CDC   More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation   Ticks are responsible for the transmission of Lyme disease and a number of other infections to humans. Nurses can help keep these illnesses in check through awareness and education campaigns.

Registered nurses are at the center of a growing campaign to keep tickborne illnesses, especially Lyme disease, from compromising the health of Californians as it has tens of thousands of New Yorkers and others in the Northeast and upper Midwest.

It’s nurses who answer health advice lines and likely are the first to see tick-bite patients in rural health care and emergency department settings, said Anne Kjemtrup, PhD, DVM, a public health biologist with the California Department of Health Services. “RNs are also responsible for conveying safety awareness messages and seasonal alerts,” said Kjemtrup, whose doctorate is in epidemiology.

In Willows, Calif., “One of the boards in our front lobby is on Lyme disease and tickborne illnesses,” said Grinnell Norton, RN, public health nursing director for Glenn County.

Ticks “are pretty disgusting little critters, but they’re part of country life,” said Rita Leeseman, RN, EdD, MA. She recently retired as coordinating nurse for 32 school districts in the outdoors mecca of Humboldt County, and said it’s again time for an inservice to raise school nurses’ index of suspicion about Lyme disease. The RNs then pass on awareness to pupils and parents.

Lyme is the No.1 tickborne disease in California. It’s been confirmed in 55 of the state’s 58 counties. Ninety-five cases were reported in 2001, a pale shadow of the nation-leading 49,174 cases in New York that year, according to the national Centers for Disease Control and Prevention. The western black-legged tick, which transmits Lyme in California, has a far lower infection rate than do the deer ticks that carry it elsewhere.

Campaign trail

Californians owe their growing awareness of the disease to a Legislature-created committee of public health officers, a public health nurse, physicians, researchers, people who have been bitten by ticks, and a statewide education campaign.

Similar campaigns are under way in the Northeast, where Lyme disease was first identified in the late 1970s and later named for victims in the area around Lyme, Conn.; the Southeast, where Rocky Mountain spotted fever is quickly gaining ground; the upper and central Midwest; and the West, which includes Montana. There, a rash of peculiar cases in the past two years has the state epidemiologist and National Institutes of Health researchers wondering whether they are seeing a heretofore unknown cousin of Lyme disease.

Ticks embed their heads under the skin to feed on blood, and transmit through saliva glands the spiral spirochete that causes Lyme disease. Nymph-stage ticks, which are no larger than a poppy seed, are most active in spring; adult ticks are most active in the fall.

RNs, as health advisers and clinicians, are on the lookout for the signature bull’s-eye rash — a red rim around a pale center — that occurs in about 40% of Lyme disease cases and signals the need for antibiotic treatment. With or without the rash, Lyme also is characterized by flulike symptoms — fever, malaise, fatigue, headache, and stiff neck. If left untreated, it can progress to chronic and debilitating neurologic disease and severely arthritic joints.

“We know ticks,” said Sherrie Muhs, RN, CEN, an emergency department charge nurse at Avera McKennan Hospital and University Medical Center in Sioux Falls, S.D. For vacationers and residents alike — actually anyone who lives, works, or plays in the wild outdoors of California, the Northeast, or the Midwest — prevention is the main thing, Muhs said.

That means light-colored clothing to more easily spot ticks, long sleeves buttoned at the cuffs, long pants tucked into socks or footwear, and use of an insect repellant containing DEET. The chemical, N-diethyl-m-toluamide, however, is toxic to children younger than 2 and shouldn’t be used on them, Muhs said. Clothing, but not skin, also can be sprayed with a repellant that contains tick-killing Permethrin.