On People

Minimizing Your Risk

Although effective therapies for Lyme disease and other tick-borne diseases exist, primary prevention of infection remains the best approach. Primary prevention measures for humans are detailed below.

In Wisconsin, be extra vigilant in warmer months (April-September) when ticks are most active. If there is an especially warm spring, be aware that ticks may be active earlier than usual. 

Campers, hikers, hunters, farmers, and people in outdoor occupations may be more likely to encounter ticks and therefore are at a higher risk of acquiring tick-borne diseases especially in counties with established populations of Ixodes scapularis or other known tick vector species.

1. Avoid Direct Contact with Ticks and Tick Habitat

  • Avoid known or suspect tick-infested areas, especially during the warmer months in Wisconsin.
  • Walk in the center of mowed or cleared trails. 
  • Avoid walking through wooded and brushy areas with leaf litter and avoid brushing up against vegetation and tall grass.

2. Use Tick Repellent such as DEET or Permethrin. 

  • DEET can be applied directly to the skin or clothing. However, DEET may cause damage to some fabrics and certain surfaces.  The United States Environmental Protection Agency (EPA) completed an extensive reevaluation of DEET and, “concluded that as long as consumers follow label directions and take proper precautions, insect repellents containing DEET do not present a health concern.” http://www.epa.gov/opp00001/factsheets/chemicals/deet.htm

  • Use insect repellents that contain at least 20-50% DEET (N, N-diethyl-m-toluamide) on exposed skin. DEET efficacy tends to plateau at a concentration of approximately 50% (Zielinski-Gutierrez et al. 2012). Always follow the manufacturers instructions on the label. DEET is only a repellent and does not provide 100% protection against tick bites. 
 
  • Use products that contain 0.5% permethrin on clothing

Permethrin cannot be applied directly to the skin. It should be applied to clothing and allowed to dry before the clothes are worn. Permethrin is an insecticide with some repellency properties and kills ticks on contact. Treat clothing and gear, including boots, pants, socks and tents.

In a controlled indoor study by Miller et al. (2011) to asses the number of tick bites (using pathogen-free nymphal deer ticks–Ixodes scapularis) received by individuals wearing either permethrin-treated or untreated summer clothing (t-shirt, shorts, socks, and sneakers), human volunteers wearing outfits treated with permethrin received 3.36 times fewer tick bites than subjects wearing untreated outfits. Success of the permethrin-treated clothing in reducing tick bites was dependent on the article of clothing. Subjects wearing permethrin-treated sneakers and socks were 73.6 times less likely to have a tick bite than subjects wearing untreated foot gear and those wearing permethrin-treated shorts and t-shirts were 4.74 and 2.17 times less likely to receive a tick bite in areas related to those garments than subjects wearing untreated shorts and t-shirts. Ticks found attached to human volunteers were also classified as dead or alive before removal. On subjects wearing untreated clothing, 97.6% of attached nymphs were alive, whereas significantly fewer (22.6%) attached nymphs were alive on subjects wearing repellent-treated outfits.

 
  • Clothing pre-treated with permethrin is available and has been demonstrated to be highly effective against ticks in several studies and can retain insecticidal activity for over 70 washings. (Vaughn and Meshnick 2011 and Miller et al. 2011). In a nonrandomized open label pilot study to determine the effectiveness of Insect Shield-treated clothing (long-lasting permethrin impregnated clothing) for the prevention of tick bites among outdoor workers from the North Carolina Division of Water Quality in actual field conditions, subjects wearing Insect Shield-treated clothing had a 93% reduction (p < 0.0001) in the total incidence of tick bites compared to subjects using standard tick bite prevention measures (Vaughn and Meshnick 2011).
 
  • There are other available options for tick repellents that have been experimentally shown to be effective including: picaridin, EBAAP, SS220 and dodecanoic acid (DDA). (see chart below).
  • Natural and plant-derived product compounds have also been shown promise as effective alternatives to permethrin-based compounds for application to clothing. In a study by Jordan et al. (2012), field trials were conducted to compare the repellent activity of two natural product compounds (nootkatone and carvacrol) with commercially available plant-derived (EcoSMART organic insect repellent) and permethrin-based (Repel Permanone) repellents against adult Ixodes scapularis (deer ticks) and Amblyomma americanum (lone star ticks) on treated clothing. Results demonstrated that one day after treatment nootkatone and carvacrol provided 100% repellency against I. scapularis adults. Nookatone maintained complete protection for up to 3 days but carvacrol showed steadily declining repellency against I. scapularis during the 7-day course of the field trials. Nootkatone was also at least as effective against host-seeking A. americanum as against I. scapularis through day 3 while, carvacrol provided little protection against A. americanum adults. After day 7, nootkatone was the most effective against both species followed by Permanone, EcoSMART, and carvacrol in order of activity.
  • For pet owners: beware when applying permethrin to your clothing or if you use spot-on treatments for dogs which contain permethrin. Cats are especially sensitive to permethrin toxicity. (Richardson 2000).

Insect repellents and acaricides for use against ticks:

  • DEET (N,N-diethyl-m-toluamide, also known as N,N-diethyl-3-methyl-benzamide)
  • IR3535 (Ethyl Butylacetylaminopropionate or 3-[N-Butyl-N-acetyl]-aminopropionic acid ethyl ester)
  • Picaridin (1-piperidinecarboxylic acid, 2-(2-hydroxy)ethyl)-, 1-methylpropylester)
  • Permethrin- (3-Phenoxyphenyl)methyl 3-(2,2-dichloroethenyl)- 2,2-dimethyl-cyclopropane- 1-carboxylate
  • MGK-326* (di-n-propyl isocinchomeronate), used in conjunction with DEET in   composite formulation.
  • MGK-264* (N-octyl-bicycloheptene dicarboximide), used in conjunction with DEET in composite formulation.
  • Oil of Lemon Eucalyptus/PMD/Citriodiol- para-menthane-3,8-diol
  • Nootkatone- is a natural organic compound from the heartwood of Alaska yellow cedar (Chaemaecyparis nootkatensis) and is considered the primary flavor component of grapefruit. It can be derived from a variety of other natural sources including citrus, vetiver grass (Vetiveria zizanioides), as well as chemically synthesized. 
  • 2-Undecanone, methyl nonyl ketone, IBI-246
  • Dodecanoic acid (DDA), lauric acid
* This is not an all inclusive list of tick repellents and acaricides.

List of Insect and Tick Repellents by Active Ingredient


Active Ingredient

Brands

Effectiveness Against Ticks

DEET (Formulations registered for direct application to human skin contain from 4 to 100% DEET).

 

Many brand names, formulations, and concentrations available from various manufacturers or distributors. Except for a few veterinary uses, DEET is registered for use by consumers, and it is not used on food.

 

DEET is an effective against ticks but is considered less repellent than piperidines or permethrin. There are approximately 230 products containing DEET registered with the EPA, which range in concentration from 4% to 100%. Effectiveness of DEET on the skin depends on the concentration, absorption through the skin, evaporation, sweating, air temperature, wind, and abrasion of the treated surface by rubbing or washing. Due to the variation in effectiveness, is must be reapplied periodically depending on the product specifications. DEET is effective against several tick species.

The range of protection provided by DEET varies among tick species and developmental stages.

When applied only to clothing, an aerosol application of 20% and 30% DEET was found to be 86% and 92% effective against all three life stages of Ixodes scapularis (deer tick), respectively (Schreck et al. 1986), but skin applications were reported to be only 75 to 87% effective against crawling Amblyomma americanum and Ixodes scapularis (Schreck et al. 1995).

DEET controlled release formulations

3M UltrathonTM

Sawyer Controlled Release

In a field trial study, a 33.25% extended-duration lotion formulation of DEET applied to military uniforms provided 87.5% repellency against I. scapularis larvae but only provided 19.1% repellency against I. scapularis nymphs. In the same study, DEET provided 50% repellent against adult D. variabilis and nymphal and adult A. americanum.

IR3535 (7.5, 15 or 20.05%)- also called EBAAP

 

Skin-So-Soft Bug Guard Plus IR3535® (spray or lotion w/sunblock)- labeled for use against deer ticks, mosquitoes, biting midges and several other biting flies.

Classified by the EPA as a bio-pesticide and approved for use in the USA in 1999. It is derived synthetically from a natural amino acid beta-alanine.

Cilek (2002) determined IR3535 was more repellent than similar concentrations of DEET against nymphal I. scapularis.

Carroll et al. (2008) tested three controlled release formulations of IR3535 against nymphal I. scapularis.

  • 10% lotion formulation- prevented ticks from crossing treated areas on human volunteers for 9.1 hours.
  • 20% aerosol- prevented ticks from crossing treated areas for 11 hours
  • 20% pump spray- prevented ticks from crossing treated areas for 12.2 hours.

Picaridin

(Icaridin or KBR3023)

1-Piperidine carboxylic acid

Cutter® Advanced*

(Bayrepel® in Europe)

(Autan® in Europe)

 

*Cutter Advanced is labeled for protection against biting flies, chiggers, fleas, gnats, mosquitoes and no-see-ums, but is not labeled for use against ticks.

Repellent based on piperidine, a colorless organic compound with a peppery odor. The piperidine structural motif is present in natural alkaloids including piperine, which gives black pepper (Piper spp.) its hot flavor. Other examples of insect repellents which are derived from piperidine include: AI3-37220 (cyclohex-3-enyl 2-methylpi- peridin-1-yl ketone) and the 1S, 20S stereoisomer of AI3-37220 or SS220  (Morpel 220). 

Under Construction

Permethrin (0.5%) For use on clothing and other fabrics such as mosquito netting or tents only.

Coulston’s Duranon® Tick Repellent

Repel® Permanone

Sawyer® Clothing Tick Repellent Cutter® Outdoorsman Gear Guard 3MTM Clothing & Gear Repellent

No Stinkin’ TicksTM

Permethrin is a synthetic pyrethroid insecticide rather than a traditional repellent for use against ticks and other arthropods. It works by killing ticks that come into contact with treated fabric although it has some repellency properties.

In a study by Schreck et al. (1986), clothing treated with 0.5% permethrin provided 100% protection from all life stages of I. scapularis.  In similar studies, clothing treated with 0.5% permethrin provided 100% protection against nymphal and adult Amblyomma americanum (Schreck et al. 1982) and Dermacentor variabilis (Mount & Snoddy 1983), while a 20% spray of deet provided only 85% and 94% protection against the same species of ticks.

MGK-326*

A repellent used with DEET in composite repellent formulations (also contains MGK-264). Example: Cutter® Tick DefenseTM

Used with DEET in composite formulations.

MGK-264*

A mosquito repellent and synergist used with DEET in composite repellent formulations (also contains R-326).

Example: Cutter® Tick DefenseTM

Used with DEET in composite formulations.

Oil of Lemon Eucalyptus/

PMD/Citriodiol- para-menthane-3,8-diol

Off! Botanical

Repel® Lemon Eucalyptus Insect Repellent

MyggA® Natural (Bioglan, Lund, Sweden), is an insect repellent similar to Citriodiol containing 30% oil of lemon eucalyptus with a minimum of 50% PMD and small amounts of geranium, lavender, and rose extracts.

Main ingredient of the by-product from the distillation of leaves from the Australian lemon-scented gum tree, Corymbia citriodora. Essential oils from C. citriodora, contains citronella, citronellol, geraniol, isopulegol, and delta pinene.

Under Construction

Citronella oil

Natrapel (Oil citronella only)

Green Ban for People (Oil citronella, peppermint, others)

Buzz Away (Oil citronella, peppermint, others) Herbal Armor (microencapsulated oil citronella, peppermint, others)

 Under Construction

2-Undecanone, methyl nonyl ketone, IBI-246

BioUD® (7.75% 2-undecanone, HOMS, LLC Clayton, NC)

Registered by the EPA in 2007

Originally isolated from the glandular trichomes of the wild tomato plant, Lycopersicon hirsutum f. glabratum.

In a study by Bissinger et al. (2009), repellent efficacy of BioUD® (7.75% 2-undecanone and DEET (98.1%) in a laboratory setting was examined using choice-tests on treated and untreated filter paper (control). BioUD® (7.75% 2-undecanone) provided significantly greater mean percentage repellency than 98.1% DEET against both A. americanum and I. scapularis and provided equivalent repellency to DEET against D. variabilis. In the same study, head-to-head assays between BioUD® and DEET, undiluted and 50% dilutions of BioUD® were more repellent than undiluted DEET against all three species of ticks tested. 

BioUD® (7.75% 2-undecanone) was also more repellent than 15% DEET in a laboratory setting against D. variabilis directly comparing the repellents on filter paper. BioUD® also provided high repellency on treated cotton cheesecloth for 8 days after treatment against D. variabilis (Witting-Bissinger et al. 2008).

Dodecanoic acid (DDA)

ContraZeck® contains 10% DDA

Zanzarin®

Saturated fatty acid that occurs as the main compound in coconut and palm kernel oil.

Under Construction

* Currently there are are no repellents registered for use in the United States that contain MGK Repellent 326 (Di-n-propyl isocinchomeronate) or MGK Repellent 264 (n-Octyl bicycloheptene dicarboximide) as the sole active ingredient. MGK-326 and MGK-264 are used together with DEET in composite formulations in repellents for human use and as synergists to enhance the repellency of DEET. MGK-326 was classified as a probable human carcinogen in 1993, therefore to mitigate risk, the EPA has limited total production and use of MGK-326 and set a maximum concentration of 2.5% in repellent products. As directed on the label, no more than 3 applications per day of MGK-326 are allowed on children twelve and under to limit overexposure in young children.

Note: Reference to any commercial entity, products or services on this page should not be interpreted as an endorsement by the company, its products, or its services.

For more information on tick bite prevention and the use of insect repellents for personal protection: 

See here: Stafford K. (2005). Connecticut Agricultural Experiment Station.  http://www.ct.gov/caes/lib/caes/documents/publications/fact_sheets/tickbiteprevention05.pdf    

3. Wear clothes that will help shield or protect you from ticks.

Light-colored clothing makes ticks easier to spot. Long-sleeved shirts and long pants are best. Tuck your pants into the top of your socks or boots, to create a “tick barrier” which can make it more difficult for ticks to get access to your skin and bite or attach.

  • In a study by Vazquez et al. (2008), the use of protective clothing (e.g., long pants, long-sleeved shirts, or light-colored clothing) was 40% effective and routine use of tick repellents on skin or clothing was 20% effective for prevention of Lyme disease. 

      

 4. Find and Remove Ticks from Your Body.

  • Bathe or shower as soon as possible after coming indoors (preferably within two hours) to more easily find ticks that are crawling on you. Remember, bathing will not necessarily wash off all ticks that are crawling or attached but allows you to more easily search for ticks. 
  • Conduct a thorough full-body tick check using a hand-held or full-length mirror to view all parts of your body or have someone assist you to check your scalp or other hard to view areas on your body after returning from known or potentially tick-inhabited areas. Parents should thoroughly inspect their children for ticks under the arms, in and around the ears, the neck area, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair and scalp area.
  • In a prospective case-control study of 364 Connecticut patients with Lyme disease diagnosed from 2005-2007, checking for ticks within 36 hours of spending time in the yard at home and bathing within 2 hours after spending time in the yard were found to be protective against Lyme disease (Connally et al. 2009). 
  • Examine gear and pets. Ticks can hitch a ride hitch into the home on clothing and pets, then attach to a human later, so carefully examine pets, coats, tents and backpacks. 
  • Tumble clothes in a dryer on high heat for 60 minutes to kill remaining ticks. A study by Carroll (2003) suggested that nymphal stages of two species of ticks–lone star and deer ticks (Amblyomma americanum and Ixodes scapularis) could survive the cold, warm and hot wash cycles of automatic clothes washers. However, a one-hour high heat cycle in the dryer was sufficient to kill all developmental stages tested. 
  • In a New Jersey study, while 84% of respondents could name at least one personal protection measure against Lyme disease, only 43% actually reported taking any precaution measures (Hallman et al. 1995). So although education and increasing  awareness about Lyme disease is the basis for many Lyme disease prevention programs, actual awareness of precaution measures and risk perception does not always correlate with their uptake and use.
 

 Is There a Vaccine to Prevent Lyme Disease?

No, currently a Lyme disease vaccine is no longer available. The Food and Drug Administration (FDA) approved a human Lyme disease vaccine, LYMErix™ (GlaxoSmithKline), which contained recombinant outer-surface protein A (OspA) of B. burgdorferi, in December 1998. However the vaccine was withdrawn from the U.S. market by the manufacturer (GlaxoSmithKline) in February 2002, citing insufficient consumer demand. Protection provided by this vaccine diminishes over time. Therefore, if you received the Lyme disease vaccine before 2002, you are probably no longer protected against Lyme disease. (Nigrovic & Thompson, 2007).

                                                                                                                     

References:

Bissinger BW, Apperson CS, Sonenshine DE, Watson DW, Roe RM. (2009). Efficacy of the new repellent BioUD®  against three species of ixodid ticks. Exp. Appl. Acarol. 48:239–250.

Carroll JF, Benante JP, Kramer M, Lohmeyer KH, Lawrence K. (2010). Formulations of deet, picaridin, and IR3535 applied to skin repel nymphs of the lone star tick (Acari: Ixodidae) for 12 hours. J Med Entomol; 47(4):699-704.

Carroll SP. (2008). Prolonged efficacy of IR3535 repellents against mosquitoes and blacklegged ticks in North America. J. Med. Entomol. 45:706–714.

Carroll SP and Loye J. (2006). PMD, a registered botanical mosquito repellent with Deet-like efficacy. Journal of the American Mosquito Control Association; 22(3):507-514. http://www.bioone.org/doi/abs/10.2987/8756971X%282006%2922%5B507%3APARBMR%5D2.0.CO%3B2?journalCode=moco

Carroll, JF. 2003. A cautionary note: survival of nymphs of two species of ticks (Acari: Ixodidae) among clothes laundered in an automatic washer. Journal of Medical Entomology. 40(5): 732-736. http://www.bioone.org/doi/pdf/10.1603/0022-2585-40.5.732

Cilek JE. (2002). Repellent efficacy of IR3535 and DEET against nymphal black legged ticks (Ixodes scapularis). in: Proc. IXth International Conference on Lyme Borreliosis and other Tick-borne Diseases, New York, NY, pp. 18–22.

Connally, N. P., Durante, A. J., Yousey-Hindes, K. M., Meek, J. I., Nelson, R. S., & Heimer, R. (2009). Peridomestic Lyme disease prevention: results of a population-based case-control study. American Journal of Preventive Medicine;37(3):201-6. http://www.sciencedirect.com/science/article/pii/S0749379709003900

Hallman W, Weinstein N, Kadakia S, Chess C. 1995. Precautions taken against Lyme disease at three recreational parks in endemic areas of New Jersey. Environ Behav 27:437–453. http://eab.sagepub.com/content/27/4/437

Jordan RA, Schulze TL, Dolan MC. (2012). Efficacy of Plant-Derived and Synthetic Compounds on Clothing as Repellents Against Ixodes scapularis and Amblyomma americanum (Acari: Ixodidae). Journal of Medical Entomology; 49(1): 101-106. http://www.afpmb.org/sites/default/files/pubs/dwfp/publications/FY12/Jordan,Schulze%26Dolan,2012.pdf

Miller NJ, Rainone EE, Dyer MC, González ML, Mather TN. (2011). Tick bite protection with permethrin-treated summer-weight clothing. Journal of Medical Entomology; 8(2): 327-33. http://www.tickencounter.org/pub/tick_repellent_clothing.pdf

Mount GA and Snoddy EL. (1983). Pressurized sprays of permethrin and deet on clothing for personal protection against the lone star tick and the American dog tick (Acari: Ixodidae). J. Econ. Entomol; 76:529–531.

Nigrovic LE and Thompson KM. (2007). The Lyme vaccine: a cautionary tale. Epidemiol. Infect. 135, 1-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870557/pdf/S0950268806007096a.pdf

Richardson, J. (2000). Permethrin spot-on toxicoses in cats. Journal of Veterinary Emergency Critical Care; 10(2):103-106. http://onlinelibrary.wiley.com/doi/10.1111/j.1476-4431.2000.tb00006.x/pdf

Schreck CE, Fish D, McGovern TP. (1995). Activity of repellents applied to skin for protection against Amblyomma americanum and Ixodes scapularis ticks (Acari: Ixodidae). J. Am. Mosq. Control Assoc;11:136–140.

Schreck CE, Snoddy EL, Spielman A. (1986). Pressurized sprays of permethrin of deet on military clothing for personal protection against Ixodes dammini (Acari: Ixodidae), J. Med. Entomol. 23: 396–399.

Schreck CE, Mount GA, Spielman A. (1982). Pressurized sprays of permethrin on clothing for personal protection against the lone star tick (Acari: Ixodidae), J. Econ. Entomol. 75:1059–1061.

Vaughn MF, Meshnick SR. (2011). Pilot study assessing the effectiveness of long-lasting permethrin-impregnated clothing for the prevention of tick bites. Vector Borne Zoonotic Disease; 11(7):869-75. http://online.liebertpub.com/doi/abs/10.1089/vbz.2010.0158

Vázquez, M., Muehlenbein, C., Cartter, M., Hayes, E. B., Ertel, S., & Shapiro, E. D. (2008). Effectiveness of personal protective measures to prevent Lyme disease. Emerging Infectious Diseases;14(2):210-6. http://wwwnc.cdc.gov/eid/article/14/2/07-0725_article.htm 

Witting-Bissinger BE, Stumpf CF, Donohue KV, Apperson CS, Roe RM. (2008). Novel arthropod repellent, BioUD®, is an efficacious alternative to DEET. J. Med. Entomol; 45(5):891–898. http://www.bioone.org/doi/pdf/10.1603/0022-2585(2008)45%5B891:NARBIA%5D2.0.CO%3B2

Zielinski-Gutierrez E, Wirtz RA, Nasci RS, Brogden WG. (2012). Protection against Mosquitoes, Ticks, & Other Insects & Arthropods. Chapter 2: The Pre-Travel Consultation, Counseling and Advice for Travelers. The Yellow Book. CDC Health Information for International Travel. http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travel-consultation/protection-against-mosquitoes-ticks-and-other-insects-and-arthropods.htm