Tick TALK Lyme Disease Is on the Rise in Massachusetts

It starts with a tradeoff of sorts — with a tick getting the better end of the deal.

“When you get a tick bite, it sucks your blood, and if it stays long enough, it can give you enough bacteria to contract Lyme disease,” said Garry Bombardier, medical director of the Work Connection at Holyoke Medical Center.

He spoke specifically about the deer tick, the only kind that carries Lyme disease, a condition that can cause rashes, flu-like symptoms, joint pain, and, in serious cases, major arthritic and cardiovascular problems.

And in Massachusetts, the incidence of the disease is on the rise. More than 2,330 cases were reported in the Bay State in 2005, the last year for which statistics are available — a striking 46{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} increase over 2004. (The incidence rose nationally by 18{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} over the same period.) Doctors say more than one factor explains the sudden, um, uptick.

“The number of infected ticks seems to be increasing, while at the same time, health care providers are becoming more aware of the diagnosis and are testing for it more often,” said Dr. Deborah Hoadley, who treats Lyme disease as part of her Heron Pond Health & Wellness practice in Longmeadow. “Both those factors have contributed to the rise in cases.”

The awareness factor is a positive, she added, because, “if Lyme disease remains untreated, it can progress into a more chronic disease that can result in damage to musculoskeletal and neurologic systems.”

Overall, said Bombardier, the rate of new cases in Massachusetts is about 36 in 100,000, ranking it fourth in the country. “It’s not incredibly common, but that number is about five times as high as the average state, which is around 7.5 cases per 100,000. So it is more prevalent here.”

This month, The Healthcare News sinks its teeth into Lyme disease — and how to avoid the worst the humble deer tick has to offer.

Sneaky Devils

Deer ticks are less common and smaller than the more ubiquitous dog tick. They can’t jump or fly, and they cling to plants near the ground in brushy, wooded, or grassy places, so they tend to climb onto animals and people who brush against the plants, according to the Mass. Department of Public Health.

Tiny deer tick larvae pick up the bacteria that cause Lyme disease by biting infected animals, such as mice. Slightly older ticks, called nymphs, which are the size of a poppyseed, are most likely to bite and infect humans. Adult deer ticks can also transmit the disease, but they are not as great a risk as nymphs because the adults are less likely to bite humans, and are easier to see and remove.

Lyme disease has long been a problem in Massachusetts, but it seems to have migrated inland in recent years, said Dr. Robert Hoffman, chief of Infectious Diseases at Mercy Medical Center. In the past, he explained, most patients who presented in the Pioneer Valley with Lyme disease had picked it up on Martha’s Vineyard, Nantucket, the beaches of Long Island Sound, or some other spot outside Western Mass.

“Now, we’re acquiring Lyme disease more locally,” he said. “Springfield has very little Lyme disease, but all the surrounding suburbs have it. In Wilbraham, Monson, Westfield, and the foothills of the Berkshires, it’s becoming increasingly prevalent.”

Lyme disease, in its most common manifestation, goes through several phases, Hoffman explained, often — but not always — starting with a ‘bullseye’ rash, which spreads and clears up in the center to resemble a bullseye or a donut. After that, “a sizeable minority of people get other symptoms, everything from aches and pains to headaches to out-and-out meningitis,” he said, as well as flu symptoms.

The third stage — which can include arthritic joints, nervous system disorders, and heart problems such as altered heart rate and fainting — is much more difficult to treat, Hoffman continued. In fact, 60{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of those who allow Lyme to go untreated develop arthritic symptoms, and 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} develop nervous system problems. “That’s why we need to treat everyone who has evidence of Lyme disease.”

The trick is early identification of a disease that doesn’t always manifest itself in the same way, Hoadley added. “Patients will often report a bullseye rash, but some rashes are atypical, and some patients may have multiple rashes, which can be confusing for diagnosis,” she said. “Sometimes a diagnosis can be missed because no rash at all is found.”

Fortunately, Hoffman said, once Lyme disease is suspected, the tests used to diagnose it are much more accurate than they were a decade ago — up to 95{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} accurate, in fact, which is right in line with the success rate on blood-sugar tests and other everyday screenings.

Of course, not everyone who is bitten by a deer tick, even an infected one, contracts Lyme disease, Bombardier stressed. “Most tick bites don’t end up giving people the disease, so I wouldn’t go rushing off to get treated on the basis of a tick bite alone. If you tested indiscriminately, especially in an area with a fair number of cases, you could end up with a lot of positive blood tests, but not nearly as much disease.”

Fighting Back

Not all areas of Massachusetts are seeing the same rate of increase in Lyme disease. In fact, according to the latest statistics from the Mass. Department of Public Health, the areas of highest incidence are Cape Cod and Southeastern Mass., Nantucket and Martha’s Vineyard, Essex County north of Boston, and towns along the Middlesex and Worcester county border.

The four counties of Western Mass. tell a different story, with some of the lowest incidences in the state, although towns along the Quabbin Reservoir watershed show higher rates of infection.

For those who have been infected, antibiotics such as amoxicillin, typically taken over the course of three to four weeks, are a common treatment, but “the best way to treat it is not to get it,” said Bombardier. “If you’re going to be outside, try to make sure you don’t expose yourself to ticks, and make sure your animals are treated with flea and tick medicines.”

One danger, he said, is dogs or cats carrying a tick into the house, and the tick falling into the carpet, where it awaits a new host; for that reason, changing an infant’s diaper on a carpeted floor isn’t a great idea during the summer tick season.

“There are other things you can do in your environment, like not having woodpiles or rock walls where mice can live,” Bombardier said. “And clean up well around bird feeders, or don’t even have them in the summertime, because the seeds fall to the ground and attract rodents.”

Chemicals work as well, he added. Products applied to the lawn to keep grubs and ants away are sometimes effective on ticks, while personal insect repellants containing DEET may also repel them. He said some people also apply a small amount of the topical antibiotic doxycycline to the skin following a bite, which has shown to prevent the onset of Lyme disease.

“All the advice we’ve been giving for the past 10 to 15 years continues to be valid, some of which might be a little rigid; people just aren’t going to tuck their pants into their socks and wear long sleeves in 90-degree summer heat,” Hoffman said. “But the principle that the tick needs to get at the skin, so the skin is safer if covered, is certainly true.”

Fortunately for outdoorsy types, the second and third days of contact are more critical than the first because a deer tick generally needs about 36 hours to transfer enough bacteria to cause Lyme disease. For that reason, Hoffman said, it’s worthwhile for people to closely examine their bodies after being outdoors — and have someone else check hard-to-see spots such as the lower back.

“After a tick has consumed a lot of blood, it can grow to twice its size, but when it’s first attached, it’s easily missed because of its size,” Hoffman said.

Still, dangerous things can come in small packages. And by all accounts, the unwanted gift of Lyme disease is arriving more frequently than ever before.