Primary prevention
To avoid Lyme disease, advise patients to:[22][23] CDC: Lyme disease Opens in new window CDC: tickborne diseases Opens in new window
Avoid areas infested with ticks, such as wooded and brushy areas, and walk in the centre of trails.
If visiting or living in a tick-infested area:
Use protective clothing such as long trousers and long sleeves to keep ticks off the skin.
Use insect repellent such as DEET (N,N-Diethyl-meta-toluamide) 20% to 30% on clothes and exposed skin. Children should use DEET 10%. Alternatives to DEET include picaridin, oil of lemon eucalyptus (OLE), IR3535 (ethyl butylacetylaminopropionate), para-menthane-diol (PMD), or 2-undecanone.
Use permethrin spray for clothes (trousers, shirts, socks, and shoes), tents, and camping gear. Permethrin should not be used directly on skin.
Check for ticks daily and remove any attached ticks promptly. A tick should be removed by pulling it away from the skin with the help of tweezers or a similar device. Even if the mouthparts of a tick are left in the skin, it is not able to transmit the bacteria. The area of skin should be washed with soap and water. Avoid crushing the tick's body.
Use strategies to reduce the number of ticks in Lyme-infested areas; for example:
Apply insecticides (acaricides).
Landscape to make it less favourable for ticks (e.g., remove leaf litter, tall grass, and brush around living areas to increase exposure to sun and air and reduce the numbers of ticks).
Exclude, or remove, deer.
A vaccine is not available at present. A previously marketed vaccine, which was considered approximately 80% effective, was withdrawn from the US market following poor demand, according to the manufacturer. Concerns had been raised regarding the vaccine's safety and efficacy.[24]
Secondary prevention
Postexposure prophylaxis of a single dose of doxycycline may be used for a significant exposure meeting all of the following:[22][25][53]
High-risk tick bite: an Ixodes tick bite; at least an estimated 36 hours of attachment; and in an area highly endemic for Lyme disease (Borrelia burgdorferi prevalence of >20% in local ticks is considered a highly endemic area).
Prophylaxis is started within 72 hours of tick removal.
Doxycycline is not contraindicated. Doxycycline is not recommended during pregnancy or lactation. In some countries outside of the US, doxycycline is not recommended in younger children due to concerns about tooth staining and enamel hypoplasia. However, one 2023 systematic review concluded that early childhood doxycycline exposure is not associated with dental staining or enamel defects.[51]
There is no human-to-human transmission.[25] There are no special measures required for hospital infection control, except for standard universal precautions. CDC: Lyme disease Opens in new window CDC: tickborne diseases Opens in new window
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