Powassan Virus

Ticks abound on Cape Cod and can cause a variety of diseases.  The black legged tick (Ixodes scapularis) can carry pathogens that cause the following diseases:   Anaplasmosis, Babesiosis, Borrelia mayonii, Borrelia miyamotoi, Lyme disease, and TickIdentificationPowassan virus.

Ehrlichiosis and Stari are transmitted to humans via the Lone star tick.

Powassan disease is relatively rare but is causing concern because of the severity of the disease  and the rapidity of transmission from tick to human…..minutes rather than hours.  Many people who are infected do not become ill, but those who do can develop encephalitis (inflammation of the brain) and meningitis (inflammation of the covering of the brain and spinal cord).  Other symptoms may include headache, fever, vomiting, confusion, weakness, speech difficulties, loss of coordination, and seizures.  The time from infected tick bite to symptoms can be anytime from one week to one month.  Diagnosis is based on symptoms and lab tests on blood and spinal fluid. This is a viral disease and the antibiotics normally used in tick borne illnesses are not as helpful.  Treatment is supportive and may include hospitalization, respiratory support, and intravenous fluids.

Protect yourself from tickbites.  Stay away from brush and high grass.  Use DEET products on skin and permethrin products on shoes and clothes.  Wear long pants tucked into socks.  Do a tick check as soon as you go indoors and put clothing in a hot dryer first, then wash.  Take a shower within two hours of being outdoors.

Remove ticks as soon as possible.giphy

How to remove a tick

  1. Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible.
  2. Pull upward with steady, even pressure. Don’t twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal.
  3. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water.
  4. Dispose of a live tick by submersing it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers.
	clipart image of a tickAvoid folklore remedies such as “painting” the tick with nail polish or petroleum jelly, or using heat to make the tick detach from the skin. Your goal is to remove the tick as quickly as possible–not waiting for it to detach.




If you develop a rash or fever or above mentioned symptoms within one to 6 weeks after removing a tick, see your doctor. Be sure to tell the doctor about your recent tick bite, when the bite occurred, and where you most likely acquired the tick.

Heart Health

Every 34 seconds someone in the United States has a heart attack.  When blood, with its oxygen supply, is either reduced or completely cutoff from the heart muscle, cells die and a heart attack occurs.  There are ways to modify your chance of having a heart attack. /What-Are-My-Risks-For-Getting-Heart-Disease-Infographic_UCM_443749_SubHomePage.jsp

Heart disease is the #1 killer of American women. Women’s symptoms may be different from men’s.

  • Neck, jaw, shoulder, upper back or abdominal discomfort
  • Shortness of breath
  • Right arm pain
  • Nausea or vomiting
  • Sweating
  • Light headedness or dizziness
  • Unusual fatigue

These symptoms can be more subtle than the obvious crushing chest pain often associated with heart attacks.  Women often tend to overlook symptoms.  This American Heart Association video is humorous but has some great take home points.

Diet, exercise, and stress reduction are important factors in heart health. Recommendations include  eating more fish, whole grains, and fruits and vegetables and avoiding trans fats, as well as limiting saturated fats, salt and sugar.  The Mediterranean Diet and The Harvard School of Public Health Healthy Eating Pyramid are two of the diets that promote heart health.                                 http://www.hsph.harvard.edu/nutritionsource/pyramid-questions/

Additional information can be found at:






PBS Documentary-September 10th

Diseases that were recently considered eradicated (measles, chickenpox, polio, whooping cough, mumps) are now reemerging as more families are choosing not to immunize their children.  PBS’s NOVA is airing a documentary  “Vaccines-Calling the Shots” on September 10th at 9 P.M.  Information from researchers, parents, and the tracking of worldwide epidemics will be presented.  

Ebola Virus

Update 9/3/2014

Dr. Tom Frieden, the director of the Centers for Disease Control, stated that there was a small window of opportunity to stop the Ebola epidemic.  Nearly 40% of the cases have occurred during the past 3 weeks with healthcare facilities filled beyond capacity, a devastating shortage of healthcare workers and medical supplies, and now a shortage of food.  Currently, the World Health Organization believes that the count of 3,069 cases and 1,552 deaths is an under count.

Research continues on the experimental monoclonal antibody, ZMapp, which has been used on a handful of patients.  In a Nature study, 18 monkeys infected with the virus and then given ZMapp survived.

Update 8/20/2014

The number of Ebola cases continues to increase.  The World Health Organization http://www.who.int/csr/don/2014_08_20_ebola/en/  states that between August 17th and August 18th there were 221 new cases and 106 deaths.  That brings the total number of cases to 2473 and the deaths to 1350.  Most of the new cases were attributed to lack of appropriate infection prevention when in contact with the bodily fluids of an infected patient. 

Update 8/7/2014

While the 2 American patients at Emory University seem to be improving, the overall situation in Africa is worsening, prompting the Centers for Disease Control to move its Emergency Operations Center to its highest activation level.  This may be due, in part, to the emergence of several Ebola cases in Lagos, Nigeria, a city of 20 million people.  The World Health Organization updated the Ebola numbers to 1,711 cases with 932 deaths.  

The experimental drug, ZMapp, a mixture of 3 antibodies which was given to the American medical workers in Liberia, is now part of a worldwide discussion about the ethics of giving experimental drugs, not approved by any government agencies, to critically ill patients.  To complicate the issue further, if the decision were made to give the limited number of experimental drugs available, which patients in which countries would receive them?  The World Health Organization is convening a group of ethicists to discuss these very issues.

                                                                                                                                                   Update 8/1/2014

The CDC issued a Level 3 travel warning yesterday for non essential travel to Liberia, Guinea, and Sierra Leone.  The number of cases of Ebola Virus continues to increase and the hospitals are understaffed and overwhelmed with critically ill patients.

Yesterday, the United States Centers for Disease Control and Prevention issued an advisory for US health care workers to consider Ebola virus, and possible isolation, for those patients presenting with viral symptoms and returning from affected countries within the past 21 days.Ebola_Virus

Ebola virus is an acute illness spread through blood and body fluids with an incubation period from 2-21 days.  Symptoms include headache, muscle pain, intense weakness, nausea, vomiting, impaired kidney and liver function, and in some cases, internal and external bleeding.  The disease so far has infected over 1000 people in West Africa and killed more than 660.  The fruit bat is considered a likely reservoir and infected animals, which are handled or eaten by locals, the way the virus moves from animals to humans.  Humans then contract the disease by coming in contact with bodily fluids such as blood, sweat, urine, breast milk, vomit, and diarrhea of persons who have already contracted the disease.


The disease is spreading quickly in Sierra Leone, Liberia, and Guinea because of multiple issues:  lack of personal protective equipment such as masks, gloves, and gowns;  small numbers of staff and isolation-wardisolation units; and the beliefs of some locals that the medical professionals themselves are spreading the disease.

While several vaccines are being tested, none are on the market at this time and intravenous fluids and fever medications are the only treatment options.


WARNING: Pure Powdered Caffeine

The FDA is warning people not to use pure powdered caffeine after the death of a teenager.  The drug is easily bought on the internet and just one teaspoon of the powder is equal to 25 cups of coffee.  This stimulant can cause irregular heartbeat, nausea, vomiting, seizures, and death.

  • The FDA wants to know about adverse events associated with powdered pure caffeine and other highly caffeinated products. You or your health care provider can help by reporting these adverse events to FDA in the following ways:
  • By phone at 240-402-2405
  • By email at CAERS@cfsan.fda.gov


Hepatitis C


800px-Anatomy_of_liver_and_gall_bladderHepatitis C is a contagious liver disease caused by a virus. It is spread primarily through contact with the blood of an infected person. It is classified as either acute or chronic. Acute disease can lead to chronic disease 75% of the time. Testing has been available since 1990.

In the United States over 3 million people have chronic Hepatitis C and aren’t aware of it because they do not feel sick. Hep C is spread when the blood from an infected person enters the body of a non-infected person:

A)   Sharing needles/syringes
B)   Needle stick injuries in the health care setting
C)   Being born to a Hep C mother
D)   Sharing razors, toothbrushes that may have been used by a Hep C infected person
E)   Before 1992 blood screening was initiated, Hep C could be spread through blood transfusions and organ transplants

If symptoms do appear, they may occur 2-6 months after exposure. Even if you don’t have symptoms you can spread the virus. Symptoms may include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay colored bowel movements, joint pain, and yellow skin or eyes. People with chronic Hepatitis C can go on to develop chronic liver disease or liver cancer. You should be tested for Hep C if:

There are several new drugs which can be used for treatment. Medication | Treatment | The American Liver Foundation

Tick Borne Diseases


4ticks_cmTicks are most active in spring and summer and can be found in grass, leaves, wooded areas, and branches.  They crawl up a blade of grass or sit on the edge of brush or leaves with their front legs extended, waiting for a passing host.  Once on you, they find a soft feeding surface, cut the skin, imbed their feeding tubes and suck blood for several days if unnoticed.  CDC – Tick Life Cycle and Hosts – Ticks.  Not all ticks carry disease and not everyone with a tick borne disease finds a tick on themselves. If you find a tick imbedded use fine tip tweezers and grasp the tick as close to the skin as possible.  Pull upward with steady pressure until the tick is removed.  Wash the area and your hands with soap and water or alcohol.  Currently, if you are a resident, you can go on TickReport – Tick Testing Services for Lyme Disease and tick-borne diseases and fill out a form to have the tick tested for bacteria and a report sent to you free of charge.  There are pre-paid envelopes available in the Public Health Nursing Office in the Human Services Building.

Symptoms of tick borne diseases may include malaise, headache, fever, joint pain, muscle pain, chills, and nausea and vomiting. For Lyme disease there may be a bullseye rash.              tick-bite

Tickborne disease we most frequently see on Cape Cod are: Anaplasmosis Home | Anaplasmosis | CDC, Babesiosis CDC – Babesiosis, and Lyme diseaseCDC – Lyme Disease Home Page. Other tick borne diseases that have been recently documented in New England are Borrelia miyamotoi, CDC – B.Miyamotoi – Ticks and STARI CDC – Southern Tick Associated Rash Illness.

If you have any of the above symptoms and especially if you have found a tick on yourself and are feeling ill call you doctor. There are antibiotics, which when taken as prescribed, can kill the bacteria.



There have been measles outbreaks in California, Washington, Ohio, and New York 1150_loresrecently and the state and local public health offices as well as the Centers for Disease Control  are concerned.

Measles is a highly contagious respiratory virus which can be spread to others 4 days before to 4 days after a rash develops.  It is transmitted by droplets when someone who has the disease coughs or sneezes.   The virus can remain suspended in the air for 2 hours even after an infected person leaves the area.

Symptoms typically develop 10-12 days after being in contact with the virus (with a range of 7-21 days) and include:   fever; cough; red, water eyes; runny nose; and white spots inside the mouth.  Three to five days later a rash begins on the face and hairline, spreading to the trunk, arms, legs and feet.   

About 30% of measles cases have complications ranging from pneumonia, ear infections and diarrhea.  About 1 child in every 1000 with measles will develop an inflammation of the brain.  There are 2.2 deaths for every 1000 people who get measles.

Fortunately, there is a vaccine which can prevent measles, the MMR vaccine.  The first shot is given at age 12-15 months and the second before the child begins school at ages 4-6 years.  Reactions are minimal and include fever and a mild rash.  Vaccines: VPD-VAC/Measles/FAQ Disease & Vaccine.