How Transplant Patients Should Protect Themselves from Insect-borne Diseases

Summer is a great time to spend time outdoors, especially now when we are all trying to do more things outside. But it is also a time when we need to make sure that we protect ourselves from getting bitten by mosquitoes and ticks, both of which can cause infections that can be more severe in transplant patients. Some of the infections we worry about include West Nile Virus, which is an infection transmitted by mosquitoes, as well as Lyme, Anaplasma, Ehrlichia, Babesia, Rocky Mountain Spotted Fever and Powassan, which are infections that are carried by ticks. All of these infections have been found during the spring and summer months. When the temperatures dip, they are rarely seen.

Because of the extra risk to transplant patients, we've pulled together some precautions that we recommend you take to protect yourself.

Precautionary Steps to Prevent these Insect Borne Diseases

1. Know where to expect ticks and mosquitoes before you go outside.
   • Ticks live in grassy, brushy, or wooded areas and on animals, so if you are outside walking your dog, camping, gardening or hunting, you could be exposed.
   • Mosquitoes lay their eggs in waters, so anywhere there is standing water (i.e., empty flower pots, old tires, etc.) could be risky.
2. Prevent bites by using insect repellent on exposed skin and re-apply as directed on the container when you will be spending time outside. Make sure the insect repellant is applied over your sun screen to maximize its effect. Acceptable insect repellants are those that contain one of the following ingredients:
   • DEET
   • Picaridin
   • IR3535
   • Oil of lemon eucalyptus (OLE)
   • Para-methane-diol (PMD)
   • 2-undecanone
3. Avoid contact with insects by
   • Wearing long-sleeved pants and shirts
   • Using screens on windows and doors.
   • Avoid standing water.
     • Once a week, empty and scrub, turn over, cover, or throw out items that hold water, such as tires, buckets, planters, toys, pools, birdbaths, flowerpots, or trash containers.
   • Avoid walking in wooded and brushy areas with high grass and/or leaf litter and make sure you walk in the center of trails.
   • Check your gear and pets for ticks to make sure you aren’t bringing them into your home.
4. Make sure you remove any ticks that you might have come into contact with
   • Shower within 2 hours after you have come indoors to wash off unattached ticks.
   • Examine your skin under good lighting to check for ticks – these can be quite small when freshly attached so make sure you are examining yourself closely, using a hand held or full-length mirror to view all parts of your body including your underarms, in and around your ears, the back of your knees, your scalp, between your legs, and around your waist and belly button.
5. If you find a tick attached to your skin, you should remove it as soon as possible
   • You can use a fine tipped tweezers to grasp the tick close to your skin surface.
   • Pull upwards with steady, even pressure. DO NOT twist or jerk the tick as this will often prevent full removal.
   • Wash the area after removal with soap and water or rubbing alcohol.
   • Place the tick in a sealed bag or container. You can then show it to your provider. Alternatively, you can dispose of it in the sealed condition or flush it down your toilet.
6. If you don’t feel well and worry you may have a tick or mosquito related infection, please call your provider for guidance. Symptoms may include:
   • Fevers or chills
   • Headaches
   • Sleepiness
   • Achiness in your muscles or joints
   • Rashes or other new skin findings
   • Bleeding or bruising

Your transplant team is available to answer any questions that you may have regarding these mosquito and tick related infections. You can reach them through the myPennMedicine patient portal or by telephone. If you don't have your care team's specific office line, please call the 215-662-6200 and a representative will connect you.