HomeMy WebLinkAboutNantucket Tick-Borne Disease Committee Report - Revised 12 13 2009_201401231020330287
NANTUCKET TICK-BORNE DISEASE COMMITTEE
Report to the Nantucket Board of Health and Selectmen
November 16, 2009
Nantucket Tick-borne Disease Committee Report 2
COMMITTEE MEMBERS
Malcolm MacNab MD, PhD
Chairman
Scott White DVM, MPH
Vice-chairman
David Boyce
Tristram Dammin MD
John Goldman MD
Bruce Hopper MD
Meredith Lepore RN-NP
Kevin Madden
Beverly Mclaughlin
Elizabeth Trillos
Helene Weld RN
BOARD OF SELECTMEN LIAISON
Patricia Roggeveen
Nantucket Tick-borne Disease Committee Report 3
ACKNOWLEDGEMENTS
The Committee wishes to thank the following individuals for their assistance and contributions in
preparing this report and recommendations.
Richard Ray –
Nantucket Health Director
Sonja Christensen –
Deer/Moose Project Leader,
MA Division of Fisheries & Wildlife
James Cook –
Bartlett Tree Service
Rob Deblinger, PhD –
Deputy Director,
MA Division of Fisheries & Wildlife
James Dougherty –
Supervisor, Town of Shelter Island NY
Ariana Ganak –
Damminix® Tick-tube distributor
Daniel Gilrein –
Extension Educator & Entomologist,
Cooperative Extension, Cornell University
Rae Lapides –
Chairperson, The Shelter Island Deer
and Tick Committee
Tim Lepore, MD –
Nantucket physician
Sarah Oktay, PhD –
Managing Director, University of
Massachusetts Boston Nantucket Field Station
Laura Simon –
Field Director, Urban Wildlife Program,
Humane Society
Dave Simser –
Barnstable County Extension Service
Sam Telford III, DSc. –
Assoc. Prof., Tufts School of Veterinary
Medicine
Susan Walker –
Extension Associate & 4-Poster Deer Project
Coordinator,
Cooperative Extension, Cornell University
Mark Willett –
Wannacomet Water Company
Nantucket Tick-borne Disease Committee Report 4
TABLE OF CONTENTS
1 EXECUTIVE SUMMARY ................................................................................................................................... 5
2 OBJECTIVE OF THE COMMITTEE ............................................................................................................... 9
3 DEFINING THE PROBLEM .............................................................................................................................. 9
A. Tick-borne Disease on Nantucket ..................................................................................................... 9
B. Medical Aspects of Tick-borne Disease ......................................................................................... 10
C. Health Care and Social Costs Associated with Tick-borne Disease ............................................... 12
4 EPIDEMIOLOGY OF TICK-BORNE DISEASE ........................................................................................... 13
5 MODES OF INTERVENTION ......................................................................................................................... 15
A. Personal Protection ......................................................................................................................... 15
B. Tick Management ........................................................................................................................... 15
(1) Deer Control ...................................................................................................................................... 15
(2) Habitat Modification and Tick Reducing Landscaping ..................................................................... 21
(3) Acaricide usage ................................................................................................................................. 22
(4) Biological Control ............................................................................................................................. 26
(5) Mice Control ..................................................................................................................................... 26
C. Education ........................................................................................................................................ 26
6 MEASURING THE RESULTS ......................................................................................................................... 28
7 COST ANAYLSIS............................................................................................................................................... 30
8 DEVELOPING COMMUNITY SUPPORT ..................................................................................................... 31
9 REFERENCES .................................................................................................................................................... 32
Nantucket Tick-borne Disease Committee Report 5
1 EXECUTIVE SUMMARY
The high incidence of tick-borne disease on Nantucket Island represents a significant public health
problem that warrants intervention. The Centers for Disease Control and Prevention has listed Nantucket
among the top three Lyme Disease counties since 1992. Our first priority should be reduce the incidence
of human disease and the resulting medical problems but there are also social consequences that result
from the high incidence of tick-borne disease including the potential for a negative image of Nantucket.
Blacklegged (or deer) ticks can transmit several tick-borne diseases. Three tick-borne diseases transmitted
by the deer tick have been reported on Nantucket. Lyme Disease, human granulocytic anaplasmosis
(HGA), and human babesiosis all result from the spillover of pathogens that occur naturally within certain
wildlife. The enzootic (wildlife) prevalence and associated incidence of human cases rely on three key
animal species: blacklegged tick; white-footed mice; and white-tailed deer.
Nantucket has become an ideal environment for the proliferation of tick-borne disease. The change of the
landscape from an open to dense vegetation habitat created an ideal environment. The climate is ideal for
ticks. A large part of Nantucket is unbuildable 50 to 67% creating space for mice and deer.
There is a large population of white-footed mice and the artificial introduction of the white-tailed deer
without natural predators has permitted an unchecked growth in the deer population.
The blacklegged tick transmits the causal agents for all three of the tick-borne diseases over a two year
life cycle. Blacklegged tick numbers and distribution are directly linked to deer density, which is directly
related to risk. Habitat structure is an important co-factor.
We recommend an integrated long-term and sustainable approach to reduce the incidence of tick-
transmitted infections on Nantucket, comprising a program of:
(1) Managed deer reduction to fewer than 10 per square mile;
– reduction to be accomplished in 5 phases over several years
– long-term community support must be measured and obtained before starting any reduction
program
(2) Island-wide and individual property owner vegetation management directed at limiting human
exposure to ticks;
Nantucket Tick-borne Disease Committee Report 6
(3) Prudent use of pesticides (acaricides)
– the strategic use and deployment of Four Poster devices on an experimental basis at
appropriate locations such as high risk neighborhoods
– widespread spaying of acaricides in open areas of Nantucket is not recommended
– establishment of a program to monitor the level of acaricides in environmentally sensitive
areas
(4) Public education programs to include;
– personal protection instruction in our schools
– information for property owners on property landscape management
– information for our island visitors provided on the various modes of transportation to the
island and in hotels, inns and rental properties
– seminars by members of the Tick-borne Disease Committee and experts on the science of
tick-borne disease
(5) The development of an improved passive and active surveillance system to better measure the
incidence of tick-borne infection on the island to more accurately measure the results of the overall
program; and
(6) Continuation of the Nantucket Tick-borne Disease Committee in some form to execute, coordinate
and monitor the progress of the recommended activities.
We understand that a deer reduction program will be controversial; however, of the trick-borne disease
intervention methods considered feasible for use on Nantucket, we believe that reducing deer herd density
to 8-10 deer/sq mile is key to decreasing the enzootic prevalence and human incidence of tick-borne
diseases island wide.
For Nantucket to reach this density threshold, the island-wide herd of approximately 2,500 deer would
have to be reduced to 500 or fewer animals. The Massachusetts Division of Fisheries & Wildlife projects
that it will take 12-16 years of dedicated effort to design, implement, and conduct the phases of a
successful reduction program.
Nantucket Tick-borne Disease Committee Report 7
Once the density goal is reached, the deer density will have to be maintained in order to prevent tick-
borne disease resurgence. With a properly sustained maintenance program, other intervention methods
could be curtailed or discontinued.
Other deer management methods such as relocation or birth control are expensive, not practical, or
experimental.
Personal protection measures (protective clothing, repellents, tick checks, and landscape modifications)
need to be emphasized within our community and more information about protection needs to be
provided to our visitors.
The use of chemicals to reduce the tick density should be considered as complimentary to the overall
effort to reduce infection rates but used with caution because of our environmental sensitive island. The
most frequently used agent, permethrin, is known to be toxic to aquatic organisms. Biological control of
tick populations is experimental and not recommended at this time for Nantucket.
The Four Poster device consists of a central bin containing whole kernel corn used as bait and two
application and feeding stations at either end of the device. When deer feed on the bait, the device forces
them to rub their head, neck and ears against permethrin impregnated applicator rollers. The device
appears to be effective in reducing tick density but is not without problems and there are considerable
expenses in maintaining the device. The device should be complimentary to other tick management
efforts.
A widespread organized program directed at artificially reducing the mice population has no supporting
data indicating a reduction in tick-borne disease and may in fact alter the ecological predator-prey
dynamics of the Island.
Finally, we cannot implement a comprehensive program to reduce the incidence of tick-borne disease
unless we can adequately measure our progress. Deer density and tick density can be measured but the
only meaningful statistic is the incidence of human infection. The number of tick-borne infections
acquired on-island is under reported. Cases are misdiagnosed, some cases are diagnosed clinically
without laboratory confirmation and diagnosis is often made after departure from the Island.
Nantucket Tick-borne Disease Committee Report 8
In summary, we can reduce the incidence of tick-borne disease on Nantucket with an integrated long-term
effort of deer reduction, proper vegetation management, comprehensive personal protection education and
the strategic use of Four Poster devices. The program will not be successful unless there is an
understanding that this will be a continuing and long-term effort by the entire community. To help in
establishing community support, members of the Tick-borne Disease Committee are willing to conduct
seminars on the science of tick-borne disease and the Committee‘s recommendations over the next several
months. The Board of Selectmen should consider an Island-wide vote on the question of reducing the
deer population and the continuation of the Committee in some form to coordinate the overall program.
Nantucket Tick-borne Disease Committee Report 9
2 OBJECTIVE OF THE COMMITTEE
To provide the rationale for developing a sustainable plan to reduce the incidence of tick-borne
infections on Nantucket Island, and in particular, recommend specific actions.
3 DEFINING THE PROBLEM
A. Tick-borne Disease on Nantucket
Blacklegged (or deer) ticks (Ixodes scapularis [=I. dammini ]) can transmit several tick-borne diseases.
Three tick-borne diseases transmitted by the deer tick have been reported on Nantucket:
Lyme disease (Borrelia Burgdorferi);
Anaplasmosis (Anaplasma phagocytophilum) – also known as human granuolocytic anaplasmosis
(HGA) or previously as human granulocytic ehrlichiosis (HGE); and
Babesiosis (Babesia microti).
The Lone Star tick (Amblyomma americanum) with the capability to transmit anaplasmosis has been
increasing in density in the North Eastern US, but has not yet been identified on Nantucket.
The exact incidence of tick-borne disease on Nantucket is difficult to determine at his time. In addition to
anecdotal reports by citizens and the experience of Nantucket physicians, data are available to support the
conclusion that there is a high incidence of tick-borne disease on the Island that requires intervention.
The Centers for Disease Control and Prevention has listed Nantucket among the top three Lyme
Disease counties since 1992.1
Research performed in the 1990s estimated that the seroprevalence for Lyme disease in the
general Nantucket population is 12-18%.2
Statistics collected capturing emergency room visits and cases confirmed by laboratory diagnosis
of tick-borne disease by the Nantucket Cottage Hospital show the following number of cases for
2007 and 2008.
Table 1: Tick-borne Disease on Nantucket 2007 – 2008 3
Lyme Anaplasmosis
(Ehrlichiosis)
Babesiosis Total
2007 190 15 53 258
2008 325 17 69 411
The term ―tick-borne disease‖ as used in this document will refer to diseases transmitted by the blacklegged or
deer tick that have been reported on Nantucket. The term ―tick‖ or ―deer tick‖ will always refer to the blacklegged
tick.
Nantucket Tick-borne Disease Committee Report 10
We cannot conclude that there has been an increase in tick-borne disease from 2007 to 2008 because the
reporting system was not fully in place until 2008.
A survey conducted of the voting members of the Tom Nevers Civic Association in December
2008 and January 2009 reported that 60% of households responding had been infected with a
tick-borne disease – family members, guests or renters ever having a tick-borne disease reported:
61.3% with Lyme disease; 17.2% with babesisos; and 8.6% with erhrlichiosis. It is important to
realize that while the 37% response rate achieved for the survey was good for this type of survey,
there was some degree of ―response bias‖ - i.e. those who responded were very likely the ones
that had a very good reason to respond. This means that there may be some error in the
percentages reported but the overall conclusion of a high incidence of tick-borne disease is
correct.
The true incidence of tick-borne disease on the Island is difficult to determine for the following reasons:
Constant changing nature of our population – unknown and changing ―denominator‖;
Many cases are acquired on-island but diagnosed off-island;
Under reporting because of an inadequate reporting system (See Section 6 – ‗Measuring Our
Results‘ for a discussion of the reporting system);
Misdiagnosis; and
Failure to capture all the cases of Lyme Disease diagnosed clinically without laboratory
confirmation.
Committee Conclusion:
Taking all information together, we can conclude that there is a high incidence of tick-borne disease on
Nantucket Island and there is true public health problem that warrants intervention.
The medical consequences of tick-borne disease are summarized the next section
B. Medical Aspects of Tick-borne Disease
Lyme Disease: The Borrelia Burgdorferi bacterium is inoculated into the skin by the bite of the deer tick.
The bacteria replicate locally and then spread throughout the body. A skin rash develops in the majority
of people who develop symptomatic disease. This is the finding that leads to diagnosis of acute Lyme
disease in the majority of cases. The organism may localize in joints, heart or nervous system causing
Nantucket Tick-borne Disease Committee Report 11
symptoms in each of these areas. It also may lead to immunologic reactions that may lead to symptoms
of arthritis at later times. Fatality rates are extremely low to nonexistent.
The acute disease is diagnosed primarily by the skin rash, but may also be diagnosed in endemic areas by
the presence of the other symptoms, especially when tick exposure has been documented or suspected.
Blood tests are not useful in the acute phases of the illness since the antibody responses arise later in the
course of the illness (weeks to months). Epidemiologic factors are critical in that the disease is almost
always seen only in endemic areas and in persons who have had the opportunity for tick exposure. The
disease is much more likely in the months June, July and August, but may be seen year-round, especially
if there are pets in the house that may harbor the ticks. Acute Lyme is successfully treated with
appropriate antibiotics. A vaccine against Lyme disease was withdrawn from the market by 2002.
Aaplasmosis (ehrlichiosis): The Anaplasma phagocytophilum bacterium enters the bloodstream from the
bite of a deer tick. The organisms concentrate in circulating granulocytic white blood cells (neutrophils
and eosinophils) and travel throughout the body. They cause low white blood cell counts, low platelet
counts and elevated liver enzymes. Fever, chills, headache, loss of appetite, nausea, fatigue and muscle
pain are the most common symptoms. Fatality rates are extremely low (<1%). Treatment with
appropriate antibiotics is virtually always promptly curative and there are no long term sequellae.
Babesiosis: The protozoa Babesia microti enter the bloodstream after inoculation from a deer tick bite.
They localize and multiply in red blood cells in a manner similar to malaria leading to destruction of
infected red blood cells. There may be enlargement of the liver and spleen. Most cases in otherwise
healthy individuals are asymptomatic and self limited. The usual symptoms are fever, chills, muscle pain,
joint pain, nausea, vomiting and fatigue. Especially in persons who have previously lost their spleens or
have underlying immunologic diseases or malignancies, the disease may be severe. In the severe cases
failure of multiple organs such as lungs, kidneys or heart may ensue leading to significant mortality rates.
Diagnosis is usually made by finding the organisms in red blood cells on microscopic exam or by other
specialized blood tests. Treatment with combinations of appropriate anti-protozoa and antibiotics is
usually curative.
Three cases of ruptured spleens occurred on Nantucket in the past year.4
Nantucket Tick-borne Disease Committee Report 12
C. Health Care and Social Costs Associated with Tick-borne Disease
Medical complications from tick-borne diseases are our greatest concern, but there are social and
economic consequences resulting from a high incidence of these diseases that need to be considered.
Negative Public Relations: The negative public relations can be significant. Although it would be
difficult to quantify the economic impact on the Island, we must be concerned about potential visitors
who might fear to come to Nantucket. As a resort community, we rely on tourism revenue. This
summer local brokers heard from those renting in Madaket that because of the mosquito problem, they
will ―never‖ return to Madaket. This year many visitors did express the fear that one of their family
members might get a tick related disease. Today with social networking on the internet, the word may
spread faster. We know from the experience of other resort areas, when a negative public relations news
story focuses on an uncontrolled health problem or on a health and welfare issue, tourism revenue falls
off.
In the early 1970‘s, there was a significant tick related disease in the Land Between the Lakes
(north central Tennessee and south central Kentucky). This area is a destination area for hikers
and campers. There was a Lone Star Tick problem with an outbreak of tick related diseases
associated with the lone Star Tick. Traffic fell off to this region.
In 1993 there was significant breakout of the Hantavirus disease in the Four Corners region
(Utah, Colorado, New Mexico and Arizona). With 40 deaths in 17 western states, travelers,
hikers and campers reduced their travel to the area.
Medical Costs: Medical costs for physicians, medications, and laboratory costs can be significant. The
average cost is unknown, but it can range from $90 to $2,000 for treatment of the various tick-borne
diseases without medical complications treated as outpatients.5 Additional costs are incurred for patients
that require treatment of cardiac, neurological and arthritic complications or hospitalization. Medical
costs are shared by the individual, as well as the insurance provider.
Lost school and work time: For a child, lost school time can be significant, and it is often difficult for a
child to re-establish himself. There are many cases of Nantucket families losing wages because the
family wage earner had a tick related disease and could not work. We don‘t know about visitors who may
have contracted a tick related disease on the island, and then are home by the time the disease surfaces
and hopefully is diagnosed.
Nantucket Tick-borne Disease Committee Report 13
4 EPIDEMIOLOGY OF TICK-BORNE DISEASE
Lyme disease, human granulocytic anaplasmosis (HGA), and human babesiosis all result from the
spillover of pathogens that occur naturally within certain wildlife. The enzootic (wildlife) prevalence and
associated incidence of human cases rely on three key animal species:
Blacklegged tick;
White-footed mice; and
White-tailed deer.
The blacklegged tick transmits the causal agents for all three of these diseases. Black-legged ticks have a
two-year life cycle that is made up of 4 stages -- eggs, larvae, nymphs, and adults. The life cycle of the
blacklegged tick is summarized below in Figure 1.
Figure 1: Life Cycle of Blacklegged Ticks
[Centers for Disease Control and Prevention]
The total population of ticks is made up of two different, but overlapping, year-groups of ticks.
Depending on stage, ticks feed on a host for 3-7 days before falling off; each stage feeds one time, on one
host. In the first year, eggs laid in May hatch into larva in mid- to late July. After feeding, the larva drop
from the host and molt into nymphs that over-winter in the environment. These nymphs emerge the
following year in late spring, with peak feeding during May, June, and July.
Nantucket Tick-borne Disease Committee Report 14
Both larvae and nymphs feed on a variety of small mammals and birds, but the white-footed mouse is the
principle animal carrying the pathogens causing each of these diseases. Following the tick‘s life cycle,
larvae can acquire one or more of these pathogens when feeding on infected white-footed mice. If not
acquired as larvae, the resulting nymphs can acquire these pathogens the following spring when feeding
on infected mice. The enzootic cycle maintaining these diseases is completed when feeding nymphs,
infected as larvae the previous summer, transmit the pathogens to uninfected mice. Once nymphs drop
from the host, they molt into adults which appear in fall of the same year.
Adult blacklegged ticks do not hibernate; they can be active on warm winter days and the following
spring. White-tailed deer are the primary and preferential host for adult blacklegged ticks,6 but do not
serve as a source of infection to ticks and do not seem to be infected themselves. Adult ticks will feed on
other mammals (including rabbits), but these animals do not serve as effective replacement hosts and do
not maintain large tick populations. White-tailed deer are the essential key for blacklegged ticks to
successfully reproduce, to lay thousands of eggs (approximately 2000), and remain abundant.
Important epidemiologic factors affecting human disease risk:
Deer density levels, tick abundance, and human disease incidence are directly linked;
These diseases are transmitted to humans by infected nymphs or adults; larvae are not capable of
transmitting these diseases;
Ticks capable of transmitting disease are present year-round, but seasonal increases in risk are
related to high nymph activity during May, June and July due to high adult activity in the fall;
Nymphs generally transmit more disease than adults due to their smaller size and high nymphal
activity that coincides with increase human outdoor activity;
Each disease requires a minimal amount of tick attachment time in order to be transmitted to
people. Lyme disease requires 24-48 hours, about 36 hours for babesiosis, and 12-24 hours for
anaplasmosis hours; and
Risk of human infection is associated with deer and tick numbers, season of the year, outdoor
activities, expansion into tick laden areas, and degree of personal protective measures.
[References for Section 4 - ‗Epidemiology of Tick-borne Disease‘: 7,8,9]
Nantucket Tick-borne Disease Committee Report 15
5 MODES OF INTERVENTION
The key to reducing the incidence of tick-borne disease is based upon the ability to reduce the exposure
and probability of human contact with infected ticks. This can be accomplished at the
Personal level by
the use of appropriate protection and awareness;
source reduction around homes by proper habitat and landscape management;
the use of host-targeted pesticides (acaricides); and at the
Community level by
habitat and landscape management;
host-targeted pesticides (acaricides); and
deer reduction.
Education is an important component at both the individual and community level.
A. Personal Protection
Personal protection is the first line of defense against tick-borne disease and includes the wearing
appropriate clothing, use of tick repellents, daily bathing and prompt removal of ticks. Individuals can
also institute measures to reduce the tick burden around their homes. Actions that homeowners can take
are discussed below in Section 5B (2) – ‗Habitat Management and Landscaping‘. Personal protection
information should be part of any comprehensive educational program and will be discussed below in
Section 5C – ‗Education‘.
B. Tick Management
(1) Deer Control
Blacklegged tick numbers and distribution are directly linked to deer density.10 Deer are the primary host
for the adult blacklegged tick; deer feed most adult ticks and are key to the reproductive success of the
tick. Other potential hosts are not as important as deer.11 Islands in Narragansett Bay Rhode Island that
lack deer do not sustain deer tick populations even with alternative hosts available.12
There is a temporal correlation between the rise in the density of deer in the eastern U.S. and the epidemic
curve for Lyme Disease13,14 High incidences of Lyme Disease have been associated with deer
overabundance. Information generated from scientific studies and successful reduction programs indicates
that if deer herd density is reduced to or below 8-10 deer/sq mile, tick numbers (and the enzootic
prevalence of tick-borne disease can be lowered to levels that decrease risk of human disease. Notable
examples of successful reduction programs include:
Nantucket Tick-borne Disease Committee Report 16
Monhegan Island, Maine: The entire deer herd was eliminated during 1996–1999. No immature
blacklegged ticks were found on rodents by 2004, and by 2007, ticks were very scarce, if not
eradicated. Tick-borne disease is now reported as practically non-existent.15,16
Great Island, West Yarmouth, Massachusetts: The deer density was reduced from 30-50/sq mile
to fewer than 6 deer/sq mile and tick numbers were significantly reduced. Lyme Disease
infection rates were reduced from greater than 3 cases per 100 people to less than 0.2 per 100
people.17,18
Mumford Cove, Connecticut: An immunocontraception project failed and controlled hunts were
started in 2000 reducing the deer density by 92% from about 100/sq mile to 10–12/sq mile.
Subsequent Lyme Disease incidence decreased from 30 cases/year to 2-3/year within three
years.19
The Crane Beach, Ipswich, Massachusetts: Crane Beach is conservation and recreation
property without a residential human population. The deer population was reduced over a
seven year period from 160/sq mile to 27 deer/sq mile with resulting statistically significant
reduction in tick densities on mice.20
A deer reduction program in Bernards Township New Jersey did not reduce the incidence of Lyme
Disease. After three seasons the deer population was reduced 46.7% from an estimated population of
approximately 118/sq. mile to approximately 63/sq mile. There was no apparent effect on the numbers of
tick subadults and the Lyme Disease incidence did not vary with declining deer.21 The deer reduction
program failed to lower deer density to the recommended level of less than 10/sq mile in the relatively
short time of the three years.
Bernards Township is surrounded by several other towns of similar ecology and human population with
few impediments to deer movement. Monhegan Island, Great Island, Mumford Cove, and Crane Beach
are geographically isolated without the ability for deer to be repopulated from other areas.
An assessment of Lyme Disease risk (density of tick-infection prevalence of nymphal ticks) using a
model comparison approach was conducted using 13 year data on several field plots within Dutchess
County New York.22 The strongest predictors of risk were the prior year‘s abundance of mice and
Nantucket Tick-borne Disease Committee Report 17
chipmunks and abundance of acorns 2 years previously. The results showed that deer abundance had no
effect on temporal variation in Lyme Disease risk. This was an observational study – the researchers did
not manage the experiment and did not perform an intervention such as actively reducing the deer
population and the specific deer density used by the investigators is not clearly defined in the report. The
management of mice will be discussed below in section 5B (5) – ‗Mice Control‘.
It is important to understand that tick-borne disease existed in the environment before deer were
introduced to Nantucket. Following a successful deer reduction, these diseases would continue to exist at
a lower enzootic prevalence in the environment, but human incidence rates would be much less and other
intervention methods could be curtailed or discontinued.
Deer were not present on Nantucket and Tuckernuck before the middle to late 1800s. After being
artificially introduced, ample food and habitat along with the lack of natural predators have allowed the
deer herd to become overabundant. Healthy deer have a tremendous reproductive capacity and can
double their population every 2-3 years. On Nantucket, 95% of does deliver 2 fawns annually.
The Massachusetts Division of Fisheries & Wildlife (DFW) currently estimates about 2,500 deer on
Nantucket, for a density of 50 deer/sq mile. The DFW estimates deer herd populations using validated
models23 incorporating biological parameters taken from harvested deer presented at check stations during
hunting season. These estimates are considered particularly reliable for Nantucket because of the quality
of information historically collected. Some groups or individuals subjectively believe the herd is smaller
than the DFW estimate, but these figures are above 1500 or 30 deer/sq mile. Considering this and the
reliability of the DFW estimates, it is clear that conducting a deer census prior to a reduction program is
not necessary.
Notably, the ideal DFW deer management density goals for Nantucket and the tick-borne disease density
threshold are essentially the same. From a social carrying capacity perspective, DFW considers
Nantucket‘s deer population to be exceedingly high, with the ideal density goal to be 6-8 deer/sq mile.
According to DFW, ―these goals are scientifically established to maintain healthy deer populations in
balance with their environment (i.e. below the biological carrying capacity), at levels which allow
sustainable deer harvest and deer viewing opportunities for hunters and wildlife watchers, and at levels
that minimize impacts on public health and safety (i.e. below the cultural carrying capacity).‖ Additional
tangible social values to deer herd reduction include:
Nantucket Tick-borne Disease Committee Report 18
Fewer vehicular-deer accidents;*
Decreased natural and ornamental habitat destruction;
Possible reductions of mosquitoes and deerflies that feed on deer;
Potentially decreased risk of other emerging human diseases (i.e. Powassan related, Jamestown
Canyon and Cache Valley viruses) where deer are reservoirs; and
Decrease of tick-borne disease in dogs and horses.
Deer reduction on Nantucket
Hunting is the only practical method for reducing the deer herd on Nantucket. In general, public hunting
requires minimal municipal funding and is the most cost effective method to control free-ranging deer
populations. Non-hunting methods for reducing deer populations (birth control/sterilization, capture &
transport, etc) are currently either experimental or impractical for Nantucket. Presently on Nantucket,
public hunting harvests about 500 deer annually (20% of the population), which only maintains deer at
current density levels. Clearly, increased annual harvest rates are needed to reduce the density to 8-10
deer/sq mile.
Well managed expanded and/or special public hunting programs and/or professional sharp shooting have
been shown to significantly increase harvest rates. Based on DFW modeling, increasing Nantucket‘s
harvest rate to 35% of the population annually over 10-12 years would reach this density goal.24
DFW recommends that a reduction program on Nantucket be divided into several hunting stages. The
first hunting stage would use expanded/special public hunting programs over 5-6 years to reach an
interim density goal of 25-30 deer/sq mile. It is unlikely that local hunters would achieve a 35% harvest
rate alone; and hence it will be necessary to attract sufficient numbers of off-island hunters that participate
in the public hunting programs for this stage to succeed. As the interim goal is reached, the program
would need to be evaluated for modifications necessary to sustain the harvest rate during the second
hunting stage over a subsequent 5-6 year period. As deer numbers continue to decrease, deer would be
more difficult to harvest; hunter satisfaction and success will decline. If the needed harvest rate cannot be
sustained, additional special hunting and/or professional sharp shooting would likely be necessary to
reach the density threshold.
* MA Department of Transportation reports that there are less number of vehicle crashes on Nantucket than other
parts of the state, but Nantucket has double the rate of crashes (3%) attributed to deer compared to the statewide
percentage (1.4%).
Nantucket Tick-borne Disease Committee Report 19
Hunting laws in Massachusetts are a combination of Fish & Wildlife Board regulations and State
Legislature statutes. New York State has allowed ―nuisance‖ hunters on Shelter Island who can use herd
reduction methods including baiting and night shooting. Before implementing the first hunting stage, the
Board will have to approve changes to existing DFW deer hunting regulations. The Board would likely
support Nantucket-specific changes to the deer hunting season calendar and tag limits, but not changes to
the legal methods of hunting deer. DFW deer management specialists would provide technical assistance
for designing sound hunting programs that would be supported by the Board. The Board would require
any changes to be in effect for a minimum number of years (presumably not less than 5 years). If public
hunting is determined to be incapable of sustaining adequate annual harvest rates to reach density goals,
the Fish & Wildlife Board could consider additional regulatory and/or statutory changes (principally
changes that allow for efficient and successful sharp shooting) to be incorporated into the second hunting
stage.
Once the threshold density of 8-10 deer/sq mile is reached, continued hunting would have to maintain
deer density at this level in order to prevent resurgence of tick-borne diseases. Fortunately, maintenance
of this population density would be easier than reduction. With 500 deer island-wide, DFW models
indicate about 75 deer (or 15% of the population) would have to be harvested annually to maintain
density at 10 deer/sq mile. Presumably, public hunting by islanders could provide these harvest rates, but
if not successful, additional special hunting or professional sharp shooting would be needed. Without
adequate maintenance, the deer population on Nantucket could return to original levels in as quickly as
10-15 years.
The science of deer and tick reduction is correct; political, economic, and social factors are the major
obstacles to deer reduction. Any proposed deer reduction program can be expected to be controversial,
generating strong and emotional opposition from animal rights activists, local hunters, and public
members. The special hunt in February 2004 harvested more deer than expected and demonstrated the
effectiveness of a special hunting program to increase annual harvest rates, but subsequent public
opposition led to the cancellation of future hunts. Accordingly, these issues will have to be addressed
before a reduction program is implemented; DFW deer biologists can assist this process by providing
metrics for judging community support for deer management options. Cooperation from conservation
organizations, private individuals, and home-owner associations holding large tracks of land will be
needed in order to expand coordinated deer hunting into currently restricted areas. (Note: According to
Massachusetts laws, property owners that allow hunting without assessing fees are not liable for any
injuries to or by hunters on their property.) Although public hunting programs require little local funding,
Nantucket Tick-borne Disease Committee Report 20
municipal and/or private funding will be needed for a person(s) to oversee and coordinate the
comprehensive elements of a reduction & maintenance program and for professional sharp shooting, if
needed. An alternative would be the continuation of the Tick-borne Disease Committee in some form to
oversee the deer management program.
Professional sharp shooting costs in other reduction programs have ranged from $200 to $650 per deer.
Locally, hunters are accustomed to the success associated with the high deer density on Nantucket, and
some are opposed to herd reduction because it will make hunting less productive personally; gaining
support from this contingent is critical. (It should be noted that most of the mainland regions of
Massachusetts have densities near or below 15 deer/sq mile, and hunter interest and activity has not
dissipated.)
Although Nantucket‘s isolation from the mainland provides the opportunity to consider deer herd
elimination rather than reduction and maintenance, elimination is not considered feasible here.
Additionally, DFW does not have any deer herd statistics for Tuckernuck, making it unclear if a reduction
program is necessary on that island.
The distribution of venison to people-in-need has been successful in other locations.25 The method and
regulatory requirements need to be evaluated for possible implementation on Nantucket.
The exclusion of deer by fencing has been shown to reduce tick densities and may be considered as part
of landscape management.26 See Section 5B (2) – ‗Habitat Modification and Tick Reduction
Landscaping‘ below. Fencing in combination with pesticide usage and vegetation management has also
been effective in reducing tick density.27
Committee Recommendation:
Initiate a deer reduction and maintenance program in the following phases:
Phase I (1-2 years): Measure and develop long-term community-based support (including
support from land holding organizations and individuals) for a reduction & maintenance program.
Phase II (1-2 years): Design a sound program and pursue supporting regulatory changes with
DFW‘s guidance.
Nantucket Tick-borne Disease Committee Report 21
Phase III (5-6 years): First stage of expanded or special public hunting programs to reduce
density to 25-30 deer/sq mile. Evaluate need for additional reduction measures and supporting
regulatory/statutory changes.
Phase IV (5-6 years): Second stage of public hunting and additional reduction measures (e.g.
professional sharp shooting) that assist public hunting in order to achieve the threshold density of
8-10 deer/sq mile.
Phase V (forever): Ensure hunting programs maintain deer density at necessary levels to prevent
TICK-BORNE DISEASE resurgence.
(2) Habitat Modification and Tick Reducing Landscaping
Habitat modification complements other modes of intervention in reducing the risk of acquiring tick-
borne disease. Studies have shown that open-grass/sparse-shrub habitats contain fewer immature
blacklegged ticks than high shrub areas. Nantucket has undergone a significant change from an open to
dense vegetation habitat since the 1970s.
Tick densities are greatest on mice trapped from areas with more shrub cover and woody stem densities.28
In residential sites,
67% of host-seeking ticks that were collected came from woods adjacent to homes;
22% from the ecotone (transition area between two adjacent but different plant communities);
9% from ornamental vegetation; and
2% from lawns proper.29
The greatest risk of acquiring a tick-borne disease is therefore closest to homes.
In laboratory and field experiments, deer ticks are very sensitive to desiccation, requiring a microhabitat
with >85% relative humidity for extended survival.30,31 Brushy sites that maintain humid microclimates
are more conducive to the survival of ticks and their sessile stages (eggs, engorged subadults) compared
to open grassy areas. Excessive watering of grass will increase the humidity and promote a more
favorable habitat for ticks. Deer browse, and the ―edge‖ effects of shrub patches provide large areas for
browsing. Furthermore, brush allows deer to hide.
Committee Recommendations:
1. Landowners and homeowner associations should be encouraged to reduce brush in yards and
common areas as well as keeping grass cut with the minimum usage of water.
Nantucket Tick-borne Disease Committee Report 22
2. Conservation organizations should be encouraged to promote more grassland habitats and reduce
shrubby scrub oak thickets. Grasslands should be cut as short as possible.
3. Landscaping contractors should be versed in the above methods of property care.
Proper landscaping techniques are also important in reducing tick host mice numbers around homes (see
Section 5B (5) – ‗Mice Control‖).
(3) Acaricide usage
Pesticides, acaricides for ticks, are the most effective way to reduce ticks in a local area, particularly when
combined with landscaping changes that decrease tick habitat.32 However, there are risks associated with
pesticide usage and they should be used prudently. There are three acceptable methods with adequate
usage data for consideration: (1) area application of acaricides; (2) the Four Poster device to apply
acaricides to deer; and (3) Damminix® Tick-tubes. ―Bait box‖ systems that are presently available have
not been extensively tested.
Area application of acaricides
Area spraying is best applied in May or early June to target nymphal ticks, the stage most likely to
transmit tick-borne disease. Adults may be targeted by spraying in the fall (or in the spring if no fall
application was made). At least 400 Nantucket families apply the acaricide permethrin to their
properties.33
Permethrin is a member of the pyrethroid class of pesticides. Pyrethroids are highly toxic to fish and
other aquatic organisms, but generally are much less toxic to mammals, birds and other wildlife.34 We
need to be aware of any potential harm to our Nantucket ecosystem.
Committee Conclusions / Recommendations:
1. Widespread spaying of acaricides in open areas of Nantucket is not recommended.
2. Although shown to be effective, the Committee cannot support or condemn local use of
acaricides by individual family property owners until sufficient information is available to
demonstrate that the use is not detrimental.
3. A program needs to be established to monitor the level of acaricides in environmentally sensitive
areas of Nantucket.
Nantucket Tick-borne Disease Committee Report 23
The Wannacomet Water Company has agreed to measure permethrin levels as part of their ongoing water
quality monitoring at the well sites. Other sites should be tested and the University of Massachusetts
Nantucket Field Station has agreed to assist in organizing such testing providing funding is provided.
The estimated cost for this additional testing is about $10,000/ year.
Four Poster device
The Four Poster (4-Poster) device consists of a central bin containing whole kernel corn used as bait and
two application and feeding stations at either end of the device.
Figure 2: Four Poster Device
[American Lyme Disease Foundation, Inc]
When deer feed on the bait, the device forces them to rub their head, neck and ears against permethrin
(10%) impregnated applicator rollers. The Massachusetts Division of Fisheries and Wildlife consider the
4-Poster device experimental pending more information on safety and efficacy.
Studies have shown the device to be effective in reducing tick density. A study conducted by the U.S.
Department of Agriculture in five eastern states concluded that the 4-Poster technology to be an
efficacious, safe, and environment-friendly alternative to area-wide spraying of acaricide to control
populations of ticks. There was a 71% reduction in nymphal ticks after 5 years in the USDA study 35
Adult, nymphal and larval ticks were reduced by 91-100% from sample plots and nymphal and larval
ticks were reduced 70-95% on sampled mice in a study conducted at a NASA facility in Maryland .36
Other studies have also shown large reductions in tick populations following the use of the 4-Poster
device.37,38,39 There is an ongoing study at several sites on Cape Cod being conducted by the Barnstable
County, Cape Cod Cooperative Extension. The Cape Cod study has one study site on Nantucket at the
Linda Loring Nature Center and a control site around Almanack Pond. The Four Poster system is also
being evaluated by Cornell University on Shelter Island and Fire Island in New York State. There is no
hunting on Fire Island and Shelter Island has an expanded hunting season. The long term results from
Cape Cod and Shelter Island / Fire Island are not yet available.
Nantucket Tick-borne Disease Committee Report 24
Although results to date appear promising, some concerns are apparent: (1) The Massachusetts Division
of Fisheries and Wildlife prohibits the artificial feeding of deer because of fears of facilitating the
transmission of chronic wasting disease, and feeding deer is illegal during hunting season; (2) the
potential for ticks to develop a resistance to permethrin and may eventually reduce our limited personal
protection arsenal (this also applies to area spraying); and (3) the availability of excess corn may induce
an eruption of rodents. The attraction of rodents has been noticed in the Shelter Island experience.40
The State of New York Department of Health monitors the deer meat, liver and hides for levels of
permethrin from the Shelter Island Four Poster program. Results from the 2008 sampling indicated that
permethrin was detected in the meat from two of three deer from the treatment area and no permethrin
from one deer from a control area. Permethrin residues were not detected in liver samples from any of
these four deer. It is possible that the permethrin residues measured in meat resulted from hide transfer
during the dressing process. The amount of permethrin detected in the deer meat from Shelter Island, in
this very limited study, is below the tolerance levels established by the US Department of Environmental
Protection for cattle, goat and sheep meat.41 Preliminary test results for 2009 have not demonstrated any
residual permethrin levels on a limited number of deer.42
The USDA study concluded that 4-Posters need to be deployed at one unit per 21 hectares (52 acres) at a
cost of $52 per hectare. The landmass of Nantucket is about 12,380 hectares (30,590 acres or 48 sq.
miles). A cost estimates provided by Barnstable County, Cape Cod Cooperative Extension for a single 4-
Poster device in the first year is about $2000 per unit. The costs include: (1) the unit; (2) corn; (3)
permethrin; (4) labor – maintenance, removal during hunting season; and (5) miscellaneous expenses.
Costs will be less during the second year, but it is important to understand that a 4-Poster program would
need to be continued for several years, if not forever. Shelter Island maintains 60 Four Poster units
spending about $155,000 to $175,000 per year.43
There are several actions that would be required to implement a Four Poster system on Nantucket: (1) a
license will be required from Massachusetts Division of Fisheries and Wildlife; (2) professional pest
control operators with appropriate certification and licensing will be required to maintain the Four Poster
stations; (3) an assessment would be required to determine the number and best locations for installing the
devices; (4) approval from property owners – private and nonprofit; (5) finding a location for storage of
corn and other supplies; (6) review of potential liability issues; and (7) sustained funding of the project.
Nantucket Tick-borne Disease Committee Report 25
The Barnstable County, Cape Cod Cooperative Extension has offered to loan Nantucket the devices and
assist in establishing a Four Poster program. Yearly maintenance expenses would be the responsibility of
Nantucket. The Extension estimates the year cost at about $1500/ unit. Pending available funding, the
Extension would measure tick-density in target areas.
Committee Recommendations:
1. Strategic use and deployment of Four Poster devices on an experimental basis at appropriate
locations such as high risk neighborhoods and high human traffic areas.
2. Establishment of a collaborated effort with the Barnstable County, Cape Cod Cooperative
Extension to determine appropriate locations and installation.
Damminix® Tick-tubes
Damminix tubes are cardboard tubes filled with cotton balls treated with permethrin that mice collect to
build their nests. Ticks that feed on nesting mice in the spring and fall are exposed to permethrin.
The effectiveness of Damminix tubes is uncertain. Two studies in Connecticut44 and New York State45
failed to show any reduction in the number of infected, host-seeking nymphs when this product was used
for a three year period in woodland and residential areas. Lack of control may be due to failure by the
mice in some areas to collect the cotton or the presence of alternative tick hosts, such as chipmunks, an
important secondary tick host.46 Reductions in tick numbers were reported in a Massachusetts study.47
Committee Conclusion:
The Committee can not substantiate the effectiveness of the Damminix tubes; it is reasonable to assume
Damminix tubes are effective to some degree, particularly since Nantucket does not have chipmunks.
Bait Box Systems
A ―bait box‖ system, Maxforce®, which attracts mice and applies an acaricides to their bodies when they
enter, has been removed from the market because of low sales of the product. Other bait box systems
have not been extensively tested.
Committee Conclusion:
The Committee can not endorse the use or effectiveness of the bait box systems.
Nantucket Tick-borne Disease Committee Report 26
(4) Biological Control
Ticks have relatively few natural enemies, but the use of predators, parasites, and pathogens has been
examined for tick control including chalcid wasps, fungi, and nematodes. Biological controls with these
agents have not been extensively tested and are considered experimental and may interfere with typical
predator-prey dynamics.
Committee Recommendations:
1. The use biological controls are not recommended at this time.
2. Continue to follow the research and development of biological control systems.
(5) Mice Control
White-footed mice are a key intermediate host for tick-borne disease. The control of the white-footed
mouse is best accomplished by reducing mouse habitat near homes.48 Dense vegetation and ground cover
plants adjacent to homes provide cover for rodents as they forage for food. A widespread organized
program directed at artificially reducing the mice population has no supporting data indicating a reduction
in tick-borne disease and may in fact alter the ecological predator-prey dynamics of the Island.
Committee Conclusions / Recommendations:
1. Property owners should be encouraged to take action to limit the habitat for mice within their
property.
2. Artificial island-wide attempt at reducing the mice population is not recommended.
C. Education
Education should be readily available to the island citizen, property owner, renters and the day visitor. It
should emphasize not only the tick and tick-borne diseases, but should stress the personal responsibility
of all to avoid ticks:
daily skin checks for ticks
scrubbing daily with a long handle bathing brush
protective clothing
repellant use
Education should extend to the homeowners so they can manage their property to kill or to reduce the tick
population.
maintain grass at 3 inches or less around buildings
Nantucket Tick-borne Disease Committee Report 27
consider spraying the perimeter of properties contiguous to wild as well as foundation plantings
with an acaricide
use of pet collars and consider the placement of products such as Damminix®
trim perimeter hedges and brush
installing high unobtrusive green metal fencing either electric or non electric to deter deer
Children must repeatedly receive instruction that provides the basis for risk reduction. Nantucket
Schools must be involved in tick and tick-borne disease awareness because information taught in the
classroom gets disseminated to the home. A Nantucket slogan and poster campaign can start in the
elementary school with a contest to develop a catchy, succinct and visible message for Nantucket Tick
Awareness. The Barnstable County School system has been the local leader in tick education and related
programs.
Committee Recommendations:
1. Engage civic associations for their organizational, volunteer and fund raising abilities: Civic
League and its 23 local groups, Garden Club and Rotary Club and neighborhood associations
such as Toms Nevers, Naushop, Nashaquisset, Hedge Row and Underhill.
2. Introduce an education awareness program in the Island schools using the Barnstable program as
a model.
3. Work with island schools to develop posters, events and a film on tick and tick-borne disease
awareness.
4. Disseminate the posters perhaps designed by the school to the public venues for people carriers:
air lines, airports, ferries, ferry terminals, taxis, buses, tour guides, and bicycle shops.
5. Disseminate tick-borne disease information to inns, hotels and rental properties.
6. Communication channels should be engaged. Local media should be approached to publish:
newspapers – Independent and Ink and Mirror, TV channels – 17 and 22 and realtor trade
organization - NAREB. Service companies that have direct link to home owners: Landscapers,
National Grid and Wannacomet Water.
The Education sub-committee of the Tick-borne Disease Committee has had preliminary conversations
with several of the groups cited in its recommendations and there has been full support.
Nantucket Tick-borne Disease Committee Report 28
6 MEASURING THE RESULTS
The objective endpoint of all the above efforts is only valid if we can accurately measure the before and
after incidence of tick-borne diseases. This is dependent upon accurate reporting by the Nantucket
Cottage Hospital and the individual private practice physicians. To date it is fair to say that there is
significant underreporting of the tick-borne incidence due to several factors:
Failure to accurately ―code‖ the illness with the correct ICD code.1 Every health condition can be
assigned to a unique category and given a code. ICD are codes used for billing purposes and to
organize the collection of medical statistics. An example of incorrect coding would be to code a
case of Lyme Disease coded as a ―skin rash.‘‘
Failure to report timely reports of positive laboratory tests.
Failure to capture all the cases of Lyme Disease diagnosed clinically without laboratory
confirmation.
Misdiagnosis
Diagnosis after departure from the Island.
Committee Recommendations:
1. Enlist the support of Massachusetts General Hospital Physicians Organization to provide
computer lists of appropriate ICD codes for Tick-borne diseases reported on Nantucket. All but
one Nantucket physician belong to this organization.
2. Education of seasonal physicians regarding the incidence, signs and symptoms of tick-borne
diseases to heighten awareness and improve accuracy of diagnosis.
3. Enlist support of Nantucket Cottage Hospital and the private physicians and emphasize the
importance of accurate numbers.
4. The Board of Health should consider introducing a local active reporting system on Nantucket
with a part-time employee to collect and collate the data.
We have formally requested the information from the Mass General Physicians Organization and are
waiting a reply.
In-direct measurement of success determined by entomological surveillance (tick density, tick infection
rates) would be helpful, although difficult to apply to a large area such as Nantucket. Repeated testing in
target areas and around 4-poster sites would provide useful information. It is possible that the state would
1 International Statistical Classification of Diseases and Related Health Problems
Nantucket Tick-borne Disease Committee Report 29
require some degree of entomological surveillance in order to obtain licensing for a 4-Poster program.
Entomological surveillance should be part of the overall tick-borne disease reduction program. Academic
institutions may wish to perform this testing with funding obtained through granting organizations.
Estimated costs range from $15,000 to $150,000 / year depending upon the scope of the work.
Nantucket Tick-borne Disease Committee Report 30
7 COST ANAYLSIS
The following table lists the estimated costs of the various proposed recommendations. The amounts
should be considered as estimations and derived from various sources.
Table 2: Estimated Costs for Reducing Tick-borne Disease on Nantucket
Year 1-5/6 Year 5/6-11+
Hunting – Minimal local funding ; individual
hunters pay licensing fees
– Depends on how well the public
hunting has reduce the herd, and
the estimated costs can really
only be determined in this time
frame; sharpshooting cost will
range from $200 – 650 per deer
based upon 2009 dollars
Acaricide
measurements
– Well testing by Wannacomet Water
– Additional site testing: $10-15,000/
year depending upon the scope*
– May not be necessary pending
outcome of testing
– May not be necessary pending
outcome of testing
4-Poster – Up to 25 devices on-loan from
Barnstable County Extension
– Shipping and transportation costs:
TBD
– Maintenance: $1500-2900 / year/
device**
– Liability insurance: TBD
– Entomological surveillance: TBD
– If successful, replacement cost
per device ~ $500 / device
– Transportation costs for
Barnstable County Extension
personnel
– Maintenance cost continues
– Liability cost continues
– Entomological surveillance cost
continues
Education – Education posters, handouts etc.
$500-600 / year
– School education program: TBD
– Education posters, handouts etc.
cost continues
– School education program cost
continues
Measuring results – Passive and active surveillance to
measure human disease: $4-5000/
year
– Entomological surveillance: $15,000
- $150,000/ year
– Passive and active surveillance
cost continues
– Entomological surveillance cost
continues
* May not be necessary for the entire 5 year period, pending results ** Shelter Island expenses: $2600-2900. Barnstable County Extension estimation: $1500
Nantucket Tick-borne Disease Committee Report 31
In addition to direct local government funding, other options should be considered. The Shelter Island
New York tick-borne disease reduction program receives funding from the State and local governments as
well as a not-for-profit foundation. The foundation was specifically established to fund the project. A
similar non-profit organization should be considered for Nantucket. Homeowner associations may wish
to fund 4-Posters devices around their neighborhoods. Fund-raising events may be considered to fund
the installation and maintenance of 4-Poster devices.
Academic institutions may be interesting in applying for grant funding from organizations such as the
CDC, NIH and USDA for entomological surveillance. External grant support would most likely not be
available to directly support deer reduction but would support collecting the entomological surveillance
surrogate endpoint data and possibly the outcome of the entire integrated program.
Worcester Polytechnic Institute is considering providing students to work of the project in September and
October 2010. How we would use these interns has not been decided.
8 DEVELOPING COMMUNITY SUPPORT
Tick-borne disease is a problem affecting all members of the community, either directly by acquiring an
infection or indirectly by involving friends and relatives or potentially by an impact on the economic
wellbeing of the Island through negative publicity. A deer reduction program is always controversial.
The special hunt in February 2004 demonstrated the effectiveness of a special hunting program but
subsequent public opposition led to the cancellation of future hunts. There was resistance by some
members of the Shelter Island New York community to the introduction of a 4-Poster program. We
cannot go forward with our recommended program, especially the proposed deer reduction program,
without community support.
Committee Recommendations:
1. Members of the Tick-borne Disease Committee and tick-borne disease experts should conduct
seminars on the science of tick-borne disease and the Committee‘s recommendations over the
next several months.
2. The Board of Selectmen should consider an Island-wide vote on the question of reducing the deer
population.
Nantucket Tick-borne Disease Committee Report 32
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