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Travel-Associated Tickborne Diseases

About

Ticks in the United States can spread at least 15 different diseases to humans. Ticks in Maine can spread 5 germs that make people sick. These include anaplasmosis, babesiosis, Hard Tick Relapsing Fever, Lyme disease, and Powassan virus disease. However, ticks in other parts of the U.S. can spread other germs that make people sick. Tickborne diseases and conditions in other parts of the U.S. include: 

  • Alpha-Gal Syndrome
  • Bourbon virus
  • Ehrlichiosis
  • Heartland virus
  • Southern Tick-Associated Rash Illness (STARI)
  • Spotted fever rickettsiosis (like Rocky Mountain spotted fever)
  • Tularemia

Which Ticks Spread These Diseases? 

The American dog tick (Dermacentor variabilis) can spread Rocky Mountain spotted fever and tularemia. Even though these ticks are common in Maine, they are not known to spread these germs here.  

The lone star tick (Amblyomma americanum) can spread bourbon virus, ehrlichiosis, heartland virus, and tularemia. They may also cause a circular rash called STARI and alpha-gal syndrome (red meat allergy). Lone star ticks are not known to live in Maine. 

What is Alpha-Gal Syndrome?

Alpha-gal syndrome is not an infectious disease. It is a food allergy to red meat, dairy products, and other mammal products. It can occur after a tick bite, especially a lone star tick bite in the U.S. 

Alpha-gal is a molecule found in most mammals, but not in primates (including humans). Lone star ticks also have alpha-gal in their saliva. When a lone star tick bites a person, it spreads alpha-gal to the person. In some people, this alpha-gal triggers their immune system to react. These people can have an allergic reaction later when exposed to things that contain alpha-gal. This includes red meat, dairy products, adn some medical products. 

Examples of products that may contain alpha-gal: 

  • Red meat: beef, pork, lamb, venison, rabbit, etc.
  • Mammal organ meat: liver, kidneys, intestines, sweetbreads, etc.
  • Dairy products: milk, butter, cheese, etc.
  • Gelatin made from beef, pork, or other mammals
  • Mammal fat products: lard, tallow, suet
  • Meat broth, bullion, stock, or gravy
  • Additives, stabilizers, or coatings in some medications and vaccines
  • Certain medical products: heart valves from pigs or cows, some monoclonal antibodies, heparin, some antivenoms

Foods that DO NOT contain alpha-gal: 

  • Poultry: chicken, turkey, duck, quail, etc.
  • Eggs
  • Fish and seafood
  • Fruits and vegetables

Symptoms

Bourbon virus, ehrlichiosis, heartland virus, STARI, spotted fever rickettsiosis, and tularemia can start with similar symptoms. These can include:

  • Fever and chills
  • Fatigue (feeling very tired)
  • Headache
  • Body, joint, or muscle aches
  • Nausea and vomiting
  • Rash
  • Diarrhea

Tularemia

Along with the symptoms above, people with tularemia can also experience a dry cough. Other symptoms depend on how the person got exposed. When exposed through a tick bite, people can develop a skin ulcer at the site of the bite. They may also have swollen lymph nodes, usually in the arm pit or groin. 

Alpha-Gal Syndrome

Symptoms of alpha-gal syndrome usually start 2-10 hours after exposure to a product with alpha-gal in it. Symptoms can include: 

  • Nausea or vomiting
  • Severe stomach pain
  • Heartburn or indigestion
  • Diarrhea
  • Hives or an itchy rash
  • Cough, shortness of breath, or difficulty breathing
  • Swelling of lips, throat, tongue, or eyelids
  • Dizziness or faintness

Symptoms can range from mild to severe. Some people can have a life-threatening reaction called anaphylaxis and need emergency medical care. People may have a reaction after every exposure or only after certain exposures. 

Treatment

If untreated, some of these diseases can be life-threatening. See a health care provider if you become ill after a tick bite or after spending time in areas where ticks commonly live. Be sure to mention any recent travel in the U.S. or internationally to your health care provider. 

Ehrlichiosis, spotted fever rickettsiosis, and tularemia are treatable with antibiotics. Health care providers currently do not know if antibiotics treat STARI. There is no specific treatment for bourbon or heartland viruses. Rest, fluids, and over-the-counter medications can help relieve symptoms. People with severe disease may need hospitalization for support. Treatment for alpha-gal syndrome involves working with your health care provider to manage the allergy. 

Prevention

Learn more about preventing tick bites here. 

Data and Publications

Surveillance Reports

Resources

Resources for Health Care Providers