Vineyard Can't Shake Stubborn Illness

Martha's Vineyard this summer has recorded more cases of tularemia than any year since 2000, deepening the mystery of why a bacterial infection that historically had come and gone after a year or two has persisted for six consecutive years on the island.

Eight adults have fallen ill with tularemia so far this year, some coming down with the respiratory form of the disease, others developing skin ulcers. All eight recovered after treatment with antibiotics, according to the state Department of Public Health.

But the cases, the most since 15 people became ill in 2000, serve as a reminder that the disease has remained stubbornly constant on the Vineyard.

"You would expect it to burn itself out quickly, especially on an island," said Sam Telford, an infectious disease specialist at the Tufts Cummings School of Veterinary Medicine who has been tracking tularemia on Martha's Vineyard. "It's puzzling why it's still around."

The cases this year have been concentrated among landscaping crews, although one patient was identified as an avid gardener, said Dr.

Fredric Cantor, state public health veterinarian.

In some cases, the disease appears to have been transmitted directly by the bite of an infected tick. In other cases, victims appear to have become ill after inhaling the bacteria.

Since the cluster of tularemia was discovered in 2000, researchers have regularly descended on the island to trap skunks, rodents, ticks, and other carriers of the disease. Tularemia is known colloquially as "rabbit fever" because that animal can also harbor it.

Telford said his research team has identified one swatch of land on the island where tularemia is endemic in ticks. He declined to provide specifics of the location, except to describe it as brushy, with elements of beach, grass, and marsh.

Scientists are also trying to figure out how bits of tularemia get into the air. Maybe, they theorize, it happens when lawn mowers zip across burrowing ticks infected with the germ. Or it could be wafting up from waste material deposited by wild animals.

"Trying to understand that," Telford said, "is really the toughest question, but the most important in terms of public health."

Dr. Michelle Jasny, a veterinarian practicing on the island since 1982, said she has witnessed lifestyle changes on the Vineyard that could explain why tularemia has emerged as a regular fixture of summer. There are more people living on the island, encroaching on natural habitats, she said.

"And we're stirring things up that haven't been stirred up," Jasny said.

"Twenty years ago, people didn't manicure their lawns. They left it wild."

The crews that do the manicuring are instructed to wear masks to prevent them from inhaling tularemia, but public health specialists concede that can be an oppressive mandate when laboring outside in the summer heat.

Once a year, a specialist from Brigham and Women's Hospital comes to the island to conduct a seminar for workers on protecting themselves and being vigilant for signs of the illness, which include sudden fever, dry cough, and headaches.

While landscaping companies continue to buy masks, interest from homeowners has waned considerably since 2000, said Amy Billings, a manager at Cottage City Outdoor Power Equipment in Oak Bluffs.

"That first summer that it came out, people were in a panic," Billings said. "They bought the masks and the whole nine yards. But it's really fizzled out since."

For Vineyarders tending to their yards or hiking paths, Cantor imparts this couture tip: Wear light-hued clothing, including white socks, because it's easier to spot ticks that have attached themselves.

"You may not make it into Vogue dressed like that," he said, "but it's a fashion statement we would endorse."

Stephen Smith can be reached at stsmithglobe.com. Editor Notes: (FOR USE BY NEW YORK TIMES NEWS SERVICE CLIENTS)