The 3 Rs of Tick-Borne Diseases
Ticks are disgusting. The thought of them is enough to make a person’s skin crawl and adds an “ick factor” that makes it easier to convince clients that parasite prevention is desirable (FIGURE 1). But are we relying too heavily on our innate disgust for them and failing to clearly convey the health risk that ticks pose to pets and people? How do we, the veterinary medical team, successfully educate clients on the threat of tick-borne disease and the best preventive methods?
START WITH THE 3 Rs
The key to being successful in client interaction is to begin with effective team communication. Every team member, from those at the front desk to those in the boarding kennels, should understand tick-borne disease enough to convey its importance, answer client questions, and communicate the practice’s preventive recommendations. It is easy to overestimate how well each person in the practice understands current protocols in preventive medicine. The responsibility of staff education falls on the clinic leadership.
Regular, all-staff meetings are an imperative part of a healthy practice. Team meetings should be more than a time for airing complaints; they should include an educational component. This component doesn’t need to be lengthy or formal. Simply use the 3 Rs: (1) Review the topic of concern, (2) discuss the current Recommendation(s), and (3) form a plan to Relay the information. Let’s use tick-borne disease as an example.
REVIEW: TICK-BORNE DISEASE
TABLE 1 correlates the most frequently diagnosed diseases with their known tick vector. Distribution maps for each tick species are located at cdc.gov/ticks/geographic_distribution.html.1 When using the maps to determine which ticks are in your area, remember that tick distribution is dynamic and ever-changing. For example, the number of counties in the United States with established populations of Ixodes species has more than doubled in the past 2 decades.2
Not only are domestic tick populations expanding, but global mobility of humans and animals presents an opportunity for the introduction and spread of new species of ticks. For example, Haemaphysalis longicornis, the longhorned or Asian tick, has recently been detected in the United States. The Centers for Disease Control and Prevention reports that there is no evidence of H. longicornis transmitting any disease to pets or people in the United States. However, H. longicornis is being monitored closely because it is a carrier of multiple pathogens in other areas of the world; the unique asexual reproduction of this tick creates exponential population growth, which can equate to infestations severe enough to cause exsanguination.3
Disease review can easily turn into an endless litany of signs and symptoms. This is not an effective method of education; most listeners tune out and rarely remember the details. To engage the team, consider turning a potentially boring monologue into a fast-paced group activity. Break into groups (or individually for small teams) and assign each a tick-borne disease. Allow 5 minutes to find answers to 5 questions that focus on information clients should know rather than getting bogged down with clinical signs and diagnostics.
Keep in mind that the goal is to prepare the team to effectively communicate with clients about
- What is the pathogen?
- What does it infect?
- Is it deadly?
- Is it a human health concern?
- What makes it unique or memorable?
When the 5 minutes are up, have each group present the findings. To aid in the retention of information, create a chart using a white board or large piece of paper, with each group filling in their findings. TABLE 2 gives an example, as well as correct answers for this activity.
A review of the practice’s recommended tick prevention products should also be discussed during the meeting. Each member of the team should be knowledgeable enough about the products offered by the practice to answer any client questions about the dose, administration, efficacy, and potential side effects.
The Companion Animal Parasite Council (CAPC) is a nonprofit organization that collects and analyzes data on the prevalence of tick-borne diseases as well as the prevalence of other parasites and diseases in the United States and Canada. Dr. Craig Prior, immediate past president of CAPC, says that the major ticks seen in the United States have 3 different hosts in their life cycles. The hosts vary depending on tick species and life stages but may encompass any mammal, bird, amphibian, and even reptile. (Adult females lay anywhere from 2000 to 8000 eggs—and some lay even more than that). According to Dr. Prior, ticks may live over 4 years and they spend over 3 years in the environment (not on a host). “If the temperature is over 43 degrees F, ticks are active, even if there’s 2 feet of snow on the ground,” says Dr. Prior. “Snow actually acts as an insulator for them and the ticks stay below the top level of snow until the temperature is 43 degrees or above and the ticks then start questing.” The dynamic changes in tick populations and distribution and the increased incidence of tick-borne diseases have led to the following recommendations, provided by CAPC (capcvet.org):4
- All dogs (and cats) should be treated year-round and throughout their life with tick control products to limit infestations on the pet, reduce the number of ticks in the environment around the home, and prevent establishment of brown dog tick populations in the home.
- Recognize that home infestations with brown dog ticks (Rhipicephalus sanguineus), once established, may take several months to bring under control and that, in addition to consistently treating pets with tick control product, the services of a licensed exterminator are necessary to eliminate the infestation from buildings.
- Because ticks transmit a wide variety of disease agents to pets and people and are active throughout the year, tick control must be practiced consistently to protect the health of the pet and to prevent untreated pets from bringing ticks—which may then infest people—into the home.
- Stay current on tick population shifts and new threats from ticks that develop over time. Tick distributions are dynamic and ever changing, and practice protocols often need to evolve to meet the growing threat ticks pose to pet health.
RELAYING THE MESSAGE
Following the review of tick-borne diseases and discussion of recommendations, it’s time to create a plan for relaying this message to clients. Rather than relying on a scripted scenario, brainstorming with the entire team will help to create a plan that is best tailored to your specific practice culture and clientele. These sessions can produce creative new ideas as well as boost morale. When team members’ voices are heard, they feel valued; when everyone is working toward the same goal, the team is strengthened. With that in mind, here are a couple ideas to get things started.
Pique the client’s interest. The “ick factor” has already been proposed as an easy hook, so just take it to the next level. Your practice should already have a clear tick jar (FIGURE 2) in a location that is visible to clients; if you don’t have one, make one! A brief note near the jar is a simple conversation starter: “Ticks are disgusting, but did you know they can transmit harmful diseases to you and your pet?” This simple note will plant a bug in the client’s mind (pun intended) so that when a team member broaches the subject it seems even more relevant.
Personalize the message. Local tick-borne disease prevalence maps, down to the county level, can be located on the CAPC website. Practices can subscribe to CAPC’s free social media tool, which generates monthly, automated posts with local information. This tool helps convey to clients the risks of tick-borne disease in their own backyards.
Provide a clear recommendation for each patient. There is limited amount of time for client interactions, so be concise and confident. The client expects members of the veterinary medical team to be experts and to advise on the best methods for keeping their beloved pet(s) healthy.
Tick-borne disease is an often underemphasized but core part of companion animal health. It is up to the entire veterinary team to broach this important topic with our clients and to help them understand why tick preventives are an integral part of a pet’s comprehensive wellness plan.
The first step toward this goal is team communication and education—get on it!
Tick distributions are dynamic and ever changing, and practice protocols often need to evolve to meet the growing threat ticks pose to pet health.
- Centers for Disease Control. Geographic distribution of ticks that bite humans. cdc.gov/ticks/geographic_distribution.html. Modified June 1, 2015. Accessed February 18, 2019.
- Eisen RJ, Eisen L, Beard CB. County-scale distribution of Ixodes scapularis and Ixodes pacificus (Acari: Ixodidate) in the continental United States. J Med Entomol 2016;53(2):349-386.
- Beard CB, Occi J, Bonilla DL, et al. Multistate infestation with the exotic disease-vector tick Haemaphysalis longicornis—United States, August 2017-September 2018. MMWR Morb Mortal Wkly Rep. 2018;67:1310-1313.
- Companion Animal Parasite Council (CAPC). Ticks. capcvet.org/capc-recommendations/ticks. Revised June 2015. Accessed January 15, 2019.
- Goddard J. Tick-borne diseases. In: Infectious Diseases and Arthropods. Infectious Disease. New York: Humana Press; 2018:81-130. Revised June 2015. Accessed January 15, 2019. York: Humana Press; 2018:81-130.
- North Carolina State University. Vector Borne Disease Diagnostic Laboratory. Rickettsiosis information. cvm.ncsu.edu/wp-content/uploads/2016/05/Rickettiosis.pdf. Accessed January 20, 2019.
- Hendrix CM, Robinson E. Diagnostic Parasitology for Veterinary Technicians, 4th ed. St. Louis: Mosby; 2012:226-231.