MGH doctor prescribes prevention at tick seminar

Dr. Stuart Harris stressed prevention as the first defense against tick borne diseases. — Photo by Nelson Sigelman

“I’ve taken tons of transfers from Martha’s Vineyard Hospital (MVH), but this is my first time on the Island,” Dr. Stuart Harris, chief of the wilderness medicine division and director of emergency medicine at Massachusetts General Hospital (MGH), said as he began his seminar on tick-borne diseases. Through the partnership between MGH and MVH, Dr. Harris has a longstanding working relationship with MVH emergency medicine director Dr. Jeffery Zack.

Dr. Harris was on the Island on Saturday to participate in the annual Martha’s Vineyard Hospital Health Fair. He talked about a wide range of tick-borne diseases – how to spot them, how to treat them, and most importantly, how to prevent them. He is well aware of the impact tick-borne disease has had on the Island.

Ticking clock

Although it still feels like winter, Islanders are already reporting ticks on their pets and on themselves. In a few weeks, ticks will be out en masse. Deer ticks, also known as black legged ticks, are the primary vectors for tick-borne illnesses.

“Spring is time for the nymphs,” Dr. Harris said. “This is when they do the most damage on the human population, in part because they are so hard to spot. Deer tick nymphs can be the size of a period on a page of text. They’ve evolved to block our sensation, they have an anesthetic in their saliva and they can attach and have a nice meal without us feeling it and brushing them off like we would a mosquito. It’s that same saliva that transmits disease from the tick to us.”

Dr. Harris estimated that about 1.4 to three percent of the human population in endemic areas contracts Lyme disease each year. Given that the Island is ground zero for Lyme disease, that statistic could be much higher on the Vineyard.

Not every tick carries Lyme, consequently not every tick bite leads to infection. Tick expert Dr. Sam Telford of Tufts University, said in an email to the Times, “The Lyme infection in nymphal deer ticks in coastal New England ranges from 10 per cent to 35 per cent, and for adult deer ticks, double that.”

Check please

The deciding factor in tick borne illness is how long the tick feeds on its human prey.  “Even if an infected tick bites you, if you catch it before 36 hours, the chance of becoming infected is negligible,” Dr. Harris said.

The majority of infections to humans occur between April and June, and frequent tick checks should be part of every Islander’s daily routine during this time. “At least once a day, do a tick check,” Dr. Harris said. “I can’t stress this one enough. Check yourself, check your kids, check your pets. And don’t just depend on your eyes. We tend to notice them with our fingertips, which is one of the most sensitive parts of the body.”

Dr. Harris recommended paying close attention to the armpits, the hair, behind ears and the crotch. He also advised using blunt-tipped forceps, not fingers, to remove a tick. “Grasp as close to the skin as possible, don’t pull too fast or too hard. If you leave the head, you can try to get it out with a needle.”

Know thine enemies

The telltale bull’s-eye rash that comes with Lyme disease infection shows up about 70 percent of the time, according to Dr. Harris. If Lyme disease goes treated, a host of more severe symptoms can develop, including facial palsy, heart damage, and debilitating arthritis. “If a pregnant woman finds a tick bite, I’d start a course of doxycycline immediately, as a preventative measure. Lyme transmitted to a fetus can be fatal.”

While Lyme disease is the most commonly reported tick-borne illness in the United States, there are a host of other tick-borne illnesses that work in concert with it.

Rocky Mountain spotted fever, while rare, is alive and well in our area and much more virulent than Lyme disease.

“Ironically, it’s found the least in the Rocky Mountain region,” Dr. Harris said. “About 80 percent of the time, Rocky Mountain spotted fever announces its arrival with a spotty red rash that usually starts on the hands and feet. Within hours, nausea and vomiting can lead to multi-system organ failure. If I misdiagnose Lyme, I can correct that; if I misdiagnose Rocky Mountain spotted fever, my patient can be dead the next day.” Dr. Harris said with proper diagnosis and heavy doses of doxycycline, a person can fully recover.

Ehrlichiosis, like Lyme disease, brings on intense, flu-like symptoms. It’s spread by the deer tick, but primarily it’s spread by the Lone Star tick.

“For some reason, it typically affects older men,” Dr. Harris said. “One in 10 people who are infected have Lyme as well. One to five people per hundred die from ehrlichiosis.”  

Although the Lone Star tick is endemic to the southern U.S., it has made its way north, and established populations on Cuttyhunk, Nashawena, and Prudence Island. A few specimens were found on the Island last year, but so far, no year-round populations have been found.

Babesiosis “lines the red blood cells like malaria,” Dr. Harris said. “Twenty percent of the time it is concurrent with Lyme.”

Babesiosis comes with a high fever that mysteriously comes and goes. “It seems to happen more often to people with long hair,” Dr. Harris said with a shrug. Untreated, babesiosis can lead to renal failure, anemia, and ascending paralysis. It’s the only tick-borne disease not cured by doxycycline.  

“With proper doses of Atovaquone, babesiosis is 100 percent treatable,” Dr. Harris said.

Really old Lyme

Because the Borrelia burgdorferi, the bacterium that causes Lyme disease, was discovered in 1982, many people assume Lyme disease is a recent phenomenon.  But Dr. Harris said that while our detection methods are recent, Lyme disease is not.

“Lyme disease has been around a lot longer than most people thought,” Dr. Harris said, showing a slide of Otzi, the well-preserved natural mummy found in 1991 in the Alps between Austria and Italy and who walked the earth around 3300 B.C.  “It turns out Otzi had Lyme too.”

Correction: An earlier version of this story incorrectly quoted Dr. Harris saying that one to three percent of ticks have Lyme disease. Dr. Harris said that one to three percent of humans in endemic areas contract Lyme disease.