Second Powassan case of 2026 confirmed; RI health officials urge precautions to reduce tick exposure

The man is the Ocean State’s 10th documented case of Powassan since the virus was first reported in the state in 2016 and follows another case reported in June, when a Providence County man in his 60s went to the hospital after first experiencing symptoms in May. The Providence County man spent time in the hospital but was recovering at home when RIDOH shared the case details with the public on June 26.

Before this year, the last two reports of Powassan in Rhode Island were in 2024. A Washington County woman in her 80s died after developing neurological symptoms related to Powassan disease in 2023.

Powassan is a viral infection much rarer than that more well-known tickborne illness, Lyme disease, which is bacterial. The U.S. Centers for Disease Control and Prevention (CDC) received around 89,000 reported cases of Lyme in 2023. RIDOH data cites 2,563 cases of Lyme in Rhode Island in 2024.

There were 76 documented Powassan cases nationwide in 2025 — a record-breaking high. Twenty-seven occurred in New England, and from 2016 through 2025, there were about 397 reported nationwide.

In the Northeast, the virus is carried by Ixodes scapularis, also known as the deer or blacklegged tick.

Reports of the virus have risen greatly in the past decade — from about one per year before 2005 to about 10 annually the following decade. One 2019 review cautioned against attributing the uptick to any one cause. The same public health surveillance used for other illnesses like West Nile virus has improved laboratory and data-collecting efforts in recent decades. Changes in human activity as well as climate change — ticks like warmer temps — could also be affecting the virus’ prevalence.

“The dramatic territory expansion of an important competent tick species, Ixodes scapularis, seen over the past decade is probably the most important contributing factor,” the authors wrote.

Rare virus, common tick

The virus takes its name from a small municipality in Ontario, Canada, where it was first identified in a 5-year-old boy in 1958. The medical literature documenting this first case described the “abrupt onset and rapid downhill course” of the boy’s illness, which involved fever, headaches, dizziness and other neurological symptoms before the boy became comatose, stopped breathing and eventually died, about six days in all from the onset of his illness.

The unknown virus was later isolated from the boy’s brain tissue and named Powassan. Researchers determined it to be a flavivirus. Powassan is the only flavivirus naturally transmitted by North American ticks that can cause human illness.

The flavivirus family is better known for being spread through mosquitoes and it includes viruses like West Nile, dengue, yellow fever and Zika.

The virus can spread from tick to person much more quickly than the bacteria that cause Lyme disease. Experimental evidence for transmission speed has found that as little as 15 minutes of tick attachment can spread the illness. Other pathogens spread by deer ticks can take 12 to 48 hours to transmit to a human host.

Deer ticks can avoid detection from hosts as their saliva is partially anesthetic, which can obscure the feeling of their bites. And most who acquire Powassan never have symptoms. Those who do have an incubation period of one to four weeks, with fever, headache, nausea or vomiting emerging as symptoms.

Severe infection can progress to meningitis or encephalitis, with confusion, weakness, seizures and other neurological problems as markers of the illness. A 2019 review of Powassan estimated that about 10% to 15% of patients with neuroinvasive illness die. About half of survivors still experience lasting or temporary neurological issues.

Treatment for severe illness is largely supportive, with a focus on preventing seizures. There’s no specific antiviral or vaccine for Powassan.

Rhode Island’s first case

The first known neuroinvasive case in Rhode Island illustrates how serious the infection can become, and it was detailed by Rhode Island Hospital doctors in a 2018 study in the journal IDCases.

The narrative began in April 2016, when an otherwise healthy, independent 81-year-old woman woke up at 3 a.m. one morning. The woman headed to the bathroom, but realized she was going the wrong way.

“As she changed course, she tripped and fell onto her back and struck her head,” the study reads. “The patient laid on the floor for four hours because she felt ‘stunned.’ She then got up, put on some clothing and headed to church.”

The woman’s daughter met her at church, noticed “oozing blood” from her mother’s head, and took her mom to the hospital.

The woman’s fever was over 103 degrees, and reached 106.1 during her illness, which led to a 19-day hospitalization. The patient was confused, couldn’t recognize her daughter and had seizures. Doctors were at first stumped, then tested for Powassan.

The woman — who often encountered ticks while tending her garden — spent two weeks in rehab and therapy after discharge. She eventually returned home under her daughter’s care.

“We all need to be thinking about tick prevention measures when outdoors,” Department of Health Director Jerry Larkin said in Thursday’s announcement. “Ticks are tiny. You may not be able to feel them or spot them right away.”

State health officials recommend avoiding brushy areas and high grass, and wearing long pants and long sleeves along with insect repellent if going outdoors. Check for ticks and shower after spending time in wooded or grassy areas.

As for the best way to remove ticks, state health officials recommend grabbing them with tweezers, staying as close to the skin as possible and pulling straight up.

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