Learning to live with ticks? The role of exposure and risk perceptions in protective behaviour against tick-borne diseases

Abstract

The purpose of this study is to analyse the role of risk perceptions and exposure for protective behaviour against tick bites and the related diseases Lyme borreliosis (LB) and tick-borne encephalitis (TBE), both of which are growing health concerns. We use data from a national survey in Sweden with respondents in geographical areas with substantial differences in both abundance of ticks and incidence of LB and TBE. We find that the share of respondents who frequently use protective clothing (64%), perform tick checks (63%) or avoid tall grass while in areas with ticks (48%) is relatively high. However, the use of protective measures is uneven and a considerably lower share tuck their trousers into their socks (18%), use repellent against ticks (16%) or use a combination of protective measures. Thirty-one per cent of the respondents report one or more tick bites in the last year and 68% report one or more lifetime tick bites, indicating that it is difficult to protect oneself from tick bites. There is a strong positive association between exposure and checking the skin for ticks, but exposure is only weakly associated with other protective measures. Tick bites are perceived as a serious health risk by as many as 43% of the respondents. The perception that a single tick bite is serious is negatively associated with actual exposure to ticks, while the opposite is true for the perception that tick bites constitute a serious lifetime health risk. This indicates a learning effect in relation to risk perceptions and the performance of tick checks, but not in relation to other protective measures. Recommendations include informing people of the risks associated with tick bites, the efficacy of various protective measures and the importance of combining multiple types of protection. Given the high exposure to tick bites, the growing incidence of TBE and LB, and the difficulties in preventing tick bites, other preventive measures should be further discussed, including vaccination programmes.

Knowledge, Attitudes, Practices (KAP) of Italian Occupational Physicians towards Tick Borne Encephalitis

“…Interestingly, while some previous reports have inquired KAP of medical professionals on other tick-borne disorders (e.g., Lyme disease) [ 29 , 30 , 31 ], there is a significant lack of evidence on OP and their understanding of TBE [ 7 , 14 , 15 , 16 , 32 ]. Some studies that have examined acceptance of preventive measures in endemic areas found uneven or low use of risk-reducing measures, suggesting that people at risk either ignore or underestimate the health threat from TBE, being unaware of risks and protective measures, or do not understand that the adoption of protective measures is worth their time [ 14 , 15 , 33 , 34 , 35 , 36 ].…”

“…Second, a previous report from North-Eastern Italy pointed out that a high percentage of farmers usually avoid behavioral protective and preventive measures [ 14 , 33 , 35 ]. Despite half of participants recalled tick bites while performing their work tasks [ 14 ], the systematic body checks for tick bites after field work (i.e., 2.8%) was often not performed [ 33 , 36 , 38 , 39 ].…”

“…Second, a previous report from North-Eastern Italy pointed out that a high percentage of farmers usually avoid behavioral protective and preventive measures [ 14 , 33 , 35 ]. Despite half of participants recalled tick bites while performing their work tasks [ 14 ], the systematic body checks for tick bites after field work (i.e., 2.8%) was often not performed [ 33 , 36 , 38 , 39 ]. Keeping in mind the increasing threat represented by TBE in some Italian Regions, but also that Borrelia burgdorferi actively circulates among Italian isolates of Ixodes ricinus , and reliable vaccines for Lyme disease still remain unavailable, an appropriate intervention of occupational physicians on such specific topic has, therefore, the potential to significantly improve health and safety of agricultural and forestry workers.…”

Management Options for Ixodes ricinus-Associated Pathogens: A Review of Prevention Strategies

“…Wearing light-colored clothes is beneficial as it makes ticks easier to detect and remove before they have the opportunity to attach. Long pants tucked into socks and wearing non-open shoes can reduce contact with ticks [56,59].…”

Nymphs of Ixodes ricinus Are More Sensitive to Deet Than Adult Females

“…Due to climate change, ticks have recently been colonizing new areas (Jaenson et al 2012, Ragagli et al 2016, Tarageľová et al 2016 and so the incidence of tick-borne diseases has increased in such areas. Beside using protective clothing and tucking trousers into socks, the use of repellent represents the only possible protection against tick attachment (Slunge and Boman 2018).…”