Growing Danger (CC Times: 7-12-03)

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Growing danger

Exploding tick population could lead to a sharp rise in Lyme and other

diseases on Cape and islands

By <A HREF= " mailto:rlord@... " >ROBIN LORD</A>

STAFF WRITER

On Cape Cod and the islands your chances of getting West Nile virus are slim.

SARS? Even smaller.But around here you run a fairly high risk of contracting

one of the region's nastiest illnesses, Lyme disease. Barnstable, Nantucket

and Dukes counties have among the highest rate of Lyme disease in the

country.And this year will be worse than most, experts say. The unusually wet

spring

preceded by a snowy winter was perfect breeding weather for deer ticks, which

transmit the disease. The tiny brown insects proliferate in wet weather. And so

does borrellia burgdorferi, the Lyme bacteria.One adult female tick can produce

1,500 eggs in her lifetime, according to Simser, entomologist with the

Barnstable County Extension Service. That means millions of ticks are crawling

through the tall grasses and low-lying shrubbery common on the Cape and

islands. " Last year was very high in terms of ticks and infection. This year the

numbers on Cape Cod and Martha's Vineyard are up, and Nantucket is holding

steady with last year, " said Simser, who has been studying ticks on Cape Cod and

the islands since 1998. " I think we're going to see more cases (of Lyme) this

year. " Imugen Laboratories in Norwood, which handles most of the testing for the

Northeast, is seeing a startling rise in the number of infections this

year. " There was a tremendous increase in the number of ticks sent to us for

analysis

and thus far, from what I can tell, I would call it a very active year for

Lyme, " said Victor Berardi, associate director of laboratory science at Imugen

Laboratories.

Hard to diagnose

In its early stages, the disease can mimic the flu, with fatigue and muscle

and joint pain usually the most distinguishing symptoms.It is often, but not

always, accompanied by a bull's-eye rash around the bite.If left untreated, Lyme

is one of the few bacteria that can cross the blood-brain barrier and cause

everything from meningitis to vague neurological problems.Many doctors believe

it can become a chronic disabling illness.Sallie Scruggs knows the ravages of

the disease all too well. The 42-year-old Nantucket musician and artist came

down with what she thought was a flu in February 2002. When it returned for the

third time, she began to press her doctor for answers.After insisting on a

Lyme test, she was diagnosed in October and placed on three weeks of

antibiotics. But, her symptoms worsened over time.Batteries of tests later, she

finally

found a doctor in Boston to treat her with long-term anti-biotics for a chronic

Lyme condition. Today, she is better, and back playing piano at two Nantucket

night spots.But the physical problems and extreme depression blotted out the

last year. " It took away my joy of living, " she said.According to a recent

article in the New England Journal of Medicine, the number of Lyme cases

reported

in the United States has increased from 491 in 1982, when national

surveillance began, to 17,029 in 2001. About 60,000 cases are reported in Europe

each

year.Nantucket can probably call itself the Lyme disease capital of the country

with 567 cases per 100,000 people last year. Massachusetts' average is 28 cases

per 100,000 people, according to the state Department of Public Health.In

Barnstable County, which encompasses all of Cape Cod, the 2002 figure is 74 per

100,000 people. On Martha's Vineyard, there were 254 cases per 100,000,

according to the state.The World Health Organization now considers Lyme disease

the

most prevalent " vector-based " (an animal which passes a disease-producing

organism to another) bacterial infection in the world, according to Pat ,

president of the Lyme Disease Association of America in New Jersey. Lyme disease

activists on Cape Cod and elsewhere believe there are many more cases than are

actually reported to the state health department. Coughlin, coordinator

for the Cape Cod-based Massachusetts Lyme Disease Coalition, said the medical

community is beginning to respond. " Bureaucracy changes very slowly. In the

last five years, we've increased the reporting of the number of cases threefold.

Sometimes little steps forward start to accumulate, " he said.

Lyme on the rise

Coughlin said there is an alarming increase in the numbers of ticks that are

infected with Lyme and two other virulent infections, babesiosis and

ehrlichiosis. " We've seen as much ehrlichia and babesia together as we have Lyme

and,

for Cape Cod, that surprises me, " he said.While ehrlichiosis can be treated by

the same antibiotic as Lyme disease, babesiosis must be treated with a

different medication, he said. Appropriate testing is therefore paramount, he

added. " The message here is we've talked about Lyme for years, but there's more

to

consider, " he said.The authors of the New England Journal of Medicine article,

Dr. B. and ph Piesman from the Centers for Disease Control and

Prevention in Fort , Colo., say that prevention measures up until now -

such as public information about wearing repellents and protective clothing -

have not been enough. " It is possible that these interventions have blunted

the increase in Lyme disease in the United States, but they have clearly not

been sufficient to lower the number of cases, and the epidemic continues to gain

momentum, " the article reads.Development of a vaccination should be foremost

in the prevention field, they say. But, none is on the horizon.A vaccine did

appear in 1998, but was taken off the market last year. The manufacturer of

LYMErix, GlaxoKline, said low sales were to blame. Doctors, including

several

on Cape Cod and the islands who took part in the vaccine's trial in 1997,

called it an important tool in the fight against Lyme. But hundreds of people

who

received the vaccine reported problems, including Lyme-like symptoms. In

their article, and Piesman conclude that it seems unlikely " given the

scientific constraints and the less than enthusiastic response to the recent

vaccine " that another will be developed.

Trying to stem the tide

Research money is also an obstacle, said. " A lot of the money from the

CDC is going to West Nile, " she said.One exception is a $4.7 million grant

from the National Institutes of Health to Columbia University to study the

benefits of long-term antibiotic treatment for chronic Lyme. Columbia is also

raising money for an endowed research center to study the disease.Others are

looking

into ways to manage tick populations, including Simser. This summer he is

taking part in a study looking at whether white-footed mice - an important link

in the life-cycle of the deer tick - can be treated with insecticide. He set up

small, baited boxes at 110 residences on Martha's Vineyard, which douse the

mouse with a minuscule amount of the same substance used for dogs and cats in

the well-known product, Front Line. Another device designed for treating deer,

another key animal in the tick life-cycle, is still in the experimental stage.

It lures deer to a corn feeding station and, when they move their heads in to

feed, they are sprayed with an insecticide.Manufacturers have yet to solve

how to make the stations child-proof, which has so far prevented its widespread

use.DEET, an insecticide, is effective when applied right to the skin, but

there is a danger in using too high a concentration, said Simser. Anything

higher

than a 25 percent concentration is not recommended, he said., whose two

grown daughters have battled Lyme for years, goes even further and hires an

exterminator each spring to treat her entire yard. She has the perimeter of her

yard in New Jersey treated, all of her ornamental plantings and around the

foundation of her house. " I hate chemicals, but what is the alternative? " she

said.(Published: July 12, 2003)

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