JOHN YANG: They're tiny, but they can pack a mean punch.

Every year in the United States, nearly 31 million people are bitten by a tick.

And tick related illnesses like Lyme disease are on the rise, a trend experts attribute to climate change, human expansion into forested areas, and overpopulations of deer.

Ali Rogin is back.

This time she's talking with Dr. Andrew Handel about how to best avoid these tiny insects.

He's a pediatric infectious diseases specialist at Stony Brook Children's Hospital in New York.

ALI ROGIN: Dr. Handel, thank you so much for joining us.

Different states have exposure to different types of ticks.

What are some of the most common ticks that bite and illnesses that they might bring with them?

ANDREW HANDEL, Stony Brook Children's Hospital: Yeah.

Absolutely.

So I live here in the Northeast where we see a lot of Lone Star ticks and deer ticks.

And like you mentioned, depending on the type of tick that's bitten you're at risk of getting different tick borne infections or other medical problem.

So by far the most common tick borne infection you can get in the United States is Lyme disease.

But then those same ticks that transmit Lyme disease can also give you other infections like babesiosis or anaplasmosis.

In the southeastern United States, there's higher risk of something called Rocky Mountain spotted fever.

And all these infections can give you very different signs and symptoms and kind of give you different degrees of severity of your illness.

ALI ROGIN: And what do we know about the rate of infections right now and the number of ticks that are out there around the country?

ANDREW HANDEL: So at this moment, the ticks are very active.

There's lots of tick bites that are happening.

I've seen lots of children in my own office and in the emergency room.

You know, this is typical for this time of year.

It's always a little bit hard to say if there are more tick bites or less than tick bites than have happened in past years.

Though the CDC, if you check their data online, you can see there actually are a higher number of people going to the emergency department for tick bites than in past years.

And so, you know, when we look back over the last couple decades, we are seeing more and more tick bites happening and more tick borne infections.

So the problem is unfortunately increasing each year.

ALI ROGIN: What are some things that people can do to help protect themselves against tick bites?

ANDREW HANDEL: So the first thing you want to think about is what you can do to avoid ticks altogether.

So ticks tend to live on tall grasses or in that leafy underbrush in forested areas.

So if you go out for a hike, you want to stay in the middle of the path and avoid brushing against the sides where the ticks are hanging out on the tall grasses waiting to grasp onto you.

In terms of when you are outside enjoying the outdoors, we always recommend that people wear long sleeve, light colored pants and shirts and you can actually even tuck your pants into your socks to prevent the ticks from biting onto your skin.

You also want to use insect repellent.

So we typically recommend deets, 20 to 30 percent insect repellent, which is really good for keeping the ticks away and for people who really spend a lot of time outside, so landscapers or gardeners, you may even want to have a pair of clothing or two that you spray with a solution called permethrin, which goes right onto the clothes.

It stays on them for, you know, a good number of washes, and then kills the ticks and other mosquitoes and other insects on contact.

And then the last part you want to think about is once you're done with your outdoor activities, you want to take your clothes and your shoes and you can actually just throw them right into the dryer on high heat for 10 minutes.

That's going to kill any ticks that are attached.

You can also use a lint brush if you don't have access to a dryer.

And then probably the most important part of all this is once you're back inside to perform a really thorough tick check.

So you want to make sure to check in any areas where there's hair in the belt line behind the ears and skin folds.

Look really closely for those tiny black dots, which might indicate that you've been bitten by a tick.

ALI ROGIN: The CDC also says that 470,000 people contract Lyme disease each year.

And we know sometimes that the symptoms don't show up right away.

So what should people be looking out for that might indicate they've contracted Lyme disease?

ANDREW HANDEL: Yeah.

So the symptoms really depend on how long it's been since the tick bite occurred.

They actually change over time.

So if you had a tick bite within the last couple weeks or so, you're going to want to watch that area for what we call the target rash or the bullseye rash, which that classic circular rash that gets bigger over the course of a few days.

That's often the first sign of Lyme disease infection.

That often tends to come along with flu like illnesses.

So things like muscle aches, fevers, chills.

Some people actually never even have the bullseye rash.

That symptom just never develops or is in an area that they didn't notice.

And so later on, some people can develop, especially children will see have Lyme meningitis, which presents as them having really severe headaches that worsen over a week or two.

Adults are prone to having Lyme carditis, meaning that it's an inflammation of the heart and that can cause them to have shortness of breath, fainting episodes, things like that, because actually can affect the electrical rhythms within their heart.

And then in children, we tend to see quite a bit of Lyme arthritis where months after the tick bite occurred, they have a swollen, red, painful joint, and that can often be the first sign that they've had Lyme disease at all.

ALI ROGIN: Some people rely on remedies and information that they find online, which may be of varying reliability.

How would you determine what's a best practice and what's not?

ANDREW HANDEL: There are tick removal kits that you can find online or in other sources that often have all the tools you need.

We recommend using tweezers to remove the tick instead of other remedies that are often used.

So I've had patients who've tried to burn the tick off with a match or who've tried to suffocate it with oils or creams.

None of those things are helpful and can actually cause harm to your skin, so we don't recommend it.

So what you're going to do is you're going to take your tweezers, grab right where the tick is biting onto your skin, and then firmly pull it straight upward.

So don't twist it.

Don't try and pull on the stomach or anything like that.

Just pull it straight upward.

And then you're going to have your magnifying glass and a tick identification card, which, if you don't have one handy at home, you can always look online and use those to try and figure out what type of a tick it is.

So you'll take the tick from the tweezers put into a sealed container, and then when you can, look at the tick and try and figure out what kind it is, which tells you which infections or other medical problems you may be at risk of.

ALI ROGIN: If someone is infected, what are some best practices that they should follow?

ANDREW HANDEL: So, of course, if you have any concern at all that you've been bitten by a tick and you may have Lyme disease, you want to speak with your medical provider.

We do have some antibiotics that work very well for it.

And I say, particularly among children, the vast majority of patients we have who have Lyme disease get their antibiotics and get better pretty quickly.

Some people can have some lingering symptoms.

And so if you're not feeling back to yourself by the time you're done with your antibiotics, you do want to speak with your medical provider again and see if there's anything else that needs to be done.

Also, you want to make sure that the Lyme disease was the correct diagnosis the first time, because Lyme disease can look like a lot of other medical problems.

And so if you're not responding to the antibiotics, we always want to take a step back and say, are we sure this is Lyme disease?

Is there something else that we should think about here?

ALI ROGIN: And what would you say to parents who might be worried about tick season?

ANDREW HANDEL: So the first thing I always tell anyone is, especially for those of us who live in areas where there are many ticks, eventually you're probably going to find a tick on your child or yourself.

I have kids and do find ticks on them throughout the season.

Again, it's just part of life.

So when that happens, I just remind everyone, don't panic.

The vast majority of tick bites do not result in tick borne infections or other medical problems.

So just because you've been bitten by a tick does not mean that you're going to get sick for it.

But of course you want to be careful about it.

ALI ROGIN: Dr. Andrew Handel with Stony Brook Children's Hospital, thank you so much.

ANDREW HANDEL: Thank you very much for having me.