Exposure settings, tick removal practices, and underdiagnosis risks of Lyme Borreliosis in student of I. Horbachevsky Ternopil National Medical University: a cross-sectional study

Abstract

This article presents a comprehensive analysis of epidemiological survey results from 275 higher education students, aimed at studying the frequency of Ixodidae tick attacks, exposure settings, level of awareness regarding vector-borne disease transmission risks, and tick removal practices. Despite the predominantly urban sample (69,8 % of respondents residing in urban areas), a high intensity of contact with ticks was established: 54,9 % of all respondents reported exposure to these arthropods, and 46,6 % reported direct tick attachment. An investigation into attack locations revealed that peak tick activity occurs in forest and meadow biocoenoses. However, 3,6 and 1,8 % of respondents reported attacks in parks and gardens, respectively, indicating the potential for arthropod exposure within residential areas. The highest number of tick attacks occurred in the Ternopil region (16,4 % of all respondents), likely related to their place of residence, while 15,3 % could not recall the exact territory. The highest number of attacks was recorded in June and July (14,9 and 12,0 % of all respondents, respectively), whereas in May and August, these rates were 8,7 and 5,1 %. The majority of surveyed students discovered ticks by chance or during self-examination following exposure to high-risk areas. This highlights the crucial role of self-inspection, which enabled most individuals to detect ticks within the first 24 hours of attachment. An analysis of the behaviors of 128 respondents who reported tick attachment revealed that only 28,1 % sought professional medical care. In 53,1 % of cases, ticks were removed by non-medical third parties, while 18,8 % removed them independently, significantly increasing the risk of trauma and infection. Although laboratory-confirmed Lyme borreliosis was documented in only 4 cases, the presence of pathognomonic erythema migrans in 35,2 % of victims, against a background of low diagnostic testing rates (only 21,8 %), suggests substantial underdiagnosis of tick-borne diseases. These findings underscore the urgent need to intensify health education efforts among youth, implement effective personal prophylaxis strategies, and improve health literacy regarding post-tick-bite action algorithms.