Public health recommendations for Lyme disease prevention generally include daily tick checks and prompt removal of attached ticks as a means of decreasing the risk of acquiring Lyme disease in highly endemic regions. In the current study, we determined whether crushing nymphal ticks during removal with forceps increased the risk of B. burgdorferi transmission, what degree of protection from transmission of B. burgdorferi was provided by removal of nymphal Ixodes scapularis Say at specific intervals, and whether commercial devices marketed for tick removal worked when tested against nymphal I. scapularis. Both removal via gentle pressure (26% transmission) or crushing the tick (30% transmission) caused a significant decrease in transmission as compared with the sham control (70% transmission). The degree of protection provided via tick removal decreased steadily up to 60 h of attachment; between 60 and 66 h, a dramatic falloff in protection occurred to the point where no protection was observed at 66 h. Finally, commercial tick removal devices varied widely in their efficacy for the removal of attached nymphal I. scapularis.
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