Biting Back: Dr. Holly Donohoe’s personal struggle with Lyme disease inspires her new research focus on emerging tick-borne diseases in Florida
How these tiny pests can cause a major problem for the tourism and recreation industries and public health as a whole.
Shortly after Dr. Holly Donohoe joined the College’s department of tourism, recreation and sport management in 2010, she was diagnosed with three tick-borne diseases; a revelation that had a significant impact on her life and has ultimately become the catalyst for her new-found research focus.
Donohoe, an assistant professor, was born and raised in Canada, where she completed her studies in geography with a specialization in environmental management and how it relates to tourism and recreation. Prior to joining UF, Donohoe taught at two universities and also ran a consulting company that developed management plans for national parks and tourism destinations as well as marketing for international events.
“When I arrived here in 2010, it was a really exciting move for me,” she said. “I had always worked in a geography department, where no one really spoke the tourism language. To come here and work with people who were doing tourism and recreation – and to work with such a diverse faculty – that was really exciting.”
It wasn’t long before Donohoe was experiencing crippling symptoms from her disease. “I had just arrived as a new faculty and I was struggling with this disease and didn’t really understand what that meant. For the last two years or so I have been extremely sick, at times bed-bound.”
Donohoe experienced everything from cognitive problems where she couldn’t speak for days, to having seizures and being unable to walk or drive, she said. “During the time I was ill, I started looking at the literature to understand how it was that someone like me, who is trained in environmental management and who does so much of my work outdoors, could not know that this tiny little bug could cripple my life.”
She found that there are very few academic papers that discuss the links between outdoor recreation and tick-borne diseases, she said. However, the literature – including that from the U.S. Centers for Disease Control and Prevention – state that those people who are at the highest risk for tick bites are people who work or spend their leisure time outdoors.
Lyme disease is the most frequently reported vector-borne disease in the United States, stemming from the bite of an infected black-legged tick. Although Florida is considered a non-endemic area for Lyme disease, Donohoe said that during the last 10 years there has been a considerable increase in local cases of Lyme and other tick-borne diseases. Some ticks can transmit more than one pathogen, and people of all ages are susceptible to infection.
Tick-borne diseases are emerging infectious diseases in the United States. The number of Lyme disease cases have increased exponentially since national reporting began in the 1980s, Donohoe said.
“Through a series of different environmental factors we’re starting to see a change in the endemic areas where ticks tend to be associated. Many cases [in Florida] have been imported; Floridians visit the northeast and then come back with the infection,” she said. “A recent serological study by Dr. Clark at the University of North Florida confirms that the Lyme pathogen is here and it’s here to stay. We’re starting to see cases among people who have never left the state.”
Outdoor recreation is the second-most popular activity for tourists who visit Florida, and millions of people work in jobs that involve outdoor recreation – from employees in national forests and parks to golf course caddies and maintenance workers, lifeguards, tour guides and landscape architects.
“Because Florida’s number one industry is tourism and recreation, this puts us in position for a potential health, economic and tourism crisis,” Donohoe said. “That is what is driving my research.”
Although the catalyst was a personal experience, Donohoe’s research has become a justifiable research need that has significant public health implications. She recently completed intensive training in the School of Public Health and Health Professions at UF, where she learned everything from tick collection methods to running DNA sequencing tests that detect pathogens in serum from humans, or in the tick itself, she said.
The unique resources on campus have provided Donohoe with a foundation to build multi-disciplinary collaborations from areas ranging from medicine and epidemiology to geography and anthropology.
Donohoe has received grants from the Travel and Tourism Research Association, the Eric Friedheim Tourism Institute and the Emerging Pathogens Institute at UF for her research on tick-borne disease. Some of her grants will allow her to work with Florida parks to conduct tick collection and identifications as well as pathogen detection, she said. She’ll also conduct surveys to better understand what visitors – as well as employees – know about the risks of tick-borne diseases and whether or not they’re taking the recommended precautions to protect themselves.
Her $10,000 grant from the Emerging Pathogens Institute has allowed Donohoe to organize a tick-borne disease think tank that will take place in the fall. “This is a multidisciplinary session involving groups from across campus and the state of Florida,” she said. “Everyone attending has a direct or indirect interest in infectious diseases related to ticks.”
The goal, she said, is to facilitate dialogue on how the researchers can capitalize on the available resources and the potential collaborations that could be developed as a result. “We want to not only pursue and receive grants to do the research, but we want to conduct research that has value to protect the health and well-being of people who live in or visit the state of Florida.”
The think-tank will be the first time that people are brought together at UF to discuss this particular emerging public health issue.
“Nobody in the tourism and recreation field is looking at this problem,” she said. “We want to identify the key issues and key research needs as well as the projects that we are capable of moving forward immediately. We’re bringing people together to mobilize the expertise and get going with some studies.”
Tick-borne diseases such as Lyme disease are especially problematic because there is no vaccine, she said. The treatment varies among the diseases, but typically involves antibiotics. Additionally, the tests to detect the diseases are not perfect and can result in false negatives and positives.
“If you catch Lyme disease quickly, it can be treated effectively with 2-4 weeks of antibiotics. If you miss the early diagnosis and it’s not caught early, it can develop into very serious symptoms,” Donohoe said.
Those symptoms can include paralysis, joint problems, cognitive difficulties and heart problems. Even after treatment with antibiotics, patients are often left with residual deficits such as chronic arthritis, fatigue, cognitive problems, and chronic inflammation.
Donohoe, who spent much of her life outdoors for work and recreation, never thought she would be at risk for a tick-borne disease.
“The summer that I was infected in Canada, I spent a majority of my time trail running, whitewater kayaking, or I was in the parks completing recreational asset assessments. That’s what I did; that was my life at work and at play. Never once did I think, ‘I need to check my socks or my shoes, or my armpits and behind my ears.’ I didn’t know,” she said. “If I didn’t know then many other people don’t know either.”
As tick-borne diseases become an increasing concern in non-endemic areas like Florida, it’s becoming apparent that there is a great need for prevention and education, for tourists and residents alike. In addition, health practitioners need to be aware of the rise in cases so they aren’t wrongly diagnosing patients – as was the case with Donohoe.
“I went to the doctor because I had a large oval shaped red rash that appeared overnight. Its similarity to the classic erythema migrans or bull’s eye Lyme rash was missed and I was diagnosed with something else,” she said. “I went back three months later because I didn’t feel like I had recovered from that infection and it was five years before I was properly diagnosed.”
Although Donohoe is feeling better, she is dealing with residual effects on a daily basis. Despite her crippling experience, she isn’t hesitant at all about conducting tick collection and research.
“The reason I’m doing this research is because I would never want anyone to suffer from what I’ve been through,” Donohoe said. “In order to do this kind of work, I take precautions and accept the risks.”
The ultimate goal for Donohoe is to raise awareness and to prevent infections. “There are a lot of things that can be done. It is very easy to prevent a tick bite,” she said. “Parks, public land, and public health agencies can put up signs that state that this is a potential tick habitat – protect yourself. Another way is by circulating communications like advisory notices, brochures, or providing workshops to locals and visitors telling them how to take precautions. The goal is to prevent infection.”
In the future, Donohoe plans to continue collaborations across campus and the state, and potentially expanding the scope to include other emerging pathogens, such as those spread by mosquitoes. “We’re looking at a movement of pathogens that is no longer local or regional; we’re dealing with global health. We are dealing with a cumulative, evolving situation where this type of vector-borne health problem is not going away.”