Hiking and Lyme Disease: Revised estimates from the CDC indicate US infection rate is 10 times more prevalent than previously reported

Lyme Disease Incidence, 2012

Hikers and backpackers are at increased risk for contracting Lyme Disease. This is something I’ve written about extensively on SectionHiker and is worth reiterating at the beginning of each hiking season.

Revised numbers from the CDC (US Centers for Disease Control) reflect that they have been under-reporting Lyme disease. Instead of the 30,000 cases a year previously reported, the CDC has now issued a statement that the numbers are more in the range of 300,000 cases a year in the United States alone. 95% of these cases were reported from 13 states: Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Vermont, Virgina and Wisconsin.

Lyme Disease Symptoms

Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected deer ticks. Typical symptoms include fever, headache, fatigue, and a characteristic bulls-eye skin rash. If left untreated, infection can spread to joints, the heart, and the nervous system.

Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), and the possibility of exposure to infected ticks; laboratory testing is helpful if used correctly and performed with validated methods. Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics. Steps to prevent Lyme disease include using insect repellent, removing ticks promptly, applying pesticides, and reducing tick habitat. The ticks that transmit Lyme disease can occasionally transmit other tickborne diseases such as the West Nile Virus

Late Lyme Disease

Different people exhibit different signs and symptoms of Lyme disease. Some people never develop a bull’s eye rash. Some people only develop arthritis, and for others nervous system problems are the only symptom of Lyme disease. Some signs and symptoms of Lyme disease may not appear until weeks, months, or years after a tick bite.

Many of the symptoms of Late Lyme disease are similar to those of other diseases.

  • The fever, muscle aches, and fatigue of Lyme disease can be mistaken for viral infections, such as influenza or infectious mononucleosis.
  • Joint pain can be mistaken for other types of arthritis, such as juvenile rheumatoid arthritis, and neurologic signs can mimic those caused by other conditions, such as multiple sclerosis.
  • Other infections, arthritis, or neurologic diseases can also be misdiagnosed as Lyme disease.

Post Treatment Lyme Disease Symptoms

Even when treated with antibiotics, approximately 10 to 20% of Lyme patients have lingering symptoms of fatigue, pain, or joint and muscle aches. In some cases, these can last for more than 6 months. Called “chronic Lyme disease,” this condition is properly known as “Post-treatment Lyme Disease Syndrome” (PTLDS).

  • Arthritis appearing as brief bouts of pain and swelling, usually in one or more large joints, especially the knees.
  • Nervous system symptoms can include numbness, pain, nerve paralysis (often of the facial muscles, usually on one side), and meningitis (fever, stiff neck, and severe headache).
  • Problems with memory or concentration, fatigue, headache, and sleep disturbance.
  • Heart rhythm may occur irregularities

The exact cause of PTLDS is not yet known. Most medical experts believe that the lingering symptoms are the result of residual damage to tissues and the immune system that occurred during the infection. Similar complications and “auto–immune” responses are known to occur following other infections, including Campylobacter (Guillain-Barre syndrome), Chlamydia (Reiter’s syndrome), and Strep throat (rheumatic heart disease).

Outdoor Research BugOut Gaiters
Outdoor Research BugOut Gaiters

Recommended Precautions

The Mayo Clinic’s #1 recommended precaution for preventing Lyme disease is to wear long pants, long sleeve shirts, hats, socks, gloves and gaiters when walking in wooded or grassy areas that are potential deer tick habitats. This is just common sense, yet so few hikers take these steps, preferring to hike in short pants and short sleeve shirts.

I love the feeling of warm sunlight on my arms as much as the next guy, but I decided six years ago to cover up whenever I go hiking and to wear Insect Shield (also called Permethrin) treated clothing which kills ticks and other insects. By taking these precautions, I have yet to be bitten or infected by a tick, which is pretty miraculous given the amount of hiking I do in prime deer tick habitat.

When you gear up for this hiking season, I encourage you to look into wearing clothing that has been treated with InsectShield, an industrial process for treating your clothing with Permethrin,  a contact insecticide proven to prevent tick bites, that maintains its effectiveness for 70 washings. You can treat your own clothing with Permethrin also, but it will only remain effective for 3-4 washings.

Clothing manufacturers such as Ex Officio, Columbia, Outdoor Research, Buff and my favorite, RailRiders, sell stylish InsectShield clothing and are your best defense against tick bites for hiking, backpacking, and camping in areas with a high incidence of Lyme disease.

See also:

CDC: Lyme Disease Frequently Asked Questions (FAQ) from the CDC

SectionHiker: Treating your Clothes with Permithrin


  1. All I can say is F******************K. That does it– I’m sending my hiking outfit to Insect Shield ASAP to get the industrial strength treatment for the summer. I’m going to be right in one of the dark portions of that map in a month and a half. Argh.

    • NOLS Alumni get a 40% discount on Railriders through promotive. Just saying since I know you went to NOLS.

      • I’ve used it a few times, but I can’t justify buying new clothes right now (although maybe soon). Also, I’ll melt if I wear long sleeves and pants in the southern summer heat :-)

      • Does that discount go for taking the NOLS WFA course (through their WMI)? If so, how do I use it?

      • Promotive.com.

  2. I personally handled at least ten cases of Lyme disease in various stages in 2013. If my experience was average for an ED nurse, that means there were likely a whole lot of cases, many of which are later stages, some in which no bulls-eye rash appeared and some of which are not known for certain due to a patient being discharged prior to a lab result being reported in the hospital setting.

  3. My Brother is living with Post Treatment Lyme Disease he has had for many years. He found a great book by Stephen Harrod Bahner , Healing Lyme: Natural Healing and Prevention of Lyme Borreliosis and it’s Coinfections. He has used much of the information in the book to help manage his condition, he found it very helpful. It’s a good book to check out.

  4. I wear RailRiders Eco Mesh Pants with Insect Shield from May through September. They do a great job keeping mosquitos, biting flies, and ticks away and my legs are kept cool by the leg length zippered mesh feature in the really warm weather.


  5. My Doctor, knowing my life style, and who also is an outdoor person, has my blood tested every year. This started when I had similar symptoms to Lyme Disease about 15 years ago which turned out to be another weird virus of some kind. I’d rather spend the $50 for the blood test than not. His nurse told me that they have found that the expensive impregnanted clothing is not 100% effective either. So do not give yourself that false sense of security. spray your socks and and or if you wear Gaiters, around the bottom and top edge of the Gaiter., and pay particular attention to the back of your head above your shirt collar or T-Shirt Collar. Dab a bit repellent on your finger and get behind your ears too..

  6. Excellent awareness article. I would like to make a quick point. There is a lot of misinformation surrounding “chronic” lyme disease. If you do a cursory google search, you will find tens of thousands of pages with people claiming to be debilitated by this disease.

    However, if you visit the Infectious Disease Society of America (the professional society representing infectious disease physicians), you can download their free guidelines, specifically about lyme disease. The PDF is very comprehensive, including the preferred diagnostic testing (apparently there are a few ways that result in a lot of false positives) and prevention tips. The PDF does acknowledge residual neurlogic and arthritic damage is possible, but not active, ongoing infection after treatment.

    “There is no convincing biologic evidence for the existence of symptomatic chronic B. burgdorferi infection among patients after receipt of recommended treatment regimens for Lyme disease. Antibiotic therapy has not proven to be useful and is not recommended for patients with chronic (?6 months) subjective symptoms after recommended treatment regimens for Lyme disease “

  7. I recommend treating your pack with Permethrin, at night when you bring the pack inside the tent, those nasty little hitch hikers seek out new places to crawl and hunker down.

    seriously Lyme is no joking matter, I’ve had it and will always have pain in my finger as a lingering reminder. Now all off my clothing, tent, bivy, pack are treated with Permethrin. I continue to wear shorts and short sleeves and I do use DEET.

    • Very good idea JJ. I will do this.

    • Will a 24 oz spray bottle of Sawyers Permethrin be enough to treat all your equipment, i.e. tent, pack, clothes, etc.? I have never used it but plan to treat everything this month

      • No – I think that amount only treats 3 clothing items.

      • No, you’ll need more than 24oz depending on how many articles of clothing and there’s no need to treat your entire tent, just the bug netting to prevent mosquitoes buzzing and keeping you awake.

        AND DON’T USE PERMETHRIN AROUND CATS. No cat jokes please.

  8. A friend contracted Lyme years ago while in the Army and suffers all kinds of problems to this day. It’s serious stuff.

    I wear treated Railriders clothing on the trail and also treat my tent, gaiters, shoes and anything else that’s not pre treated. I also spray picaridin on my exposed skin (I can’t stand the feel of DEET). When car camping, I bring a spray bottle of mixed permetherin and spray the perimeter of the tent and the entry. Other than the above, I’m not letting fear of Lyme stop me.

  9. If you have cats in your family be very careful with permetherin products as cats are very susceptible to poisoning: http://www.icatcare.org/permethrin/vet-info

  10. It’s also bad for birds and fish. When we had a cat, I made sure I did all treatments in my shop with the doors closed, although the cat rarely tried to explore there. Once the clothing dried out, it went into Ziploc bags for storage.

  11. Even as a child I was freaked out by Lyme disease. My cat always comes home full of ticks. We really need to take precautions, wear long sleeve clothes, and treat our clothes with materials that kill ticks.

  12. Veterinary supply stores (and Amazon) sell bottles of 10% Permethrin that can be diluted to treatment strength.

  13. There is a local store that sells feed and other supplies to horse people and I can buy an 8 oz. bottle of 10% for under fifteen dollars. Mix 20 parts water to 1 part of that and you’re in that .5% range of the Sawyer product and you have over six times the amount for the same price.

    • When I treat my gear, I mix up about a half gallon (approximately 3 oz of the feed store Permethrin to 2 quarts of water) at a time and put it in a plastic bucket. I dunk my hiking clothing in the bucket and let it saturate, then pull the clothing out and wring out the solution back into the bucket while wearing rubber gloves and my paint respirator. I hang it all up to dry over a plastic covered table in my shop. What drips onto the table gets squeegeed back into the bucket. I’ll also dip my Tarptent and ground clotht, my gaiters, and my hiking shoes in the bucket and hang all those up as well. By the time the tent and shoes get dunked, what’s in the bucket has gotten a bit dirty. I filter the remnants through a paint strainer and it goes into a hand sprayer for use to spray the perimeter of the tent when car camping. Before I shut down the shop for the night, I’ll turn a fan on to help things dry quicker.

      I haven’t gotten Lyme but I do wish that extra head growing out from my shoulder would just shut up some time…

  14. If you have cats (and maybe other pets) be VERY careful with Permethrin. I have several friends who did not know that Permethrin is very very poisonous to cats – and their cats died as a result of coming in contact with it on their clothing.

    It doesn’t take much of this chemical to kill them.

    Just a word of warning.

  15. The CDC is a big part of the problem, or at least the infectious disease doctors that follow their guidelines for diagnosing Lyme Disease. I could write pages about my struggles with Lyme Disease and the countless doctors I was referred too. Some were adamant I had Lyme, and others were adamant it was something else. Not only can Lyme be difficult to treat, but there is so much controversy as to what even constitutes Lyme Disease. It is a bad enough disease without a messed up medical industry that can’t get out of its own way in how to diagnose the disease. The politics of Lyme are unbelievable. I cannot recommend enough the importance of dressing appropriately in the woods. And, you should be extra careful if you hike with your dog.

  16. Thank you so much for the wake-up call! Just ordered two Insect Shield shirts today (already got the pants). Thanks

  17. Keith 2 posts above this IS SPOT ON ABOUT THE CDC COVERUP OF LYME DISEASE! I went 9 YEARS fighting doctors who went by the ‘CDC Protocol’, who kept telling me I ‘did not have Lyme Disease’ ! Some of the ‘INFECTIOUS DISEASE DOCTORS’ took the side of the INSURANCE COMPANIES WHEN THE ‘PROTOCOLS’ WERE WRITTEN!! This was told to me by my own ‘Infectious Disease Doctor’ who was one of the few doctors at the time that stood up to the CDC and Insurance companies and sided with the PATIENT!! He told me as much, and also told me, ‘No doctor can CURE PTLD so if they tell you that find another doctor!” He can only moderate my current symptoms as he sees me. Lyme Disease is a precursor to all manner of MAJOR illnesses like Parkinson’s, Cancers, MS, etc. THIS IS WHY THE CDEC AND INSURANCE COMPANIES ARE DENYING IT!!! Imagine their bills if they had to cover everyone that had/has Lyme Disease and develops these other MAJOR Illnesses!! The nickname of REAL Doctors who TREAT LYME Patients is ‘The Great Imitator’. Prevention is THE only way to avoid the devastating effects of PTLD Lyme Disease. I’m a victim of the CDC and Insurance Companies policies!!

Leave a Reply

Your email address will not be published. Required fields are marked *