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.