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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning again, everyone. Did you see the Gothamist article a while back with the headline that said, 'Tick season is back in force: Why Outdoorsy New Yorkers should check themselves every 15 minutes,' every 15 minutes? That may sound excessive, but the article quotes Jennifer White, director of the vector-borne disease unit of the New York State Health Department, who says, "Folks have been accustomed to do a full body check at the end of the day for ticks and those once a day checks are important for stopping Lyme disease, but there's also Powassan virus," I don't know if I'm saying that right, "which can be transmitted in as little as 15 minutes."

The Gothamist article goes on to note that emergency room visits for tick bites were already at a six-year high for January and February this year because we had the warmest January in February on record for New York and New Jersey, and ticks can be out anytime the temperature is over 40. A New York Times article on ticks says in recent years, ticks not previously prevalent in New York, such as the ones called Gulf Coast ticks and Asian longhorned ticks have become more abundant around here.

You may not want to hear it on a day that Michael Hill just told us we'll have a heat index approaching 100 degrees, but long pants and long sleeves are recommended if you're going to be doing certain kinds of outdoor things. We'll find out more now from the expert I cited a moment ago, Jennifer White, director of the vector-borne disease unit of the New York State Health Department. Jennifer, thanks so much for joining us. Welcome to WNYC.

Jennifer White: Thank you so much and thank you for having me this morning.

Brian Lehrer: What's Powassan virus? I think many listeners have heard of Lyme disease, but not that, and am I even pronouncing it right?

Jennifer White: Very close, and yes, many people have heard of Lyme disease and some of the other less frequent tick-borne diseases we have in New York State like anaplasmosis and babesiosis, but Powassan virus, it's actually named after a region in Canada where the first case was identified many years ago. Powassan virus is what we would consider a very rare virus in New York State.

When we're talking case numbers, we usually only see anywhere from two to seven-ish cases a year or so, which is good because when we do see cases of Powassan virus, we do tend to see severe illness. Now, as with a lot of other viruses that are carried by mosquitoes, ticks, we know that asymptomatic infection is also possible so there may be people who are exposed to the virus but never develop symptoms.

When we do see cases, we tend to see neurologic illness in individuals who've been infected with Powassan virus. Unfortunately, Powassan virus has a higher risk of death than many of our other tick-borne illnesses and it also can cause long-term severe neurologic consequences so that folks aren't able to go back to their normal activities of daily living. Again, very rare, a handful or so, less than 10 cases per year on average in New York State.

Found in many regions of New York State, but what's interesting about Powassan is that we see a couple of different types of Powassan virus. We call them all Powassan virus, but Powassan virus can be transmitted by something called the woodchuck tick, but it can also be transmitted by the deer tick or the black-legged tick as we like to call it yes. The black-legged tick is the same tick that can cause Lyme disease, can cause babesiosis, can cause anaplasmosis.

It's our main tick that we're concerned about when we're talking about tick vectors because we know that that particular tick can carry a lot of things that can make people sick, Powassan is just one of them. Like I said, very rare, but with severe consequences. [crosstalk] You had mentioned earlier-

Brian Lehrer: So check yourself every 15 minutes.

Jennifer White: -this once-a-day tick check. When we're talking Powassan, the once a day isn't enough because that particular virus can be transmitted in as little as 15 minutes.

Brian Lehrer: Listeners, our phones are open for everything you always wanted to know about ticks but never had the director of New York State's vector-borne disease unit over for dinner. We've got Jennifer White here now, so help us report this story with your story of close encounters with ticks in our area or your questions about how to live among them. 212-433-WNYC, 212-433-9692 call or text.

What about these other newly found ticks that I mentioned from The Times article, new for our area anyway, Gulf Coast ticks and Asian longhorn ticks? Why would these ticks species suddenly be showing up if you agree that they are showing up?

Jennifer White: A million-dollar question. There's a number of factors that go into that. Generally speaking, we can use climate, we don't always talk about climate change when we're talking about communicable diseases, but when we're talking about vector-borne diseases, climate change is really a reason why these things happen. Sometimes there's a different range for these ticks and then as climates get warmer further north, or we can have a longer life cycle, I should say, due to warmer climate conditions.

Sometimes we see ticks that may be imported into an area by, say, falling off a bird, something like that and then they're able to establish a population because the climate conditions are suitable for that. Something like the Gulf Coast tick so far seems to have only been found in the Staten Island region of New York State but the Asian longhorn tick that you referenced is something that we've seen up further in the Hudson Valley.

When we see it, we tend to see a lot of it where it is. It's an interesting tick because it doesn't need a mate to reproduce. The females are able to reproduce without a male. We see predominantly female ticks having lots and lots and lots of tick offspring, and so we'll see these little focal populations of ticks, but what's important to note about those Asian longhorn ticks is that so far we don't believe that they would have an impact on human health.

Some lab studies are still ongoing but we have not seen them be able to transmit any vector-borne diseases to humans at this point. Something that we keep on our radar and we'll continue to study but right now, we're looking at the ecological consequences of having those ticks in the area, and then keeping our eyes open for how those ticks might impact human health down the road.

Brian Lehrer: The Gothamist article notes that ticks emerge more when the air has been humid. Do the drenching rains that we had earlier this week mean ticks are more prevalent right now, and the areas of New York and Vermont that got flooded are particularly at risk?

Jennifer White: What's really interesting about ticks is that, it's the combination too of what the ticks are doing but also what people are doing. Even when we're seeing potentially more ticks in the environment as the result of environmental conditions, it doesn't necessarily mean that we're going to see a spike in human disease. That can be because sometimes when we've had these, days of drenching rain and then these hot humid conditions afterwards, it may limit people's outdoor activity. When that happens, it limits people's exposure to ticks.

I know, in our family alone, when it gets to be heat index of almost 100, we're not outdoors. We're doing more of our exercising indoors than we normally would outdoors. That human component really plays a role in how much tick-borne disease we see. There have been plenty of times, there's been a lot of ticks and we've said, "Wow, it's a really busy tick season," when we go out and do our active tick surveillance and collect those ticks, but we don't see much in the way of tick-borne disease sometimes and that may be because human behavior is impacting how often people are encountering ticks in the environment.

Brian Lehrer: Julian in Northvale New Jersey, you're on WNYC. Hi, Julian.

Julian: Hi, thank you. My question is, how do I check my dog for ticks after he's been outside? He happens to be a rat terrier mix.

Jennifer White: Great question, Julian. Thank you for that. One thing I would also, I'll tell you a little bit about how to check your pet. Obviously, you're thinking along the right lines of, "He's been outdoors, he comes in, what should I do to check him?" You want to check around the neck of the dog. You want to give them really a full body check. Ticks will tend to want to go in areas where it's warmer so make sure you're checking behind hind legs, in between legs, things like that. They're going to want to try to go and burrow down into the fur.

You're going to want to remove a tick. A pair of tweezers is honestly our preferred tool, whether you're removing a tick from an animal or from a person and you just want to get that tick as close to the body of the animal or a person as you can and grab those mouth parts and then pull straight and a little bit firmly because the tick actually has barbs that make it difficult to remove. It wants to stay in the skin of the animal that it's bitten, but you just want to pull straight up and out.

What's important when you are removing a tick, if you find one on a pet or a person, is that you don't squeeze the body of the tick because squeezing the body of the tick can actually cause the tick to regurgitate its gut contents through its mouthparts and into the skin. You may actually be more likely to get infected with a tick-borne illness whether, again, it's a person or an animal if you squeeze that body. You want to go down towards its mouthparts and remove the tick from there.

Another thing we recommend, Julian, is to reach out to a veterinarian and speak to the veterinarian about some of the things that you can do to prevent ticks from wanting to go on your pet in the first place. Some of the products work repelling the tick, the tick gets to the skin of the animal and has no desire to be there and will drop off. There's some preventatives like that, and then if you feel like there's a chance that your pet may have acquired a tick-borne illness to take the pet to the veterinarian as well and get a good checkup for your animal.

Brian Lehrer: Pretty fine line you're describing there. Gripping hard enough to remove the tick without squeezing too hard so that it emits its virus.

Jennifer White: Well, it's where you're squeezing. What you don't want to do is squeeze the body of the tick, like the bulb. Imagine a turkey baster and think about the bulb of the Turkey baster being the body of the tick. That's not the part you want to squeeze because that's exactly what it'll do. It'll act like a turkey baster and put those contents right back into the animal. If you go below that, sometimes you can think of the mouth parts as being like a flap that's attached to the skin. You can flip the tick's body a little bit and then you can get closer to the skin underneath that bulby part and grab there and pull up and out.

Brian Lehrer: I wonder how easy it is to do with different kinds of ticks because some are so tiny. Let me tell you a story. Someone I know, her friend found a tick in her 16-month-old baby's ear after some kids were playing in some bushes and running on some grass. The mom saw the one tick because it was big enough to see. That prompted a more thorough check that night and they found a number of more ticks behind the ear and a number more ticks elsewhere on the child that were so tiny that the mom said she would not have even seen them if she wasn't specifically looking for them. Does that story ring true to you?

Jennifer White: It sure does. It may have been a time of year. We do have times a year where both adult ticks are out and nymphal ticks are out. The adult are the largest ones. They're the size of a sesame seed. The nymphal ones are the ones that are the size of a poppy seed. We call them our teenager tick or our second life stage of a tick. It could have been that you were seeing multiple stages or that person was seeing multiple stages on their infant. It could also be that it was different types of ticks to your point. We certainly have more than just the deer tick or black-legged tick in New York State.

Those tiny ones admittedly are harder to remove, which is really why we do recommend those fine-tip tweezers or a forceps size where it's very tiny. Those are also good. They have some tools on the market, some that you can also use. They have a number of different names but they're considered like tick removal tools. We really do recommend those fine-tip tweezers because when you get them in an odd area, like the fold of an ear or they are that tiny, those fine-tip tweezers are really the best method.

For the same reason I described, not wanting to squeeze the body of the tick, some of those home remedies or old wives' tales that some of us had heard growing up are not things we want to do like covering the tick with petroleum jelly or lighting a match and putting that near the tick. Obviously, that's a bad idea for a number of reasons, but it also could-

Brian Lehrer: [crosstalk] Because it's on your body.

Jennifer White: -agitate the tick and make the tick regurgitate its gut contents again potentially increasing your risk of infection.

If folks are interested, we have a video on the New York State Department of Health website that we produced that shows the proper way to remove a tick. We actually did it by having what we would consider clean ticks. Ticks that we had gotten from CDC that were not known to carry any pathogens and my coworker allowed them to bite him and then I removed the tick from him on camera. That gives folks a really good visual of how to go through the process if it's not something they're comfortable with or have ever done before.

Brian Lehrer: Just to follow up on that, on how to make sure you are checking yourself sufficiently enough, I just told you the story of that baby. An adult with that tiny size tick or an adult with or anybody with darker skin or hair on their bodies, wouldn't it be so easy to miss?

Jennifer White: It can be. The importance of a full body check particularly at the end of the day, like I said, predominantly when we're outside during the day, I mentioned that 15-minute window. Like in my family, when I'm outside during the day, I'm checking my clothes pretty frequently. I'm checking the parts of my body that I can visualize to make sure ticks haven't decided to take a little walk up me and try to find a good place to burrow.

At the end of the day when we come in, it's wonderful if you have a partner who can help you do that, check that tick check for places like your back or up in your hairline, but a full body mirror where you can, if you don't have a partner who can help you check, can be really helpful as well. Taking that extra minute to say, "Oh, is that a new freckle? I don't remember seeing something like that before," can be really useful in helping folks identify if they've been bitten by a tick.

Brian Lehrer: I think Matt in Jersey City said he had a reaction to that story I told about the kids playing in the grass and the bushes. Matt, you're on WNYC. Thanks for calling in.

Matt: Hey Brian. Of course. I have been wrestling for a few years now with what to do with our kids because it's got-- Our son, he is a very sensitive guy, but he also loves rolling in the dirt, digging in the dirt. He, sometimes on hikes, he'll get scared of going into the grass now because we have a relative who works online disease stuff and he's really drilled into him the risks of these ticks. I guess when I hear 2 to 10 people, I don't want to dismiss that. I know Lyme disease rates are also up, but I feel like if I'm checking him every even 30 minutes for bugs, it really could start to have an effect on him. I'd love a bit more perspective on like [crosstalk] reasonable [unintelligible 00:16:41].

Brian Lehrer: Yes, how do you not rob your kids or their childhood-

Matt: Exactly.

Brian Lehrer: -for a risk that's only going to affect 2 to 10 people in all of New York State per year?

Jennifer White: Thanks for asking that question. As the director of the vector-borne disease program at the state health department, my kids have clearly gone through this too. What I will tell you is that we really do recommend repellents, and repellents are safe even in children, even in young children. That's just that extra layer of prevention protection that you can use.

Obviously, we talk about covering as much of your body as possible, but you can also, like I said, consider repellents and there's a number of them that are safe and effective. You can find them either by looking at our state health department web website, the CDC website, the EPA website as well. A lot of what you've probably heard of are products that contain DEET, but there are other products as well, like picaridin, IR3535.

In addition to that, in our household, what we do is we use something called permethrin. Permethrin, you can either buy clothing that's impregnated with permethrin or it's something you can treat your clothing or your hiking boots or something like that with and it comes as an aerosol spray and you can buy it at many big-box stores, sporting goods stores, many of which it's easy to find, you can find it online. Basically, then you can treat those clothing or those hiking boots or something like that prior to going out into the woods. They will prevent a tick from basically wanting to come anywhere near those clothes or on those boots. If they get there, they're going to drop right off.

We do that and our family, and then we have the boots that we're going to go outside and hike with. We have the sneakers that we're going to go out and garden in or play soccer in, things like that. That way, even if one of the kids forgets to put repellent on before they had outside, those prevention measures with that permethrin-treated clothing can be really helpful.

It's that layered approach that we really recommend, which is protecting your body by the long sleeves, long pants, and then also using repellents to repel the ticks and then doing the tick check. Those are really still our tried and true methods of trying to prevent tick bites and still allowing our kids and all of us to enjoy the outdoors.

Brian Lehrer: We're talking about ticks with Jennifer White, excuse me, director of the vector-borne disease unit of the New York State Health Department and Ingrid in Westchester, you're on WNYC. Hi, Ingrid.

Ingrid: Hi. Thanks for taking my call. I found a tick on me on Friday and I do checks every day and I shower, but this tick was so tiny I didn't notice it till it had been on for about 36 hours. I wanted to send the tick for testing in New York State but it seems there's no place you can send the tick to get tested. I sent it to a lab out of state and I'm waiting for a result. Now the question is what do I do in terms of treatment? It was a nymphal tick that was attached for about 36 hours.

Jennifer White: Great question, Ingrid. It's one we get a lot and you're right. As a state health department, we do not do testing on individual ticks. For folks that choose to do so, like you said, there are a number of options that are available online. Tick testing, when you've been bitten by a tick, is a little bit tricky. First of all, if this particular tick comes back, the report comes back suggesting it was infected with a number of pathogens, one, two, or more, it doesn't necessarily mean that you're going to be infected with those pathogens just because the tick was.

Vice versa if this tick comes back negative, there's always the chance that because you've been in tick habitat, that you've been bitten by another tick that you may not have even noticed. Sometimes it gives people a false sense of reassurance when they get that result back that says, "This tick was fine. This tick was disease free." Doesn't necessarily mean you haven't been exposed. Those are just things to know while you're waiting for those tick results to come back, but it's certainly worth a discussion with your provider regardless of what those results are.

What we generally recommend is that we tell people really watch and wait. Look for a rash which often starts around the site of the tick bite, but there can be satellite rashes that may occur on other parts of your body in the case of Lyme disease, but not everyone gets that rash. It'd be wonderful if everybody with Lyme disease got a rash. Everyone saw it. We could treat them very early, but a number of people say 20%, 30% sometimes do not develop the rash.

You'd be looking for what we would call summer flu-like symptoms, fever, headache, chills, that general sense of malaise, "I just don't feel good and I don't know what else could be wrong." It's worth a call to a provider because there's a lot of testing that providers can do to pick up Lyme disease or other tick-borne diseases that are carried in our area as well as sometimes making the diagnosis based on the exam of the patient. Like I said if they're seeing that hallmark telltale bullseye rash that's associated with the Lyme disease diagnosis, they may just diagnose that way. Great question. One we get asked a lot, but definitely also something to speak to your healthcare provider about.

Brian Lehrer: That caller was concerned because there was a tick attached to her for 36 hours. We had another caller who I was going to take, but maybe you just answered her question, which is if you don't find a tick on you but then you start to have some kind of symptoms, how do you know if they are symptoms related to a potential tick bite that you didn't see and what do you do?

Jennifer White: To your point, the summer flu-like symptoms I described can occur in lots of other things beyond Lyme disease. It can be associated with other summer or viral illnesses. It can be associated with something even like COVID still. It's that phone call to the provider to say, "I just don't feel well," and then saying to the provider, "I do spend time outdoors," or, "I'm concerned about tick-borne illness."

As Ingrid had mentioned before, there is something called prophylaxis that some providers will offer once someone has been bitten by a tick, if that tick has been attached for greater than 36 hours. It's a single dose of doxycycline antibiotic and sometimes that's prescribed for individuals with tick bites that they know have been on for longer than 36 hours and they're in an area where Lyme disease is prevalent, which is basically all of New York State at this point.

Giving the provider the heads up in that other situation can potentially lead to getting that single dose of antibiotic which can help to prevent Lyme disease, not the other tickborne diseases, but Lyme in particular, which is obviously our most common. That general awareness of, "I'm outside a lot and I'm not feeling well, so I'm going to make sure when I tell my provider I'm not feeling well that I also spend time outdoors so tick-borne illness is a potential cause of my symptoms."

Brian Lehrer: One more call, Jay in Queens, you're on WNYC. Hi Jay.

Jay: Hi, thanks. Is this something we have to worry about, for instance, in Central Park or in a small backyard in Brooklyn or Queens? Is it only in the country or is it an urban problem too?

Jennifer White: Thanks for asking that question. What we do in New York State is a little bit different than what New York City does. They're actually their own jurisdiction. They do their own active tick surveillance in their parks and some public areas in New York City so I can't speak to exactly what we're seeing by way of ticks and their prevalence this year and another year in Central Park, but what I can say is this. That we consider New York State to be an area where ticks are common and that anytime the weather is over 40 degrees, ticks can be out and can be active.

What we often see in New York City residents, even in areas where they're considered urban areas, they're not spending a lot of time in rural areas, but they are going to parks or they're going out of the New York City metropolitan area and they're going to Long Island or the lower Hudson Valley or summer vacations, we certainly see tick-borne illness in residence of New York City for all of those reasons.

It's a really good idea just to remind yourself that when you're outdoors and it's over 40 degrees, tick-borne illness is a possibility and you should be checking yourself for ticks. Then using some of those other measures I discussed like preventing tick bites using repellents and things like that.

Brian Lehrer: Last question as we run out of time. A number of people are texting or calling in to ask about progress on vaccines, particularly for Lyme disease.

Jennifer White: We definitely are seeing national progress by way of Lyme disease vaccine. That one's the one that will likely come to market first is that's the one that's in phase three clinical trials right now I believe. Still a couple of years away from coming to market. Again, it all depends on how those clinical trials go, but it's predicted that Lyme disease will be the first tick-borne disease vaccine that will be available.

Obviously, that will be a game changer for folks in New York State where Lyme is so prevalent, but when that vaccine comes to market, we're also going to have to make sure that folks know that it's not the only tick-borne disease they can be exposed to in New York State. While it can be the goal is to have it prevent Lyme disease, we're also going to have to remind folks that all those same tried and true methods of preventing tick bites in the first place are still going to be important because you can also get anaplasmosis, babesiosis. I had mentioned, although rare before, Powassan virus, another disease called Borrelia miyamotoi, there's a number of Rocky Mountain spotted fever.

There's another number of other diseases that ticks can carry that will not be prevented if folks get a Lyme disease vaccine. I think the holy grail that everyone hopes will come to market someday is an anti-tick vaccine. One that if the tick bites you, no matter what species it is, what type it is, what it's infected with, the tick would drop off before it could transmit disease, but that would be something further down the road.

Brian Lehrer: There, listeners, is everything you always wanted to know or maybe wish you didn't know but now you can't unknow it about ticks. In our midst, Jennifer White, director of the vector-borne disease unit of the New York State Health Department, thank you so much for all the information.

Jennifer White: Thank you for welcoming me on the call today. I really appreciate the time.

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