Bad Weather Brings Mixed Prognosis for Tick-Borne Illnesses

By CHRIS BURRELL

When you're talking ticks and the many illnesses they can
spread, bad weather can be a double-edged sword.

Donna Enos, the infection control nurse at the Martha's
Vineyard Hospital, will tell you that the combination of rain and cool
temperatures have kept many people indoors, significantly reducing their
risk of a tick bite.

But Sam Telford, the parasitologist from Tufts University who has
been studying ticks on both the Vineyard and Nantucket for the last ten
years, says the weather could have the opposite effect when it comes to
tularemia, the rare and potentially fatal disease that has infected 22
people on the Island in the last three years.

"When it's wet and cool, the organism could survive
better," he told the Gazette yesterday in a telephone interview
from his laboratory at Harvard University.

Tularemia is just one of the topics scheduled for a Martha's
Vineyard Hospital forum this Thursday at 5:30 p.m. at the Oak Bluffs
School library, a meeting devoted to discussion of preventing any of the
tick-borne illnesses that thrive on the Cape and Islands, including Lyme
Disease, babesiosis, ehrlichiosis and Rocky Mountain Spotted Fever.

Tularemia is the only disease of the bunch to have claimed a life,
killing a Chilmark man back in 2000, the first summer of an outbreak
that continued for the next two summers.

No new cases of tularemia have been confirmed this year, but Mr.
Telford is convinced the disease hasn't left the Vineyard.
"We will still find tularemia in ticks and animals out
there," he said. "But whether we will see any human cases,
we don't know."

The main point of Thursday's forum is focusing on prevention
measures. "We want to bring everybody's awareness level up
to where it should be," said Ms. Enos.

In the case of tularemia, wearing dust masks while mowing lawns or
cutting brush could be the best barrier against the pneumonic form of
the disease, which is contracted simply by breathing in contaminated air
particles. Landscapers were found to be at the highest risk for the
disease.

Of 22 cases, 18 of them have been landscapers or people who worked
outdoors on a regular basis. All but five of the cases contracted on the
Vineyard were the pneumonic form, a fact that has not only baffled
scientists but also made the Island an absolute anomaly in the
epidemiological record books.

No place else in the country has ever experienced such an outbreak.
Epidemic intelligence teams from the federal Centers for Disease Control
have flown to the Vineyard three times already, looking for clues to
explain why pneumonic tularemia seems to have such a hold here.

While the disease is rare in any form - infecting only one or
two people a year statewide - the pneumonic form is even rarer and
more virulent than typical cases of tularemia, which are transmitted by
a bite from a dog tick. Scientists investigating the outbreak have
pinpointed potential hot spots for the disease around Katama and the
Squibnocket area.

Mr. Telford said that Aquinnah, Chilmark and Chappaquiddick continue
to be especially infested with ticks. But he also said that he expects
to see the numbers of dog ticks decline this year since they have been
on the increase since 1999.

But Mr. Telford, who continues to do field studies on the Vineyard
in the spring and summer months, also said, "There hasn't
been any real change in the transmission intensity of babesiosis and
ehlichiosis in the last decade."

While public health officials have emphasized prevention efforts
such as checking your body daily for the presence of ticks, Mr. Telford
has been motivated by trying to unravel the mystery of tularemia on the
Vineyard. Tularemia is also recognized by the federal government as a
bacteria that could be used for bio-terrorism.

But the issue now is time and money. Officials at the CDC's
division of vector-borne infectious diseases in Fort Collins, Colo. told
the Gazette that they are not actively researching the Vineyard
tularemia outbreak. And Mr. Telford is waiting on a grant from the
National Institutes for Health.

"Until we get some more money, we can only do so much,"
he said. "I'm actually paying for this field study out of my
pocket. I'm confident that some day the government will see it as
important."

Panelists at Thursday's tick forum include Dr. Alan Hirshberg,
director of emergency medicine at the Vineyard hospital; Susan Soliva, a
researcher from the state department of public health, and Ms. Enos.