As a particularly pervasive summer for ticks on the Island winds down, the Infectious Disease Society of America has released new draft guidelines for the prevention, diagnosis and treatment of Lyme disease. A public comment period has been extended to Sept. 9.

The 100-page draft guidelines were developed after a series of discussions and literature review from a 36-member panel that included representatives from the Infectious Disease Society of America, the American Academy of Neurology, the American College of Rheumatology, as well as cardiologists, microbiologists, pediatricians and three patient representatives. Foremost among the recommended changes would allow the prescription of the antibiotic doxycycline for children under eight.

Although the guidelines are still in draft form, they represent a rare consensus and compromise on a disease that has long frustrated members of the medical community and its patients. Dukes County, which includes Martha’s Vineyard and the Elizabeth islands, consistently ranks among the top counties nationally for incidence of Lyme disease.

The recommendation used to be that doctors did not prescribe doxycycline for young children because it could lead to dental discoloration or affect tooth enamel. But according to the new draft guidelines, those concerns arose primarily from experiences with the related antibiotic tetracycline, not doxycycline.

“Subsequent research, albeit mostly observational and of limited sample size, casts doubt on an association between doxycycline and tooth staining,” the draft guidelines read in part. “A growing consensus accepts the safety of doxycycline use in young children for at least up to 14 days duration.”

Doxycycline, unlike amoxicillin, can treat a febrile, tick-borne disease called ehrlichiosis, as well as Rocky Mountain Spotted Fever. It can also be used to treat children with neurological manifestations of Lyme, providing a non-intravenous option for patients suffering from the symptoms. Despite the recommendation, the guidelines maintain that the more traditionally prescribed amoxicillin will be usually preferred over doxycycline in uncomplicated pediatric Lyme cases.

Dr. Melanie Miller, a pediatrician at the Martha’s Vineyard Hospital who prescribes Lyme treatment on a case-by-case basis, said a number of factors go into the decision to use amoxicillin or doxycycline, including the age of the child, the ability to take oral medication, and the nature of the symptoms. While doxycycline can treat tick-borne illnesses other than Lyme, amoxicillin has fewer side effects, like upset stomachs or headaches. She said while she has used doxycycline with children in the past, the new draft guidelines would not change her practices because they were primarily based on recent studies regarding teeth staining, which was not her primary concern.

“I do use doxy, but I haven’t changed my practice based on what just came out,” Dr. Miller said. “Every case is individual, and it does depend on the age of the child.”

Another change in the pediatric guidelines is the recommendation of post-exposure prophylaxis for children. The draft guidelines now advocate for a single dose of doxycycline in children and adults within 72 hours of a high-risk tick bite in areas of high tick exposure, including places like the Vineyard.

The guidelines also advocate against testing ticks for the bacterial spirochete that carries Lyme, and do not recommend testing asymptomatic patients after they have been bitten.

Currently, the two-tier tests conducted at the hospital are sent to the

Mayo Clinic for confirmation of certain Lyme antibodies. Dr. Miller said testing used at the hospital almost always catches Lyme, meaning that while false positive tests are possible, false negatives are rare.

Meanwhile, the FDA recently announced a new Lyme test that will run the two-tier process concurrently, meaning that the hospital would no longer have to send samples to the Mayo clinic for verification.

“It’s less expensive. It’s quicker. It’s been approved,” Dr. Miller said. “And to get approved it has to work as well or better than the current test.”

Dr. Michael Jacobs of West Tisbury, a retired internist and well-known diagnostician who had a family practice on the Vineyard for many years, declined to comment on the guidelines. But he said there continues to be a lack of agreement about the treatment of Lyme disease on the Island, despite the prevalence of the disease. He said the Center for Disease Control has recommended the use of doxycycline in children under eight for a few years now, but some doctors are still tentative. And while many doctors have advocated for the prophylactic use of two doxycycline after deer tick bites, a few have not.

“There’s a lack of consensus or uniformity on how doctors treat Lyme disease on this Island, and that is a real concern for me,” Dr. Jacobs said. “I would support the public commenting on the guidelines, and I look forward to some consensus for diagnosis and prevention in this epicenter for the disease,” he added.

State Department of Public Health data compiled by Tisbury health agent Maura Valley indicates that the incidence of Lyme disease on the Island has decreased in the past five years. The hospital reported 163 suspected cases of Lyme between July 2018 and July 2019. By comparison, the hospital reported nine confirmed and 187 suspected cases in 2017-2018. From 2014 through 2016, more than 200 cases of the disease were reported, according to available records.

“I don’t want to speculate on why, but I would hope that it’s because of increased education,” Ms. Valley said. “Tick checks, getting two doses of doxycycline after a bite, that kind of thing.”

She said most primary care doctors she knows at the hospital will prescribe two doses of doxycycline if patients come in immediately after a deer tick bite. She also said that is what boards of health advocate if they get calls from people asking about what to do in the aftermath of a bite. But she said the calls have decreased too.

“I think it’s more public knowledge now,” the health agent said.

Part of that public information campaign comes from the Martha’s Vineyard Tick Borne Illness Reduction Initiative, headed by field biologist Richard Johnson over most of the past decade. The primary goal of the initiative is to reduce the number of ticks and tick-borne illnesses on the Island through education, awareness, and yard surveys. While Mr. Johnson is happy about the reduction in Lyme patients — however small — he said there’s still much work to do, particularly regarding the increased prevalence of Lone Star ticks on the Island.

“It was a very bad year for ticks,” Mr. Johnson said. “We did 50 surveys, and only there were only two places we didn’t find Lone Star ticks.”

The relatively new species of tick used to be restricted to the Island’s outermost reaches in Aquinnah and Chappaquiddick, but Mr. Johnson said his team found them creeping into the down-Island towns as well this summer. Often they see a direct correlation between the presence of Lone Star ticks in areas with a high deer population.

And as the tick program continues to struggle for funds, Mr. Johnson hopes to shift gears to focus more on curtailing the Island deer population. He wants to conduct flyover and pellet surveys to better gauge the quantity of deer on the Island and their location, promote a community cooler to hang deer and encourage more homeowners to allow hunting on their property.

Unlike like deer ticks, Lone Star ticks transmit a spotted fever that is similar to Rocky Mountain fever. According to the state DPH data, there was one suspected case of Rocky Mountain Spotted Fever in 2014. In 2019, there were 29. Mr. Johnson believes it’s the new type of fever that is turning up from Lone Star ticks. “We’ve been talking about what we can do about it for a little while,” he said. “But if we don’t start, it’s just going to get worse every year.”