New Lyme treatment draws fire from experts

A place not unlike this Island is engaged in a debate similar to one here about how to best treat Lyme disease and to eradicate tick-borne diseases.

The back-and-forth on the issue on Martha’s Vineyard has made for lively discussions for years, with a new method of treatment making news and triggering negative reactions to the proposal.

Dr. Nevena Zubcevik, co-director of the Dean Center for Tick-Borne Illness at the Spaulding Rehabilitation Hospital in Boston, and an instructor at Harvard Medical School, recently made a presentation to physicians at Martha’s Vineyard Hospital on new theories to treat Lyme disease.

The two-day course of the anti-biotic doxycycline often prescribed to patients here on Shelter Island after they report a tick bite has little or no prophylactic value, according to reports of Dr. Zubcevik’s presentation.

Dr. Zubcevik didn’t respond by press deadline to the Reporter’s requests for comment.

“It should be 100 to 200 milligrams of doxycycline twice a day for 20 days, regardless of the time of engorgement,” Dr. Zubcevik said, according to the Martha’s Vineyard Times, a local newspaper. “It is not a two-day thing.”

Although a specialist in rehabilitation at Massachusetts General Hospital, her work has focused on head trauma and recognizing similar cognitive impairments diagnosed along with Lyme disease.

“I’m new to this field,” Dr. Zubcevik told Martha’s Vineyard doctors, as reported by the local paper.

She also took issue with other concepts, disputing that:
• A tick has to be attached for 48 hours to inject the bacteria into a person.
• Children, infants and pregnant women shouldn’t be given doxycycline.

Despite Dr. Zubcevik’s arguments, Massachusetts Governor Charlie Baker rejected a budget amendment that would have required insurance companies to cover the cost of long-term antibiotic treatment for chronic Lyme disease. The Massachusetts Infectious Disease Society doesn’t recognize chronic Lyme, maintaining that long-term intravenous antibiotic therapy is dangerous.

Similarly, the Centers for Disease Control also doesn’t recognize chronic Lyme disease.

And the New England Journal of Medicine (NEJM) weighed in with a report in March that stated: “Previous randomized, clinical trials have not shown convincingly that prolonged antibiotic treatment has beneficial effects in patients with persistent symptoms attributed to Lyme disease. Nonetheless, the debate about this issue has continued.”

The NEJM reported that a European study showed long term antibiotic treatment lasting 12 weeks proved no more effective than a short course of antibiotics.

Sam Telford III, professor of infectious disease and global health at Tufts University Cummings School of Veterinary Medicine, is among those who dispute Dr. Zubcevik’s theories. Professor Telford has been studying tick-borne illnesses since he was a Harvard post-graduate on Nantucket in 1984. He knows and respects Dr. Zubcevik, he said, but recommends the short-term course of antibiotics to be administered immediately after a person discovers a tick bite or experiences symptoms related to Lyme.

If there is misinformation about the treatment of tick-borne illnesses,it’s matched by theories defining what causes them, Professor Telford said.

For example, those concerned that culling a deer herd will result in disease being spread by white-footed mice don’t understand that infection is a two-step process, he said. Tick larvae are uninfected and their feeding on white-footed mice sustains them to grow in their two-year life cycle into the adults that feed on deer. It’s halfway through the time of feeding when the tick begins injecting infectious material into a host, Professor Telford said.

Contrary to Dr. Zubcevik, Professor Telford maintains that if a nymphal deer tick is pulled off within 24 hours, it’s doubtful a person will develop Lyme or other tick-borne diseases.

While tick drags conducted on Shelter Island have revealed tiny ticks too small to be seen, an adult tick capable of spreading disease is easy to spot, he said. It takes seven days to feed and that makes it likely a person bitten would find the tick before three days have passed, he said.

He decries that Lymerix, a tick vaccine, was pulled from the market after threats of a class action suit and said that rather than get involved in protracted litigation, Lymerix’s manufacturer SmithKline Beecham — now SmithKline Galaxo — withdrew it from the market in 2002.

“Lymerix works.” Professor Telford said. There have been years of follow-up since the drug was pulled and no complications have developed among those who received the vaccine, he added.

Professor Telford supports deployment of 4-poster units — feeding stands that brush deer with a tickicide, permethrin — noting that they not only are useful in fighting deer ticks, but are also effective in killing disease-carrying lone star ticks that show up later in the summer season.

A female deer tick lays about 2,000 eggs while a female lone star tick lays about 6,000 eggs, so the need to get the tick population down is vital, Professor Telford said.

He strongly disputes the argument that permethrin makes venison inedible and called it “ridiculous” that anyone should fear eating it.

Professor Telford said he would argue his case with anyone that “the meat is safe.”

But most critical to a solution to tick-borne illnesses is culling a herd to a level of eight to 10 deer per square mile and maintaining that level. That will be the ultimate solution, he added.

On Cape Cod’s Great Island, Professor Telford said a single hunter and his wife have been effective in culling the herd to acceptable levels since 1985. Of course, Great Island is much smaller than Shelter Island, but with more active hunters, it could be done effectively here, he said.