June 8, 2026

USET Office of Tribal Public Health (USET OTPH) | Tick-Borne Illness

Dear USET/USET SPF Family,

The USET Office of Tribal Public Health (OTPH) is sharing this alert to inform USET member Tribal Nations about increasing emergency department (ED) visits related to tick-bites and rising tick-borne illness cases across the USET region. Recent surveillance activities and communications with state health departments indicate an increase  in tick bite related ED visits and tick associated conditions this year compared to previous years, including but not limited to Alpha-Gal Syndrome (AGS) and Tularemia. Surveillance findings also suggest increased tick exposure risks and higher number of tick bite related ED visits in wooded areas across the northeastern portions of the USET region where Tribal citizens live, work, and participate in cultural and outdoor activities. Below is an overview of tick exposures and tick-associated illnesses, prevention and educational awareness and resources to support the health of USET Tribal Nations and communities.

What are Ticks and Tick-Borne Illnesses?

 Ticks are small parasites commonly found in wooded, brushy, or tall grass areas. They attach to mammals, including livestock, wildlife, pets, and humans, by biting the skin and feeding on blood. Because ticks can be very small, they may be difficult to notice or identify on the body, especially in areas covered by hair or skin folds.

Some ticks can carry bacteria, viruses, or parasites that may be transmitted to humans through their bite, potentially leading to tick-borne illnesses or allergic reactions such as Alpha-Gal Syndrome (AGS). Prompt tick removal and early medical attention for concerning symptoms are important to help reduce the risk of illness.

For humans, exposure to ticks can include general symptoms such as:

• Fever and chills
• Allergic reactions to red meat or animal by-products associated with Alpha-Gal Syndrome (AGS)
• Skin rash (in the shape of a circle or bullseye)
• Muscle aches
• Nausea and vomiting
• Itchiness
• Swollen lymph nodes

It is important to note that symptoms of a suspected infection may develop within a few weeks.

Alpha-Gal Syndrome

Alpha-Gal Syndrome (AGS) is a serious, potentially life-threatening allergic condition associated with tick bites that has been increasingly reported in Northeastern states. Alpha-gal, also known as galactose-α-1,3-galactose, is a sugar molecule naturally found in most mammals, except humans and other primates. In the United States, the Lone Star tick is the primary tick species associated with AGS. AGS may develop after a tick bite introduces alpha-gal into the body, triggering an immune response. Individuals with AGS may experience allergic reactions, including anaphylaxis, after consuming red meat or being exposed to certain mammalian by-products such as dairy products, gelatin, or some medications. Symptoms often occur several hours after exposure, which can make diagnosis difficult.

The Lone Star tick is an aggressive tick species commonly found in the South, Midwest, and increasingly in Northeastern regions of the United States. Adult female Lone Star ticks are identifiable by the single white dot located on their backs. These ticks are commonly found in wooded areas, brush, and animal resting sites. In addition to their association with Alpha-Gal Syndrome, Lone Star ticks are also associated with several other illnesses, including ehrlichiosis, tularemia, and bourbon virus disease.

Figure 1: Life Stages of the Lone Star Tick, (University of Rhode Island)

USA General Tick Trends

Figure 2: Emergency Department (ED) Visits for Tick Bites by Week, CDC (2026)

The number of ED visits in 2026 is noticeably higher compared to the past four years. We are seeing a rise in ED visits earlier in the season in 2026 than in the past four years.

Figure 3: Emergency Department (ED) Visits for Tick Bites by Age and Sex, CDC (2026)

Over the past four years, males have higher ED visits for tick bites than female. Children, ages 0-9 years old, have a higher rate of tick bite visits than any other age group within the past four years.

Figure 4: Emergency Department Visits for Tick Bites by Region, CDC (2026)

Over the past four years, the Northeast region has the highest ED visits for tick bites incidence. The second highest is the Midwest region.

Health Overview

As emergency department visits related to tick bites and tick-borne illnesses continue to increase, it is important to understand prevention strategies and public health recommendations.

Stay informed: Please share this alert with community members and remain aware about going outdoors and best practices regarding ticks. Your health and well-being are our top priorities.

Public Health Recommendations

1. Tick prevention before and after outdoor activities:

• Wear protective clothing such as long pants, long sleeves, socks, and close toe shoes.
• Treat clothing and gear with products containing 0.5% permethrin or wear permethrin-treated clothing. Permethrin should not be applied directly to skin.

• Use EPA-registered insect repellents.

• Examine gear, clothing, and pets before entering your home.

• Shower soon after being outdoors.

2. Personal Checks for Humans and Pets:

     Humans:

• Check for areas on your body where ticks may be located. This can include areas you may or may not see, such as underarms, in and around ears, inside the belly button, back of knees, back, head, between your legs, and around the waist.

• If diagnosed with Alpha-Gal Syndrome, consult your healthcare provider regarding foods or products containing mammalian ingredients that may trigger allergic reactions. (Check to see if your food products have alpha gal)

     Pets:

• Similar for pets, check your pets or livestock for ticks throughout their body in places such as in and around ears, legs, head, and paws/hooves.

• Consult with your veterinarian on tick prevention medication.

3. Environmental Checks:

• Learn about common tick species in your region and the illnesses they may carry. (Types of Ticks and Geographic location)

• Maintain lawns and outdoor areas by keeping grass trimmed and removing brush where ticks may live.
• Avoid areas with long grass and heavily wooded areas.

Step-by-Step Guide After Exposure

• If a tick is present on skin, remove the tick as soon as possible by using clean fine-tipped tweezers to grasp the tick as close to the skin's surface.
• Pull the tick away from skin with steady, even pressure and be careful not to twist or jerk the tick.
• Dispose of a live tick by taking one of these steps: place it in a sealed container; wrap it tightly in tape; flush it down the toilet; or put it in alcohol. Do not crush the tick with your fingers.
• After removing the tick, thoroughly clean the bite area and your hands with soap and water, rubbing alcohol, or hand sanitizer.
• Do careful checks for additional ticks on your body or pet and remove them.
• Monitor symptoms of potential tick-borne illness over the next few weeks, and if present, contact your local healthcare provider. (How to remove a tick)

Clinical and Provider Resources

• Learn how to identify and manage alpha-gal syndrome through a CDC TRAIN course. Understanding and Managing Alpha-Gal Syndrome for Healthcare Providers (Web Based)

• Learn to recognize and respond to anaphylaxis. Save a Life: Recognizing & Responding to Anaphylaxis - FoodAllergy.org

For additional information, please see the resources below. The USET Epidemiology Team is available to assist with any questions or concerns. Please do not hesitate to contact us at usetepi@usetinc.org. 

Sources

1. CDC Ticks and Tickborne Disease
2. CDC Prevention of Tick Bites
3. EPA-Approved Insect and Tick Repellents
4. Directory of Local Health Departments by State
5. Alpha-gal Information
6. Two Alpha Gals
7. Alpha-Gal Syndrome | islandspublichealth.com
8. 10-Tickborne-Disease-Prevention-Strategies.pdf
9. 09-Tick-Removal-Instructions.pdf

Established in 1969, the United South and Eastern Tribes, Inc. (USET) is a non-profit, inter-Tribal organization serving thirty-three (33) federally recognized Tribal Nations from the Northeastern Woodlands to the Everglades and across the Gulf of Mexico. USET is dedicated to enhancing the development of Tribal Nations, improving the capabilities of Tribal governments, and improving the quality of life for Indian people through a variety of technical and supportive programmatic services.