DNA and RNA tick testing subsidized statewide

Rich and Telford, two of America’s foremost tick scientists, disagree on tick testing.

A Lone Star tick magnified. The TickReport is offering a reduced price to test ticks like this one for disease. - Courtesy UMass Amherst Laboratory of Medical Zoology.

TickReport testing will go down in price as a result of funding from the Centers for Disease Control. CDC gave $100,000 to the Massachusetts Department of Public Health to subsidize DNA and RNA tick testing across the commonwealth via the Laboratory of Medical Zoology at the University of Massachusetts, Amherst, according to laboratory director Steve Rich.

The subsidy reduces the fee from $100 to $15 to mail in a tick and test it for Lyme, babesiosis, anaplasmosis, ehrlichiosis, STARI, Rocky Mountain spotted fever, tularemia, Powassan, and other pathogens. The test also identifies the species of tick.

Widely used on Cape Cod, TickReport testing hasn’t really taken root on Martha’s Vineyard and Nantucket, Rich said.

“It’s frustrating,” he said.

While Rich is a vigorous advocate for the DNA testing his lab conducts, Sam Telford, director of the New England Regional Biosafety Laboratory at Tufts University, isn’t.

“I don’t agree with it,” Telford said, “[Vineyarders] could also spend the 15 bucks and buy some permethrin-treated socks.”

Telford advocates for physician consultation and use of doxycycline prophylactic as defense against Lyme and other tick-borne illnesses if used in a timely manner. “Clinical trials have shown that it [prophylactic] reduces the risk of getting Lyme disease by 80 percent. It would not work for Babesia [microscopic parasite that causes babesiosis], but would work for many of the others.”

Rich argued DNA testing can help tick-bite victims tell doctors precisely what pathogens a given tick harbors. Depending on the quality of the sample received, he said the testing has 99 percent or more accuracy. The ability to identify a given tick species is helpful, Rich said, because certain diseases only come from particular species of ticks, not all ticks. Ticks are mailed to the lab where they are ground up and analyzed; thereafter a report is available online.

“If that tick comes back negative, you can stop sweating bullets about yourself or your kid. Now you have hard data you can share with your doctor,” entomologist Larry Dapsis, Barnstable County tick project coordinator, said.

Though he doesn’t have a medical background, Dapsis said he finds the standard medical Lyme test questionable.

“I know it’s an unreliable test,” he said. “There needs to be a more reliable test.”

DNA testing continues to trend on the Cape, and remains a staple of the education campaign Dapsis quarterbacks.

“That’s a very popular program here [TickReport], and Cape Cod Healthcare is now funding it directly,” Dapsis said.

Dapsis said he was informed by the Harvard School of Medicine that Barnstable County is the only county in the commonwealth “where the incidence of Lyme is not increasing.”

Previously, Barnstable used to be the third worst in the state, he said, behind Dukes and Nantucket counties.

“We’re the only county in the state that’s committed resources to having a full-time entomologist,” he said (though he conceded ticks are not insects).

“Last year I did over 80 workshops and events,” he said, and added DNA testing remains “an important piece of the puzzle.” In 2017, 13 percent of the ticks on the Cape tested as co-infected, he said.

“The more important work is prevention, avoidance, symptom recognition, treatment,” Edgartown health agent Matt Poole said. “I would not make tick testing my No. 1. I think we need to put it in its proper context. I would not make it one of the main priorities.”

Nevertheless, Poole said, tick testing remains a constant in the background, and he is open to exploring ways to blend it in: “There is a place for it in the mix. It does make me nervous to maybe drown out the essentials of risk reduction.”

Poole is part of the Tick-Borne Reduction Initiative, along with agents from the Island’s other health departments. Originally funded by Martha’s Vineyard Hospital, the initiative is now funded by the six Island health departments, along with donations. Biologist Dick Johnson conducts field work for the initiative, and Telford advises it.

“We’re on Telford turf, we are,” Poole said.

Nevertheless, Poole said he was amenable to hearing Rich make a pitch.

Rich said he reached out to Island boards of health in hopes of making inroads for tick reporting and got nowhere. Poole said he recalled an email a year or two ago, but no phone call has come his way.

“Steve has never spoken to us directly,” Poole said. He said it would be helpful if Rich did, and invited him to do so.

Ever a promoter of tick safety, Poole asked Islanders to consider not letting outdoor cats sleep on their beds as they shed ticks into the bedding.

Rich said the current subsidy will likely last until July. Once $50,000 has been expended (1,000th tick tested), the RNA portion of the testing will phase out, he said. RNA tests include Powassan, deer tick virus, Heartland virus, Colorado tick fever, and bourbon fever. The DNA tests, which include Lyme, babesiosis, and several other diseases, will continue until the funds are used up (2,500th tick tested), Rich said.

Going forward, Rich said his lab is willing to work with towns to reinstitute the availability of testing subsidies in exchange for marketing.

“Our goal is to increase availability of the service and to reduce pricing by reducing our costs,” Rich wrote the Island boards of health. “This we achieve through favorable economies of scale that come with greater submissions. At this time, we offer any town in the commonwealth a TickReport partnership that includes discounted fees on any of our services for the participating town’s residents. We only ask that the town post a link to TickReport on its web page and distribute our informational pamphlets in town libraries or offices. Additionally, if the town wishes to subsidize any portion of the fee for its residents, we can easily arrange this (40 towns in the state currently subsidize some portion of the TickReport fee for their residents).”

Telford remains unenthused.

“The CDC and the Infectious Disease Society of America don’t recommend tick testing. They see no clinical utility,” he said. “The point I have with tick testing is it confuses everybody.”

He said he feared people might wait to see a doctor.

“What do they do?” Telford said. “Do they listen to the Martha’s Vineyard boards of health tick committee? We don’t want a conflicting opinion.”

Telford also advocated for reduction of deer populations, though he said this is more for “our grandchildren.”

“If you’re focused on Bambi for your solution, you’re focused on the wrong damn thing,” Dapsis said.

Dapsis said he is “not remotely” on board with deer-centric solutions to ticks.

On Martha’s Vineyard, “you’re not getting the right advice, that’s my humble opinion,” he said.

Thomas Mather, director of TickEncounter Resource Center at the University of Rhode Island, offers DNA and RNA tick testing through Rich’s lab. Mather’s Center also offers a service called TickSpotters, where ticks are identified by photography.

More often than not, people can’t identify, or misidentify, ticks, Mather said. TickSpotters can rule out the threat of certain diseases simply by pinpointing the species of tick attached to someone.

Black-legged or deer ticks, for example, carry Lyme, babesia, anaplasmosis, and hard tick relapsing fever, he said. Dog ticks do not. Two-thirds of ticks on the Vineyard are American dog ticks, he said.

“The good news is American dog ticks are rarely affected with germs,” he said.

Part of the merit of DNA and RNA tests is that they “provide people peace of mind,” he said. DNA tests will show bacteria and parasites, while RNA tests will show viruses, he said. He also called the tests a valuable “passive surveillance tool.” Clinically speaking, he cautioned that just because a tick harbors a particular pathogen doesn’t mean it has transmitted that pathogen to somebody.

Telford said he thinks physicians may not know how to use DNA/RNA data. “Many have told me that they would be puzzled about what to do with the information,” he wrote in an email. “One treats a patient showing signs and symptoms, not a positive tick.”

Thus far, Rich said the CDC funds have stimulated areas of the state, like the Berkshires and Worcester County, that normally don’t send in many ticks, to do so. But his UMass lab hasn’t seen an uptick in reporting from the Vineyard this year, he said.

“Still nothing really coming from Dukes County,” he said.