State Health Officials Document Increase in Tick-Borne Illnesses

By BRIEN HEFLER

Massachusetts public health officials have confirmed eight cases of
tularemia on the Island this year, the highest number since 2000, when
15 people were diagnosed. The report raises the number of confirmed
tularemia cases to 37 since the summer of 2000 and marks the sixth
successive summer that the rare disease has been documented on the
Island.

Dr. Frederic Cantor, the public health veterinarian for the state
department of public health (DPH), said three of the eight cases have
been confirmed as pneumonic tularemia, a form of the disease that
affects the respiratory tract and is caused by inhaling airborne
tularemia particles. While rare in other parts of the nation, pneumonic
tularemia has been documented in increasing numbers on the Vineyard in
recent years. Health officials continue to urge people who work outdoors
to wear respirators rated at N-95 or higher to filter out potentially
harmful particles. Dr. Cantor said none of the three victims of
pneumonic tularemia appeared to be wearing masks when they were
infected.

"Most of these again seem to have exposure to outdoor
activities in terms of landscaping, caretaking and gardening. I think
part of the issue is, are all these people not wearing masks and
why?" he said. "That seems to be a risk factor and most of
the people seem not to be wearing masks."

He also cautioned that masks might be ineffective for men with
beards.

"If someone has a beard, you won't have a good fit,
you'll be wearing a respirator for your beard," he said.

Dr. Cantor said the DPH is examining a possible four additional
cases of tularemia. At least two of this year's confirmed cases
were other types of tularemia, which can be spread by handling infected
material, such as animal carcasses or by bites from dog ticks, known to
carry the disease. Three of the eight cases are still unclassified, Dr.
Cantor said. One has been confirmed as tick borne, and the first case of
the year, contracted in April by a Vineyard landscaper, was
oropharyngeal, indicating that the affected glands were in the
man's throat. While the pneumonic form of tularemia is the most
common type seen on the Island, Dr. Cantor said the other cases this
year point to the fact that the disease can be spread a variety of ways.

"What the cases say is that there are multiple ways people can
get tick-borne illnesses," Dr. Cantor said, "We're
trying to do what we can to raise awareness of the risk."

Health officials caution people who believe they may have been
exposed to seek immediate medical treatment if any symptoms appear
including fever, sore joints and throat, swollen glands and chest pain.

Tularemia has been documented on the Island since the 1930s, when
some hunters began contracting the disease, also sometimes known as
rabbit fever because rabbits primarily carry the disease. The first
major outbreak of pneumonic tularemia occurred in 1978, when 15 people
were infected, seven of them from one home in Chilmark. A Chilmark man
died in the summer of 2000 after contracting the disease.

Tularemia usually affects about 200 people a year nationwide,
putting the Island at the foreground for study in the medical community.
Since the first outbreak in 1978, the high number of tularemia cases
have baffled public health officials and fueled numerous studies.
Researchers first traveled to the Island after the 2000 outbreak,
including investigators from the Centers for Disease Control (CDC), the
DPH and Harvard and Tufts universities. The teams concluded that
landscapers were most at risk, but so far they have been unable to
conclusively locate areas where the risk for tularemia is the greatest.

"There is work that's still being done on the
Island," Dr. Cantor said, "There may be areas that are
likely hot spots but we can't really ascertain that."

Sam Telford, an associate professor of infectious diseases at Tufts
University, has been coming to the Island since 2000 once a month during
the spring and summer to collect dog ticks and examine the wild animal
population as part of a tularemia study. Mr. Telford told the Gazette in
June that the number of infected dog ticks has remained the same in the
last two years. Mr. Telford's study shows that Squibnocket and
Katama have higher rates of infected ticks than other parts of the
Island.

Island health officials say the incidence of tick-borne illness in
general has been higher than usual this year. Donna Enos, the infection
control nurse at the Martha's Vineyard Hospital said she has
confirmed at least 50 cases of tick-borne illnesses since April and is
investigating at least 50 more. Lyme disease tops the list and one case
of Rocky Mountain spotted fever has been confirmed. Mrs. Enos believes
the number of tularemia cases seen this year may in the end the record
of 15 set in 2000.

"Ultimately, by the time we have the cases confirmed, we are
going to see that," Mrs. Enos said, "I've seen more
[cases] than I've seen in a long time come through my desk in lab
results. I truly believe the numbers are higher in comparison to other
seasons."

The reason is unclear, but Mrs. Enos said she believes people are
spending more time outdoors this summer because the weather has been hot
and sunny.

Dr. Timothy Tsai, director of emergency services for the hospital
agreed. He said the hospital emergency room has seen a higher number of
patients complaining of tick-borne illness symptoms. Dr. Tsai said the
hospital this year began a panel that tests for four of the most common
tick diseases and is now offering precautionary antibiotics to patients.

"Some patients are very concerned and they want the
protection, so we will offer antibiotics on a short term course,"
he said.

He also cautioned people to be extra vigilant and to see a doctor or
go to the emergency room if symptoms appear. Blood tests are not always
certain and can be negative at first and later turn up positive results.

Dr. Cantor and state health officials have been working with Island
veterinarians to collect blood samples from animals. Dr. Cantor said
about 12 per cent of animals tested show evidence of having contact with
tularemia. Dr. Michelle Gerhard Jasny, a veterinarian participating in
the study, said the information could some day be used to study where
tularemia is most common and provide insight into how immune systems
battle the disease.

Many of the animals that tested positive for tularemia did not
necessarily have the disease. Why some animals, like dogs, are less
susceptible to contracting tularemia is one of the issues being studied.

A Providence, R.I., pharmaceutical company is studying tularemia
cases on the Island as part of a program to create a vaccine against the
disease. EpiVax, Inc. was awarded an $831,000 small business grant as
part of a federal counter-terrorism initiative to develop a vaccine
against Tularemia, which is ranked as one of the top five bio-terrorism
agents. The company is taking blood samples from Island residents who
have contracted tularemia in the past to study antibodies as part of the
first phase of the program.