Dr. June Nymph sits in her cramped office at the Massachusetts Department of Public Health, surrounded by tick surveillance maps that look increasingly like a military invasion chart. Yes, that's her actual name. No, it's not a professional pseudonym, though she's spent two decades explaining this to colleagues who assume she's committed to an elaborate bit. As the state's Vector-Borne Disease Coordinator, she's spent fifteen years watching the red zones creep across the Commonwealth, documenting an expansion she predicted but couldn't prevent. Her specialty is medical entomology, which means she knows more about tick reproductive cycles than anyone should, and she's developed the kind of mordant humor that comes from watching your worst-case scenarios materialize on schedule.

We meet in late March, when the nymphal ticks (the life stage she's named after, the ones that pose the greatest risk to humans) are just beginning their spring emergence. Outside her window, Boston is experiencing one of those deceptive 60-degree days that feels like a gift but actually means tick season has already started. She's just returned from a meeting about the state's Lyme awareness campaign, scheduled for May as always, and she's in a mood.

So May is Lyme Disease Awareness Month. How's that going?

June: [laughs] May is when we tell people to be careful about ticks, which is a bit like announcing Hurricane Awareness Week in October. By May, we're already in the thick of it. The nymphal ticks—the tiny ones, size of a poppy seed, the ones that actually transmit most Lyme cases—they're out there looking for blood meals in April now. Sometimes late March if we get a warm spell.

But the awareness campaigns are all scheduled for May because that's when they've always been scheduled, and changing government timelines requires approximately seventeen committee meetings and an act of God. I've been trying to move our messaging earlier for five years. Five years. Meanwhile, I'm getting calls in February from people who found ticks on their dogs after a warm weekend. February!

We used to have a solid four months when ticks were dormant. Now we get these warm snaps in winter and they're active again. I had a case last year—a guy found a tick on himself in late January after walking his dog in Franklin Park. He thought it was a piece of dirt until it moved.

What does that kind of seasonal shift actually mean for your work?

June: Constant catch-up. Our whole surveillance system was built around a predictable tick season. Late spring through early fall, peak risk in June and July. That's when we'd deploy our field teams, do our tick drags, collect specimens, run our analyses. Nice contained season.

Now? I've got tick activity basically year-round except when the ground is frozen solid, which is increasingly rare.

And it's not just longer seasons. The geographic range is exploding. When I started this job in 2010, we had Lyme cases concentrated in the usual spots—Cape Cod, the Islands, some suburban areas west of Boston. Now I'm seeing cases from neighborhoods in Dorchester, Roxbury, Mattapan. Urban Boston. We're finding established tick populations in city parks.

I had a case last summer—a person experiencing homelessness, sleeping on a bench in Franklin Park, came in with not just Lyme but Babesiosis. That's a malaria-like protozoan infection that can be fatal if you're immunocompromised.¹ That's when you know the ticks have really moved in. They're not just in the suburban woods anymore. They're in the city, finding hosts wherever there's a bit of green space and some mice and squirrels.

You mentioned Babesiosis. Most people have only heard of Lyme disease.

June: Oh, Lyme is just the opening act. We've got at least four other tick-borne diseases circulating now—Anaplasmosis, Babesiosis, Powassan virus, and Borrelia miyamotoi. They're all increasing.²

Powassan is the scary one. It can transmit in fifteen to thirty minutes of tick attachment, compared to Lyme which usually takes at least thirty hours. And it's a virus, which means we have no treatment. Case fatality rate is about ten percent, and survivors often have permanent neurological damage.³

The thing is, our public health messaging is still overwhelmingly focused on Lyme because that's what people know. But I'm watching these other diseases creep up in our surveillance data, and we don't have good systems for tracking them. Lyme is a reportable disease, so we get case counts, even though they're massively underreported. But the others? We're flying blind. We think Anaplasmosis cases are increasing, but our surveillance is patchy. Babesiosis isn't even reportable in all states.

And here's the kicker—people can get co-infected. Multiple pathogens from a single tick bite. I've seen cases with Lyme and Anaplasmosis together. The symptoms overlap but the treatments are different. It's a diagnostic nightmare.

What's it like trying to track all this with patchy surveillance?

June: [long pause] You know how sometimes you're trying to have a conversation with someone but you can only hear every third word? That's what our surveillance system feels like. You know something important is being said, you can catch the general drift, but you're missing crucial details.

Our surveillance system is built on passive reporting—doctors diagnose cases and report them to us. But that only works if people get tested, if doctors think to test for tick-borne diseases, if the tests are accurate, if the results get reported. There are so many points where cases fall through the cracks. We estimate the actual number of Lyme cases could be seven times higher than what's reported.⁴ Seven times!

And we don't have good integrated data systems. I should be able to pull up a map showing where we've detected high tick populations, overlay it with humidity and temperature trends, cross-reference with public park usage data, and identify high-risk areas for targeted interventions.

But that would require linking environmental data, wildlife data, and human health data across multiple agencies and systems that don't talk to each other. Instead, I've got a bunch of Excel spreadsheets and some graduate students doing tick drags in the summer.

Tick drags?

June: It's exactly what it sounds like. You take a white flannel cloth, drag it through vegetation, and count how many ticks latch on. Very high-tech. [laughs] We've been doing it the same way for decades.

It gives us a rough sense of tick density in different areas, but it's labor-intensive and we can only sample a tiny fraction of the landscape. And it doesn't tell us anything about infection rates in those ticks unless we bring them back to the lab and test them, which is expensive.

Meanwhile, ticks are expanding into new areas faster than we can survey them. The CDC data shows the number of counties reporting blacklegged ticks has more than doubled in twenty years.⁵ We're always catching up, documenting spread that's already happened rather than predicting where it's going next.

Is there anything that would actually help?

June: Money. [laughs] I mean, yes, there are lots of things. Better surveillance infrastructure. Integrated data systems. More field staff. Public awareness campaigns that start in March instead of May. Research into tick behavior and ecology. Development of better diagnostics and treatments. A Lyme vaccine would be nice—there's one in development, but it's not here yet.⁶

And that requires a shift in how people think about risk. You don't just check for ticks after hiking in the woods anymore. You check after walking your dog in the neighborhood park. After your kid plays in the backyard. After sitting on a bench. Ticks are part of the urban and suburban landscape now, and people need to adjust their mental models.

How do you talk to your own family about this?

June: [pauses] My kids are teenagers now, and they're so over my tick lectures. But yeah, we check for ticks. Every time they come in from being outside, even if it's just shooting baskets in the driveway. I keep tweezers in every bathroom. We use permethrin on our outdoor clothes. We avoid sitting directly on the ground. It's just part of our routine now, like washing hands before dinner.

But I'll be honest—I think about it more than I want to. Every time I see them heading out to meet friends at a park, part of my brain is calculating risk. And I know too much. I know that nymphal ticks are most active in spring and early summer. I know that they're often found in leaf litter and low vegetation. I know that a lot of infections happen in people's own yards, not on hikes. I know that the symptoms can be subtle and the tests aren't perfectly accurate.

So yeah, I worry. And I feel a bit helpless sometimes, because I'm the state coordinator for vector-borne diseases and I can't even fully protect my own kids. I can reduce their risk, but I can't eliminate it. Nobody can. That's just the reality of living in the Northeast now.

What do you think this looks like five years from now?

June: More of the same, but worse. Longer tick seasons, broader geographic range, higher case counts, more co-infections. We might have a Lyme vaccine by then, which would be huge, but it won't address the other diseases. And vaccines only work if people get them, which means overcoming vaccine hesitancy and ensuring access and affordability.

I think we'll see continued urban expansion. More ticks in city parks, more cases in urban populations. That's going to require different public health approaches because the traditional "avoid wooded areas" messaging doesn't work when people are getting infected in their own neighborhoods.

And I think—I hope—we'll see better surveillance and data systems. But that requires sustained investment and political will, and public health funding tends to spike after crises and then decline when people stop paying attention. We're not good at sustained investment in prevention.

Do you ever think about leaving this field?

June: All the time. I could make more money in the private sector doing literally anything else with my degree.

But somebody has to do this work. Somebody has to track the ticks, analyze the data, sound the alarm, try to get people to pay attention. And despite everything—the inadequate funding, the bureaucratic frustrations, the feeling that we're always playing catch-up—I still think it matters.

Plus, I'm named June Nymph. I was basically destined for this. [smiles] My parents thought they were naming me after my grandmother and the month I was born. They had no idea they were creating a vector-borne disease coordinator.

The universe has a sense of humor.

Footnotes

1. https://www.bu.edu/articles/2025/tick-borne-diseases-risk-increase ↩

2. https://pmc.ncbi.nlm.nih.gov/articles/PMC10587693/ ↩

3. https://pmc.ncbi.nlm.nih.gov/articles/PMC10587693/ ↩

4. https://healthjournalism.org/blog/2024/04/lyme-disease-on-the-rise-as-climate-change-expands-tick-range/ ↩

5. https://www.caryinstitute.org/our-expertise/disease-ecology/lyme-tick-borne-disease/climate-change-and-tick-borne-disease-risk ↩

6. https://www.bu.edu/articles/2025/tick-borne-diseases-risk-increase ↩