any permethrin users out there?

[Bob Gross]

I don't think that you want to put concentrated DEET on your skin. I've been known to dab a little or spray a little on my clothing in areas where body heat will vaporize it. Permethrin is much milder, and you get the chemical thoroughly into the clothing fabric for it to do any good. Alaskan black flies didn't seem to like the stuff at all, but they were adept at finding exposed skin somewhere.

The solution is: use both. Get the Permethrin into your clothing fabric as level one protection. Then apply some DEET to critical spots on your clothing as the threat increases.

I use DEET from a tiny atomizer, and I use Permethrin from a large spray can.

–B.G.–

[Michael Ray]

Thanks Bob, good info. I don't use the concentrated DEET..even the mild and diluted consumer-grade stuff gives me a rash. I use deet free stuff that works well for mosquitos, but I am hoping to use something like Permethrin for tent, socks, pant legs, etc to do a better job against ticks. I just don't want to have skin reactions in these areas where I'll have contact.

[Anonymous]

I believe that "Lemon Eucalyptus oil" has shown some definite efficacy, though it's not as long lasting as DEET.

Unfortunately, the natural stuff tends to get less funding and testing overall than the synthesized or the occasional stuff which is concentrated, processed, and distilled from natural. Ok, maybe the exception is exotic Amazon type plants which some drug companies do sometimes spend lots of money and research on.

Large corporations are less interested in things which people can obtain more easily, cheaply, make themselves, etc. They like specialized or patented stuff–easier to make money off of, and at the end of the day, to many larger corporations, banks, and governments you are less an individual person and more a walking $ sign and/or number.

There are things out there which can and should be tested more like Karanja oil.

Re: DEET, Permethrin, etc. lately i lean towards James Marco's stance when it comes to others–people should decide for themselves with all available information. However, it's important to point out that humanity currently lives in an unprecedented age as far as various toxins go. Our food, our air, our water, our oceans, our soils, our living spaces, etc. all contain various toxins, and in many cases or areas–increasing levels of same.

It's also important to point out that modern medicine is still an evolving science with A LOT of room for growth and evolution. Toxicological studies and research generally are kind of "blunt" in the sense that they look for obvious damage and to important, critical organs and bodily systems. Once you get to the levels to do that much damage, it's usually means you're screwed more long term and there may be lasting damage. There are far less studies and research as a whole which research, long term but much smaller amounts, which can over time cause more chronic and SUBTLE issues which can then cause body imbalances hard to pinpoint.

Having spent many years trying to balance an imbalanced body (which happened through a combo of crappy diet, stress, so called (pharma) "medicine", our increasingly toxic environment, etc), personally i try to avoid anything which may add to the toxic load and that includes a very wide range of stuff. It's not fun having chronic and uncomfortable body imbalances…

I would be open to possibly using clothes with just the outside sprayed with permethrin, as it seems less likely to cause issues, however with netting etc i've been pretty fine so far.

Also, the more and more people use permethrin, the more and more likely it is that different bugs will eventually start to adapt to it. This HAS started to happen with DEET and mosquitoes in some places.

[Steven McAllister]

I find most natural pest solutions to be useless, except permethrin(spelling?) for tick control.

My clothes are treated with permethrin and I watch ticks crawl on my clothing and die.

I used to put lemon eucalyptus on my neck and bandanna and found that certain mosquitoes were attracted to my neck and bandanna.

I even took the bandanna off and laid it on the ground to look at it covered in mosquitoes.

Head nets, long sleeves and long pants are the best way to go when bugs get real bad.
And for tick control, definitely permethrin is the way to go, but make sure you use it correctly.

[Anonymous]

I've never had much luck with any one particular and isolated "natural" thing, but last latish spring in the White Mountains, i had made a concoction of Karanja oil with various essential oils from plants, and found it helped with mosquitoes.

However, it didn't seem to do much for the black flies. Nothing seemed to do much for them, not my friends DEET spray either. I however, put on my over the hat netting, and could tolerate it wheras the poor fellow i was with, was eaten alive.

Slight edit. I did experiment with eating a crap load of garlic, over a few days, and it did really decrease mosquito attraction.

[Steven McAllister]

Yes, black flies and many other bugs don't seem to be repelled by anything.
So in the spring in the Northeast Mountains, I cover every part of exposed skin with clothing and wear a head-net on breaks or in camp.

I still get bites on my hands, I just can't wear gloves when it's warm out.

[Anonymous]

Steven, does the Permethrin kill and/or repel black flies at all?

[obx hiker]

If your interested in stopping arachnids (ticks/chiggers) copied below is an old post on a simple effective and MINIMAl system using permethrin that has been "field tested" almost daily for years in local (from my experience extreme) conditions and it WORKS

I took an old pair of thicker acrylic socks and cheap gym sweat-shorts, cut out the feet of the socks and cut off the waistband of the sweatshorts and treated those to a permethrin soak. Wear the old socks as gaiters over socks above your shoe/boots and the waist-band goes there over your pants and presto no next to skin contact and the main access points are BLOCKED. This system has been used almost daily for years and STOPS chiggers and ticks.

Mosqitoes and other flying insects are another issue and personally I rely on lightweight and light colored long-sleeves and pants treated with permethrin in extreme situations.

Repel Permanone spray comes in a .5% solution. they're proud of it! an 8 oz. can cost @ $10.00. The local Wal-mart has a horse dip solution sold by the quart for @ the same $ that's a 2.5% solution so add 4 parts water and you have the .5% if you want to make a soak at MUCH less expense than buying the kit sold by Sawyer. Plus you'll only use a fraction of the dip and you can retreat each spring. I'm on year 4 with the first quart treating pants/shirt/"gaiter-socks and waistband. I mostly use the gaiters and waistband, occasional the shirt as like a jacket over a tee and rarely the pants. Funny thing I was just getting ready to re-do my basic "bug" kit for 2013 You can find lots of info on treating clothing by googling.

[Steven McAllister]

obx hiker has the plan.

Regarding permethrin and back flies,
Permethrin is not a repellent, it kills, but only after a certain amount of time. Also, you don't put permethrin on your skin.

Permethrin works very well with ticks, which are extremely dangerous, if you follow the guidelines.

Although black flies are very annoying, they are not as dangerous as dear ticks.
If they should come in contact with permethrin treated clothes, they can still bite before they kick the bucket a few minutes later.

Ticks crawl up your clothing so permethrin is effective in their case, reducing the chances of them causing Lyme Disease.

[Sam Farrington]

1. When sprayed on pant legs and socks, it has prevented ticks from attaching. When not used in warm weather, ticks have attached. When not used again after pants and socks have been washed, ticks have attached in warm weather. This has been the case during over 20 years of frequent hiking and bushwhacking through tick infested areas around Mount Chocorua.

2. For flying insects, DEET is much more effective.

3. The toxicity of permethrin on the skin is not clear; but I would never use it on the skin when DEET is available. No point. For that reason, I would never wear clothing impregnated with permethrin. Toxic effects can take many years to develop, so the fact that it seems to work without noticeable side effects when impregnated in clothing is of little consolation to me. All the permethrin products I've seen bear a warning to avoid contact with skin.

4. CONCLUSION: I use the minimum amount needed to keep ticks from attaching, and no longer bushwack in moist and low lying areas here in warmer weather. The 'hardened' trails offer avenues in which vegetation will not be brushing me above the pant legs.
I greatly miss bushwacking in warmer weather, but the increasing prevalence of deer ticks, that often carry Lyme disease, is too great a concern. I've gone through the Giardia nightmares. The Lyme nightmares can be much worse. Not for me, thanks.

[Michael Ray]

again, great info. thanks!

[Jan S]

"Permethrin works very well with ticks, which are extremely dangerous"

Uhm, ticks are not extremely dangerous. They are extremely annoying and a bite from them puts you at risk to get Lyme disease, which can be very well treated with antibiotics and Tick-borne encephalitis. You can get shots (at least in Germany) for Tick-borne encephalitis.

The risk to get Lyme disease is actually pretty low – about 1% of tick bites result in Lyme disease, again according to Wikipedia. That said: If you have been bitten by a tick it helps to know the symptoms and keep a close eye on the spot where tick bite was. Also improper removal techniques (drown them in oil, turn them till the come out) increase the infection risk.

Tick-borne encephalitis is a different matter and in the high risk areas you really need to have got your shots. But in North America there are no high risk areas – I'm not even sure ticks carry the virus there.

There are a couple other illnesses but these two are the main risks. Here in Germany I've had about 3 tick bites in my whole life and have never used any chemical treatment in my clothes and have certainly not been very careful to avoid them. YMMV of course but even if you're bitten by one it's not extremely dangerous.

[Rex Sanders]

Everyone will have a different risk tolerance for tick-borne diseases, so "extremely dangerous" is a judgement call.

A couple of short stories:

I was bit by a tick in my sleep about 10 years ago while backpacking, and groggily scratched it off without realizing what happened. Within 24 hours, I had a half-grapefruit sized infected swelling on my chest, so I cut my trip short and hiked out a painful 10 miles. The doctor gasped from across the room when he saw it. Diagnosis: staph infection. He claimed staph was much more likely than Lyme disease or other exotic diseases, but potentially deadly. He used a magic marker to draw a circle around the swelling, and told me to go to the emergency room if it got any bigger. I got a strong round of oral Cipro, and recovered fully. Don't know what the outcome might have been with a different strain of staph (e.g. MRSA), or a multi-day hike out.

Lyme Disease often goes unnoticed or misdiagnosed, until it has progressed pretty far. My best friend went through years of disability and several rounds of IV antibiotics because of this.

So tick bites are borderline "extremely dangerous" in my opinion.

Still, I don't worry much about ticks. I stay out of the tall weeds in the spring, and check myself after hiking. If a tick is removed correctly and quickly, and the wound cleaned well and kept clean, your chance of infection with anything is pretty low. I'd rather not have a lot of chemicals around me.

But your risk evaluation will be different.

[Anonymous]

Thank you for the good tips Obx hiker. I think i shall try that method in the near future. I wonder if i can get that horse dip stuff at Tractor Supply or some other place.

[obx hiker]

"The risk to get Lyme disease is actually pretty low – about 1% of tick bites result in Lyme disease, again according to Wikipedia."

Now that might be one of the most curious remarks I've ever seen posted on BPL
I can say that this isn't Germany….. around here someone spending one day in the wrong woods…… lots of underbrush…. plenty of warm-blooded 4-legged mammals…. could easily pick one hundred ticks off their clothing or body. I've known people to get so many tick bites from one misadventure they had to get a prednizone shot just to calm the itching.

I would advise our dear readers in the US to completely discount that statement

You talk about fools rushing in where angels fear to tread. Golly. I thought only Americans had a tough time with math and evaluating statistical risks. That comment has me floored seriously.

I'll bet you don't have to worry too much about Anacondas in Germany either. Lucky thing and by an amazing coincidence neither do we. Whew! that was close! Now about those pythons in the everglades……

[Harald Hope]

obx, thanks for correcting what has to be one of the most wrong statements made in this thread.

To add to what you said, here's the reality: nobody in the world knows infection rates where you will be backpacking. That's the short version. The longer version is that, in for example California, they trap ticks and test them, a mere handful, you can look up this data online, they have a database you can access. For example, in the entire South of Monterrey area, they have a handful of sites, almost all, if not all, along the coast, for example Andrew Molera state park, and there they have collected a handful of ticks for sampling. So if you are backpacking in big sur, that data has exactly nothing to do with your actual risk factors.

Also, each eco-region has its own infection rates, so any article that says there is a 1% infection rate without referring to the region/specific area is totally worthless and should be immediately discounted as a valid source of information, since whoever wrote it is clearly totally ignorant and unable to understand the question at hand. Even with regions the infection rates can be totally different depending on specific factors such as presence of walnut trees, ground mice, and deer, to name just one factor.

Because the alleged data is so absurdly and badly done, one group at least in I believe Sonoma/North state counties collected their own tick samples and found up to I believe if memory serves, about 40% lyme infection rates in nymphs.

The other factor is that infection rates seem to vary widely between nymphs (this big: . – and flesh colored, find that in your knee-pit after a hot sweaty day, I challenge you to do that) and adults, the nymphs have much higher infection rates than the adults, sometimes near 50% depending on the area.

The other factor that people need to be aware of is it's very common for ticks to carry up to 3, or even more, diseases, only one of which is tested for, lyme, and that test is extremely poor, up to 50% false negative, which is one reason lyme is such a growing issue in the world, the tests are terrible and were originally not even meant to be used for diagnostic purposes, but were rather intended to test subjects that registered positive for clinical trials, I don't remember the exact details, sorry. So if you are treated for lyme, you may actually have one or two untreated co-infections, at worst case.

Lastly, the notion that using antibiotics as plan A for treatment, that's a very very bad idea, that should be plan B, or even C, avoidance, careful checking (although with nymphs, that's a dream if you think you can spot those each time, 50% of lyme sufferers never even saw or felt the tick, and about 50% never get, or never see, because they weren't looking, the rash), permethrine, should be plans A/B, antibiotic treatment is plan C, and if you don't catch it in time, or don't get the symptoms properly diagnosed (very likely sad to say), look forwards to your backpacking days, and work, and other factors, being over, possibly forever, unless they find some way to get deep seated stuff out of your body.

So yes, use permethrine, it's a no brainer, there is simply no comparison between the correctly noted possible toxic side effects of sprayed clothing and the absolutely certain damage lyme and related diseases will do.

This ignores things like rocky mountain spotted fever, which can be, and is often, fatal.

When talking about ticks and lyme, try to avoid spreading myths and untruths, it's extremely dangerous to have bad information on this subject, just use the permethrine and keep enjoying your hiking, while still being very aware and alert. Or don't, in the end natural selection will take care of the problem I guess, unless you've already had kids…

[Jan S]

So, I do not think that permethrin is bad. Not at all. I also do not want to discourage it's use, quite the opposite.

I do think however that the use of permethrin does not replace due diligence in regard to ticks – like searching for them if you walked through the bush in an area where there are a lot of ticks. And, should you have been bitten by one to keep a close look on the spot where you have been bitten for about at least three weeks. And yes, catching Lyme disease isn't completely trivial. Treating Lyme disease (and only Lyme disease) in the early stage however is as trivial as using the right antibiotic for the right amount of time (or are there Lyme strains that are resistent to treatment?)

As for the 1% statement: Well, I think you should either talk to the English wikipedia (no, it's not from the German page) or probably change the article there. And yes, I do know my math and know that this is probably the mean risk for each individual tick bite. This does not say anything about the risk to a) get bitten by a tick and b) the risk to get infected by a tick in the area you hike in.

Actually my intention was to provide more information then just "extremely dangerous". I apologize if this information wasn't very good or not to the point.

[Buck Stolberg]

Here is some info on Lyme, hopefully enough to make sure you never want to get it. I'd recommend Permethrin for those in areas with lots of ticks, Lyme or not. It is a neurotoxin for insects and humans, but humans can break it down. I do remember some pets were susceptible to it while people were treating clothes, so be careful.

http://www.cdc.gov/lyme/

Incidence Maps 2001-2011, ie –Places to Worry!–
http://www.cdc.gov/lyme/stats/maps/interactiveMaps.html

Increased incidence over the years may be due to better reporting (Lyme is a reportable disease), increased spread, and/or changes in habitat which favor the mice and deer that are part of the life cycle (more meadows and mice, less predators, etc…) There is no current consensus except that it is a combination of these factors. Incidence shown above correlates strongly with the % of ticks that carry Lyme (up to 40% in some areas).

There was a 'shot' for Lyme disease which was the Lyme 'vaccine' that was on the market for a short time about ten years ago. It wasn't a true vaccine in the sense that it created perpetual immunity. It was actually just exogenously grown antibodies to Lyme that would be sucked up with host's blood and inactivate the Lyme before anything was regurgitated back in to the host. It only gave estimated protection for one year. It was available for pets after it came off the market.

There has been more research in the past year about the types of lyme, but they all respond to the current regimen of antibiotics. Co-infection with sub-types is not un-common, and there may also be other tick-borne diseases such as Rocky Mountain Spotted Fever in the same tick. I am not sure if the current test for Lyme recognizes these sub-types.

Testing for lyme is an antibody titer (count of host created lyme specific antibodies), which usually takes at least a month to be over the threshold. The diagnosis can be made clinically (by history and physical) without the test though. Again, half of the people never see a tick, and half never see a rash. Symptoms come in stages, and it may entirely skip some (like the rash). Sometimes the rash may be confused with cellulitis, which may then be treated with a too short course of antibiotics.

Current medical guidelines do not recommend Lyme prophylaxis (short course of antibiotics) for a simple tick bite, because the medications (like any meds) have possible side effects that outweigh the benefit of early treatment. The situation where it may be advised based on a practitioners judgement is if it was in a highly endemic area (at least 10% of ticks carry Lyme), finding of a tick, that the tick was attached over 24 hours, and the general health of the patient.

[Steven McAllister]

I live and do a lot of hiking in the most concentrated Lyme area.

A good portion of the Appalachian trail runs through this area and a lot of thru-hikers get it.

I know a lot of people who have contracted it. One person developed partial paralysis within a couple months of infection. She had no sign of a tick bite.
Many of us encouraged her to get tested when she first started getting the symptoms, but as usual, everyone said it wasn't that common.
She finally did when the paralysis kicked in:-(

One person has been suffering for years because it didn't get diagnosed soon enough.

Another person got it twice.

I was very ill before I realized I had it and it took a lot of effort to get my doctor to test for it. She has seen several cases ever since and was very surprised by how common it is in New York City and the suburbs.

Most cases get misdiagnosed and/or are discovered too late.

A very high percentage of outdoors people I know in the North East have had it.
Don't listen to people who say otherwise. It is very real.

[Bob Gross]

Despite the uncommon incidence in California, one friend of mine got the disease. For the longest time, there were symptoms that no physician could reason. Finally they did the specific test for Lyme disease, and it was the culprit. My friend still has not gotten rid of all of the symptoms after many years, despite treatment.

Better safe than sorry.

–B.G.–

[Harald Hope]

"they all respond to the current regimen of antibiotics."

With a huge qualifier, if you start them before they enter the core of your body, ie, the stage where you begin to manifest neurological symptoms, and/or joint issues, the treatment seems to generally work as intended. Once the deeper systemic infection happens, it's a total cr#pshoot re your luck and resistance and many other factors. Even though the IDSA current line is that the suggested type/treatment length of antibiotics work for all cases, that is simply not true once it gets in you deeply enough, as thousands of long term sufferers from this disease can explain with lesser or greater degrees of patience.

There is however progress, I believe 5 or so years ago, they were recommending 2 weeks initial treatement with oral antibiotics, now they are up to 4, and for long term, they will get to much longer once they start treating actual patient data and not mythology of various types that continues to linger due to sloppy and highly questionable medical practices, some of which were succcessfully challenged in a connecticut law suite against the IDSA group.

At that rate, I expect better diagnostic and treatment advice to be recommended by the cdc and other organizations (you know the ones, that's what most doctors google to decide how to treat the disease, literally, sad, but true) within the next decade. As one prominent researcher said, the only thing you can say for sure about our understanding of lyme is that what we think is right will either be proven wrong, or will change profoundly within a few years, so assuming any steady state type knowledge is a huge mistake, particularly if you are trusting a doctor who is not up on this stuff. Big gamble, I recommend against it.

For those interested, here's a 2012 rhesus monkey study (silly bpl forum software, won't let link work: http://www.plosone.org/article/info:doi/10.1371/journal.pone.0029914 that disproves most of the nonsense the current (and erratically evolving status quo) promotes as fact or reality, including the fact that antibiotics do NOT work necessarily or reliably once it's deep in the body, and that the organisms live in a sort of suspended state that antibiotics are not able to do anything about since I believe they are only active to stop reproduction of the bacteria, or something. Hand the link on to anyone you know who had/has to deal with the sheep like ignorance of the industrial medicine technicians masquerading as 'doctors' which are currently the biggest obstruction to actual progress in this area.

These results demonstrate that B. burgdorferi can withstand antibiotic treatment, administered post-dissemination, in a primate host. Though B. burgdorferi is not known to possess resistance mechanisms and is susceptible to the standard antibiotics (doxycycline, ceftriaxone) in vitro, it appears to become tolerant post-dissemination in the primate host. This finding raises important questions about the pathogenicity of antibiotic-tolerant persisters and whether or not they can contribute to symptoms post-treatment.

Don't take this stuff lightly, it's no joke, use the permethrine, if you still can hike at all, that is.

Re the percent thing, again, there is no such thing as any meaningful mean count or percentage, that is useless data, and can do nothing but lull you into a totally unwarranted, and false, sense of security, what matters is the infection rate where YOU ARE NOW, and of the specific creature that decided to feed on you NOW, and where you will be. Since that data is totally non available, don't even consider that as relevant in any decision you make. I also would not trust the notion you can tell when you are in a heavily infected or even lightly infected area, I'm sorry, but you can't, trust me, it takes only one, and you may not even see that one, so just forget all those ideas that you can somehow evade this statistically, though of course, there are some areas that are fairly free of them, certain ecosysystems and climates. They don't like it above the polar circle that much, for example. I would imagine that if you are on high mountains with only rock, there's close to no risk either.

As they say, party on, but do it with brains and keep yourself healthy by taking basic precautions that cost you virtually nothing long term. Personally, I am unaware of any way a solo hiker can actually truly check his/her body for tick nymphs, that's very close to a fantasy in my opinion, though of course, that doesn't mean you shouldn't check carefully, you just can't fully rely on that check unless you carry a nice big full sized mirror with you, two ideally….

[Harald Hope]

Bob Gross, your friend is lucky the test came up positive, in many cases it does not, which makes dealing with the medical system even worse since that means they have to actually try to think for themselves and do what even the cdc says to do, rely on clinical evaluation for the actual diagnosis. And this makes them very uncomfortable, it's not what they are trained to do in most cases, unless you are lucky and have an actually smart doctor who can think for him/her self. The levels of antibodies your body generates apparently can vary very widely, which is why they keep looking for a more accurate test, with not so great results so far.

Your friend is probably getting inadequate treatment if he/she is going to a run of the mill doctor, that's the norm currently, the state of ignorance is really bad in this area, particularly in Calif.

[obx hiker]

Harold, Thanks for keeping this bumped along and for all the useful info. You inspired me to delve a little further into tick borne disease. Maybe some o the more medically and scientifically attuned can add info

here's what I found about Hosts or host reservoirs which as I understand it are the warm blooded ( usually?) species that host the bacterium or maybe in some cases the virus ( but not w/ Lyme) which is then transmitted by the vector…. Mr Tick…. to the "victim" or maybe new host/reservoir ( or both)

This from a report on the web found by googling hosts/reservoirs for Lyme Disease

To predict and prevent human risk of exposure to vector-borne diseases, it is vital to identify the reservoir hosts of the pathogens. Lyme disease is the most commonly reported vector-borne disease in the United States and is caused by the spirochete Borrelia burgdorferi sensu stricto, a member of the bacterial complex of Borrelia burgdorferi sensu lato.1 In the northeastern United States, the principal reservoir host of B. burgdorferi is the white-footed mouse (Peromyscus leucopus), but chipmunks (Tamias striatus), short-tailed and masked shrews (Blarina brevicauda and Sorex cinereus), and eastern gray squirrels (Sciurus carolinensis) also serve as infectious hosts.2–5

Similarly, in California, B. burgdorferi has been isolated from several host species including western gray squirrels (Sciurus griseus), dusky-footed wood rats (Neotoma fuscipes), and California kangaroo rats (Dipodomys californicus).6,7 However, prevalence of B. burgdorferi infection in wood rats and kangaroo rats typically has been low.6–9 Conversely, a study of western gray squirrels in oak woodlands in Mendocino County, northwestern California, showed that squirrels are commonly infected with B. burgdorferi (80% by polymerase chain reaction [PCR]), and that larval Ixodes pacificus ticks readily acquire infections (47% of attached larvae were infected).6

We broaden the geographic survey of Lyme disease in Californian sciurids to sites throughout northern California and perform xenodiagnosis and transmission experiments using I. pacificus to determine whether western gray squirrels are competent

I 'd surmise that the hosts/reservoirs on the Outer Banks of NC are the following mentioned eastern gray squirrels and we have lots of mice but not sure about white-footed. Also not sure about masked shrews but there are resident shrews but absolutely no chipmunks. We also have lots of thick brush, Ticks tend to get out on the ends of branches or grass stems and when they sense movement waive whichever of their 8 legs aren't holding the plant and grab whatever walks brushing by. I've carefully observed this. There's some lively discussion about whether or not they might actually "parachute" down on a passing victim but I wouldn't be surprised….. still contact with the plant/perch seems the greatest problem/vector unless you're maybe sitting/standing or laying down. Around here there's also a heavy population of both deer and rabbits which must help support the tick population, and a relatively benign environment in which ticks may be …..ahem… encountered year round though May through October are the worst months.

It appears to me that the locales and incidence are spreading and increasing. According to Harold's posted map NC has a relatively light incidence yet anecdotally I'm hearing of more and more cases.

[Author]

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