Category Archives: Lyme disease

5/8 BoS minutes

Lyme Disease Study Committee:  Medfield deer hunt costs town $1500 to cull 30 deer, or $50 per deer, versus state deer hunt at Blue Hill which cost nearly $300,000 in 2015 and 2016, translating to a cost of at least $2,200 per deer.  Medfield’s annual number of deer/vehicle crashes continues the decline that started with onset of the deer hunt eight years ago.  The committee’s primary goal is to reduce the incidence of ticks, with one secondary goal being to reduce the adverse effects on our forests from the over grazing by too many deer.

Minutes May 8, 2018 Chenery Meeting Room PRESENT: Selectmen Michael Marcucci, Gus Murby, Osler Peterson; Assistant Town Administrator Trierweiler; Town Counsel Cerel; Administrative Assistant Clarke Chairman Marcucci called the meeting to order at 7:00 PM and announced this meeting is being recorded. He asked for a moment of appreciation for our Troops serving in the Middle East and around the world. 7:00 PM LYME DISEASE STUDY COMMITTEE; MEMBERS CHRIS KALDY AND FRANK PERRY Ms. Kaldy remarked that she is here to present the committee's annual update on our activities. The committee was formed eight years ago and in general we feel that we have been successful in our efforts of the deer management program and also educating the public to raise awareness that protection is vital to prevent illness from tick bites. She went on to report that first and third graders receive tick check cards, and this year as a new educational item, Tick Check Shower Cards were ordered from the University of Rhode Island that were distributed to third graders. The committee posts warning signs around Town about ticks, particularly at the playing fields. Frank Perry remarked that they encountered no issues the past year with deer culling. The average number per year has been approximately 30 deer. So we feel we have met our goal annually regarding deer management. He noted that he has been tracking deer hit by vehicles in Town and the number continually has gone down. Chris remarked that Barbara Gips and Nancy Schiemer will not continue as members of the committee; she will be looking to step out in a while. Frank and Barry Mandell will continue. Frank said that we have about 47 hunters involved with our program, 43 are very active. He offered that he will contact the hunters to see if anyone may be interested in joining our committee. Selectman Marcucci said that you are the first committee to respond to our new committee structure, thank you. The Board thanked the committee for their continuing good efforts. 7:15 PM MEDFIELD LIONS CLUB MEMBER RON GUSTAVSON Mr. Gustavson said that he is requesting the Selectmen's permission for the Lions to conduct their annual Toll Booth on Saturday May 19. Lions will be stationed at North and Main Streets, Pleasant Street, in front of Needham Bank, SWAP area at the Transfer Station and this year we added Starbucks and Blue Moon Bakery. Our goal is to collect $5-7,000 for eye research. He remarked that he has been in contact with Chief Meaney and he approves our date of May 19, and time 9 AM to Noon. Mr. Gustavson also announced that the Eye Mobile will be in the Shaw's parking lot this Saturday May 12 from 9-noon for eye screening. 'Vote: Selectman Murby made a motion to approve the Medfield Lions Club holding their annual Toll Booth on May 19 at the locations as mentioned by Ron Gustavson. Motion seconded by Selectman Peterson and the vote was unanimous May 8, 2018 Page two ACTION ITEMS MEDFIELD HISTORICAL COMMISSION Selectmen received a letter from Co-Chairmen David Temple and Dan Bibel letting them know that member William Hasapidis has resigned due to a job change. They recommend that the Selectmen vote to appoint Seth Meehan as his replacement. 'Vote: On a motion made by Selectman Murby, seconded by Selectman Peterson it was voted unanimously to appoint Seth Meehan as a member of the Historical Commission for a three year term ending June 2021 and as recommended by Co-Chairmen David Temple and Dan Bibel The Selectmen extended their appreciation to Bill Hasapidis for his service. LIP PROJECT, MEDFIELD GREEN, 41 DALE STREET 'Vote: Selectman Murby made a motion, seconded by Selectman Peterson to authorize Chairman Marcucci execute both the application page and letter of support for the 36 Unit project. Additionally voted unanimously for the Board of Selectmen to sign the Memorandum of Understanding ENERGY GRANT CONTRACT Facilities Director Jerry McCarty requests the Selectmen vote to sign contract with Rise Engineering for exterior LED light upgrades at the middle school, high school, library, town hall, memorial elementary and wheelock elementary schools. Contract amount is $130,515. Grant monies will cover $128,286 and the remainder of $2,228 will be paid from the Town budget. 'Vote: On a motion made and seconded it was VOTED unanimously to sign the Energy Grant Contract with Rise Engineering, Cranston, Rhode Island for exterior LED light upgrades at several municipal buildings EAGLE SCOUT The Selectmen are invited to attend the Eagle Scout Court of Honor for Samuel Weston Evans on Saturday June 16, 2018 at the United Church of Christ at 1:00 PM DISCUSSION ITEMS Mr. Marcucci said that at the Affordable Housing Trust meeting we discussed the Medfield State Hospital and what we could be doing to help move the project forward. The Committee May 8, 2018 Page three authorized funds provisionally for a site survey and subject to Board of Selectmen approval. We also talked about a subdivision plan but that could come later. Selectman Marcucci remarked that he had discussion with Steve Nolan about it who feels that a subdivision plan is premature. Selectman Peterson agreed that a site survey is needed for whatever we do up there. Holding off on a subdivision plan makes sense. Discussion continued highlighting that Judith Nitch did a survey for boundary lines a while back. That should be reviewed again. Bill Massaro said that he and John Thompson have walked the back area many times without finding any markings to indicate any back lines. Mr. Murby queried would this be a survey to document where those lines are. Yes, that is what we/ MSH Committee would want. Cost for this survey could be in the $38,000 range and $10-12,000 for a subdivision. Mr. Marcucci said that he thought it best to take this up now and come the fall when we need it we will have it. Mr. Murby agrees that anything we can do to get the preliminaries out of the way is prudent. Selectman Marcucci said that he will let Sarah know she can get the RFP going. June 11, 2018 ballot Town Counsel Mark Cerel advised the Board that he has written a document that only clarifies and ratifies the Selectmen's May 3, 2018 vote regarding the June 11, 2018 proposition 2 Yi ballot questions. He remarked that he feels this spells it out and hopefully if explanation should be needed in the future for overrides we have it in hand. Actually it is G.L. Ch. 59 Section 21C that mandates how a ballot question may be worded. As such, he advised that the document be part of the Selectmen's record. There are a few minor word changes that the Board agreed to. Selectmen are requested to vote to sign 'Vote: On a motion made by Selectman Murby that the Selectmen approve and sign the Document Clarifying and Ratifying the May 3, 2018 vote to basically define the nature of the five override questions on the June 11, 2018 ballot, seconded by Selectman Peterson, and the vote was unanimous LICENSES AND PERMITS (CONSENT AGENDA) Granted as noted by the Chair: Memorial Day Committee parade permit and discharge of firearms permit for May 28, 2018 MEMO permission to hold Summer Concert Series June 14 through August 16 and to hang a banner across Main Street announcing the event MEMO permission, a common victualler permit and to hang a banner across Main Street Promoting the 39th Annual Discover Medfield Day to be held September 15 High School Swim Team permission for May 19 car wash behind Town Hall Norfolk Hunt Club one-day wine and malt beverage permit for Sunday May 27, 2018 Notch Brewing, Salem, MA one-day wine and malt beverage permit for three dates, July 27, July 28 and July 29, 2018 for Traveling Biergarten event at Rocky Woods Reservation May 8, 2018 Page four MINUTES 'Vote: Move to approve the May 1, 2018 and May 3, 2018 meeting minutes as submitted SELECTMEN REPORT Selectman Peterson, no special report Selectman Murby remarked that as of this date the housing survey has had a strong response, 550 returns which is about 25% from approximately 2200 residents. Selectman Marcucci reported that the Affordable Housing Trust has learned of a proposed project on Adams Street and a prospective group home is being researched. Mr. Marcucci remarked that it was a great day for the baseball parade last Sunday. ADJOURNMENT Selectman Murby made a motion to adjourn the meeting at 7:45 PM, seconded by Selectman Peterson and the vote was unanimous.20180508_Page_220180508_Page_320180508_Page_4

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Lyme Disease on WBUR this week

From Chair Kaldy, Chair of the Lyme Disease Study Committee, and along with Frank Perry, the leader of the remarkably successful Town of Medfield deer culling program, which the state reportedly considers as a paradigm –

Great article on the issue of funding tick/lyme research.
Science Shortfall: Why Don't We Know How Best To Fight Ticks And Lyme Disease?

Science Shortfall: Why Don’t We Know How Best To Fight Ticks And Lyme Disease?

In this 2014 photo, an informational card about ticks distributed by the Maine Medical Center Research Institute is seen in the woods in Freeport, Maine. (Robert F. Bukaty/AP)closemore
In this 2014 photo, an informational card about ticks distributed by the Maine Medical Center Research Institute is seen in the woods in Freeport, Maine. (Robert F. Bukaty/AP)

Part of our Losing to Lyme series

Beneath the midsummer Martha’s Vineyard sun, the gentle wind breathes waves of motion into a flag-sized swath of white fabric laid out on a large rock. Suddenly, an eye-catching bit of motion: a black, eight-legged speck on the move. Tick scientist Sam Telford pounces. He snatches it with his tweezers and tucks it into a small plastic vial with a satisfying pop.

There, the deer tick, endemic carrier of Lyme disease and other infections, lands in a comfy habitat of green leaves Telford has prepared for it. “I need these ticks to stay alive,” he says.

Tufts scientist Sam Telford snatches a tick with his tweezers. (David Scales for WBUR)
Tufts scientist Sam Telford snatches a tick with his tweezers. (David Scales for WBUR)

Telford will gather dozens of them in the course of a Chilmark morning, as part of research that has brought him tick-hunting to Martha’s Vineyard so many times that he’s lost count. For 30 years, Telford, a professor and epidemiologist at Tufts University’s Cummings School of Veterinary Medicine, has been working to understand ticks and the diseases they spread to humans.

These years have brought some progress: We have widely accepted practices for personal tick-bite protection, from repellents to body checks. But the biggest and most important question remains unanswered: How do we stop the spread of Lyme?

“What have we done for Lyme disease?” Telford asks. “The incidence keeps increasing and increasing, the distribution keeps increasing and increasing.”

Good Science Is Hard To Do

Take, for example, deer control. One of Telford’s first projects, back in the 1980s, looked at what happened to tick numbers when the deer population on Great Island in south Cape Cod was reduced.

http://d3kwtionx0p7im.cloudfront.net/embeds/newsletter/article/commonhealth.html?initialWidth=348&childId=iframe-embed-2&parentTitle=Science%20Shortfall%3A%20Why%20Don%27t%20We%20Know%20How%20Best%20To%20Fight%20Ticks%20And%20Lyme%20Disease%3F%20%7C%20CommonHealth&parentUrl=http%3A%2F%2Fwww.wbur.org%2Fcommonhealth%2F2017%2F07%2F14%2Fscience-fighting-ticks-lyme

The $20,000-per-year study showed that cutting the number of deer worked to cut the number of ticks, which depend on sucking deer blood during their life cycle. But it lacked definitive proof that the drop in ticks also brought a drop in Lyme disease, because the modest funding did not cover a study big enough to draw a clear conclusion.

Deer studies like Telford’s illustrate a central problem with Lyme and tick-borne disease prevention: We don’t know the most effective recipe to reduce tick populations and prevent Lyme because the studies that would definitively answer questions like that have not been done. Should your town follow Telford’s advice and cull deer populations? Spray public spaces? Trim back trails? Do all of the above?

The problem is complex, too complex for a simple answer.

“For a very long time, people have been looking for that silver bullet or the magic answer to make Lyme disease go away,” says Catherine Brown, the state’s public health veterinarian. “We’ve known for a while now that’s just not going to happen.”

“For a very long time, people have been looking for that silver bullet or the magic answer to make Lyme disease go away. We’ve known for a while now that’s just not going to happen.”

Catherine Brown, the state’s public health veterinarian

Put another way, trying to fight Lyme is like “trying to solve a multivariate equation with 18 variables and only knowing two of them,” says Henry Lind, the co-chair of the Barnstable County Lyme/Tick-Borne Diseases Task Force.

Ideally, when scientists do a study, they control all important factors, then change just one or two and observe the impact. But in an environment as complex as what surrounds tick-borne diseases, many factors affect the ecosystem.

We know deer, white-footed mouse and chipmunk populations are important in the tick life cycle. We know if they have a lot of food one year, they have more babies. We know ticks like warm, humid areas like leafy underbrush, and thrive in warm, wet summers but their numbers dwindle in drought.

Then there’s what humans do — whether we wear personal protection, put on repellent, spray our lawns, treat our pets, check our bodies for ticks. And while we can control our own behavior, we can’t control the whole ecosystem, especially the weather and food supply for rodents.

Finally, we can’t just count the number of ticks at the end of a study because what we really care about is the number of human infections. Some studies show impressive reductions in the numbers of ticks, but don’t show much impact on the number of infections.

In the face of this complexity, scientists have to do high-quality studies to give more certainty to the results. But that means large studies that span years and large areas to be more sure the results aren’t just due to weather changes or other things outside our control. All of that costs a lot of money.

Take, for example, a recent high-quality study led by Alison Hinckley, a CDC scientist. The researchers sprayed yards once a year with tick-killing chemicals and looked for the effect on tick bites and infections.

It was a two-year, randomized, double-blind, placebo-controlled study. It’s tough to get higher quality than that. It looked at over 2,700 households in three states. And it went further than most studies by looking not just at the numbers of ticks but also the number of tick-borne infections.

All of this cost about $3 million, a huge sum in the world of entomology and ecology.

And it didn’t work. That is, tick numbers dropped by 63 percent but tick sightings and infections didn’t change. Maybe people got ticks from the areas of their yards that weren’t sprayed, like gardens. Or maybe they got infected while on hikes. And, since it was only a two-year study, maybe rainy spring weather made spraying less effective.

An editorial in the same journal, headlined in part “Still No Silver Bullet,” lamented: “Unfortunately, this study confirms that effective prevention of tick-borne disease remains arduous and will likely rely on multiple methods.”

But the study wasn’t a waste. It answered an important question and offers opportunities for digging deeper in the next study.

Richard Ostfeld, a senior scientist at the Cary Institute of Ecosystem Studies, wants to do that next-step research. He and his co-director, Felicia Keesing of Bard College, have been encouraged by a recent trend toward “integrated tick management” that includes multiple ways to reduce tick populations, then checking the impact on rates of Lyme disease.

Their randomized, double-blind, placebo-controlled study will look at the effect of two interventions: a sprayed fungus that kills ticks, and bait boxes that drop a tiny amount of tick poison on small mammals. Because ticks don’t respect property boundaries, the study examines whole neighborhoods instead of just treating single yards.

It will track four groups of neighborhoods:

  • Where yards are sprayed with the tick-killing fungus
  • Where bait boxes with the tick-poison are installed
  • Where both are done
  • “Control” neighborhoods that get placebos (water spray and/or bait boxes with no tick poison)

The researchers will then compare the tick encounters and infections of each group. The goal, as the study puts it, is to “answer once and for all whether we can prevent cases of tick-borne disease by treating the areas around people’s homes.”

Follow The (Lack Of) Money

Thus far, Ostfeld and Keesing’s five-year study, called the Tick Project, has raised only $5.5 million of the $8.8 million it needs — 90 percent of it from the Cohen Foundation, and the rest from various donors and state and federal sources.

Such high-quality studies do not come cheap. “Those studies are very difficult and expensive to do,” says Dr. Ben Beard, chief of the bacterial disease branch in the CDC’s Division of Vector-Borne Diseases. An additional challenge: Funding is often allocated for specific diseases, he says, but the problem is broader — tick-borne diseases in general.

From 2006 to 2010, about $370 million in federal research money went to tick-borne diseases, according to an Institute of Medicine report, with over half of it spent on tularemia, an uncommon disease but cause for concern because of its potential use in bioterrorism. Funding dropped off dramatically as concern about bioterrorism waned.

Most money spent on Lyme goes to basic biology research, relatively little to research trying to understand the best tick reduction and prevention strategies. Today, according to an analysis of the NIH grant database, almost two-thirds of 2016 research funds for Lyme disease went to study basic biology. Another third went to studies looking for better diagnostics. Research of the kind done by Ostfeld and Telford was less than 10 percent of the 2016 total: only about $1.2 million.

Even in a state like Massachusetts, where Lyme is so widespread, state funding for research is highly unlikely. “State government quite frankly doesn’t have the money to be funding medical research,” says Rep. David Linsky of Natick, who chaired a legislative commission on Lyme. “I’d like to see the federal government that is really the source of funding for extensive research put some more money into Lyme disease.”

And funding is always tight for ecologists who study ticks and the animals they crawl on. For example, Telford doesn’t have research funding that supports his tick-gathering trips to the Vineyard. Like virtually every scientist, he’s had grants denied, including his most recent proposal to try to bring back Lymerix, the Lyme disease vaccine that was pulled from the market in 2002.

The limited funding means the science on preventing ticks is filled with smaller studies, many without controls, with small sample sizes, small geographic areas, that don’t look at the impact on human infections.

The result is a plethora of studies with confusing results, like the deer studies: Some, like Telford’s, show deer reduction works. Others seem to show it doesn’t work as well. None of the studies have conclusively linked deer reduction to effects on human cases of Lyme disease.

Scientists simply just don’t have the funds to do enough high-quality studies. As Ostfeld says, “the obstacle is more financial, not intellectual.”

Falling Between The Funding Cracks

Research on preventing Lyme also falls between the cracks in scientific funding. The National Institutes of Health fund research on better diagnosis and treatment of human disease, so they are not likely to fund field ecology research, even for Lyme disease, Ostfeld says.

The National Science Foundation funds ecology research, but its budget is much smaller than the NIH budget. An $8 million study could be as much as 10 percent of their ecology budget in any given year. And they do not tend to focus on public health.

The CDC would be a logical funding source, but it does not have a large external research program in this area. CDC researchers are helping with Ostfeld’s study, he says, but there’s “no way in the world they could fund an $8 million, five-year project.”

“We always have a wish list of unfunded studies, but there are a lot of competing disease issues,” Dr. Beard of the CDC says. Some recently announced funding for “vector-borne diseases” may help.

To sum it all up: “With over 300,000 new cases each year, the scope of the problem definitely hasn’t been addressed by the scale of the funding,” says Dr. Tom Mather of the University of Rhode Island. “I’m not sure when and if we can change that — maybe when there are 500,000 new cases of Lyme every year. Or maybe when ticks fly.”

And things look likely to get worse before they get better. Dr. Beard said in a presentation last year that he sees a troubling trend of less money going into tick-borne disease and not enough scientists specializing in it. “It’s not the disease outbreak du jour that gets the attention of the media,” he says.

So, no magic bullet. Little money. No simple answer to a number of questions about what communities should do. But Telford of Tufts, perseveres — still pushing for deer reduction, among other anti-tick tactics, and still arguing that communities and neighborhoods need to join forces to address the problem together.

He keeps his lab afloat from a hodgepodge of sources — a small grant here, some funds from collaborations there — and with the help of his wife, Heidi Goethert, also a trained scientist, who works in the lab full-time but only gets paid half-time to stretch the money as far as possible.

In early June, he submitted another National Institutes of Health grant to study a Powassan-like tick-borne virus, but it will be months before he hears the results.

“I remain hopeful,” Telford says. “I remain also very guarded in my optimism.”

David Scales MD, Ph.D., is a physician at Cambridge Health Alliance and Harvard Medical School. He can be found on Twitter @davidascales.

Related:

 

Ticks

From the Lyme Disease Committee –

Tick Season Notice 2015 v2

Lyme Disease Citizen Study Committee update

ticks

The Lyme Disease Citizen Study Committee and its hunt in town are remarkable well organized, as witnessed by its attached minutes.

Selectmen recently heard from the Trustees of the Reservations’ ecologist, Russ Hopping, about the beavers, but who also reported that at the TTOR Moose Hill property in Sharon the deer have eaten all hardwoods in the forest so completely that there are now no new hardwoods growing under six feet in height – dramatic changes in that forest.  He also confirmed that due to the excessive number of deer over eating our forests, that habitat for ground nesting birds, such as the grouse and woodcock, and the birds themselves, are just disappearing from the area.

Restoring balance in our forests is one of the additional benefits of culling the deer by our town hunt.


Town of Medfield Lyme Disease Citizen Study Committee

Meeting Minutes – Monday June 15, 2015 – 7:00 pm

Attendees: Chris Kaldy (Chair), Frank Perry, Barry Mandell
Minutes – reviewed meeting minutes from Apr 29.

 Controlled Hunt, Fall 2015 (season 5)

Frank starting interview process of new hunters. Will need to schedule proficiency testing.

October 3 is a new MA kids hunt day. Discussion about additional hunting property. Hospital land issue – large fields on each side of hospital are state owned. Medfield property is only the buildings; Dover owns behind buildings down to the river. Need to work with Dover. Maybe Selectmen can help recruit private properties.

Would like to send thank you letter to private property owners, signed by Selectmen.

Want to promote TTOR membership to hunters. Only a few showed up for work days.

Barry reported 20 deer hit by vehicles in Medfield in 2014, up from 18, per the animal control officer.

Actions:

  • Chris to print 60 yellow hunting signs and laminate hunting permit tags.
  • Chris will print up more deer management brochures with 2015 date.
  • Chris to draft TY letter to property owners from Selectmen.
  • Frank will ask Selectmen about help with recruiting private properties.
  • Frank will drop hunting signs at P&R
  • Frank and Barry will interview rest of new hunters.
  • Barry will purchase additional stands.
  • Barry will provide updated deer collision/road kill data from Medfield & area towns.
  • Chris will follow up again with Millis BOH (376-7042), Barbara Thissell (bthissell@millis.net)

On hold:

  • Frank to talk to ConComm more about 4H barn and property.
  • Chris will contact Sam Telford to discuss tick study on 4H property.

Tick & Lyme Education

Ongoing during tick seasons: Facebook site posts & Medfield TV 30 second spots.

Chris reported:

– P&R would like more signs. Frank to drop off.

– Met with Susan Cowell to update school curriculum. Have a few items to follow up on.   Susan will find out from grade 3 teachers whether value in distributing tick check cards a second time (1st & 3rd graders receive cards currently). Cost is $1.75 ea so budget issue.

– NNT never came back with date to speak to members. Chris will follow up in fall.

– New member possibility – Chris met with Allie Sahr (involved with field spraying effort)

  • Chris to provide Susan Cowell with updates to curriculum.
  • Chris to follow up with NNT for fall.
  • Chris will confirm late summer with Allie Sahr about joining committee.

Other:

Spraying fields – Chris reported through Michelle Whelan’s and others’ efforts, Park & Rec erected blue fencing around the edges of the fields at McCarthy Park. Norfolk County Mosquito applied a low volume organic spray at the start of June for mosquitos and ticks. P&R also cut back the brush another 10 feet and put a 3’ mulch barrier behind the fence. Signs are posted on the fence to not go into the area to retrieve balls and that the area is tick habitat. They will continue to keep the grass cut short and enforce the rule of no dogs off leash. P&R is looking into the possibility of tick tubes and deer stakes. They plan to do tick dragging to measure effectiveness of prevention measures. Hinkley is also part of plans.

They plan to meet with Dr. Marsden and try for a similar plan at the Wheelock fields.

  • Chris will follow up with Allie / Michelle again and P&R Kevin Ryder.

Budget – Note: Need to submit any expenses by end of June. Buying 3 new stands will use up most of balance of budget.

Next Meeting: TBD Sept 2015 in Warrant Meeting Room at Town Hall

Submitted by Chris Kaldy

A better way to remove ticks

From the Lyme Disease Study Committee chair –


Chris Cole Kaldy
June 19 at 7:13am
Here’s a different way to remove a tick which leaves no remnants in your skin. Take a look!
You HAVE to learn this tick removal trick before you go camping

theshrug.net
It’s easier and safer than using tweezers or your fingers.

Lyme Rx

From Chris Kaldy, chair of Lyme Disease Study Committee –

Medfield Lyme Disease Study Committee Information site
Some very hopeful news!
In Test Tube, ‘Pulse-Doses’ Of Antibiotic Wipe Out Lyme Disease Bacteria Persisters

commonhealth.wbur.org
A germ-fighting scientist finds a possible new way to eradicate Lyme disease bacteria that persist a…

Lyme disease

Chris Cole Kaldy posted in Medfield Lyme Disease Study Committee Information site

Chris Cole Kaldy 3:02pm Mar 31

Time to start Tick Control on your pets!

If you stopped your pet’s tick preventive over the winter, get it started again NOW. Outdoor dogs and cats will likely be the first family members to find a tick. There are three basic types of products; be sure to use the product that best matches your goals. Ask your vet which suits your pet best.

1 Products that kill ticks pretty much on contact before they attach and start feeding (quick tick knockdown).
2 Products that kill after ticks have attached and started to feed (ticks bite to die).
3 Products that may kill fleas and other parasites but don’t really kill ticks effectively (read the label).