Lyme disease has been known as a medically important illness since
1975 when many residents near Lyme, Connecticut, were mysteriously
stricken. The disease is now known to be caused by a tick-borne
bacterium (Borrelia burgdorferi). In the intervening years, Lyme
disease has become an important tick-borne illness in North America.
The ticks that carry Lyme disease have expanded their range across
the country. Cape Cod, Nantucket, Martha's Vineyard, Long Island, and
Connecticut have experienced more cases of Lyme disease than most other
areas of the Northeast, and are referred to as highly endemic areas for
The Lyme disease bacterium is carried by a tick commonly known as
the deer tick or black-legged tick. It can pass the bacteria to a human
or animal as it feeds upon them to obtain a blood meal. Deer ticks are
active on Cape Cod year round, especially during years with mild
Deer ticks have a three-stage life cycle. The adult tick is active
in the late fall and early spring while the larvae and nymphs are
active during the late spring, early summer and fall. The adult tick is
a dark reddish brown and the size of a sesame seed. The nymphs are
smaller, poppy seed sized, and are difficult to see. The larvae are
extremely small, similar in size to a period. Any deer tick stage can
be carried by dogs and cats, but the usual hosts are woodland mammals
such as the while-tailed deer and while-footed mouse.
Adult ticks feed and mate on large mammals such as deer, pets, or
humans in the fall and early spring. Female ticks drop off and lay eggs
on the ground in the spring. Miniscule larvae hatch and feed upon
white-footed mice, other small mammals or even birds. If the host
mammal is infected with Lyme disease bacteria, then deer tick larvae
will become infected. After feeding, larvae become inactive until early
spring when they molt into the nymph stage.
Nymphs that have picked up the bacteria in the larval stage are
capable of transmitting the bacteria to humans or other hosts,
including pets. This stage is most active in June, and causes more
cases of Lyme disease than the adult tick. Nymphs seek a host for a
blood meal in the late spring and summer. The host may be a small
mammal or bird, but may also be a dog, cat, or human. After feeding,
nymphs molt into the adult stage. Adult ticks start the cycle over by
feeding on a large mammal such as a deer, pet, or human. Note that both
infected nymph and adult ticks can transmit the Lyme disease bacteria.
These ticks may also transmit Babesiosis and Ehrlichiosis.
There are two common ticks found on Cape Cod and the Islands: the
deer tick and the American dog tick. The American dog tick is larger
than the deer tick and is more readily seen and easier to remove.
The females of both species become engorged or greatly swollen
during a blood meal. The color of the abdomen changes to a uniform gray.
Deer ticks are most often found in woodland habitats such as hiking
trails, conservation lands and other forested recreational areas. They
move onto brush, vegetation or tall grasses as they seek a host. They
do not jump or fly but will crawl onto and cling to humans and animals
that pass by. When walking in these types of areas, take the following
A careful tick check is the most effective way to protect you and
your family from Lyme disease. After outdoor activities, brush off
clothing thoroughly and do a visual inspection paying particular
attention to folded areas such as cuffs, belts and shirt collars.
Do a complete body check on a daily basis. Check children more
frequently. Carefully inspect the hairline and scalp as well as
difficult-to-see areas such as the back. A daily shower or bath is
advised as unattached ticks can be washed off.
Ticks may hitchhike indoors on pets or clothing and then fall off.
Pets should be checked on a regular basis, particularly around the
eyes, ears and underbelly.
A tick's mouthparts are barbed like a fish hook. Once inserted, a
cement-like substance is released, making tick removal difficult.
Proper and prompt removal of ticks includes the following:
Many people do not realize they have been bitten by a tick,
particularly by the nymphal stage. Early symptoms may vary among
Many patients do not develop a rash. If you suspect the possibility
of Lyme infection do not wait. See a doctor right away. Antibiotics can
be prescribed to help treat this disease. This is especially important
in such highly endemic areas such as Cape Cod and the Islands. Delayed
treatment may result in late Lyme disease with major medical problems
such as potentially serious heart, nervous system, and arthritic
conditions. A vaccine is now available; consult your physician as to
whether it is appropriate for you.
Diagnosis of Lyme disease is often difficult as symptoms of Lyme
disease may mimic those of other illnesses. Blood tests are not always
reliable. Antibiotics are generally prescribed for treatment. Dosages,
duration, and mode of administration are a matter of medical
We now know that, once transmitted from the tick, the bacteria can
move very quickly from beneath the skin to deeper tissues in the body
(before the blood tests can detect evidence of illness).
Thus, in highly endemic areas, following the removal of an engorged
deer tick, some physicians may choose to treat preventatively before
Brewster Health Department
508-896-3701 Extension 120
Barnstable County Department of Health and the Environment
Superior Court House
Cape Cod Cooperative Extension
Deeps and Probate Building
Route 6a Barnstable MA 02630
Nantucket Board of Health
37 Washington Street
Nantucket, MA 02554
UMASS Vineyard Extension
PO Box 1696
Oak Bluffs, MA 02557
Information from the Centers for Disease Control and Prevention,
Massachusetts Department of Public Health, Southampton Hospital (NY),
Tick Research Lab, University of Rhode Island, and National Park
Service was used to prepare this brochure. Additional information may
be obtained from the Cape Cod Lyme Awareness Association, PO Box 1916,
Mashpee, MA 02649
This webpage based on a pamphlet courtesy of The Barnstable County
Dept. of Health & Environment; P. O. Box 427; Barnstable MA
Brewster Town Offices
2198 Main St
Brewster, MA 02631