New emphasis and resources on ticks needed

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To The Editor:

Memorial Day is upon us, and with summer comes the nymphal deer tick and the infections that it transmits (Lyme disease, human granulocytic ehrlichiosis/anaplasmosis, Borrelia miyamotoi disease, and Powassan/deer tick virus encephalitis … all of which are endemic to Martha’s Vineyard). The dog ticks are a perennial pest, one for which the Vineyard has been famous since the 1920s; they sometimes transmit Rocky Mountain spotted fever or tularemia. The lone star tick, a very aggressive human biter, has invaded and established itself in Aquinnah, Chilmark, and Chappy, and brings with it the risk of another set of unique infections (spotted fever, monocytic ehrlichiosis, STARI disease) as well as the horror of their bites sometimes inducing an allergy to red meat.

The County of Dukes County has consistently ranked in the top 10 counties nationally for Lyme disease incidence, and with that in mind, the M.V. Tick-Borne Disease Initiative was started back in 2010 with the generous support of the M.V. Hospital local grants program. Under the direction of Michael Loberg and Matt Poole, with the All-Island Boards of Health, a comprehensive program was developed and implemented. (I serve as an advisor to the program, with an active interest in promoting health in a community that has served as a major basis for my longstanding research on tick-borne disease.) This includes enhancing diagnosis and reporting of cases, educating children, and providing locally sourced information via a superb website (MVBOH.org); I urge everyone to bookmark it, use it frequently, and recommend it to others. The MVTBDI continues today as the Tick Borne Illness Reduction Initiative (or simply the Tick Program), with a small amount of BOH funding through the tireless work of Dick Johnson, much of his time pro bono, for the past nine years, doing yard surveys to inform homeowners about what they might do to reduce tick habitat, educating the public, and exploring means of trying to manage the Island deer herd more effectively. Even with its limited capacity due to a lack of funding, MVTBDI remains a shining example of tick-borne disease education and prevention in Massachusetts.

We are now at an important crossroads: Dick has not been able to expand the program due to a lack of sufficient funds, and, in fact, health issues increasingly make it difficult for him to do the very physical work of tick sampling and community outreach. We need to find the next-generation “tick czar” to ensure that this outstanding prevention program will continue into the future and expand its range of services. As usual in public health, the issue is money. Back in 2012, I wrote an editorial in a local paper about the MVTBDI and issues with tick-borne disease, and some of the words apply today: “Who will pay, and can we justify the expense, given all the other worthy public health issues? But I hope that all of us would agree that it would be most gratifying to return the Vineyard to what it was like more than 40 years ago, when deer ticks and Lyme were rare, so that our children’s children won’t be faced with what we have today. This means a commitment at the community and individual level to do whatever it takes using a mix of short-term and long-term approaches. We need to set aside as many objections as we can and just get to work.” The question of who pays is now very acute. Although surveys that we have conducted indicate that the majority of Dukes County study subjects assign financial responsibility for tick-borne disease prevention to state or local government agencies, few support raising local taxes to do so. Although several individuals have contributed $1,000 to $5,000 checks to help support the program, particularly after the original five-year MVH grant for the program ended, what is urgently needed now is a level of support that will provide an endowment to ensure an annual operational budget. We need to find a way to fully fund a tick czar to carry out an educational and environmental intervention program for the foreseeable future.

For almost any public health problem, we know what we have to do to reduce incidence, but cannot get people to do it. HIV risk is obvious, as is that of lung disease due to smoking. For deer ticks and lone star ticks, deer elimination or drastic reduction of the herd would work to greatly reduce risk, but that intervention remains to be accepted by the community. It is gratifying that Islanders are now better educated about ticks and Lyme disease due to the MVTBDI. Island healthcare providers now promote the two-tablet doxycycline prophylaxis for ticks that have been attached for more than a few hours, a practice demonstrated in peer-reviewed research to reduce the risk of Lyme disease by 80 percent. And even though new modes of intervention are being tested, such as MIT’s Mice Against Ticks, the best strategy even when that is operational is to attack on as many fronts as possible … reduce tick habitat, use host-targeted insecticides, spray judiciously, manage the deer herd, and be aware. The most important thing we can all do is to prevent tick bites. Whenever you go outside, whether it is just to walk over and look at a flower in your garden, kick a soccer ball, or go for a hike, apply an effective repellent (as directed by the label), wear permethrin-treated clothing if possible, and take a shower afterward and check for ticks by feeling for new bumps. Remove any attached ticks by just pulling them out, but do not panic … not every tick is infected, and prompt removal greatly reduces risk of infection. If the tick has been feeding on you for more than a few hours, consider asking for the two-doxycycline-tablet prophylaxis. During the summer, if you have a fever of more than a couple of days’ duration without sniffles, always go get yourself checked out by your healthcare provider. These simple precautions can greatly reduce the risk of tick-borne infection, and allow us to enjoy the Vineyard during Memorial Day and the summer that follows.

Sam Telford, professor of infectious disease and global health
Tufts University