A four-year-old boy from Newton is this year's first confirmed case of tularemia on the Vineyard, but state and Island health officials stopped far short of sounding an alarm this week over a new outbreak of the rare bacterial infection.
That's because the boy's bout with tularemia was contracted from a tick bite, resulting in the more common, ulceroglandular form of the disease. By contrast, last year's outbreak was remarkable to experts because most of the victims - 11 of the 15 confirmed cases - contracted the far rarer pneumonic form of tularemia after breathing in air particles contaminated with the bacteria.
"This case is more in the realm of what you would see normally in any given year," said Roseanne Pawelec, a spokesman for the state department of public health in Boston. "There's really no bearing or relationship to the outbreak last year or concern for a repeat outbreak this year."
The boy who got sick was vacationing with his family in Chilmark in mid-April, according to Ms. Pawelec. By April 24, he experienced his first symptoms of fever, headache and swollen glands. He also had the telltale ulceration at the site of a tick bite.
He was hopitalized on May 4 at Children's Hospital in Boston, treated with antibiotics and released two days later, according to the DPH.
"We're assuming the tick bite occurred on Martha's Vineyard," said Ms. Pawelec.
Both Chilmark and Katama were the subject of scrutiny last summer and fall as federal epidemiologists from the Centers for Disease Control and Prevention (CDC) traced several of the pneumonic cases to those areas. Investigators suspected that David Kurth was mowing a lawn near Squibnocket last summer when he contracted tularemia, possibly inhaling the remains or feces of an infected rodent. Mr. Kurth later died, having failed to seek medical attention in time.
This year, health officials on the Island are on the lookout for more pneumonic cases. According to infectious disease specialist Dr. Dennis Hoak of Edgartown, "We have pneumonia a lot, and this time of year we think about tularemia. If they have the right epidemiology - outside mowing a lot - we're doing tests. We're doing a lot of tests."
The most recent suspected cases sent off for testing, according to the DPH, include a 25-year-old man from New Hampshire who came to the Island to do landscaping and got sick with pneumonic symptoms on May 27. The other suspected case is a 72-year-old farmer whose first onset of achiness, coughing and fever came on May 28.
Both men were treated with antibiotics for both pneumonia and tularemia and have recovered well. Hospital officials are still waiting on blood tests to determine whether they had tularemia. Those results should be back in about five days, hospital officials said.
But Dr. Hoak warned against jumping to any conclusions until the results are in. There were plenty of cases last year that he was sure were tularemia but then tested negative, he said.
Meanwhile, health officials have all but ruled out tularemia as a factor in the death of Kathryn Fagan, 31, who was found dead in her home in Chilmark on May 28. Blood samples have been sent to the CDC to test for tularemia since the woman worked as a landscaper.
According to State police Sgt. Jeff Stone, early indications from the Barnstable County medical examiner are that she died of heart disease.
Some of the speculation has been fueled by overzealous media reporting, according to Dr. Alan Hirshberg, director of emergency medicine at the Martha's Vineyard Hospital. He told the Gazette that on Tuesday he had to calm down some Boston television news reporters who were ready to blame the death and the other two suspected cases on tularemia.
"They had some outlandish tales," he said.
What physicians and public health officials would prefer is that people follow recommendations made in last February's health advisory on tularemia. Among the suggestions are that people check their yards for dead animals before mowing and to use plastic gloves and bags to dispose of carcasses. The advisory also warns people to stay away from rodents such as rabbits who appear to be sick.
Lawn mowing and brush-cutting were considered chief risk factors for pneumonic tularemia, and the advisory suggests people wear a dust mask or respirator while doing such work. The mask should have a rating of N-95 or higher, according to the DPH advisory.
And Dr. Hirshberg also urged people to exercise some basic common sense about ticks. It's the dog tick, not the tiny deer tick, that can transmit tularemia from infected animals to humans. The DPH advisory suggests insect repellent and a daily check of the body for ticks. For more information, people can call the DPH at 617-983-6800.