Promoting prevention and wellness: The case of tick-borne illnesses in an endemic area

To address the long-standing problem of endemic tick-borne illness (TBI) on the island of Martha's Vineyard, MA, in 2011, the six towns' boards of health collaborated to develop a Program to Reduce the Incidence and Severity of Tick-Borne Illness. In the fall 2011, six health professions students conducted an island wide survey that included local clinicians, residents, and visitors. Survey results indicate that island caregivers are shifting to a “Better safe than sorry” attitude re treatment and to TBI panels instead of Lyme only titer. Providers expressed high concern for visitors who may seek care for emerging Lyme symptoms upon returning to non-endemic areas. Exploration of the DPH/CDC TBI Incidence reporting system uncovered provider misconceptions regarding requirements for reporting, lack of time for paperwork and follow-up, and a wide range of opinions regarding the importance of reporting. Providers indicated diagnosing and treating many more cases of Lyme than reported. Recommendations regarding how the Incidence reporting system could be improved include clarifying DPH/CDC reporting guidelines for provider education to correct misconceptions. Survey results also highlighted the issue of pharmacists possibly dispensing prophylactic treatment without a written prescription within 72 hours of confirmed tick bite. In 2010, island pharmacists filled an estimated 1,200 prescriptions for doxycycline. They estimated that 1,079 of these 1,200 prescriptions were for new cases of Lyme disease. Each of the eight pharmacists interviewed believe in dispensing doxycycline 200 mg by mouth, as a single dose for prophylactic treatment of tick-borne diseases in asymptomatic patients with a tick bite.