Recently, during an outing, a family friend tried to explain to me the dangers of a new disease. She said she had learned all about “Powassan disease” from a friend on social media. Now, this person knows well what I do, yet in an excited tone, proceeded to explain to me about this new disease, how it was caused by ticks and, if anyone is infected, would die within days. She then told me that she heard that almost a dozen people had died from this disease so far this year, and it was only May. While she is, for the most part, a reasonable adult, when it comes to diseases, from infections to cancers, she prefers to listen to hair stylists, people she meets at the check out at the grocers, anyone it seems who has an opinion based on anything, except of course education and experience.
When we stop to consider where most people gather their information, social media, we can easily see why there is so much misunderstanding about, well, everything. A recent analysis found that almost 90% of the health-related information on Facebook was inaccurate, and with summer now in full swing, and tick season in over-drive, the opinions on Tick-Bourne disease are everywhere. And almost universally wrong. Some clarification is evidently needed.
Old Lyme, Connecticut.
In the early 1970’s a group of people living around Old Lyme, Connecticut, began suffering from a number of puzzling, debilitating symptoms. Chronic fatigue, swollen joints, skin rashes, agonizing headaches, and in some cases paralysis. The cause of these symptoms went unidentified, and therefore untreated, for years. Even those rare physicians who accepted their patient’s symptoms as real could do little to treat them. The medical community seemed to be at a loss for the cause of these unusual symptoms. Unusual, as many of the victims were small children.
Patients began conducting their own research, and it was concluded that those suffering from the symptoms had one thing in common besides their geographical location: each recalled having been bitten by a Tick before the onset of a skin rash, followed quickly by arthritic conditions.
Tick Bourne Diseases
Tick-Bourne diseases and the Ticks that carry them have existed in the American wilderness for tens of thousands of years. The disease we know today as Lyme disease was first identified ago by Alfred Buchwald, a German doctor who described the chronic skin rash and other symptoms that occurred after a Tick Bite, over 130 years. However, Borrelia burgdorferi, the bacteria that has been identified as the cause of Lyme disease, was not officially classified until in 1981. Medical research scientist Dr. William Burgdorfer was busy studying Rocky Mountain Spotted Fever (also caused by a Tick bite) when he began to look at Ticks as a source of the newly identified Lyme disease. He discovered that a spirochete bacterium carried by ticks was the cause of disease in humans (Dr. Burgdorfer was rewarded for his discovery when the medical community named the bacterium after him, Borrelia burgdorferi).
When Borrelia burgdorferi infection is suspected today, there are varying approaches to treatment. Some doctors treat the disease as a severe infection, while others believe the infection can be treated with a prescription of Doxycycline. Still, other physicians are convinced the disease is mostly psychosomatic. Today, with thousands of patients suffering from persistent and often extreme symptoms, Lyme disease is finally becoming recognized as a serious, endemic illness.
Lyme disease has been identified in all states except Hawaii. In the Northeastern US, the disease has become a critical public health problem and is one of the top notifiable diseases by the CDC.
Symptoms of Lyme disease
The most common sign of a Lyme infection is an expanding area of redness on the skin, erythema migrans, which starts with a Tick bite. While the rash is neither itchy nor painful, only about half of those infected with Lyme disease develop the rash. Other early symptoms are typical of an infection, including fever, headache, and feeling tired. If left untreated, the symptoms may quickly include the loss of the ability to move one or both sides of the face (Palsy), arthritic-like joint pain, severe headaches, and stiffness in the neck. While some symptoms may clear up, they my return months later, and the patient may experience repeated episodes of joint pain and swelling. Even when diagnosed and treated immediately, about one-in-five people develop recurrent joint pain, memory problems, and fatigue for months.
The name Powassan encephalitis comes from Powassan, Ontario, where a small child died of encephalitis that was traced to a Tick bite in 1958. There has been a surge in the number of cases of Powassan virus infection, along with geographic range since about the year 2000. In the United States, cases have been recorded in the Northeastern U.S. and the Great Lakes Area.
Unlike Lyme disease, which is caused by a bacterium, Powassan encephalitis is caused by a flavivirus (A form of positive‐stranded RNA virus). This type of virus is responsible for several diseases in humans, including Zika, Dengue Fever, and West Nile. Flavivirus are Zoonosis, or animal-vectored diseases, meaning they are spread through invertebrate vectors, generally insects or ticks. The diseases do not seem to harm the Ticks, and the virus is spread to humans through a Tick bite. Since both the bacterium that causes Lyme disease and the virus that causes Powassan are found in the same Tick species, it is possible to be infected with both.
Like Lyme disease, some people who are bitten do not develop symptoms. And like Lyme disease, the incubation period ranges from several days to a few weeks. The symptoms, at least the initial ones are very similar to Lyme disease, including fever and headache; however, those infected to Powassan may also suffer from vomiting, weakness, memory loss, confusion, coordination problems, and seizures. In some cases, the virus infects the central nervous system, causing inflammation of the brain (encephalitis) or the membranes that surround the brain and spinal cord (meningitis). About 50% of infected survivors will suffer permanent neurological symptoms (recurrent headaches, muscle wasting, and memory problems); about one-in-ten Powassan encephalitis cases prove fatal. Currently, there are no vaccines to prevent Powassan infection, and treatment often includes hospitalization, respiratory support, fluids, and medications to reduce swelling in the brain or meninges.
Preventing Lyme and Powassan Infections
While Western medicine is geared toward treatment, we must take a public health approach in regards to zoonosis: prevention. Avoid Tick bites by wearing long pants and sleeved shirts; apply products that contain DEET to clothing (I apply repellants to outdoor areas). Check yourself and children carefully after being outdoors, especially in wooded areas. Ticks prefer warm, moist areas to bite, so check carefully. If found, Ticks can be removed carefully with tweezers. If you are bitten, notify your medical provider and seek treatment as soon as possible. Your medical provider may prescribe an antibiotic like doxycycline, amoxicillin, or cefuroxime.
Lyme disease is the most common Tick disease in the Northern Hemisphere, affecting over a quarter-million people each year. While most infections occur in spring and early summer but can occur at any time. While there is no current vaccine to prevent Lyme disease, due to a large number of infections each year, along with the spread of the disease, research to develop new vaccines is ongoing.
For more information, go to the Infectious Disease website for the State of Maine http://www.maine.gov/dhhs/mecdc/infectious-disease/epi/vector-borne/lyme/tick-prevention.shtml