Vineyard Epidemic: Lyme Disease on the Rise: Health Experts Track
Cases

By BRIEN HEFLER

The Martha's Vineyard Hospital reports a large increase in
Lyme disease cases this summer - over double the number seen last
year - fueling concerns about what many public health experts say
is now an epidemic of the disease carried by tiny deer ticks.

Donna Enos, infections control nurse at the hospital, said case
reports submitted by emergency room and primary care physicians show a
sharp increase in Lyme disease over last year's numbers, with 40
cases in June, 110 in July and 105 in August. Mrs. Enos predicts
September will show an increase as well due to warm weather.

"September is looking very high too; let's not forget
the temperature out there, it's like August all over," she
said.

The numbers reflect diagnosis by hospital doctors. Final
confirmation will come through the Massachusetts Department of Public
Health (DPH), a process that takes several months.

Surrounded by a sheaf of case reports for the summer, Mrs. Enos
spoke from her office this week about the incidence of tick-borne
illness on the Island.

"This year is significantly greater than years past on what
I'm reporting right now, but the final word will come from the
DPH," she said.

Each case of Lyme disease diagnosed in the hospital is documented
using a reporting form from the state DPH. Mrs. Enos said the process is
lengthy and final numbers will not be available until winter. Every case
submitted by the hospital must meet a strict set of criteria to qualify
as a confirmed Lyme disease case. Some Lyme disease cases seen on the
Island may not be reported, including cases involving visitors who
contract the disease and return to their home state for treatment.

In short, the actual number of cases may be higher than reported.

Dr. Frederic Cantor, a public health veterinarian for the DPH,
agreed the numbers may not reflect the complete number of Lyme disease
cases seen on the Island, but he said guidelines are necessary when
comparing the number to state and national totals.

"For our statistical, yearly evaluation, we need to make sure
we're talking about the same thing year to year," Dr. Cantor
said, "There may be some cases that we cannot capture that are
clearly [Lyme disease] but without the recording and information they
get put into different categories."

While the final tally is not yet available, Dr. Cantor agrees that
there has been an increase in Lyme disease cases this year, along with
other tick borne illnesses. Already, the DPH has confirmed eight cases
of tularemia on the Island this year and is investigating four more.
While rare in other parts of the nation, tularemia seems to flourish on
the Island, with 37 confirmed cases seen since 2000.

The Health Report of Martha's Vineyard, a comprehensive study
of health issues in the adult population on the Island done in 2002 and
2003, found epidemic levels of Lyme disease. A draft final report
completed late last year found one in five full-time residents reported
having a tick borne illness, and 12 per cent reported having had Lyme
disease. Seven per cent of part-time residents also reported having
either been diagnosed or treated for Lyme disease.

The rate of Lyme disease was even higher for up-Island residents.

Dr. Cantor and Mrs. Enos both said the increased numbers this year
can at least partly be attributed to better reporting by Island doctors.

Mrs. Enos said emergency room doctors at the Island hospital have
quickly become experts at recognizing Lyme disease and other tick borne
illnesses.

"I don't think [the increase] is because there are more
ticks, but more awareness," Mrs. Enos said.

But Dr. Cantor and Mrs. Enos also believe weather is a factor. Mrs.
Enos said a wet winter coupled with a warm, dry summer means more people
venturing into areas where they are exposed to ticks, including
woodlands and beaches.

Dr. Cantor agreed.

"I think it's a combination of things. It's not
just the increased vigilance at the hospital because we've had
that since 2000," he said, adding: "I think the weather
again is warmer and lasting longer, so there are going to be more
exposures. We see that for a lot of diseases, like rabies - if
it's something that's weather dependent it means people
either have to go out there and be exposed or that the bugs aren't
there."

Dr. Bela Matyas, medical director of epidemiological studies for the
DPH, said the large deer population on the Island give deer ticks an
ideal breeding ground. Deer ticks, which carry Lyme disease, use large
mammals such as deer to lay eggs.

"You have the perfect ecology for [Lyme disease] and animals
that are important in the cycle that transmit it - the only
natural predators on the Island [for deer] are automobiles and there are
no other predators that keep the process in check," he said.

Dr. Matyas said studies have shown that reducing a deer population
has a direct correlation on the number of deer ticks. One female deer
tick can lay between 2,000 and 3,000 eggs and one animal can support
dozens of ticks. A task force formed earlier this spring began to
examine the question of reducing the deer population, including
extending the hunting shotgun season from one week to two weeks. The
Island is the only region in the commonwealth with a one-week shotgun
season.

Five years ago Nantucket added a third week to shotgun season for
deer, and lowered the deer population by an additional 200. But the
additional hunting saw vocal opposition from some residents, and
Nantucket selectman have since opted to return to a two-week season.

Health experts say prevention is still the best cure. Mrs. Enos
recommends people take all necessary precautions to prevent tick bites,
such as tucking pants into socks, wearing light colored clothing so
ticks are easier to spot and applying tick repellents with a
concentration of DEET no greater than 30 per cent. If a tick is found,
Mrs. Enos advises slow and careful removal, using tweezers or special
removal tools like the Pro Tick Remedy - small, precession
tweezers designed for tick removal and available at the hospital. She
also reminded people to thoroughly wash the area where the tick was
found, as well as the hands after removal. Avoid crushing ticks with
bare hands or touching the face or mouth before washing hands, Mrs. Enos
said.

Fast action is also important when symptoms appear. Mrs. Enos said
anyone who experiences symptoms associated with Lyme disease such as
headache, joint pain, fever or facial paralysis, should seek immediate
medical attention.