attached for at least 24 hours, usually more than 36 hours, for the bacteria that causes Lyme disease to be transmitted from the tick to a human. The available evidence suggests similar attachment times are needed for Anaplasmosis and Babesiosis.  

Powassan virus is different, with available animal studies suggesting that the black-legged tick only needs to be attached for 15-30 minutes to transmit the bacteria.  

To know whether you are at risk after finding a tick on you in Nova Scotia, it is very helpful if you can confirm the type of tick. Only black-legged ticks are known to spread diseases in Nova Scotia, but there are several different types of ticks in our province that can be hard to tell apart. Nova Scotia Health does not provide a tick identification service. It’s recommended you use  eTick.ca, which is a free and easy-to-use tick identification website. Once you submit a tick photo, you can expect a response from experts identifying the tick within 24 hours.  

When and where should someone seek medical care? 

Doctors, nurse practitioners and your local pharmacy can provide care for tick bites.  

Preventative treatment is available for Lyme disease after a black-legged tick bite in certain situations. Specifically, the following conditions, established by expert guidelines, should be satisfied: 

• The tick is adult or adolescent. 
• The tick was removed within the previous 72 hours (three days). 
• The tick was attached for more than 36 hours (confirmed either by the degree of tick engorgement – how enlarged the tick is – or certainty about the time it attached). 
• The tick bite occurred in Nova Scotia, or an area endemic for Lyme disease.  

When these conditions are satisfied, a healthcare provider can provide a single dose of preventative treatment. For children under 8 years old, the provider will discuss with guardians the risks and benefits of preventative treatment. 

If using etick.ca for tick identification, seek out preventative treatment while waiting if results may take longer than 72 hours after the tick was removed. 

If you think you may have a tick-borne disease, talk to a healthcare provider about testing and treatment.  

What symptoms should I watch for after a tick bite, and when do they appear? 

Lyme disease presents in stages, though not all people will get symptoms at any given stage.  

It can begin with an expanding target or bullseye rash at the bite site. This can appear three to 30 days after a bite. The rash doesn’t always look like a target, but is fairly large, 5 cm or more, and expands. Other early symptoms include flu-like symptoms such as fever, fatigue, headache, muscle aches and swollen lymph glands.  

If a person doesn’t experience early symptoms or they aren’t recognized or treated as Lyme disease, they could develop another more serious stage of Lyme. This typically occurs a few weeks to a few months after a bite. Symptoms can include: 

• Flu-like symptoms 
• Multiple target rashes in various places 
• Neurological problems such as facial paralysis, or Bell’s Palsy 
• Infection of the brain, meningitis or encephalitis 
• Heart complications 

If this stage of Lyme disease isn’t recognized or treated, a person can get late-stage Lyme disease months or years later. This late stage can involve complex neurological symptoms or arthritis, especially in the knees.  

Anaplasmosis is often mild with flu-like symptoms, but no rash. There may be some abnormalities on lab testing involving the liver and platelets, the clotting component of blood. Rarely, meningitis or encephalitis can occur.  

Babesiosis is often mild with flu-like symptoms or no symptoms, and no rash. More severe disease can occur, in which case a person may experience: 

• Anemia, or low red blood cells that can be severe  
• Severe fatigue or trouble breathing 
• Jaundice, a yellowing of the skin and eyes 
• Confusion 
• Rarely, and only in severe cases, multi-organ failure 

Powassan virus usually presents with mild flu symptoms or no symptoms. However, more serious disease involving brain infection can occasionally occur.  

Symptoms of Anaplasmosis, Babesiosis and Powassan virus vary in when they appear.  A good general rule is to watch for symptoms from five days to five weeks after a tick bite.  

Lyme disease, Anaplasmosis, and Babesiosis have specific and effective treatments. Only Lyme disease has a preventative treatment. There is no specific treatment at this time for Powassan virus.  

Learn more: 

• Tick safety  
• Tick-borne diseases 
• Identify a tick