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Montgomery County Health Department
Questions & Answers about Lyme Disease

1.  What is Lyme disease?

Lyme disease is a bacterial infection caused by a spiral shaped microorganism called a spirochete. The name of the Lyme disease bacterium is Borrelia burgdorferi; consequently the disease often is called Lyme borreliosis.

2. How is Lyme disease spread?

Lyme disease is spread by the bites of certain ticks. The deer tics, Ixodes dammini, are responsible for transmitting the infection in the northeastern and central United States. On the Pacific Coast and in the southeast, Lyme disease is spread by blacklegged ticks that closely resemble the deer tick.

3. How do ticks carrying Lyme disease differ from other ticks?

The most important distinction is size. The vector ticks of Lyme disease are much smaller than dog ticks and cattle ticks. The nymphal stages of Ixodes dammini which are chiefly responsible for transmitting infections to humans are black and no bigger than a pinhead. The adult tick, which may transmit infections in the fall, are only slightly larger.

4. What are the early symptoms of Lyme Disease?

The earliest signs of Lyme disease are flu-like symptoms (fatigue, fever, headache, muscle and joint pains, and a very characteristic skin like rash called erythema migrans. This rash generally appears as a red, circular patch that expands slowly, often to a very large size. The center of the patch may clear as the rash enlarges. resulting in a ringlike appearance. The rash may be warm but is not painful.

5. What are the later manifestations of Lyme Disease?

Some of the symptoms of Lyme disease may not appear until weeks or months after the initial onset of illness. The infection may inflame the heart, leading to disturbances of the heart rhythm. Lyme disease may affect the nervous system causing muscle weakness of the face and limbs or pain and numbness. Meningitis, an inflammation of the covering of the brain may occur resulting in a stiff neck and severe headache. In later stages of the disease, arthritis may develop, and the joints may become red, swollen and painful.

6. How is Lyme Disease diagnosed?

Lyme disease is diagnosed from its clinical features and with the aid of serological (blood) tests. Often the serologic test does not become positive until several weeks after the onset of illness.

7. Can Lyme disease be treated and cured?

Most Lyme disease patients treated in early states of the disease, when only rash and flu-like symptoms are present, will respond favorably to therapy and remain well. Even among patients not treated until later stages of the disease, the majority respond to therapy. In a small proportion of cases, symptoms may recur and additional courses or antibiotics are necessary. Permanent damage to joints can occur in a small number of patients. 

8. What antibiotics are used to treat Lyme disease?

Tetracyclines (tetracycline, doxycycline) and penicillins (penicillin, ampicillin) are usually used in treating early stages of Lyme disease. Intravenous penicillin and ceftriaxone are commonly used to treat patients in later stages of the disease. Other antibiotics and drug combinations are under evaluation.

9.  Are there special problems if Lvme disease occur?

Lyme disease acquired in pregnancy may lead to infection of the fetus. Although some cases of fetal infection resulting in malformations and miscarriage have been reported, there have been no reported instances of an adverse outcome when the expectant woman was adequately treated.

10.  Where does Lvme disease occur?

Lyme disease occurs in a near worldwide distribution in Europe, northern Asia and North America. In the United States, Lyme disease has been reported from 46 states; only Alaska, Hawaii, New Mexico and Arizona have not reported cases. However, the risk of Lyme disease is greatest in 3 areas: (1) in the mid-Atlantic and New England states, from Maryland to Boston; (2) in the upper mid-West in Wisconsin and Minnesota; and (3) on the Pacific coast, especially northern California. Over 80% of the nations cases occur in these three areas.

11.  Is Lyme disease spreading?

Yes, the tick vector of Lyme disease is now present in areas of the country where it had not been recognised previously. The tick can be spread by birds, deer, and by humans transporting pets, including horses.

12. Where am I likely to be exposed to ticks carrying Lyme disease?

The tick vectors prefer wooded areas and overgrown fields. However, in many suburban areas where residential lawns and parks are located within or near woods, ticks may be found in the borders between maintained areas and woods, and even among ornamental plantings and on lawns. Local health departments, park or extension services may have information on the local distribution of ticks.

PRECAUTIONS TO REDUCE YOUR RISK OF EXPOSURE TO TICK-BORNE LYME DISEASE

• Whenever possible, avoid areas that are infested with ixodes danmini or other vector ticks of Lyme disease (Ixodes pacificus on the Pacific coast).
• Wear light colored clothing, so that adherent ticks are visible. Inspect yourself frequently for adherent ticks and remove them.
• Wear long pants and long-sleeved shirts, and tuck pant cuffs into socks. Tape the tops of socks over pant legs. Avoid wearing sandals.
• Use repellents on clothing and/or skin. Repellents; containing DEET may be used on clothing and skin. In some states, permethrin, an insecticide that kills ticks, is available for use on clothing. This product should not be used directly on skin. Follow label directions and avoid excessive use.
• There is some evidence that the longer an infected tick stays attached, the greater the likelihood that it will transmit infection. Inspect yourself frequently for adherent ticks and remove them promptly. These ticks are very small, as tiny as a pinhead, and may be difficult to find.
• In areas where Lyme disease is endemic, ticks may be brought into the home on pets. Inspect animals to remove ticks that are loose in the hair. Consult a veterinarian for appropriate tick repellents for your pets.

 

Tick Removal Guidance for School Nurses

Act 120 of 2024, which amended the Public School Code of 1949- Health Services, takes effect December 29, 2024 after being enacted into law on October 29, 2024. This amendment requires a school nurse, school physician or designated employee of a school entity to remove a tick from a student in accordance with guidelines issued by the Secretary of Health. After removal, the tick shall:

1. Be preserved for the parent or guardian of the student to send to the Tick Research Lab of Pennsylvania for testing if they choose to do so. The school entity shall provide information to the parent or guardian on how to send the tick to the Tick Research Lab of Pennsylvania; or
2. Be sent directly by the school entity to the Tick Research Lab of Pennsylvania for testing using the free basic panel tick test.

Pertaining to this Act, "school entity" means a school district, intermediate unit, charter school, cyber charter school, regional charter school or area career and technical school.

If sent by the school entity, upon receiving the results, the school entity shall send the original results to the student's parent or guardian without making a copy of the results or including results in the student's school medical record. The school entity, however, may notate the disease present in the tick without identifying personal information of the child for data purposes.

After the tick is removed from the student, the school entity needs to notify the parent or guardian of the student in writing, using the prompt below as required by law. Additional resources to attach with this notice including guidance issued by the Secretary of Health on proper tick removal can be found here.

A tick was removed from your child today. Ticks can transmit disease and make people sick. A common illness caused by ticks in Pennsylvania is Lyme disease. Not all tick bites lead to Lyme disease. We advise that you record the date on which the tick was removed. It is recommended that you seek medical treatment from your child's doctor promptly if you notice any early signs or symptoms of illness within three {3} to thirty {30} days of the date of removal.

Some people with Lyme disease will get a bull's-eye rash. Others may have an atypical rash. Not everyone who has Lyme disease gets a rash. Other symptoms which may occur during the early stages of Lyme disease include chills, fever, headache, tiredness, stiff neck, joint pain or swelling and swollen lymph nodes. Lyme disease is treated with antibiotics. If untreated, infection may progress to joint, heart, brain or nerve abnormalities.

More information and resources on Ticks can be found on the Pennsylvania Department of Health's website, but please contact your child's physician if there are any medical concerns.

If you have any questions regarding the requirements of this Act, please reach out to paschool@pa.gov.

Learn more about Ticks and Tickborne Diseases here.

The United States Department of Agriculture regulates that milk is the only allowable beverage that may be served with the lunch platter. If you wish a beverage other than milk, it must be purchased separately.

If a student is allergic to milk, then a doctor's note must be turned into the nurse and he/she will give a copy to the kitchen. Juice will be the alternate beverage.

Please send the doctor's note as soon as possible to avoid cafeteria problems for your child. If you have any questions, please call your School Nurse.

Head Lice (Pediculosis Capitis)

The Centers for Disease Control and Prevention (CDC), American Association of
Pediatrics (AAP), and the National Association of School Nurses (NASN) all agree that
“no-nit” policies should be discontinued. Head lice can be a nuisance, but no research has proven that it causes spread of disease. Exclusion for head lice is not
recommended by the Centers for Disease Control and Prevention (CDC), the American Association of Pediatrics (AAP), and the National Association of School Nurses (NASN).

Maintaining the child’s confidentiality when a child has been identified with head lice
should be the number one priority. Parents should be notified by phone that the student has been identified with live lice and/or nits. Parents should be notified by phone that prompt and proper treatment is needed. If the child is to remain in school, the School Nurse should discourage the student from close direct head contact with others.

To maintain confidentiality:

• No classroom checks will be performed.
• No classroom, or school wide parent notification letters will be sent by the School Nurse or Administration.
• The School Nurse will check siblings at parent request.
• The School Nurse will make available accurate information regarding diagnosis, treatment, and prevention of head lice in an understandable form upon request.