Intended for healthcare professionals

Rapid response to:

Clinical Review

Tick bite prevention and tick removal

BMJ 2013; 347 doi: (Published 09 December 2013) Cite this as: BMJ 2013;347:f7123

Rapid Response:

Re: Tick bite prevention and tick removal

I learnt much from this review but feel some of its “advice for patients” is unrealistic[1]. Outdoor pursuits are very popular and the risk of an individual getting Lyme Disease in the UK is still very small, although rising. Checking for ticks is not easy, especially if you have rarely or never seen one, so the general advice “When outdoors check for ticks every 2-3 hours” risks deterring people from outdoor activities. More likely, it will simply be ignored as irrelevant, unless clear information is also given about which areas are highest risk, i.e. infested with enough infected ticks for regular checking to be most likely to be worth the effort. Unfortunately no-one in the UK seems to provide even a best guess at this: Public Health England mentions about 10 areas as having the most frequent reports of Lyme Disease[2], but the risk obviously depends partly on the number of outdoor users of those areas.

For tick removal, the most practical approach might be to encourage people to carry a tick removal tool so they can remove a tick as soon as possible, rather than wait to find someone with fine tipped forceps and experienced in using them on ticks. Personally, when out walking I’ll keep carrying an O’Tom Tick Twister and hoping it’s not needed (luckily I’m in the habit of tucking my trousers into my socks anyway).

[1] Due C, Fox W, Medlock JM, Pietzsch M, Logan JG. Tick bite prevention and tick removal. BMJ 2013;347:f7123.
[2] Public Health England. Epidemiology of Lyme borreliosis in the UK.

Competing interests: No competing interests

08 January 2014
John Temple
Retired GP