How long does it take for a tick to transmit Babesia?

The numbers of cases of Babesia are climbing - a real concern, particularly since this tick-borne pathogen can be transmitted immediately following a tick bite. In their study “Lyme borreliosis: a review of data on transmission time after tick attachment,” Cook and colleagues describe the various timeframes it may take for an individual to become infected depending upon the tick-borne pathogen.

The study is of particular interest given the news that Babesia cases are on the rise. According to a recent Morbidity and Mortality Weekly Report (MMWR) from the Centers from Disease Control and Prevention (CDC), there has been an alarming increase in the numbers of Babesia cases in the Northeastern U.S. [1] Eight states in this region reported the greatest rise in cases. These states included: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, and Vermont.

It takes 24 to 48 hours for a tick bite to transmit Lyme disease per the CDC, wrote Scott et al. [2] Other studies have demonstrated the transmission time to be even less. According to Cook et al., the time it takes for a tick to transmit Lyme disease was less than 16 hours, particularly if the salivary glands are infected. [3]

Meanwhile, since Babesia can reside in tick salivary glands, it can be transmitted immediately when the tick starts to take a blood meal, wrote Scott.

“There is no grace period between tick attachment and transmission [of Babesia],” wrote Scott.

Anaplasma phagocytophilum (the causative agent of human anaplasmosis) can often be transmitted in less than 24 hours, wrote Mehlhorn. [4]

Finally, “Powassan virus can be transmitted in less than 15 min.,” according to Ebel et al. [5]

The absence of a grace period between tick attachment and transmission makes reports of an increase in Babesia cases in the Northeastern U.S. more concerning. Furthermore, the actual number of cases in other states is not clear.

“Babesiosis is not reportable in all states; for example, although transmission of B. microti has been documented in Pennsylvania, babesiosis is not a reportable condition in that state,” wrote the CDC.

The CDC’s MMWR did not discuss whether Babesia might explain reports of individuals becoming sick in less than 24 hours after a tick bite.

The CDC’s MMWR briefly discussed treatment. The prescribed treatment with doxycycline for a tick bite will not work for Babesia. Instead, Babesia is typically treated with atovaquone (marked as Malarone and Mepron in the US) and azithromycin (marketed as Zithromax in the U.S.)

  1. Swanson M, Pickrel A, Williamson J, Montgomery S. Trends in Reported Babesiosis Cases – United States, 2011-2019. MMWR Morb Mortal Wkly Rep. Mar 17 2023;72(11):273-277. doi:10.15585/mmwr.mm7211a1
  2. Scott JD, Clark KL, Foley JE, Bierman BC, Durden LA. Far-Reaching Dispersal of Borrelia burgdorferi Sensu Lato-Infected Blacklegged Ticks by Migratory Songbirds in Canada. Healthcare (Basel). Jul 25 2018;6(3)doi:10.3390/healthcare6030089
  3. Cook MJ. Lyme borreliosis: a review of data on transmission time after tick attachment. Int J Gen Med. 2015;8:1-8. doi:10.2147/IJGM.S73791
  4. Mehlhorn H, Shein E. The piroplasms: life cycle and sexual stages. Adv Parasitol. 1984;23:37-103. doi:10.1016/s0065-308x(08)60285-7
  5. Ebel GD, Kramer LD. Short report: duration of tick attachment required for transmission of powassan virus by deer ticks. Am J Trop Med Hyg. Sep 2004;71(3):268-71.

15 Replies to "How long does it take for a tick to transmit Babesia?"

  • Colleen
    05/05/2023 (12:09 pm)

    In one of the questions I saw someone asking about testing, it may have been on another post. Regardless, you did not have answers but pointed them to the scientist that wrote the article.
    Since I have found that apparently Igenex and TLabs from MD do the fish test which is apparently the best way to detect the parasite. Dr. Linden? (My memory isn’t great) Has done an interview that can be found on youtube. His daughter has it, and he has been devoted for approx 2.5 yrs now.
    He said the tlabs is specific to the new varient but neither is perfect and Physicians should treat on symptoms as many LLMDs agree.
    I just wanted to share the information hoping again to help your patients.
    He also states that the treatment he uses starts with the general malaria drugs increasing as needed and warranted. Gradually stepping up dosage along with adding different types of malaria drugs as well as antibiotics.
    I’m now adding this information to my pcp in hopes she will order the test and do further investigation into the different types of TBD as they all only use antibody testing which this does not show up on.

  • Liz Lindner
    04/12/2023 (11:23 pm)

    I live in North Carolina and was diagnosed with Lyme Disease 8 years ago and now suffer from chronic Lyme. I took several course of antibiotics over the first 9 months but was still not getting better. Labwork was being drawn frequently. Finally after 9 quelling months of suffering, no energy and felt as though i was dying, labwork came back positive for Babesiosis. Treated with Mepron and felt so much better but my Ig kept getting lower and lower. I’ve been on immunoglobulin infusion for 4 years now. It helps but I’m still exhausted, weaker than I should be and get major brain fog. My 1st Infectious Disease doctor retired and my 2nd Infectious Disease doctor doesn’t believe Lyme is this far south. He has me diagnosed with CVID(COMMON VARIABLE IMMUNE DEFICIENCY). Does anyone have any advice for me on what I might be able to do to regain some life back? Thank you in advanced! Liz Lindner in Winterville NC.

    • Dr. Daniel Cameron
      04/13/2023 (10:38 am)

      I also find treatment for Babesia helpful. I don’t enough about whether CVID rx will help.

  • Joel
    03/27/2023 (4:51 pm)

    I was treated with much more than Azith & Atovaquone, I actually saw a better response to Atovaquone, but it usually stops working after two months, then I need to take a break and start again.

    I was on Rifampin on the off months, as well as doxy.

    Do not know what the end game is, I cannot afford this treatment, when I die I die.

    Suffering from brain fog, tremors, tingling & burning all over, heel pain, neck pain, eye floaters, weird liver area pain, since 2019/2020.

    Most blood tests are normal, so are the MRI’s besides a positive B.Duncani and some spondelysis, but nothing to explain this sudden onset.

    Was told it’s Fibro, so I should stop searching for relief and just accept the fate, I dont know, I wish there was more proof to prove either one or the other, they are both scientific mysteries.

    • Dr. Daniel Cameron
      03/29/2023 (6:54 am)

      Thanks for sharing hot complex your journey has been.

    • Liz Lindner
      04/12/2023 (11:32 pm)

      I have all of your symptoms as well and have been diagnosed with fibromyalgia, peripheral neuropathy, cervicogenic neuralgia, occipital neuralgia, trigeminal neuralgia, chronic migraines, major fatigue and pain all over. I do have old injuries that caused pain in neck and back with some migraines. Since my Lyme Disease diagnosis 8 years ago, I hurt so much more all over, brain fog is terrible. I live in NC without Lyme literate doctors. I had to be my own advocate even though I had classic ‘Bullseye Rash and finally diagnosed with Babesiosis 9 month later. I wish I could find a way to get some quality of life back. I’ve always been a ‘Go getter’ person but my get up and go has got up and gone!!! 🙏🙏🙏

  • Rosanne
    03/24/2023 (11:46 am)

    Hi, Sorry you’ve both suffered from Babesia. Michele, I have been treating for almost a year with a specialist. I am taking zith and atovaquone for 11 months. I started with Malarone since it was stronger (with 2 drugs as Michael points out). Unfortunately, I had an allergic reaction, so moved to the atovaquone. Seems there is no set timeline for treatment. Will depend on your symptoms. Michele, I keep notes in my calendar. I also do monthly bloodwork to make sure nothing goes out of whack. I did cut back a bit with zithro to twice a week but continue to increase atovaquone. The zithro needs to stay on board in order for it to be effective. I have greatly improved. I also added NAC (natural supplement) 4 times a day. …I understand your doctor wanting to stop the meds. My primary wanted me to wean off. But my specialist says if you stop prematurely and you relapse, drugs may not be as effective second time around. I am choosing to continue. Hope that helps.

    • Rosanne
      03/24/2023 (9:13 pm)

      …I left out a very important piece from my treatment. 2 hours after taking zithro I flood with probiotics and Sach B ( to replenish good bacteria and prevent yeast infection). Also, I know long term treatment isn’t typical, but we suspect I contracted Babesia 30 years ago when I tested positive for Lyme. I got the typical antibiotic treatment for Lyme at the time and wasn’t tested further. Fast forward, I got bit again and after primary gave me regular Lyme treatment, I was still sick. I chose to seek out a tick born infection specialist and thank God I did. I tested positive for lyme and 2 strains of Babesia. I’m curious: Are we only keeping the parasitic load down or really eradicating this?

      • Michele
        03/27/2023 (6:34 am)

        Thanks Rosanne,
        I was bit in 2001 – starting getting really sick in 2009. I’ve been treating borrelia, bartonella for past 4 years. Now I’m treating, what I believe it the last infection, babesiosis. And I believe we are treating the parasitic load and it never goes away. I saw an abstract from NIH website where it reported this. I am guessing we can reduce it and then maintenance dose? I see the LLMD next week and I’m going to ask her. I might consult with Dr. Cameron too. But I want to talk to other people who have been treating longer than I before I do.

  • Michael Janket
    03/24/2023 (6:19 am)

    I was on Malarone for nearly two years, along with atovaquone and zithromax. Malarone is not the same as Mepron, it contains atovaquone plus proguanil. I can attest that babesiosis is bad stuff.

    • Michele
      03/24/2023 (7:13 am)

      Hi Michael,
      I’ve been looking for a person who has taken Atovaquone & zith for a while. I have babs. I’ve been on atovaquone & zith for 7 months. I thought I only had to do a 6 month course, but when I stopped my symptoms came back. I am guessing from your post that I was wrong, or Marty Ross was wrong, about the length of treatment. How did you know when to stop treatment & how are you feeling now?

      • Dr. Daniel Cameron
        03/29/2023 (6:50 am)

        The researchers have not worked it out. Dr Krause advocated 10 days for acute Babesia. I have had to treat Babesia longer using clinical judgement for my patients.

        • Colleen
          04/11/2023 (9:50 pm)

          Would you treat immediately if a person got bit and the tick tested positive?
          Are there different protocols for the different strains? I have not heard of different protocols for different strains.

          • Dr. Daniel Cameron
            04/13/2023 (10:32 am)

            I use shared decision making with my patient. The presence of Lyme in the tick does not mean it was transmitted. If I treat, i am opposed to a single 200 mg of doxycycline

      • Michael Janket
        07/08/2023 (7:37 am)

        Sorry I did not get back to you sooner on the antibiotic treatment of babesiosis. After being on atova and zithromax and atova and proguanil (called Malarone) after one full year I felt fine and my tests were all negative. However, I was kept on the gamish mentioned for another full year. Why this was so I am not sure, the doctors were totally non-committal on this issue of telling me, the patient, what the rationale was for the extra year of treatment in the face of having all negative tests including the smears. I’m about 9 months beyond cessation of antibiotics and I feel super duper. Could I have stopped after one full year on the “stuff”? Dunno. It’s water over the dam and I wish I could get some answers from the docs but no way, Jose’.
        I’m at if you need to contact me for any issue related to your drug regime, etc.

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