With the arrival of summer come nymphal deer ticks and the infections they transmit: Lyme disease, ehrlichiosis/anaplasmosis, Borrelia miyamotoi disease, and Powassan/deer tick virus encephalitis — all of which are endemic to Martha’s Vineyard.

Dog ticks have been a perennial pest on the Vineyard since the 1920s; they sometimes transmit Rocky Mountain spotted fever or tularemia. The Lone Star tick, an aggressive human biter, has invaded and established itself in Aquinnah, Chilmark and Chappy and brings with it the risk of another set of unique infections (spotted fever, monocytic ehrlichiosis, STARI disease) as well as the horror of the bites sometimes inducing an allergy to red meat.

Dukes County has consistently ranked in the top 10 counties nationally for Lyme disease incidence. With that in mind, the Martha’s Vineyard Tick Borne Disease Initiative was begun in 2010 with the generous support of the Martha’s Vineyard Hospital. Under the direction of Michael Loberg and Matt Poole with the all-Island boards of health, a comprehensive program was developed and implemented. I serve as an advisor to the program, with an active interest in promoting health in a community that has served as a major basis for my longstanding research on tick borne disease. This includes enhancing diagnosis and reporting of cases, educating children, and providing locally-sourced information via a superb website (MVBOH.org). The tick program continues today as the Tick Borne Illness Reduction Initiative with a small amount of board of health funding and the tireless work of Dick Johnson, much of his time pro bono. For the past nine years he has been doing yard surveys to inform homeowners about what they might do to reduce tick habitat, educating the public, and exploring way to manage the Island deer herd more effectively. Even with its limited capacity due to a lack of funding, the program remains a shining example of tick-borne disease education and prevention in Massachusetts.

We are now at an important crossroads. Dick has not been able to expand the program due to a lack of sufficient funds. Health issues increasingly make it difficult for him to do the physical work of tick sampling and community outreach. We need to find the next-generation tick czar to ensure that this outstanding prevention program will continue into the future and expand its range of services.

As usual in public health, the issue is money.

Although surveys we have conducted indicate that the majority of Dukes County study subjects assign financial responsibility for tick-borne disease prevention to state or local government agencies, few support raising local taxes to do so. Although several individuals have contributed generously to help support the program, what is urgently needed now is a level of support that will provide an endowment to ensure an annual operational budget.

For almost any public health problem, we know what we have to do to reduce incidence, but cannot get people to do it. HIV risk is obvious, as is that of lung disease due to smoking. For deer ticks and Lone Star ticks, deer elimination or drastic reduction of the herd would work to greatly reduce risk, but that intervention remains to be accepted by the community. It is gratifying that Islanders are now better educated about ticks and Lyme disease.

Island health care providers now promote the two-tablet doxycycline prophylaxis for ticks that have been attached for more than a few hours, a practiced demonstrated in peer reviewed research to reduce the risk of Lyme disease by 80 pefr cent. And even though new modes of intervention are being tested, the best strategy is to attack on as many fronts as possible: reduce tick habitat, use host-targeted insecticides, spray judiciously, manage the deer herd, and be aware.

The most important thing to do is prevent tick bites. Whenever you go outside, apply an effective repellent as directed, wear permethrin treated clothing if possible, and take a shower afterwards and check for ticks. Remove any attached ticks by just pulling them out but do not panic — not every tick is infected and prompt removal greatly reduces risk of infection. If the tick has been feeding on you for more than a few hours, consider asking for the two doxycycline tablet prophylaxis. During the summer, if you have a fever of more than a couple days duration without sniffles, always go get yourself checked out by your health care provider.

These simple precautions can greatly reduce the risk of tick borne infection, and allow us to enjoy the Vineyard during the summer that lies ahead.

Sam Telford

Medford

The writer is professor of infectious disease and global health at Tufts University.