Virtually all of us who have spent time in the outdoors have either heard about or experienced an encounter with a tick. Diseases transmitted through the bite of a tick represent a growing health concern in the United States and around the world. Tick bites can affect individuals who live in, work in, or travel to wooded, grassy, or brush-filled environments. Ticks are generally more active during warmer months of the year (usually April through September), but they can be active any time the temperature is above freezing. Therefore, taking precautions can be close to a year-round activity, including an increased emphasis during vacation travel when the climate may differ from that of your usual environment. Nurses play an essential role in patient education, prevention, early recognition, clinical management, and public health surveillance of these diseases—and their credibility and trusted relationships enable impactful opportunities.

Adult deer tick, Ixodes scapularis/via Wikimedia Commons

The following summary outlines key facts about tick biology and transmission, clinical manifestations of major tickborne diseases [TBDs], prevention strategies, post-bite care, public health reporting, and updates on vaccines—particularly for domestic and international travelers.

Understanding ticks and disease transmission

Ticks are blood-feeding arachnids capable of transmitting pathogens, including bacteria, viruses, and protozoa, through their saliva. In the U.S., several tick species are associated with disease transmission and include:

  • Blacklegged tick (Ixodes scapularis) – Transmits Lyme disease, anaplasmosis, babesiosis, Powassan virus.
  • Western blacklegged tick (Ixodes pacificus) – West Coast variant of Ixodes.
  • Lone star tick (Amblyomma americanum) – Causes ehrlichiosis, tularemia, Heartland virus, and alpha-gal syndrome.
  • American dog tick (Dermacentor variabilis) – Transmits Rocky Mountain spotted fever (RMSF), tularemia.

Transmission risk increases the longer a tick remains attached, with some pathogens (e.g., Lyme disease) typically requiring 36–48 hours to transmit, while others (e.g., Powassan virus) can be transmitted within 15 minutes.

Common tick-borne diseases: what nurses should know

The CDC provides extensive information about ticks and diseases transmitted by ticks. Information is made available for the general public and for health care providers (along with useful graphics, resources, and education modules). Some of the diseases associated with tick bite are included below, along with some points of interest.

  1. Lyme Disease
  • Pathogen: Borrelia burgdorferi
  • Geography: Northeast, Upper Midwest, Northern California
  • Signs/Symptoms: Erythema migrans rash, fatigue, fever, joint pain
  • Nursing Notes: Requires a 10–21 day course of doxycycline, amoxicillin, or cefuroxime, depending on age and pregnancy status.
  1. Anaplasmosis
  • Pathogen: Anaplasma phagocytophilum
  • Symptoms: Fever, chills, headache, myalgia, leukopenia, thrombocytopenia
  • Treatment: Doxycycline; no alternatives for children or pregnant women due to disease severity
  1. Ehrlichiosis
  • Pathogen: Ehrlichia chaffeensis
  • Vector: Lone star tick
  • Symptoms: Fever, headache, malaise, possible rash (especially in children)
  1. Rocky Mountain Spotted Fever
  • Pathogen: Rickettsia rickettsii
  • Signs/Symptoms: Fever, petechial rash, headache, GI symptoms
  • Importance: Prompt treatment with doxycycline is life-saving and must not be delayed pending test results.
  1. Babesiosis
  • Pathogen: Babesia microti
  • Signs/Symptoms: Hemolytic anemia, jaundice, flu-like symptoms
  • Special Considerations: More severe in immunocompromised and asplenic individuals
  1. Tularemia
  • Pathogen: Francisella tularensis
  • Signs/Symptoms: Ulceroglandular form most common; may present with local skin ulcer and swollen lymph nodes
  1. Powassan Virus
  • Pathogen: Powassan virus (flavivirus)
  • Features: Rare but serious and may cause encephalitis or meningitis; no specific treatment
  1. Alpha-Gal Syndrome
  • Cause: Delayed allergic reaction to mammalian meat triggered by Lone star tick bite
  • Symptoms: GI upset, rash, anaphylaxis; often misdiagnosed

Prevention and Patient Education

Personal Protection

  • Use insect repellents with products such as 25-35% DEET or picaridin.
  • Treat clothing and gear with permethrin. Do not use permethrin on skin or DEET on clothing.
  • Wear long sleeves, long pants, and tuck pants into socks when in tick-risk environments.
  • Stay on clear trails and avoid brushing against vegetation.

Tick Checks and Removal

  • Perform full-body tick checks after outdoor activities.
  • Remove ticks promptly using fine-tipped tweezers or instruments designed for tick removal; clean site with antiseptic.
  • Document the date, location, and duration of attachment if known, in case this information needs to be shared with a health care provider.

Post-Bite Monitoring

  • Watch for fever, fatigue, rash, and flu-like symptoms up to 30 days post-bite.
  • Reach out to a health care provider quickly if symptoms occur post-bite.

Vaccines for Tick-Borne Diseases

Lyme Disease Vaccines 

  • Past vaccine (LYMErix) was discontinued in 2002.
  • A new vaccine candidate, VLA15 (Pfizer/Valneva), is in phase 3 trials for prevention in high-risk areas such as the Northeast and Upper Midwest.
  • That vaccine is not yet available but may be considered for people with frequent outdoor exposure if/when approved.

Tick-Borne Encephalitis (TBE) and Vaccine

  • TBE is caused by the tick-borne encephalitis virus, found primarily in Europe and parts of Asia.
  • It can lead to serious neurological complications, including meningitis and long-term cognitive deficits.
  • No antiviral treatment exists—prevention via vaccination is critical.
  • FDA-approved vaccine in 2021 for individuals aged 1 year and older for pre-exposure prophylaxis.
  • Vaccine is indicated for use among U.S. travelers spending extended time in TBE-endemic areas such as Austria, Germany, Czech Republic, the Baltics, and Russia.  Particularly for outdoor enthusiasts or long-term residents engaging in activities like hiking, biking, or camping during the tick season in endemic regions. [https://www.cdc.gov/acip-recs/hcp/vaccine-specific/tbe.html]

Role of Nurses in Clinical Care, Education and Reporting

Nurses assess symptoms, identify risk factors, and help initiate prompt treatment to prevent complications. In addition, nurses are key in educating patients and their family members regarding the risks of tick bites and preventive activities.

Key activities for nurses include:

  • Educating patients, families, others in the community regarding the risks associated with tick bites.
  • Providing information regarding prevention including clothing to wear when outdoors, use of permethrin on clothing, deet on skin, and body checks when returning from outdoor activities.
  • Informing patients of procedures to use when removing a tick that has attached as well as about post-removal monitoring.
  • Monitoring and recognition of symptoms that may be associated with tick bites.
  • Patient education relevant to antimicrobial use and, in particular, patient questions and interactions that may improve appropriate use of those agents.
  • Interaction with health care providers and public health regarding tickborne infections
  • Knowledge regarding current vaccine, its use and indications, and where to find vaccine consultation.

Conclusion

Tick-borne diseases are complex, potentially serious, and increasingly prevalent. Nurses serve on the front lines of prevention, early detection, clinical management, and patient education. By educating patients, promoting prevention, and supporting public health reporting, nurses are instrumental in reducing the burden of these diseases across communities, patient populations, and themselves.

Ruth Carrico, PhD, FNP-C, CIC, FSHEA, FNAP, FAAN
Adjunct Professor
Division of Infectious Diseases
University of Louisville School of Medicine
Louisville, KY