Last updated: March 13, 2024
Article
Employee Surveys Give Clues to Reducing Tick-Borne Disease
Two studies show the value of standardized procedures, in-person training, and site-specific information.
By Stefanie Bolas and Maria Said
Image credit: Centers for Disease Control and Prevention
People in national parks are passionate about the outdoors. They look forward to encountering animals, expect exposure to extreme temperatures, and even seek isolation. These experiences, though rewarding, carry risks. Among these risks are tiny disease-carrying ticks. Tick bites can transmit organisms that cause Lyme disease, Rocky Mountain spotted fever, and other serious illnesses to people and wildlife. And the lone star tick, Amblyomma americanum, famously causes an allergic reaction to red meat. Three National Park Service public health offices collaborated to assess how individual parks deal with tick-borne disease. The studies changed how agency employees—and by extension, visitors—are educated about ticks.
An Ideal Environment
National parks often have an abundance of wildlife and vegetation. This provides ideal habitat for certain tick species like the black-legged ticks, Ixodes scapularis and Ixodes pacificus. Black-legged ticks transmit the bacteria that cause Lyme disease. They are found in the Northeast, upper Midwest, Mid-Atlantic states, and California in wooded, grassy, and shady areas. Ticks are present throughout most of the eastern United States, and parks have served as living laboratories to track their spread.
Image credit: NPS
From seminal work in the late 1980s to work published just this year, scientific research in parks has provided invaluable information to further our understanding of tick-borne diseases. These studies have given us insights about things like where Lyme disease and black-legged ticks exist, grow, and multiply, and the benefits of forest restoration in reducing tick densities.
Tick-borne disease cases are increasing steadily in the U.S. but are under-reported, and health care providers rarely collect patients’ history of travel within the U.S. For these reasons, we don’t know how many cases are associated with national parks. National park employees report tick-related injury or illness through an electronic reporting system. But it isn’t feasible to keep track of visitors who contract tick-borne diseases in national parks. There’s too much delay from tick bite to disease (often weeks to months) to know where and when visitors were infected.
Image credit: Centers for Disease Control and Prevention
Although we don’t know the true extent of tick-borne diseases in national parks, we know how to prevent transmission. The most important thing is to prevent tick bites from occurring altogether. The Centers for Disease Control and Prevention recommend that people wear long-sleeved, light-colored clothing when outdoors, check for ticks, shower soon after being outside, and use insect repellents approved by the Environmental Protection Agency.
The Importance of Education
Because of the risk of encountering ticks in parks, educating staff and visitors and promoting prevention are critical. For years, the National Park Service’s Office of Public Health and Wildlife Health Branch have been monitoring ticks in national parks. In 2018, Public Health collaborated with the Office of Risk Management and the Wildlife Health Branch to develop a survey questionnaire to assess individual park needs regarding tick-borne disease. The purpose of the assessment was to understand what parks were doing and uncover knowledge gaps. In total, 335 employees from 238 parks participated. Most respondents held natural resource or leadership positions and worked in eastern national parks from Maine to Virginia.
Respondents felt challenged by tick-friendly environmental conditions, competing priorities, and inadequate funding.
The unpublished survey data show that most parks, especially in the Eastern U.S., considered themselves at high risk for tick-borne disease. About half of the parks monitored ticks. Many parks said they trained employees and encouraged visitors to use repellents and protective gear. But respondents felt challenged by tick-friendly environmental conditions, competing priorities, and inadequate funding. Parks requested help in understanding local tick prevalence and disease risk. Some expressed a need to enhance visitor and employee education. Parks also said they would benefit from a standardized operating procedure for managing ticks and the diseases they transmit.
The survey results prompted the Office of Public Health to add in-person training to its ongoing tick-borne disease surveillance. The office also developed a standardized tick-borne disease prevention policy and a website offering prevention materials and training. In response to survey respondents’ request for more local data, Public Health collaborated with U.S. Geological Survey ecologist Alynn Martin. Together, they developed another survey questionnaire, this time to assess whether having site-specific surveillance information affected employees’ knowledge and attitudes towards tick-borne disease.
In total, 34 employees from seven parks participated in the new survey in 2022, though many more attended the in-person and virtual trainings. Job positions within the parks varied, but all respondents’ work had outdoor components that placed them at elevated risk of tick-borne disease. Most respondents had a bachelor’s degree or higher level of education. Although the sample size was small, the new survey’s findings confirmed the previous findings that tick-borne disease risk was a source of concern for employees.
Hints about Risk and Location, Location, Location
The new survey further showed that in the previous year, on average, employees discovered at least one tick attached to their bodies and more than four ticks crawling on them. This empirically justified their concerns about exposure. As a result of the trainings, employees demonstrated increased knowledge of tick-borne disease and willingness to take preventative measures.
Employees receiving site-specific data beforehand scored the importance of wearing insect repellents and performing tick checks higher.
The survey data showed a difference between those who received site-specific information before the survey versus those who received it after. Employees receiving site-specific data beforehand scored the importance of wearing insect repellents and performing tick checks higher than those who did not receive site-specific data.
The new study’s small sample size limits our ability to draw reliable conclusions about all National Park Service employees. Yet the findings suggest there are benefits to having local tick surveillance data. Annual trainings with site-specific data don’t address challenges raised by competing priorities and limited resources. But they help employees understand local risks and the importance of individual preventative measures.
Image credit: Centers for Disease Control and Prevention
Andrew Landsman is the program manager for Natural Resources at Chesapeake & Ohio Canal National Historical Park in Williamsport, Maryland. He thought the training was valuable “even for experienced field staff,” as it “provided site-specific information about local tick density and ways to prevent tick-borne disease.” He said Office of Public Health staff gave park employees “the tools to reduce and avoid exposure to ticks and to apply effective preventative techniques while working in the field.” He added that those benefits extended outside the workplace for employees who “enjoy being outdoors for work and for their own recreation.”
More Resources
National parks are rewarding workplaces and recreational retreats for many people. They allow people to reconnect with nature and enjoy the outdoors. But they can also be risky environments when it comes to tick-borne diseases. Avoiding contact with ticks remains the most effective way to prevent infection. Educating park staff is critical to helping them protect themselves and others. The Office of Public Health offers resources to do that.
The National Park Service’s Office of Public Health, Office of Risk Management, and Wildlife Health Branch plan to continue tick surveillance and in-person education in targeted parks. They will also maintain remote support to all parks and look for new ways to give people the information they need to protect themselves from tick-borne disease.
About the authors
Stefanie Bolas, DVM, MS, DACVPM, is the state veterinarian and state public health veterinarian of Maine. Image courtesy of Stefanie Bolas.
Maria Said, MD, MHS, is the Epidemiology Branch chief for the National Park Service. Image courtesy of Maria Said.