In many parts of the United States, this weekend marks the start of summer sleepaway camp season, which means swimming, arts and crafts, marshmallow roasts -- and, very often, ticks.
Summer campers face deadly ticks and mosquitoes
Of the more than 1,600 overnight camps that are members of the American Camp Association, more than a third are in New England and the mid-Atlantic states, where Lyme disease is particularly prevalent, according to the Centers for Disease Control and Prevention.
According to a May CDC report, cases of vector-borne diseases -- those caused by viruses and bacteria carried by ticks, mosquitoes and other bugs -- tripled in the United States from 2004 to 2016.
For years, experts have voiced concern that many local public health agencies are unprepared to control such pests and limit the spread of these diseases which include Lyme disease, dengue fever and Zika.
"I started to look into it, and the numbers were on the increase and didn't show any signs of stopping," said Lauren Rutkowski, who with her husband, Joel, owns Indian Head Camp for children in Equinunk, Pennsylvania. "As a mom and a camp director, I was concerned."
Every summer from 2010 to 2014, seven or eight campers had confirmed or suspected tick bites at Indian Head, and each summer, three or four of those children tested positive for Lyme disease, according to Rutkowski. Lyme disease is a bacterial infection transmitted through bites from infected ticks, and if left untreated, it can spread to joints, the heart and the nervous system.
She said it's not known whether the children contracted the disease from the tick bite they got at camp or from a previous tick bite at home.
In 2014, her son, Oakley, was bitten by a tick at the family's camp, which hosts 650 children every summer. He did not contract Lyme disease.
The next year, Rutkowski hired a new service that helps fight ticks, including spraying the perimeter of the camp with pesticides and offering advice on how to get rid of habitats where ticks breed.
Since then, not a single camper is known to have been bitten by a tick, Rutkowski said.
Now, 123 camps use the service, Ivy Oaks Analytics, according to Isaiah Ham, who started the company after one of his summer campers contracted Lyme disease from a tick bite.
Ham, then a college student working as a counselor, said he wasn't pleased with the camp's response.
"The camp just kind of shrugged and thought it was just inevitable, like a hurricane; it was just part of being in the outdoors," Ham remembered.
It's unknown how many children are bitten by ticks at summer camps or how many camps are using services to mitigate the pests, according to Sam Borek, president of the New York/New Jersey section of the American Camp Association.
Camps don't exist in a vacuum, of course, and there are concerns that state public health departments aren't doing enough to fight diseases caused by ticks, mosquitoes and other pests.
"Mosquitoes, ticks, fleas can all carry very serious diseases that are life-threatening," said Dr. Irwin Redlener, a professor at the Columbia University Mailman School of Public Health.
A report from the National Association of County and City Health Officials says 84% of programs to control diseases from mosquitoes need improvement. In 18 states, every program is falling short.
These programs often aren't well-funded and aren't equipped to do proper surveillance or prevention, Redlener said.
"We're, simply put, not ready, and we should be," he said.
Redlener and other experts have criticized President Trump for ignoring climate change, part of the reason for the proliferation of pests that carry diseases.
"We have to wonder why the president and the administration [are] not taking this issue more seriously," he said.
The White House declined to comment on climate change, referring questions to the CDC, which makes clear on its website that climate change increases the number and geographic range of disease-carrying insects and ticks.
The White House statement also said the President takes such diseases seriously, requesting more than $49 million to fight them next year, an increase of $11 million over this year.
Back at Indian Head Camp, as the campers arrive on Saturday, they're hoping for another summer without a tick bite.
"We're ready," Rutkowski said. "We just can't wait to get them here."