For Maureen Fuller of Middleborough, summer weekends once meant camping among the trees and under the stars.
But this month, when the first human case of Eastern equine encephalitis since 2013 was confirmed in Massachusetts, Fuller did not leave the house for two days.
Just a few months ago, her husband, Jeff, died following a grueling eight-year battle with the mosquito-borne virus.
Since early August, four people in Massachusetts have been infected with EEE, most recently a Fairhaven woman who died Sunday. The cases mark the beginning of a new, intense cycle of EEE activity that will likely persist for two to three years, according to Catherine Brown, epidemiologist for the Massachusetts Department of Public Health.
On Monday, the department added Methuen to its growing list of communities at “critical” risk for EEE, bringing the total to 24. Residents in cities and towns at critical risk are urged to use caution and “limit outdoor activities after sunset.”
Jeff Fuller was 43 when he was infected during the state’s last big EEE cycle, from 2010 to 2012; the last human cases were reported in 2013, according to the state.
“Never in a million years did we think one mosquito bite could take down a person,” Maureen Fuller said. “We would worry about elderly people and children, but my husband was a hulk of a man. Over 6 feet and 280 pounds.”
Even during an intense cycle, EEE infection in humans is extremely rare. Just 28 people in Massachusetts have been diagnosed with the disease since 2004, according to the Centers for Disease Control and Prevention. From 2009 to 2018, Massachusetts logged 10 cases of EEE, trailing Florida by three cases for the most in the nation, according to the CDC.
But the virus is particularly deadly — with a 40 percent mortality rate — and cruel even to those who survive. Like Fuller in the years before his death, the majority of survivors will suffer from some type of long-term neurological deficit, according to Brown. There is no vaccine or specific treatment for EEE infections in people.
EEE was first recognized in 1831 when dozens of horses in Massachusetts died from encephalitis. Mosquitoes and wild birds, especially in the East and Gulf coasts of the country, are conduits for it.
The virus is transmitted when a mosquito bites an infected bird, then bites another mammal, such as a horse, goat, or human. The virus then targets the mammal’s central nervous system and causes encephalitis, or severe swelling of the brain.
Maureen Fuller recalls seeing her husband swat at pesky mosquitoes while emptying grass clippings into the woods one day in late August 2010. The yard work was bookended by camping trips, so any mosquito that bit him around that time could have passed on the virus. The CDC warns the incubation period, or the time from a mosquito bite to the onset of the illness, is four to 10 days, so the moment of Fuller’s transmission remains a mystery.
The Fullers left on a Thursday for a long weekend of camping that August. They ate dinner and drank around the fire with friends that Friday night. Jeff Fuller awoke Saturday with a headache, so his wife let him spend the day sleeping while she took their son and daughter — then 5 and 8 — to the beach.
He had a fever when they returned, but Maureen Fuller had to leave the campsite to work an overnight shift. When she got home from work the next morning, her husband’s fever had spiked.
“He was very confused and talking crazy. I knew something wasn’t right,” she recalled. “By the time I got him to the hospital, he did not know his name or my name. He thought Lincoln was the president. They put him on a gurney and within a couple of hours he was slipping into a coma.”
Symptoms of EEE include headache, chills, fever, malaise, and joint and muscle pain. The onset is sudden and dramatic as evidenced by Fuller’s 36-hour transformation from outdoorsman to febrile patient. It is possible that some people who become infected with the virus will not develop symptoms, said Brown, the state epidemiologist.
Roughly 40 percent of all people with EEE die within 2 to 10 days of showing symptoms. Those who recover will likely suffer from disabling and progressive mental and physical impairment. Many will die within a few years.
Jeff Fuller emerged from his coma after three months.
“When he woke up, he could only move his thumb. He had to learn how to do everything all over again,” his wife said. “It’s like we lost him nine years ago. He improved physically to the point he could walk, but he never spoke another conversation with someone. Just intermittent words.”
He required around-the-clock care for 8½ years until his death from pneumonia in May. He was 52.
“The virus decimated his brain,” Maureen Fuller said.
Of the four people in Massachusetts confirmed infected with EEE this year, one has died. Laurie Sylvia from Fairhaven in Bristol County died Sunday, according to a
Facebook post from union Teamsters Local 59, of which Sylvia’s husband is president. Members of the family could not be reached for comment this week.
Brown said a variety of factors are contributing to the recent spike in EEE cases. A wet spring followed by a hot, wet summer has created an ideal environment for mosquito reproduction. Experts have observed higher levels of the mosquito species that carries EEE compared to previous years.
But the most likely catalyst is the introduction of a new virus strain brought in by migratory birds from Florida and other Southern states, Brown said. This is particularly hard to monitor, but tends to trigger a new cycle.
The 24 communities designated as being at critical risk for EEE include Acushnet, Rochester, Lakeville, Wareham, Carver, Middleborough, Raynham, Norton, Easton, Uxbridge, Mendon, Grafton, Hopkinton, Upton, Methuen, Heath, Colrain, New Bedford, and Freetown.
A positive EEE test in an animal automatically raises the threat level for EEE to “critical” in a community, but counties also may be given the designation if officials believe the virus originated or passed through the area.
Additionally, authorities have designated 24 other communities as being at “high” risk and 55 are at “moderate” risk. A full, updated list of risk levels can be found at www.mosquitoresults.com.
Ground spraying has been taking place in these at-risk communities throughout the summer.
“Aerial spraying is considered a last-ditch tool. It is most successful when you have a very high risk over a large geographic area,” Brown said. “Most important is personal prevention.”
This means limiting outdoor activities from dusk to dawn, when mosquitoes are most active. Those who have to be outside should wear long-sleeve clothing and apply repellent. The Department of Public Health particularly recommends a repellent with permethrin, picaridin, IR3535, DEET, or oil of lemon eucalyptus. The latter two should not be used on young children.