Many Tufts students first learned of eastern equine encephalitis (EEE) on Aug. 16; the rare mosquito-transmitted virus has affected nine Massachusetts residents since its initial outbreak in August. In a mass email sent days before the beginning of first-year pre-orientation, the Tufts Department of Public Safety warned students of this disease, which can cause brain swelling or paralysis in its victims.
“The Massachusetts Department of Public Health announced today the first confirmed human case of eastern equine encephalitis (EEE) in the Town of Grafton,” read the email, which provided a link to press EEE prevention tips from the Grafton Board of Health Department. “We’ll ask that you read this information and take appropriate prevention procedures.”
When asked what students should know about the disease, Tufts Medical Director of Health Service Dr. Margaret Higham explained that EEE strikes quickly and with prominent symptoms.
“EEE causes inflammation of the brain,” Higham said. “The signs of inflammation of the brain are severe, persistent headache, vomiting, often not really knowing what’s going on — kind of being out of it, we call that change in mental status — trouble walking. They’re not subtle symptoms.”
Although the Medford-Somerville region currently faces low risk of the virus, Higham did not rule out the possibility that EEE could spread to Tufts.
“Usually the first warning about EEE will be rising numbers of mosquitoes in a particular area who are carrying the virus,” Higham said. “Up till now that virus hasn’t been found in … the more urban areas where there are fewer mosquitoes. But city health departments are continually monitoring from all different areas of the state, so more information will be coming along.”
Despite the uncommon nature of EEE, some Tufts students whose hometowns have previously been at risk for the virus are familiar with its impact. A recent Boston Globe piece highlighted concerns regarding EEE in the wooded town of Easton, Mass., where Tufts senior Danielle Blelloch and sophomore Sarah Pircio call home.
“I feel like [EEE] has impacted my community because it’s a rural suburban town,” Blelloch said of Easton. “Being told you can’t be outside during the most beautiful months of the year is frustrating. There is fear associated with it.”
In a community surrounded by protected lands and state parks, Blelloch said that news of the outbreak sent residents inside for the rest of the summer out of fear they might contract the disease.
“I was home for four days before college [with] my friends from high school, and we couldn’t do a lot of the things we do together … we were all on the cross-country team together, but you couldn’t go for runs. You couldn’t go swimming because a lot of people were tarping their pools,” she said.
Blelloch said that she has been surprised to discover that many Tufts students are unfamiliar with EEE, as she remembers the disease from past outbreaks.
“If you look up the science behind EEE, it comes in cycles,” Blelloch said. “I remember when I was in fourth or fifth grade, there was one summer when it was worse — it happened earlier. I remember not being allowed to play outside and that being the worst thing ever.”
Because EEE is carried by mosquitoes, Higham explained that wooded areas like the town of Easton are most at risk for the disease.
“You tend to find those infections in more rural areas,” Higham said. “They come from mosquitoes, and mosquitoes breed in standing water, areas where there’s lakes and streams and things aren’t as developed.”
To prevent students and fans from spending time outside during dusk, Easton’s Oliver Ames High School recently rescheduled its Friday night football games to take place during the day on Saturdays. Pircio said she believed such a shift would change dynamics of student life at her alma mater.
“[Football] was a social event. A lot of people went to hang out and watch … it definitely would have changed the social aspect of it,” Pircio said on the shift. “During the day it’s not going to be the same.”
Tufts Department of Public Health Associate Professor Paul Beninger emphasized the importance of staying inside during dusk hours to avoid the risk of being bitten by mosquitoes carrying EEE.
“When that interval of risk is, which is towards sunset, I think that’s the time that you should not be outdoors playing frisbee,” Beninger said. “That’s when you should be indoors. By the time you end up going in for dinner, I would say stay inside for the next interval of time until we know the risk has passed.”
Beyond exercising caution when outdoors near dusk hours, Beninger also recommended minimalizing unprotected skin when outside.
“The risk is depending upon how exposed you are,” Beninger said. “Long sleeves, and pants, and reasonable cover is going to reduce that risk.”
He noted that the disease is maintained in nature by a species of mosquitoes that feed on the blood of birds — which are an entirely different class of mosquito than those capable of infecting humans or horses with EEE.
“It could well have been and is likely to have been having an ongoing cycle of infection, release, infection, release, with regard to birds for years before it reached the level of population density to then for example allow it to be picked up by … the two species of mosquitoes that transmit the virus to humans and horses,” Beninger said.
Beninger also noted that “aerial spraying” will take place in parts of Massachusetts, a practice designed to quickly reduce populations of mosquitoes through aerial applications of insecticide. While the products used in such efforts pose a low risk to humans, Beninger stressed that they are proven to eliminate mosquito populations with efficiency.
“There are very good sprays to reduce [the] population of mosquitoes. That’s probably the other thing you may want to be aware of, if there’s increased helicopter flights; they’re very effective,” he said.
Beninger said that Tufts students can minimize the possibility of contracting EEE through simple precautions.
“Cover yourself, be indoors at sunset — those are the biggest factors I think that students really need to pay attention to. That will essentially eliminate the risk,” Beninger said.
Pircio said that she had remained cognizant of EEE while planning to return to Tufts from Easton this fall.
“It’s not a huge impact, but it’s definitely something that’s in the back of our minds,” Pircio said on the news of the outbreak. “At night as I was packing for college, I was thinking … we should not be making all these trips to the car.”