Mosquitoes, ticks and bees: summer protection and first aid

Mosquitoes, ticks and bees: there is hardly a summer without meeting at least one of them. Most bites and stings are annoying but harmless and fade within a few days with simple home care.

There are situations, however, where the right reaction in the first minutes matters, and some folk tricks do more harm than they help. Here is what is proven to work, verified against official medical sources and my own practice.

Only female mosquitoes bite: they need blood to develop their eggs. They are most active at dusk and during the night, and the itch after a bite is the body's reaction to their saliva.

In Bulgaria mosquitoes rarely transmit diseases, but West Nile fever is recorded every year in Europe, including Bulgaria, according to the European Centre for Disease Prevention and Control. Most infected people do not even notice, but in older and chronically ill people it can be severe, so protection is worth the effort.

Repellents with DEET, icaridin (picaridin) or IR3535 are proven to work. The concentration determines how long they protect: 10 percent DEET protects for about 2 hours, 30 percent for about 5 hours, and 20 percent icaridin for 8 to 12 hours. Concentrations above these levels add no real benefit.

For children over 2 months, repellents with up to 30 percent DEET are approved according to the American Academy of Pediatrics. An adult applies them: first onto their own hands and only then onto the child's exposed skin, skipping the child's palms, eyes and mouth, because young children rub their eyes and touch their mouth with their hands. Products with oil of lemon eucalyptus are not used for children under 3 years. Permethrin is only for clothing and gear, never for skin.

At the beach the order matters: first the sunscreen, then the repellent. Once back home, wash the skin with soap and water. A repellent is also an essential part of the summer travel medicine kit.

Wash the spot with soap and water and apply a cold compress or ice wrapped in a cloth for 10 to 20 minutes. This calms the swelling and itching fastest.

For strong itching, an antihistamine tablet and a hydrocortisone cream from the pharmacy help. The key rule is not to scratch: a scratched bite gets infected easily, and then it turns into a job for a doctor.

Ticks do not fall from trees: they crawl through grass and shrubs and latch on as you pass. That is why in forests and parks you should wear long trousers tucked into socks and light-coloured clothing, on which a dark tick is easy to spot.

After a walk out in nature, check the whole body, especially the armpits, groin, scalp and the folds behind the ears and knees, and do the same for children. A shower within 2 hours of coming home washes off ticks that have not yet attached. Pets should be treated against parasites regularly, as they are the most common transport for ticks into the home.

Grasp the tick with fine-tipped tweezers as close to the skin as possible and pull slowly and steadily upwards, without twisting and without squeezing its body. Twisting applies only to the special tick hook sold in pharmacies; tweezers are not twisted, because the mouthparts can break off and stay in the skin. If you are not sure you can manage, do not postpone for hours: see a doctor, who will certainly remove the tick correctly. Then wash and disinfect the spot.

Forget the tricks with oil, petroleum jelly, alcohol or a burnt match: they only make the tick release more saliva into the wound. If a small part of the mouthparts stays in the skin after removal, do not panic: if it does not come out easily with tweezers, leave it, the skin pushes it out on its own as it heals. If redness, pain or pus appear, the spot should be shown to a doctor.

Lyme disease is the most common tick-borne infection in Bulgaria. It is recognised by an expanding red ring around the bite site, which appears days to weeks later, sometimes with flu-like complaints. It is treated with an antibiotic prescribed after a doctor's examination, and the earlier it is caught, the easier it is. The risk of infection grows when the tick stays attached for more than 24 hours, so early removal truly protects.

Mediterranean spotted fever (Marseille fever) is typical of Southern Bulgaria and the Black Sea coast and is carried by the dog tick. Its hallmark is a dark scab at the bite site, followed by a high fever of 39-40 degrees, severe headache and a rash over the body. With such symptoms you should see an infectious disease specialist and always mention the tick: this shortens the path to diagnosis.

Crimean-Congo haemorrhagic fever is rare and occurs mainly in Southeast Bulgaria. The general rule is simple: fever or rash in the weeks after a tick bite means a doctor, without waiting.

The bee leaves its stinger in the skin, the wasp does not. The stinger is scraped off sideways with a fingernail or the edge of a bank card, not with tweezers: squeezing pushes more venom out of it. Then the spot is washed with soap and water, a cold compress is applied for about 20 minutes and, if possible, the limb is raised.

For pain, paracetamol or ibuprofen help, and for swelling and itching an antihistamine tablet. Repellents do not protect against bees and wasps, so near them move slowly and calmly, without swatting or sudden arm movements.

A severe allergic reaction is recognised by swelling of the face, lips, tongue or throat, difficulty breathing or swallowing, hives over the whole body, dizziness, nausea and fainting. If even one such symptom appears after a sting, call 112 immediately.

People with a proven allergy carry an adrenaline auto-injector, and those close to them know how to use it. A sting in the mouth or throat requires emergency care even without an allergy, because the swelling can close the airways. Multiple stings at once, especially in a child, are also a reason to see a doctor.

The information in this article has been verified and is based on: CDC guidance on repellents and on tick removal, the NHS page on insect bites and stings, Mayo Clinic first aid for stings, the American Academy of Pediatrics recommendations on repellents for children, and data from the European Centre for Disease Prevention and Control (ECDC) on West Nile fever.