As the Island boards of health begin to engage in a five-year effort to battle tick-borne illnesses on the Vineyard, early field work from a group of medical students on the Island points to serious deficiencies in reporting tick diseases to state public health officials, especially for Lyme disease.
For two weeks ending last Friday, a team of rural health scholars, nursing and pharmacy students from the University of Massachusetts conducted 945 surveys on ferries, at the high school, at ESL classes and at local churches about tick-borne illness. The work complemented hours of interviews with Island health care workers and pharmacists also conducted by the students. The work is supported by a $250,000 grant from the Martha’s Vineyard Hospital.
Results presented last Friday at the regional high school show early statistical evidence of high rates of Lyme disease here.
Researchers report that in 2010 Island pharmacies filled an estimated 1,200 prescriptions for doxycycline, the antibiotic of choice for treating Lyme disease. Of those prescriptions, pharmacists estimated that 90 per cent, or 1,080 of the prescriptions were for new cases of Lyme. By contrast the Centers for Disease Control recorded 25 officially-reported cases of Lyme disease in Dukes County.
“We know that the number less than 30 is not right,” said Tisbury health commissioner and study coordinator Michael Loberg. “The state knows it’s not right, the physician prescribing community knows it’s not right. We don’t need to capture every patient; we just need to get a good representative number because we’d like to show that our interventions can change that number, and capturing only 30 patients isn’t going to give us the database we need.”
The medical students agree, saying future funding for the study and prevention of tick-borne illnesses on the Island depends on a baseline of accurate data.
“There was no one who thought that incidence reporting was anything other than very important,” said Mr. Loberg. “But I think that everyone also realizes just how beleaguered everyone is in the health care delivery space.”
To relieve some of the paperwork-intensive burden of reporting, the medical students recommend that the Island establish a dedicated tick-borne health care worker to assist providers with reporting and act as a conduit between the state Department of Public Health and the Island. Mr. Loberg is hopeful that state public health grant money may be available to support such a position.
“The good news is the state worked well with the students and I think everyone is going to be pulling in the same direction to fix this,” he said. “I’m quite hopeful.”
Researchers also underscored the importance of prophylactic treatment for tick-borne illnesses. It is now believed that taking 200 milligrams of doxycycline within 72 hours of receiving a deer tick bite can significantly reduce the chance of contracting Lyme disease. The researchers also suggested the Island consider pressing for regulatory changes that would allow pharmacists to dispense the treatment without a prescription, much like the Plan B emergency contraceptive pill. Survey results show that the approach has the support of Island pharmacists, even though it would require a complex legislative process.
“We’re not saying it’s easy to do, we’re not even saying it’s the right thing to do, but the students are saying that it should be looked at and I think the committee generally agrees,” Mr. Loberg said.
The medical students also found there was ample room for better education about tick-borne illnesses in the community, particularly among high-risk workers like landscapers and construction workers and also for tourists and casual visitors. While most survey respondents could identify Lyme as a tick-borne illness, many were largely ignorant of other diseases such as babesiosis and anaplasmosis. Public service announcements at local movie theatres before screenings, and education programs in the public schools were among the recommendations.
The boards of health are preparing to make a set of recommendations to the Island selectmen next year, and Mr. Loberg said the work of the medical students puts them in a good position to do so.
“I felt that in terms of the quantity of the work that they did, the thousand questionnaires that were filled out, the fact that they were able to reach out to the at-risk communities, they greatly exceeded my expectations,” he said. “But the quality of what they did even exceeded that. They’ve come up with actionable recommendations for us to consider. It doesn’t mean that we will choose to go forward with all of them but they have talked to people in the community and come back with some ideas. That’s exactly what we wanted them to do. I think they reflected very well on the University of Massachusetts.”