Although a Barnstable County health official reported earlier this month that two Cape men had died this year after contracting the Powassan virus, state health officials said last week that they do not have any reports of the tick-borne virus in 2017.

“Multiple patients with central nervous system disease in Massachusetts have been tested for Powassan virus this year,” Massachusetts Department of Public Health Deputy State Epidemiologist Catherine Brown wrote in an email. “At this time there have been no positive laboratory results, and therefore no confirmed or probable cases of Powassan reported in 2017 in Massachusetts.”

Barnstable County entomologist Larry Dapsis told the Barnstable County Assembly of Delegates June 7 that two Cape men, one from Falmouth and one from Sandwich, had died this year after contracting Powassan, which can cause swelling of the brain and injure the brainstem.

The state health agency had previously declined to confirm or deny any link between Powassan and the deaths, even without identifying information, citing privacy and confidentiality. But the policy of not confirming any specifics about these cases has led to confusion and concern from county health officials, who say they need that information to make sure people understand it's a possible diagnosis.

State public health officials have reports of 13 confirmed Powassan infections between 2013 and 2016, resulting in three deaths — one in 2015 and two in 2016, according to Department of Public Health spokesman Omar Cabrera.

But the deaths reported by Dapsis in 2017 could actually be those the state is reporting for 2016.

“Similar to the way information is presented for West Nile Virus, we can report total number of cases that occur in a year and total number of deaths,” Cabrera wrote. “Please note that cases are ‘counted’ in the year their illness starts and any deaths are attributed in that same year.”

Dapsis said he heard about the recent deaths on the Cape from the men’s widows, one of whom came to visit him at his office. The other woman introduced herself when he was doing a presentation at Falmouth Public Library, he said.

“New test reports are reported daily and this data is only current as of right now,” Brown wrote in her email.

State public health officials do not report Powassan cases by town, nor do they notify the public of cases the way they have when people have fallen seriously ill with mosquito-transmitted West Nile virus, to which Powassan is closely related.

But the potentially fatal virus has sickened Cape residents. Of three cases in Massachusetts in 2015, one was in Barnstable County. Of five cases reported statewide in 2016, two were on Cape Cod, state health officials said.

“They didn’t really diagnose me with Powassan until I had been in the hospital for about one month,” said Tucker Lane, 24, of West Barnstable, who counts himself lucky to be alive after contracting the virus in the summer of 2014.

Lane, who was living in Marstons Mills at the time and spending a lot of time outdoors, said he remembers pulling a couple of ticks off his hip and falling ill not long afterward.

“I had a very bad headache, a persistent headache that only got worse,” Lane said.

He went home from his job working for a plumber and napped for two hours, only to feel worse when he work up, with tremors, nausea and chills.

A medical center gave him antibiotics because of his tick-bite history, Lane said.

Antibiotics are routinely used in the fight against Lyme disease and other tick-borne bacterial illnesses including babesiosis, anaplasmosis and relapsing fever, or Miyamotoi.

But Powassan, which was little known in New England until a few years ago, is a virus for which there is no treatment except supportive care for patients sick enough to be hospitalized.

Lane couldn’t keep down his food, his vision got blurry and his memory fuzzy.

He went to Cape Cod Hospital, but he was so dehydrated that medical staff had a hard time finding a vein from which to draw blood, Lane said.

He said he spent the night at his father’s house, where his mother found him barely conscious the next morning.

An ambulance brought him back to Cape Cod Hospital, where an emergency room physician suspected him of abusing opiates because of the needle marks in his arm, not realizing they were from his visit to the hospital the day before, Lane said.

After hospital officials realized he did not need Narcan, they did a spinal tap and ran scans that showed swelling in his brain, he said.

Lane was rushed by ambulance to Brigham and Women’s Hospital in Boston, where he said he spent two weeks in the intensive care unit, including one week in a coma.

Severe Powassan can cause encephalitis of the deep structures in the brain that are crucial for consciousness and basic life functions such as breathing and blood pressure regulation, Dr. Jennifer Lyons, chief of Brigham and Women's division of neurological infections and inflammatory diseases, wrote in an email. 

Powassan can also cause swelling of the cerebellum, which “prohibits the normal flow of spinal fluid and can result in severe brainstem dysfunction and death,” Lyons said.

Other impairments associated with Powassan include seizures and meningitis, Lyons said.

Patients need to be supported with breathing tubes, artificial nutrition and blood pressure support, but survival is not assured, especially if the swelling in the brain is too great, said Lyons, who has seen about 10 Powassan cases since 2013.

Lane’s clinical symptoms, spinal fluid results and MRI findings were indicative of arbovirus encephalitis, Lyons said.

West Nile virus and Eastern equine encephalitis also are neuroinvasive arboviruses, but “Powassan was the test that returned positive,” said Lyons, who spoke of Lane's case with the patient's permission. 

 “I’m immune to it now,” said Lane, who spent a month at the Boston hospital followed by a week at Spaulding Rehabilitation Hospital Cape Cod.

He stuck close to home for a month after being released from the hospital and was unable to drive for a while, Lane said. He said he has made a complete recovery and the tick-borne virus is only a painful memory.

Other people have not been so lucky.

Between 2006 and 2015, eight people in the U.S. died from Powassan, according to the Centers for Disease Control.

Dapsis said one of the Cape men he was told had died of Powassan spent eight months in the hospital before succumbing to the effects of the disease.

Public health officials said they do not list Powassan cases by town because of the small number of cases.

And although state officials have announced the sex, county and age range of people who died of West Nile virus, they follow no such protocol for Powassan cases.

“DPH releases information about specific cases only when the recognition of that patient indicates a geographically current risk that requires immediate public health action,” agency spokeswoman Ann Scales wrote in an email. “Recognition of a Powassan virus is not indicative of increased risk in that specific area relative to any other area and the public health recommendations to avoid tick bites remain the same across all counties.”

Of the 13 confirmed cases in Massachusetts between 2013 and 2016, 12 patients were male, and ages ranged from 21 to 82, Scales wrote.

The journal of Clinical Infectious Diseases previously has reported that two Massachusetts men — one 82, the other 49 — died in 2015 and 2014 after contracting Powassan and demonstrating symptoms including dizziness, nausea, fever and headache.

It is unclear whether the Department of Public Health included those two cases in its report of three Powassan deaths. While the 49-year-old was diagnosed with Powassan, his death followed a motor vehicle accident in which he was not restrained.

Advocates for people with tick-borne disease said they would like the state to provide more detailed information about Powassan cases, especially when they result in fatalities.

“I’m a nurse. I’m just looking for a number,” said Barnstable County Public Health Nurse Deirdre Arvidson, who is also a member of the Barnstable County Tick-borne Diseases Task Force.

She heard there were two Powassan deaths in Barnstable County between 2016 and 2017, Arvidson said.

“You can’t seem to get a clear answer,” she said. “It’s frightening.”

Physicians and other clinicians need to know when cases occur so they consider Powassan when the symptoms fit, Arvidson said.

But not everybody who gets Powassan gets deathly ill.

While mortality rates were once thought to range between 10 and 60 percent, there is increasing evidence people have mild cases of the virus or remain asymptomatic even after being bitten by deer ticks carrying the pathogen, said Dr. Stephen Rich, whose medical zoology laboratory at the University of Massachusetts runs a tick testing program that is discounted for residents of Barnstable County.

Since January, three people on the Cape have been bitten by deer ticks found to have the Powassan virus, but the human hosts did not fall ill, Rich said.

Last spring, Powassan virus was found in four out of six Cape sites surveyed, Dapsis has said.

Edward Daniels, of Eastham, took an attached tick off his abdomen last year that tested positive in Rich’s lab for Powassan as well as tick-borne bacterial diseases Lyme and anaplasmosis.

“It was loaded,” said Daniels, 69.

The tick had not become engorged, but that’s scant reassurance when it comes to Powassan, which research shows can be transmitted to an animal host in 15 minutes.

Daniels said he feels lucky.

“I haven’t had any ill effects,” he said.

— Follow Cynthia McCormick on Twitter: @Cmccormickcct