Wet spring increases Lyme risk
The Boston Globe, July 4, 2003
Massachusetts residents may be facing the riskiest summer ever for contracting Lyme disease, doctors warn, because the cold, wet spring has dramatically boosted the population of deer ticks that carry the bacteria that causes the debilitating condition.
Once thought of as a problem mainly on Cape Cod and the islands, Lyme disease has marched across the entire state and the number of people infected has almost tripled since 1998.
Now, the sheer number of deer ticks concerns physicians from the Cape to the Berkshires. Some doctors in the Boston area and Western Massachusetts have already seen an increase in the number of Lyme disease cases compared to this time last year, although most people are diagnosed with the condition a bit later in the summer.
''In general, the more ticks there are, the more people will become infected [with Lyme disease],'' said Dr. Jonathan Edlow, emergency physician at Beth Israel Deaconess Medical Center and author of the new book ''Bull's-Eye: Unraveling the Medical Mystery of Lyme Disease.''
Tick season begins in springtime and continues through the warm summer months, according to the Centers for Disease Control and Prevention, with the peak tick activity occurring between May and August.
Lyme disease, a bacterial infection that can lead to serious neurological problems, is easily treated with antibiotics when diagnosed early.
But some patients sometimes don't realize that they have the condition, or even that they've been bitten by the speck-sized deer tick.
The first warning sign of Lyme disease is often the appearance of a bull's-eye rash, although 1 in 5 patients exhibit no rash.
Early symptoms of Lyme disease often include fever and joint aches.
The growth of the deer population has brought deer ticks to areas of the state where residents tend not to take typical precautions, such as wearing long pants in the woods.
As a result, the number of Lyme disease cases has grown from about 700 in 1998 to nearly 2000 last year.
This year, an unusual amount of rain and cooler temperatures allowed adult ticks from last year to survive instead of dying as they normally do when the woods dry out.
Coupled with the newer generations of ticks, they put people at more risk of getting bitten.
''We're seeing more adult ticks now, but that doesn't necessarily decide what's going to happen [with Lyme disease] this season,'' said Dr. Richard Pollack, instructor of tropical public health at Harvard School of Public Health.
In part, that's because adult deer ticks are larger and more obvious to spot, making it less likely they will draw blood before being picked off; in general, ticks are unlikely to transmit the disease unless they are attached to their victim for 24 hours.
As a result, adult deer ticks account for less than 10 percent of Lyme disease cases, according to Dr. Sam Telford, assistant professor at Tufts Veterinary School who has worked on Lyme disease for the past 20 years.
However, physicians in some parts of the state say they are seeing more patients suffering from symptoms of Lyme disease.
Dr. Barbara Stechenberg, director of pediatric infectious diseases at Baystate Medical Center Children's Hospital in Springfield, has fielded numerous calls in the last few weeks from local doctors ''saying they're having patients coming in with early signs of Lyme disease.''
''It's not surprising, hearing about these cases,'' Stechenberg said. ''We've had an explosion of deer ticks in our area.''
''There's been a tremendous increase in the western part of the state,'' said Fredric Cantor, Massachusetts state public health veterinarian, ''with rates much higher than the national average.'' That's largely because the rural, heavily forested region has an exceptionally large deer herd, he said.
But this may also be a bad year for the more forested Boston suburbs, such as Wellesley, Dover, and Needham, according to Dr. Alan Steere, director of rheumatology at Massachusetts General Hospital.
''I'm regularly seeing cases from that area and since I also live there, I'm aware that we see deer and the deer tick regularly,'' Steere said.
Even with increased awareness, underreporting remains a problem in tracking Lyme disease. Many physicians, already overloaded with paperwork from insurance companies, do not have the time or inclination to fill out the necessary forms.
''Reporting something that is a mild disease is not high on their radar screen,'' Stechenberg said.
For people hiking in the woods - or even just lounging in their backyards - doctors suggest a tick check afterwards. If you do see a bug somewhere on you, they suggest removing it with a pair of tweezers.
The Massachusetts Department of Public Health recommends wearing light colored clothing when spending time outdoors so that the tiny ticks will show up better later when you are looking for them, and keeping a well-manicured lawn to keep ticks away.
A tick bite does not necessarily warrant a doctor's visit, but anyone with the telltale bull's-eye pattern should see a doctor promptly.
This story ran on page A1 of the Boston Globe on 7/4/2003.