Lyme disease

Lyme disease is a bacterial illness transmitted to humans by the bites of infected blacklegged ticks. Typical symptoms include fatigue, chills, fever, headache, muscle and joint aches, swollen lymph nodes and a characteristic red, expanding skin rash that begins at the site of the tick bite. If left untreated, infection can spread to joints, the heart, and the nervous system.

Untreated Lyme disease during pregnancy may lead to infection of the placenta and possible stillbirth. Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), the possibility of exposure to infected ticks and laboratory tests. Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics.

Most infections occur in the Northeast, the North-Central States (mostly Wisconsin and Minnesota), and on the West Coast. Individuals who work outdoors in areas where the disease is found may have increased exposure to infected ticks and therefore Lyme disease. NIOSH recommends that employers and workers take the following steps to prevent tick bites when working outdoors.

Employers should:

• Provide training for workers on how Lyme disease is spread, the risks of exposure and infection and how workers can protect themselves.
• Ensure workers wear appropriate personal protective equipment (PPE), such as light-colored long-sleeved shirts, long pants, socks and hat. High boots or closed shoes that cover the feet completely should be worn.
• Provide workers with insect repellents registered by the U.S. Environmental Protection Agency (EPA).

Workers should:

• Learn the symptoms of Lyme disease
• Wear PPE, such as a hat, light-colored clothing, long-sleeved shirts, and long pants, high boots or closed shoes. Pant legs should be tucked into boots or socks.
• Use insect repellents containing DEET (e.g., 20 to 30 percent) that provide protection for the amount of time you will be outdoors. A higher concentration will last longer. Some formulations of DEET may degrade certain types of materials, such as plastic. Refer to the label and manufacturer's instructions.
• Use permethrin (e.g., 0.5 percent) on clothing but not on skin.
• Follow product label directions for use and reapply as needed per the label and manufacturer's instructions. Do not spray products directly onto face, and avoid contact with eyes and mouth.
• Avoid wooded and bushy areas with high grass and leaf litter, and walk in center of trails whenever possible.
• Bathe or shower as soon as possible after coming indoors.
• Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Remember to check your hair, in and around your ears, underarms, waist, bellybutton, groin, and behind the knees for ticks.
• Remove any attached ticks promptly and carefully with fine-tipped tweezers by gripping the tick as close to the skin as possible. Pull the tick's body away from your skin with a steady motion; do not jerk, twist, squash or squeeze the tick. Clean the area and tweezers with soap and water and antiseptic. Do not use petroleum jelly, a hot match, or nail polish to remove the tick.
• Examine gear and clothing for the presence of ticks, and wash and dry work clothes at high temperature.

If you develop symptoms of Lyme disease, notify your employer and seek medical attention promptly. Be sure to tell your health care provider that you work outdoors in an area where ticks may be present.

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