Don't Fall for Misconceptions on Ticks, and Remain Vigilant, Experts Tell Forum

By BRIEN HEFLER

Coming home from a day at the beach, a hike through nature's splendor or a walk in the backyard, one may find a hard, foreign body on their person, holding fast and feeding voraciously. It's a familiar and unsettling feeling here on the Island, one of the worst areas in the state for ticks and tick borne illnesses.

Martha's Vineyard had the highest rate of Lyme disease in the state with 300 cases per 100,000 in 2003, and one out of seven people living here reports having had the disease, according to a survey conducted by the Massachusetts Department of Public Health (DPH).

Prompted by the proliferation of ticks and risks of disease, medical experts presented a public forum on tick-borne illness Thursday evening at the Oak Bluffs School, fielding questions on tick removal, types, diseases and treatments.

Dr. Alan Hirshberg, director of emergency services at Martha's Vineyard Hospital; Donna Enos, registered nurse, and Susan Soliva, epidemiologist from the DPH, presented a series of slides and handed out pamphlets and tick identification cards to a small crowd at the forum. The experts all cautioned that people must be vigilant about ticks and dispelled some common misconceptions, including the notion that some ticks do not spread disease.

There are two species of ticks found on the Island, deer ticks and dog ticks. While dog ticks do not carry Lyme disease, they may transmit Rocky Mountain spotted fever and tularemia. Deer ticks, the smaller of the two, carry Lyme disease and may transmit other diseases as well.

"There are no good ticks," said Mrs. Enos in response to a question about whether dog ticks are a concern. Mrs. Enos conducts infection control studies with the DPH at the Martha's Vineyard Hospital, tracking and tick-borne illnesses.

Deer ticks are roughly the size of a poppy seed when in their nymphal stage, the adolescence of the tick world. Growing to the size of about a sesame seed, the ticks feed more often when in the smaller, harder-to-spot nymph stage. They are orange-brown with a black dorsal shield near the head; the hard, fingernail-like substance protects the tick's body, which swells underneath it during feeding. Dog ticks are about the size of a watermelon seed when fully grown and are distinguishable by white marks on the dorsal shield. Deer ticks feed most from May to July, putting people at risk during the summer months.

Ticks must feed for 12 to 24 hours before a risk of infection can arise, as it is believed that ticks spread disease only after they finish feeding and inject saliva excretions into the host. Dr. Hirshberg explained that ticks have a barbed, harpoonlike appendage used to draw blood. Ticks also secrete a cement-like substance, making extraction difficult.

Extraction Tricks

A tick cannot be simply pulled off with a finger, because the harpoon may rip off and remain in the skin, leading to infection. Rather, ticks must be removed using tweezers and slow, steady traction, which when applied, will cause the tick to back out.

The experts recommended using fine-tipped tweezers such as those used to remove splinters. A fine tip allows better positioning closer to the skin, to prevent the separation of the harpoon and body. A simple plastic or metal device, shaped like a spoon and notched to accommodate a tick, can also be used. These devices are available at most Island drugstores.

Many people think ticks must be immediately removed when spotted; it's a reasonable safety measure, but impractical and dangerous if the tick is found while outdoors without any proper removal equipment.

Dr. Hirshberg cautioned against using creams, salves or even peanut butter to remove a tick, and asked the audience not to use matches, hot pins or lighters. "I've had two people come in with burns," he said.

When removing a tick, clean the area and tweezers with alcohol before and after. After the tick is out, identify its species and save it with the date for medical use if you develop any symptoms of tick-borne illness.

Seeing the Doctor

If you are bitten by a tick, or find one and are unsure of when it attached itself, rushing to the emergency room or doctor's office is not necessarily the best course of action. Blood is drawn to check for Lyme disease, but it takes your body about a week to develop the telltale antibodies used in the test. Doctors may also use a more in depth test called a western blot test that is more thorough and checks for the antibodies. A western blot is usually employed if the initial blood test comes back positive. If symptoms of Lyme disease appear, however, going to the doctor is strongly recommended.

Symptoms can be flulike with fever, swollen lymph nodes, stiff neck and joint pain. Sometimes a person will exhibit a bullseye rash radiating from around the bite area, days or up to a month after a tick bite.

"If you live on Martha's Vineyard, which is kind of like Lyme central, and you have the rash, chances are you have Lyme disease," Dr. Hirshberg said.

Untreated Lyme disease can cause facial paralysis, chronic arthritis in knees, elbows and wrists, meningitis and chronic pain. If the Lyme disease is diagnosed early, a course of antibiotics is an effective treatment.

Deer ticks also transmit babesiosis, carried from infected animals like white-footed mice. Symptoms appear about one to nine weeks after infection and can include headache, fatigue, nausea, dark urine and abdominal pain. The elderly and those with a weakened immune system or spleen can develop life-threatening symptoms. The disease can be treated with antimicrobials.

Another tick-borne illness, Rocky Mountain spotted fever, has symptoms of fever, severe headache and a rash that starts on the arms and legs and may spread over the body. The disease can be treated with antibiotics, but can be fatal if not treated early.

Exhibiting symptoms similar to Lyme disease, human granulocytic ehrlichiosis is a less common tick-borne illness found in the Northeast, sections of California and Cape Cod. Symptoms appear one to three weeks after a tick bite and can include abdominal pain, nausea, vomiting and joint aches. It can also be treated with antibiotics, but can be serious if not diagnosed early.

Caution and Prevention

With all tick-borne illnesses, early diagnosis is critical. Dr. Hirshberg stressed that every day, at least once a day, you should check yourself for ticks. When his family goes to the beach or outdoors, the four scour each other like monkeys in National Geographic films upon their return, Dr. Hirshberg said.

Additionally, Mrs. Soliva recommended wearing insect repellent containing DEET, which repels ticks. DEET comes in various concentrations, but wearing 30 to 35 per cent concentrations is considered safe and highly effective. A 30 per cent concentration lasts about six hours. Children, though, should not wear more than a 10 to 15 per cent concentration and should not have the repellent applied to their faces. DEET cannot be used on infants.

Clothing is another form of prevention. Mrs. Soliva said wearing light clothing and tucking pants into socks can help prevent tick bites. The application of permethrin to clothing kills ticks on contact. Permethrin cannot be used on skin, but is a good safeguard when sprayed onto clothing and allowed to dry. As with all chemicals, clothes should be washed and laundered after use and a shower is recommended after wearing DEET. Putting clothes in the dryer for 15 minutes will also kill any hitchhiking ticks.

Tick Control Systems

Two systems currently on the market to control tick populations on properties were discussed at the forum. The MaxForce tick management system uses bait boxes to lure mice, which carry deer ticks, into walking through permethrin-coated rollers. An ongoing study of about 100 houses on the Island has shown that houses with this system showed a lower number of ticks.

Another system being tested on Island is the four-poster system, used to kill ticks on deer. Deer feed on corn fed into troughs that are flanked by permethrin coated rollers, killing ticks on their heads, necks and shoulders. One system will cover 40 to 50 square miles. Deer with thousands of engorged ticks on their heads were shown compared to permethrin-coated deer, who had none, in slides at the forum.

"None of these systems are 100 per cent effective," said Mrs. Enos. "Prevention needs to be a multi-pronged approach."

Tularemia, a rare bacterial disease, has become a health concern on the Island in the last few years. While cases seldom appear in Massachusetts, in 2001, 19 of 21 cases of the disease reported to the DPH occurred on Martha's Vineyard. Carried by small animals like mice, rabbits and squirrels, the disease can be transmitted by ticks feeding on infected hosts.

Tularemia symptoms include swollen glands, slow-healing sores and sometimes, the sudden feeling of severe illness accompanied with high fever, chills, headache and sore joints. Symptoms can appear as early as three to five days after exposure, though it can take as long as 21 days.

"Tularemia has a ferocious course," Mrs. Enos said, pointing out that those infected will have a very high fever, around 104 degrees and should immediately see a doctor if the symptoms appear. The disease can be treated with antibiotics.

Tularemia can also be spread by contact with infected animals or by stirring up soil and inhaling particles. Inhalation of the bacteria causes pneumonic tularemia, a serious type of the disease that can be fatal. Dr. Hirshberg said 95 per cent of Island cases occur within the landscaping community and recommended that landscapers wear respirator masks to filter out the germs. A mask rated at N-95 will filter out 95 per cent of airborne particles, effectively protecting against airborne tularemia.