Ticks do not jump, fly or drop from trees, but grasp passing hosts from the leaf litter, tips of grass, etc. Most ticks are probably picked up on the lower legs and then crawl up the body seeking a place to feed. Wear light-colored clothing with the pants tucked into socks. Repellents can substantially increase the level of protection (next page). On returning home, remove and wash the clothing. Carefully inspect the body and quickly remove any attached ticks. Tick bites are usually painless and, consequently, many people may be unaware that they have been bitten. Also, carefully inspect children and pets. Ticks may attach anywhere on the body. Pets can bring ticks into the home, resulting in a tick bite without the person being outdoors. Many tick bites are thought to occur around the home. A tick bite does not necessarily mean a person will develop Lyme disease. Many ticks are not infected and studies have indicated that it may require 36-48 hours or more for transmission to occur from an attached nymph.

Prompt removal of an attached tick will reduce the chance of Lyme disease infection. Use thin-tipped tweezers or forceps to grasp the tick as close to the skin surface as possible. Pull the tick straight upward (see illustration) with steady even pressure. This should remove the tick with the mouthparts intact. If the mouthparts break off, it will not affect the chance of getting Lyme disease. Disinfect the area; a topical antibiotic may also be applied. A dead tick can be saved in alcohol. If a tick is to be tested for spirochetes, place it in a small vial or jar with a blade of grass to keep it alive. Note the site and date of the bite. Other methods of tick removal (e.g. petroleum jelly to suffocate the tick) are not effective. Use of heat from matches to make the tick back out or gasoline or other chemicals are unacceptable. Watch for signs and symptoms of Lyme disease.

Localized infection - Approximately 70 - 80% or more of patients develop a red rash (erythema migrans or EM) within 2 to 32 days (typically 8 or 9 days) after the tick bite. The rash gradually expands over a period of a week or more. Rashes vary in size and shape, and may occur anywhere on the body, although common sites are the thigh, groin, trunk, and armpits. Many rashes reach about 6 inches in diameter, but some can be 8-16 inches or more in size. The rash often remains red, but swelling, blistering, scabbing or central clearing may occur, resulting in a "bulls-eye" appearance. The rash may be hot to the touch, but it is usually not painful. Mild nonspecific, flu-like symptoms may be associated with the rash. In most cases, symptom onset occurs during the summer months when the nymphal stage of Ixodes is active. Lyme disease affects all age groups, but the greatest incidence has been in children under 14 years and adults over 40 years of age. There may be no early symptoms in some cases.