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Scott G Winterton, Deseret News
Nancy Bush with her sons Christian, Benny and Graydon outside the Logan city library on Monday, June 12, 2017. Christian, who had already had Lyme disease, found a tick on his head while visiting the library in 2015.

Nancy Bush and her children were checking out books at the Logan Library when one of her 9-year-old twins asked her to look at something under his hair. What she found shocked both Bush and the physicians the family saw a half-hour later: An engorged tick was feeding on her son's head.

Bush, who lives in Mendon, Utah, was stunned because her son had just recovered from Lyme disease he contracted from another tick earlier that summer. The doctors and nurses who gathered around her son’s head at Logan InstaCare were fascinated because it’s so rare to see a tick in a Utah health-care facility.

Nancy Bush with her son's Christian, Benny and Graydon outside the Logan city library on Monday, June 12, 2017. Christian and Benny both contracted Lyme disease after a family trip. | Scott G Winterton, Deseret News

Ticks that harbor the bacteria that cause Lyme disease aren’t common in Utah; most found on people in Utah hitchhiked here from another state, health experts say. That seems to be what happened to Christian Bush. His mother believes the tick crawled on her son when they were visiting family in Missouri a few weeks earlier. And Shenom Allred of Tooele, Utah, found a tick burrowing into his thigh a few days after hiking in Washington state with his mother and son.

Ticks are a potentially dangerous souvenir that families traveling to certain areas of the country should take steps to avoid, especially since the Centers for Disease Control and Prevention are warning of another worrisome tick-borne illness — Powassan — that is emerging in the Northeast and around Great Lakes.

As if Lyme disease and Zika weren't enough to worry about, the CDC is warning that deer ticks are increasingly carrying a potentially deadly virus called Powassan. The risk is slight, but families on vacation should be wary.

While only 75 cases have been confirmed in the past decade, Powassan troubles health officials because the virus can be transmitted in just 15 minutes after a tick bite, unlike the bacteria that cause Lyme disease, which can take from 24 to 36 hours, according to the CDC. Powassan can cause swelling in the brain, seizures, confusion and memory loss; children and seniors are most vulnerable to serious illness.

A graphic of where you can find various ticks. | Heather Tuttle, Deseret News

Last year was the summer of Zika, the virus spread by the Aedes aegypti mosquito that can cause birth defects in children of infected pregnant women. Powassan is unlikely to inspire as much fear as Zika did, but families who travel this summer should learn which states have the highest concentration of ticks, and if you'll be outside, pack plenty of bug spray. (Or prepare to buy it at your destination if you're catching a plane.)

Ticked off

Two years ago, a 40-year-old woman from Salt Lake City spent a few days hiking in New Hampshire. When she came home, she discovered that a black-legged tick had hitched a ride on her neck. Disregarding the advice of the CDC, which says to flush ticks down the toilet, the woman mailed the tick back to New England, to a basement laboratory at the University of Massachusetts at Amherst, which found that the tick carried the bacteria that causes Lyme disease.

It’s unknown if the woman developed Lyme disease herself. Dr. Stephen Rich's tick-testing laboratory doesn't follow up with people who send ticks in to be tested, although they hope to expand the program to do so in the future.

Rich started the service that became Tick Report in 2006 and tested 60 ticks that year. The number doubled in each of the next few years, and the scientists working in Rich's lab have now tested more than 26,000 ticks, from all 50 states. They expect to test 10,000 ticks in 2017.

When the ticks arrive at the lab, nearly half of them are still alive, and the team photographs them and creates a file for each before putting them in a freezer set to -20 celsius. After they're frozen, a technician extracts DNA and RNA from the bodies and tests for seven strains of disease-causing bacteria.

The people who sent the ticks in get a report, and the information and a picture of the tick is posted in a database on the Tick Report website, so people can see what kinds of ticks have been found in their cities and what, if any, diseases they carry.

The powdery remains of the ticks are frozen indefinitely in case there is ever any reason to analyze the results again. The test costs $50, and people receive their results in three days, about two weeks before their bloodstreams would reveal antibodies if they contracted a disease.

About one-quarter of the ticks Rich's lab has tested carried Borrelia burgdorferi, the bacterium that causes Lyme disease; about 35 percent carried Borrelia general species, which can cause Lyme or tick-borne relapsing fever, most common in Western states.

But just because you're bitten by a tick that tests positive for disease-causing bacteria doesn't mean you're going to get sick. Fewer than 5 percent of bites result in an infection, health experts say. However, knowing that the tick you found on yourself or a family member doesn't harbor the bacteria doesn't mean you won't come down with Lyme.

"If you have one tick on you, that means you were in an area that had ticks," Rich says. You could have been bitten by another one that went undetected.

That's what happened to Nancy Bush's son, who had been diagnosed with Lyme disease earlier in the summer of 2015 after a rash developed on his forehead. The family was moving from Massachusetts to Utah, and en route to their new home, spent a month in New York. There, doctors twice dismissed Christian's rash as inconsequential, but when it returned and grew larger after a week of antibiotics, Christian was finally tested for Lyme, and the test was positive.

"He must have had a tick I never knew about," his mother said.

The CDC says there are about 30,000 diagnosed cases of Lyme in the U.S. each year, but the CDC estimates that the disease's true incidence is closer to 300,000 because of infections that are unnoticed or unreported, said Janis J. Weis, a professor of pathology at the University of Utah. Most confirmed cases are in New England and the Upper Midwest, although the disease is found up and down the Eastern Seaboard, and there are pockets of infection in Oregon and Washington state, Weis said.

Lyme in Utah

Utah has ticks, particularly in its mountains and canyons, but is not known to have deer ticks, the kind that carries Borrelia burgdorferi. Those ticks thrive in cool and wet temperatures and need large populations of deer to reproduce. There have been just 118 confirmed cases of Lyme disease in Utah since 1999, according to state Department of Health records, but that's a statistic that the Utah Lyme Disease Alliance vigorously contests.

"There are about 450-plus people in Utah who have Lyme disease, just in our support group alone," said Jenny Jones, the group's vice president.

Like Bush's son, Jones contracted Lyme outside of Utah; she found a tick lodged in her neck in 1996, three months after she returned from a stay in Russia, where she frequently took walks in the woods.

But Jones, a mother of eight, said many members of the group contracted Lyme in Utah, which is one reason the group will hold its annual picnic in Alpine, where she lives, this year. "If it were in a canyon, a lot of people wouldn't come," she said.

She said people have found ticks on them after hiking in Moab and St. George, and members have also reported getting ticks in the Timber Lakes region and the Heber Valley Camp area.

But sometimes ticks show up in Utah and no one is sure where they came from.

Two years ago, Layne Peterson of Salt Lake City found an engorged deer tick — the kind that's not supposed to live in Utah — on his dog. Testing revealed that the tick did not carry the Lyme bacteria or any other kind of disease, but left Peterson wondering how it got to Salt Lake City. He had recently traveled to South Carolina and Oregon and concluded it must have hitched a ride from one of those states.

And last year, when the 7-year-old son of Kindra Fehr of Salt Lake City complained of a painful bump on his head at bedtime, Fehr investigated and found a bloated dog tick that appeared to have been attached for several days. She mailed it alive to the Amherst lab and was relieved when the tests came back negative. But she has no idea how the tick got on her son. He'd played in friends' yards and a local park, but the family had not recently traveled.

Kindra Fehr of Salt Lake City found this dog tick on her 7-year-old son's head. | Kindra Fehr

While Lyme is the most well-known disease transmitted by ticks, there are many others, including anaplasmosis, babesiosis, Colorado tick fever, Rocky Mountain spotted fever, tularemia and tickborne relapsing fever (also known as TBRF), the latter of which has been diagnosed in Utah, according to the CDC.

In addition to disease, ticks can cause a rare but terrifying condition called tick paralysis, which many people learned about recently when an Oregon mother posted a video online after her 3-year-old daughter woke up one morning and was unable to stand or use her arms. An emergency-room physician found a tick embedded in the child's hair and removed it; shortly after the tick was removed, the child regained limb function.

The condition occurs when toxins from the tick's saliva spread through the bloodstream; the treatment is simply removing the tick.

Powassan, named for the Canadian town in which the virus was first discovered can cause inflammation of the brain after an incubation period from one week to one month. At least two people in Maine have recently been infected, and a 5-month-old in Connecticut who was having seizures was diagnosed with it at the end of last year. The parents said they pulled a tick off the baby's knee, and it had been there for less than three hours. The child has recovered, The Washington Post reported.

Removing a tick isn't as easy as swatting a mosquito, however. Tick experts bemoaned a recent viral video that showed a woman pouring peppermint oil on a tick to get it to detach. Some people say that any method that agitates the tick — like immersing it with oil or Vaseline, heating it with a blow dryer or applying dish detergent — may cause the tick to vomit, depositing more bacteria under the skin. The same applies to burning it with a match.

The CDC says to carefully remove it with tweezers; there are also special tick tweezers for sale at pet-supply stores and on the internet. Never crush a tick between your fingers, the CDC warns.

A primer on prevention

Last summer, the world's most feared pest wasn't an arachnid, but an insect: the Aedes aegypti mosquito that transmits the Zika virus.

So far, there have been no reported cases of Zika in Utah for 2017. All but one of 123 cases reported this year in the U.S. involved people who traveled outside the U.S.

Whether it's Zika, Powassan or Lyme, the main way to prevent these diseases is to avoid getting bitten by their hosts. Both ticks and mosquitoes are repelled by insecticides contained DEET and clothing, shoes and gear treated with permethrin, the CDC says. (You can buy items that are pre-treated, or apply it yourself.)

If you're going to be outside in an area that potentially has ticks and mosquitoes, wear long-sleeved shirts and long pants. And even after taking these precautions, you should check yourself and your children for ticks and shower soon after coming inside.

Rich, at the tick-testing lab at the University of Massachusetts, says people should familiarize themselves with various types of ticks and their life stages. Some are as small as the point of a pencil, or a poppy seed on a bagel, and can be mistaken for dirt or a freckle. (In fact, one of Rich's colleagues at the lab has a poppy-seed bagel in which three dead ticks are embedded so people can try to spot the tick.)

And Bush, the Mendon mom whose son contracted Lyme disease during the family's travels, urges parents to check their kids frequently if they play outside in areas known to harbor ticks.

Nancy Bush poses with her sons Christian, Benny and Graydon outside the Logan city library on Monday, June 12, 2017. After Christian had recovered from Lyme disease, his mother found a tick on his head while visiting the library in 2015.| Scott G Winterton, Deseret News

“Check your kids every night, every day — their hair, their armpits, everywhere. If you see a tick, I’d say get it removed professionally so you can be sure all of it is out. And absolutely get it tested; it relieves so much mystery and worry," she said.

The University of Massachusetts isn't the only tick service in the U.S.; the University of Rhode Island offers a tick identification service for people who send in pictures, and the Bay Area Lyme Foundation offers free tick testing through Northern Arizona University that provides results within three weeks.

And for the rare traveler who'd actually like to see ticks on vacation, there's the U.S. National Tick Collection that is open to the public two days a week at Georgia Southern University, in Statesboro, Georgia.