First, the bad news.
Floyd County’s rate of Lyme disease is about 19 times higher than the state rate, according to the Virginia Department of Health. Pulaski County’s is seven times higher, Giles County’s is six times higher and Montgomery County’s is nearly four times higher.
These statistics are from 2023. However, “Year after year we don’t see a lot of changes. The New River Health District and surrounding areas have the highest rates of Lyme disease in the Commonwealth of Virginia. We’ve known for years that Floyd County is a really hot spot for Lyme disease and potentially other tick-borne illnesses,” said New River Health District epidemiologist Jason Deese in a phone interview on Wednesday.
More bad news.
Lyme isn’t the only tick-borne illness in the NRV. There are at least 12 diseases caused by ticks in Virginia.
It gets worse.
Tick-borne illnesses can be fatal. Lyme disease, the most common tick-borne illness in Virginia, is “like a shape-shifter and can affect the neurological system,” said Deese. Nerve issues and arthritis caused by Lyme can persist for years, and research published in Neuropsychiatric Disease and Treatment demonstrates that Lyme contributes to suicidality in people who were not suicidal before being infected.
A second serious tick-borne illness in Virginia is Rocky Mountain spotted fever, which, according to the Centers for Disease Control and Prevention, is fatal in 20% to 25% of untreated cases. There’s also alpha-gal syndrome which causes a potentially life-threatening allergy to red meat.
The ramifications of tick-borne diseases extend beyond physical health. For example, the red meat allergy caused by alpha-gal syndrome can cause anxiety, social isolation, grief over missing out on cultural traditions such as holiday food, intellectual burden of checking food labels for hidden ingredients, and loss of recreational activities because of the need to be near a restroom, according to Dr. Jenny Hall, founder of ticksinvirginia.com and assistant dean of interprofessional education and practice and associate professor of public health at Radford University, in an interview on Wednesday.
Add to all that a distressing fact: “Most people who get Lyme and other tick-borne illnesses don’t even know they’ve been bitten,” said Deese.
There are affordable, straightforward actions you can take to reduce your risk
There’s something you can do about all this bad tick news.
Deese and Hall shared recommendations for how to avoid tick bites and what to do if you are bitten.
To help remember the tips for avoiding tick bites, here are 4 C’s: cover, clear, check, clean.
How to avoid tick bites, part 1: Cover
“The number one part of primary prevention is dressing appropriately for the outdoors,” said Deese. Putting on the right clothes and repellant before going outdoors can thwart ticks.
For clothing, Hall recommends the following strategies:
- Wear long sleeves, pants and socks to create a barrier between your skin and ticks.
- Tuck your pants into your socks.
- Stick double-sided tape or carpet tape around the hem of your pants or top of your socks to prevent ticks from climbing up your clothing.
- Wear light-colored clothing so that it’s easier to see ticks.
- Treat clothing, boots and outdoor gear such as camping tents or backpacks with permethrin, an insecticide that incapacitates ticks. Follow instructions on the permethrin package.
- Consider purchasing clothes and gear pretreated with permethrin from a reputable company such as InsectShield. Hall pointed out that InsectShield offers tick-repelling pet gear and a service in which you can mail in your clothes to be treated and mailed back to you.
For repellants, Hall recommends using EPA-approved products, particularly ones with an ingredient called picaridin. Her go-to brand of tick repellants is Sawyer. For a chemical-free option, she recommends repellants by Tick Tock naturals or lemon-eucalyptus sprays, with the caveat that natural products need to be applied more often than ones with picaridin.
How to avoid tick bites, part 2: Clear
Clearing the yard of vegetation and animals that attract ticks is another important strategy for avoiding tick bites. “The primary place you’re going to run into ticks is along the edge of woods or in high grass. So clear away leaf litter and keep the grass trimmed in your own yard,” said Deese.
Hall also emphasized the importance of keeping wildlife such as deer and mice out of the yard and away from the home. “Mice are big, big hosts and carriers, as well as deer,” she said.
How to avoid tick bites, part 3: Check
Hall recommends checking for ticks during outside activities and when back inside: “Check often, and check everywhere,” including behind the knees, between the legs and inside the belly button. For children, in particular, Hall said, “Check behind the ears and in the scalp area because there’s thinner skin behind the ears, and since kids are shorter, ticks are quicker to get up to the head.”
Deese recommends doing a tick check at least every 24 hours, “including all the cracks and crevices, but also your clothing because ticks hide in clothing and can bite you later.” He also advises people “to have a buddy tick-check you in areas you can’t see and to check pets for ticks.”
How to avoid tick bites, part 4: Clean
Hall recommends three strategies for cleaning up after being outdoors:
- Run a lint roller over clothes to remove hard-to-see ticks or tick larva.
- Put clothes in the dryer on high heat for 15 minutes to kill ticks.
- Shower as soon as possible.
Deese also emphasizes the importance of taking “a shower with soap and water to wash off ticks and to recognize if you have a tick on you.”
If you find a tick attached to your body, removing it in a specific way is important to prevent a tick-borne illness.
What to do if you are bitten
“Appropriate tick removal prevents the time a tick can basically vomit the bacteria into you,” said Deese. Both Deese and Hall were adamant: Use fine-tip tweezers to remove the tick.
Don’t use matches to burn off the tick. Don’t slather petroleum jelly over the tick. Don’t scratch off the tick. And don’t twist or squeeze the tick.
“Ticks are like a tube of toothpaste,” said Hall. Squeezing an attached tick can cause the tick to regurgitate bacteria and pathogens into the bloodstream.
The best way to remove a tick is “use a set of tweezers to get the tick as close to the skin as possible, making sure you get the little biting mouth part and head, and then gently pull the tick off,” said Deese.
Hall recommends placing the tick in a plastic bag or taping it to a notecard for identification. Identification is important because different types of ticks carry different diseases. To identify the tick, use the printable chart provided by the Health Department or upload a photo of the tick at Ticksafety.com, a Virginia-based nonprofit that offers free tick identification. Hall is not sponsored by any of the companies or products she recommends.
After removing and saving the tick, Hall recommends cleaning the bite area and the tweezers with alcohol pads.
Then, according to Hall and Deese, watch for symptoms. Descriptions of symptoms of the 12 tick-borne diseases in Virginia are available on the VDOH website and ticksinvirginia.com. Several possible symptoms are highlighted below.
- Lyme: “bull’s-eye” rash, fatigue, fever, headache, muscle and joint pains, and swollen lymph nodes.
- Rocky Mountain spotted fever: sudden onset of moderate to high fever, severe headache, fatigue, deep muscle pain, chills and rash.
- Alpha-gal syndrome: hives, swelling of skin and tissue, gastrointestinal upset, diarrhea, stuffy or runny nose, sneezing, headaches, a drop in blood pressure, and in certain individuals, anaphylaxis about two to six hours after eating meat or dairy products.
If symptoms develop, see a health care provider as soon as possible and ask to be tested for tick-borne diseases.
Although there are treatments for some tick-borne diseases, “The intervention truly is prevention,” said Deese.
Prevention, to summarize the information above, involves covering the skin with clothes and repellant, clearing the yard of high grass and leaf litter, checking for ticks often and everywhere, and cleaning clothes and skin after being outdoors. Prevention also includes removing attached ticks with fine-tipped tweezers and watching for symptoms.
“Nothing is 100%, but combining all of the strategies minimizes the risk,” said Deese.
Rates are not cases
In an email on Thursday, Deese clarified state Health Department data: “Just to clarify with [tick-borne illness] rates, we use a denominator: per 100K population. There’s a small grain of salt to take with these numbers when converted to rates, because small changes in raw case counts in a low population area such as Floyd County influence the rate per 100K more dramatically than in a higher population area like Montgomery County.”
Floyd County’s population was just under 16,000 in July 2025, according to the census.gov site. So the cases-per-100,000 rate below is likely five times the actual number of cases in the area. Montgomery County, with a population hovering just under 100,000 according to the same site, would have an actual case number that would more closely align with the cases-per-100,000 rate.
“Although mathematically correct, the 19x state level [for Floyd] could easily become 21x state level with a handful of additional cases,” Deese wrote.
Here is the Virginia Department of Health’s data on Lyme disease cases in 2023:
- Virginia (entire state): 20 cases per 100,000 population
- Floyd County: 390 cases per 100,000 population
- Pulaski County: 148.4 cases per 100,000 population
- Giles County: 127.8 cases per 100,000 population
- Montgomery County: 73.0 cases per 100,000 population
