Relapsing Fever, Tick-Borne in Nebraska

• First Febrile Episode: Sudden onset of high fever, headache, muscle and joint aches, chills, nausea, vomiting, and sometimes a rash.
• Afebrile Period: A period of 3-10 days where symptoms subside completely or significantly improve.
• Relapses: Return of fever and other symptoms, often milder than the initial episode but can recur multiple times.
• Other possible symptoms: Jaundice, cough, abdominal pain, neurological symptoms.

Relapsing Fever, Tick-Borne is primarily transmitted to humans through the bite of infected *Ornithodoros* (soft) ticks. These nocturnal ticks typically feed for short periods (15-30 minutes) while a person is sleeping. The ticks acquire the *Borrelia* bacteria from reservoirs like rodents (e.g., squirrels, chipmunks, mice) and other small mammals. It is not transmitted from person to person.

• Avoid tick exposure: Use insect repellents containing DEET or picaridin when in endemic areas.
• Protective clothing: Wear long sleeves and pants, especially at night or when visiting areas known to harbor ticks.
• Tick checks: Inspect skin and clothing thoroughly after spending time outdoors.
• Rodent control: Reduce rodent populations around homes and cabins to limit tick habitats.
• Seal entry points: Block potential entry points for rodents and ticks in dwellings.
• No vaccine: Currently, no vaccine is available for TBRF.