Study reveals large differences in knowledge about ticks between countries

Ticks are found all over the world. There are more than 900 species, and many of them pass on dangerous diseases to both humans and animals.

Recently, researchers conducted the largest study of its kind to find out what people know about ticks. They asked more than 9,400 people from 22 European countries about which diseases ticks can carry, how to recognize them, and how to avoid getting bitten.

Norwegians responded that they are aware of Borrelia and TBE virus, but many were not aware of other microbes like Anaplasma and Babesia."

Vivian Kjelland, researcher, University of Agder

Although Anaplasma and Babesia usually lead to disease in sheep and cattle, they can also cause disease in humans.

Large differences between countries

The study reveals large differences in knowledge about ticks between countries. In Greece and Spain, for example, many people struggled to distinguish ticks from other insects in the images shown to them.

"Further south, around the Mediterranean, people have been more concerned about mosquitoes and sand flies that can cause disease. Ticks have somewhat disappeared from public conversation there," says Kjelland.

The survey was sent to staff and students at research and higher education institutions across Europe. In this way, the researchers could ensure a relatively uniform group of participants in each country.

Of those who responded, 75 per cent had been bitten by ticks at least once. Around 12 per cent had contracted a tick-borne disease. In Norway, only cases of Lyme disease were reported among those who responded to the survey.

Laid-back southerners

Kjelland is concerned that many Norwegians do not know how common ticks have become and how serious it can be to contract a tick-borne disease. Especially in southern Norway, she believes many people take the danger of ticks too lightly.

"People who have lived a long time and spent a lot of time in the forest without getting sick tend to think ticks aren't very dangerous. But that doesn't mean they are immune to the diseases ticks carry," she says.

Here is a reality check: The risk of getting ill from a tick bite is relatively low. For instance, a Swedish study indicates that only 2 per cent of people bitten by ticks carrying Borrelia bacteria fall ill. But that doesn't mean we should take it lightly, Kjelland clarifies - some get very ill.

It's also not the case that you only encounter ticks in the forest. You can also be bitten in the park or in the garden if you're unlucky.

Kjelland sees that where southerners may be too relaxed, people in Eastern Norway tend to be much more worried about being bitten by ticks.

"It's important that people get good information and balance their fears. Take ticks seriously, take precautions to avoid being bitten, and check yourself thoroughly after a walk. And enjoy nature, the joy of hiking and the health benefits of being outside," says the researcher.

Misconceptions about removal

There are several precautions you can take to avoid tick-borne diseases. Use mosquito or insect repellent, especially on your lower body. It may also be wise to stick to paths and not walk through tall grass or bushes. After the hike, you should check yourself thoroughly. It's also a good idea to change clothes after the hike and comb your hair with a lice comb.

The study shows that many people do not know what to do if they have a tick. Many people twist it or leave it while they wait for a doctor's appointment.

"Twisting the tick is a myth. Doing that can break off the tick's mouth parts. Just pull it straight out with tweezers or using your nails," says Kjelland. If you are unfortunate and some of the tick remains, it's not dangerous - though it may feel a bit unpleasant.

She explains that TBE virus is transmitted within minutes, while Borrelia bacteria typically take a day to be transmitted from the tick. The longer the tick stays attached, the greater the chance of infection.

"So don't waste time looking for tweezers, just pull it out right away," says Kjelland.

Changing climate brings new tick species

Many exotic tick species come to Norway with migratory birds each spring. If the climate changes and becomes warmer and wetter, more of these species might establish themselves in the north. They may carry new types of bacteria and viruses.

"An example of this is the Hyalomma tick that was found in Vestby in 2018. It will chase you, instead of sitting still and waiting for you to walk by," says Kjelland.

What worries her especially about this tick species is that it may be a carrier of the CCHF virus.

"The summer of 2018 was particularly hot, and that likely explains why the tick was found that year. Most summers in Norway aren't warm enough for Hyalomma ticks brought here by migratory birds to survive," says Kjelland.

She also mentions that the tick species Ixodes persulcatus, which can be a carrier of the eastern TBE virus, has now been detected in northern Norway. The eastern virus is far deadlier than the western TBE virus our native ticks might carry.

The TBE vaccine, often called the tick vaccine, generally offers good protection against both types of TBE virus, assures the researcher.