Sca protocol for the prevention of tick-borne illness

SCA Protocol for the Prevention of Tick-Borne Illness


Because SCA has experienced increased incidence of embedded ticks and Lyme
disease, when working in areas with known high populations of ticks and based on a job
hazard assessment, the following protocol for the prevention of tick borne illnesses has
been developed.
1. Cease or do not engage in service in areas with an unmanageably high exposure 2. Wear and use protective clothing/equipment • Hats (for work not requiring hard hats) • Treat clothing/equipment (clothing, hats, gaiters, boots) with permethrin to • Inspect body thoroughly for ticks, paying special attention to the waistband of clothing, back of neck, armpits and groin. It may be helpful to have someone assist in this inspection. 5. Remove ticks as soon as they are seen. 6. Carefully monitor for yourself and others for signs and symptoms of tick 7. Seek medical attention after signs and symptoms of a tick borne illness appear.

Protocol for Treatment of Clothing with Permethrin
The SCA, similar to the EPA, has determined that the benefits of permethrin outweigh
the risks. Permethrin is an extremely effective insecticide relative to ticks, does not
have significant implications for human health, and, when used correctly, poses little
environmental risk.
SCA participants should treat boots, gaiters, pants, hats (for sites on which hard hats
are not required) and shirts with permethrin spray every two weeks, or as directed by
the manufacturer.
General Guidelines
• Treat clothing with permethrin in a windless but well-ventilated area, away from water sources and insect populations (particularly bees) to reduce the effects of permethrin on aquatic life and insects • Wear latex or vinyl gloves (all applications) and a facemask or bandana over • Wait until clothing is completely dry before wearing SCA Protocol for Prevention of Tick-Borne Illness 3/6/09 Page 1 of 6 • Retreat clothing after several washes or after a couple of weeks, according to the
Background

In many areas in the United States, tick-borne illnesses (such as Lyme disease) are on
the rise. In the years between 1992 and 2006, the annual count of incidences of Lyme
disease increased 101%. Even though Lyme disease has been reported in 49 of 50
states in the U.S., about 99% of all reported cases are confined to five geographic areas
(New England, Mid-Atlantic, East-North Central, South Atlantic, and West North-
Central).
Permethrin Information

The CDC recommends that anyone, including pregnant women and children, traveling
in areas where disease-carrying insects are present, use permethrin-containing
repellents on clothing, shoes, bed nets, and camping gear to help prevent diseases
transmitted by insects. Permethrin is highly effective both as an insecticide and as a
repellent for ticks, mosquitoes, and other arthropods.
Permethrin has been shown to be a safe preventative measure. The CDC states that
there appears to be little potential for toxicity from permethrin-treated clothing.
Permethrin “has low mammalian toxicity, is poorly absorbed through the skin and is
rapidly inactivated by the body.” Exposure to permethrin from wearing permethrin
treated garments at the recommended concentrations is unlikely to cause skin
sensitization or other skin effects on humans.
Permethrin is used widely in the United States as the active ingredient in shampoos and
lotions. Permethrin is also commonly found in pet flea shampoos, lice shampoos, and
on agricultural crops, particularly fruits and vegetables.
1 Centers for Disease Control and Prevention (CDC): “Surveillance for Lyme Disease, United States 1992-2006” 2 CDC: “Lyme Disease Statistics” 3 CDC: “Traveller’s Health – Yellow 4 CDC: “Traveller’s Health – Yellow 5 Kirby C. Stafford III: “Ticks and Tick Control” (June 2007) Connecticut Department of Forestry and Horticulture 6 Extension Toxicology Network: “Pesticide Information Profile” 7 Commission on Life Sciences: “Health Effects of Permethrin-Impregenated Army Battle-Dress Uniforms” (1994) 8 Public Broadcasting System: “Last Battle of the Gulf War” 9EPA: “Permethrin and Resmethrin – TEACH Chemical Summary” (2007) SCA Protocol for Prevention of Tick-Borne Illness 3/6/09 Page 2 of 6 In registering permethrin as an approved insecticide, the EPA “considered post-
application exposure to… permethrin treated clothing. All scenarios were below the
Agency’s non-cancer and cancer LOCs [level of concern].” The EPA also stated that
all postapplication cancer risk estimates for both populations [military personnel and
garment workers exposed to permethrin-impregnated clothing] were in the 10-6 range
and do not exceed the EPA’s level of concern.
Permethrin used as an insecticide to protect agricultural interests is highly toxic to both
freshwater and estuarine aquatic organisms. Permethrin is also highly toxic to
honeybees, as well as other beneficial insects. The EPA regulates the use of
permethrin when used in emulsifiable concentrates and ready-to-use formulations
because of the possible adverse effects on aquatic organisms.
In its registration of permethrin as an approved chemical for insect control, the EPA
conducted a risk/benefit analysis of use of permethrin and concluded that “given the
significance of the use of permethrin and the mitigated nature of the risks of permethrin,
the Agency believes, on balance, that the benefits of permethrin outweigh the risks.”
Permethrin Risks

Permethrin is a Type I pyrethroid, with the primary target being the nervous system.
The neurotoxic effects are consistently characterized by tremors, hyperactivity, and
altered functional observation battery observations at high doses. Permethrin is
absorbed by all routes; however, it has a low acute toxicity via the oral, dermal, or
inhalation route of exposure, and is not an eye or skin irritant and not a skin sensitizer.
Following oral administration, permethrin is rapidly absorbed, metabolized, and excreted
via urine and feces. Permethrin is classified by the EPA as “likely to be carcinogenic
to humans” by the oral route.
10 Environmental Protection Agency (EPA) (June 2006): “Permethrin Facts (Reregistration Eligibility Decision Fact 11 Id. 12 Environmental Protection Agency (EPA) (June 2006): “Permethrin Facts (Reregistration Eligibility Decision Fact 13 Id. 14 Extension Toxicology Network: “Pesticide Information Profile” http://pmep.cce.cornell.edu/profiles/extoxnet/metiram-propoxur/permethrin-ext.html 15 Environmental Protection Agency (EPA) (June 2006): “Permethrin Facts (Reregistration Eligibility Decision Fact 16 Urban Pesticide Pollution Prevention Project (UP3) (August 2005): “Overview of Permethrin Risk Assessment.” 17 Environmental Protection Agency (EPA) (April 2006): Reregistration Eligibility Decision for Permethrin. SCA Protocol for Prevention of Tick-Borne Illness 3/6/09 Page 3 of 6 Tick Facts

Deer Tick
• Identifying feature – circular dark spot above long mouthparts (clockwise from top large tick: female, male, larval, nymph) Dog Tick – dark spot above short mouthparts (Dog Tick engorgement sequence)
Fiction: Lyme disease always starts with a “bulls eye” wound.
Fact: A circular, outwardly expanding rash can occur at the site of the tick bite 3 to 32
days after being bitten. However, a true bulls eye appears in less than 9% of cases.
18 http://www.tickinfo.com/deertick.htm 19 http://www.tickinfo.com/browndogtick.htm 20 Wikipedia: “Lyme Disease” http://en.wikipedia.org/wiki/Lyme_disease SCA Protocol for Prevention of Tick-Borne Illness 3/6/09 Page 4 of 6 Fact: the best way to remove a tick is to use sharp tweezers. There are a lot of myths about methods of removing ticks, including using matches, petroleum jelly, nail polish, etc. The safest way to remove a tick is to use sharp tweezers. Grasp the tick as close to the skin as possible, and pull away from the skin in a steady motion. Clean the wound with soap and water.

Signs and Symptoms of Lyme Disease

According to the National Institute of Health, in the first stage of Lyme disease (days to
weeks after infection), called the early Lyme disease, symptoms can include fatigue,
chills and fever, headache, muscle and joint pain, swollen lymph nodes and erythema
migrans (rash).
In the second stage of Lyme disease (weeks to months after infection), called early disseminated Lyme disease, symptoms can include numbness and pain in arms or legs, paralysis of facial muscles, meningitis, and abnormal heart beat. In the third stage of Lyme disease (weeks, months or years after infection), called late or chronic Lyme disease, symptoms can include chronic Lyme arthritis (60% of untreated patients), nervous system problems including memory loss and difficulty 21 CDC: “Tick Removal” http://www.cdc.gov/ncidod/dvbid/lyme/ld_tickremoval.htm 22 American College of Physicians: “Initiative on Lyme Disease – Patient’s Guide” http://www.acponline.org/clinical_information/resources/lyme_disease/patient/diagnosis.htm 23 National Institute of Health: “Lyme Disease- The Facts, The Challenge http://www3.niaid.nih.gov/topics/lymeDisease/PDF/LymeDisease.pdf 24 American College of Physicians: “Initiative on Lyme Disease – Patient’s Guide” http://www.acponline.org/clinical_information/resources/lyme_disease/patient/diagnosis.htm 25 National Institute of Health: “Lyme Disease – The Facts, The Challenge” http://www3.niaid.nih.gov/topics/lymeDisease/PDF/LymeDisease.pdf 26 Centers for Disease Control and Prevention (CDC): “Learn about Lyme Disease” 27 Id. SCA Protocol for Prevention of Tick-Borne Illness 3/6/09 Page 5 of 6 concentrating (up to 5% of untreated patients), chronic pain in muscles and unrestful sleep, heart problems and liver disease. 28 Id. 29 American College of Physicians: “Initiative on Lyme Disease – Patient’s Guide” http://www.acponline.org/clinical_information/resources/lyme_disease/patient/diagnosis.htm 30 National Institute of Health: “Lyme Disease- The Facts, The Challenge http://www3.niaid.nih.gov/topics/lymeDisease/PDF/LymeDisease.pdf SCA Protocol for Prevention of Tick-Borne Illness 3/6/09 Page 6 of 6

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