John Reagan was enjoying the first few months of retirement when he pulled a tick off his skin in early May.
He didn’t think much about it. Reagan, 66, a retired pharmacist who lives in Concord, New Hampshire, loved being outdoors, often hunting, fishing or going on long walks with his son and daughter’s dogs – aka “the grand-dogs” – in tow.
Reagan fully appreciated the risks of tick bites. Lyme disease is a common infection in the area where he lives. Because it takes about 36 hours for an infected tick to transmit Lyme once it attaches to the skin, he pulled the tiny bloodsucker off almost immediately after returning home and thought he was safe.
A few weeks later, though, he started having flu-like symptoms that included a headache, body aches, a fever, nausea and diarrhea. He visited a local emergency room in mid-May, but doctors couldn’t zero in on a cause, so they sent him home after giving him fluids and anti-nausea medications. Still, he got worse.
His wife thought he might have been having a stroke. Back at the hospital, he lost his ability to speak, move or even open his eyes. Still, tests were negative. His family asked whether this could be related to Reagan’s tick bite a few weeks earlier. They were told no.
Reagan was transferred to Massachusetts General Hospital in Boston, where staff ran a slew of tests, including ones checking for tickborne illnesses. They sent a blood sample to a specialized lab at the Mayo Clinic.
On June 9, his family got a diagnosis: Powassan virus, a rare and serious infection that he almost certainly caught from the all-but-forgotten tick. Unlike Lyme, Powassan virus can pass from a tick to a person in about 15 minutes. Before that moment, they’d never heard of it.
Ticks and the diseases they carry are becoming more common in the United States. In the US, about 90% of all illnesses that are caused by a bite – including mosquitoes – are caused by ticks.
Lyme disease is on the rise but is already the most common tickborne disease, with nearly half a million cases each year, according to CDC estimates. Other growing tickborne threats include alpha-gal syndrome, an allergy to meat and other animal products that can be caused by the bite of lone star ticks.
Powassan virus disease is incredibly rare, with fewer than 100 cases diagnosed and reported in the United States each year, according to the CDC. But in recent years, this number too has been growing as the populations of ticks that carry it have increased.
“There are more ticks in more places,” said Dr. Stephen Rich, a microbiologist at the University of Massachusetts Amherst who runs TickReport, a tick-testing service the public can use to determine whether the tick that bit them is carrying something that could make a person sick. “Whenever you have more of something, more of the vectors, you’re inevitably going to have more of the pathogens.”
In 2025, 76 human cases of Powassan virus disease were reported in the US, an all-time high. Ten of these were fatal.
The virus was first identified by Canadian scientists in the 1950s. A child who had been hunting woodchucks with his father came down with a severe illness that resulted in brain swelling. The boy died, and the virus was ultimately isolated from his brain and named after the town in Ontario where the family lived.
Powassan virus is carried by blacklegged or deer ticks, the same species that carries Lyme disease. It’s an orthoflavivirus, part of the same family as West Nile and Zika.
About 1 in 10 cases are fatal. For those who survive, disability is common: About half of patients have long-term complications.
After living through the past months of fear and uncertainty of not knowing whether they would ever get their dad back, Reagan’s family is eager to make people aware of how serious Powassan virus can be.
Because there’s no specific treatment, the only way to protect people is to urge them to be aware of the disease and take steps to prevent tick bites in the first place, said John’s son, Jeff Reagan.
“Advocate for yourself or your loved ones if they’ve been bitten by a tick recently,” he said. “Because not all medical professionals are familiar with Powassan.”
Early in John’s hospitalization, brain swelling caused him to stop breathing. Doctors inserted a breathing tube and feeding tube and put him on a ventilator, hoping that supporting his vital functions with machines could buy his body time to recover in the ICU.
The strategy worked. After nearly a month, he woke up and began to regain communication. He could follow some commands, but he’d been bedridden for so long that other problems had developed, including blood clots and pneumonia.
Doctors have managed those complications, and John is slowly regaining his ability to move. Since early July, he’s been at Spaulding Rehabilitation Hospital in Boston, where he’s been working on walking, talking and thinking properly again.
“He wants to walk, and he’s trying to get his coordination and balance and depth perception back,” Jeff Reagan said.
Although it’s been encouraging to see his dad’s progress, Jeff knows that he has months of recovery ahead.
“It’s been a roller coaster,” he said. “He has made some pretty good progress, especially with his cognition.”
As he was waking up, Jeff said, his dad was just listening and going with the flow. Now, the emotions are coming back.
“Now I think he realizes like, ‘oh, wow, I was essentially in a coma for almost a month, and I almost died,’ and he’s been pretty emotional about it, and that’s a good sign that the brain is healing properly,” Jeff said.
As with other kinds of diseases carried by insects, experts think that some people become infected but don’t get very sick because their immune systems are able to clear the virus.
“But in some appreciable fraction of cases, the virus is really able to replicate effectively in neurons and other cells in the brain, and that’s where you have this brain damage that can happen,” said Dr. Greg Ebel, a professor of microbiology, immunology and pathology at the Center for Vector-Borne Infectious Disease at Colorado State University.
Then, Ebel says, the immune system gets the message that something is going wrong in the brain and makes a slew of chemicals that aren’t supposed to be there to launch a counterattack.
“So there’s two problems: One is that the virus is killing neurons and other cells, and the other is that the immune system is kind of making things worse,” he said.
The result, as the Reagans have seen, can be devastating.
Powassan virus disease can be extremely serious, but because there are so few cases, there’s no commercial market to support the development of a vaccine or medicine to treat it. That makes government funding critical for research to develop tests, treatments and cures.
This year, both chambers of Congress passed the Kay Hagan Tick Reauthorization Act, named after the North Carolina senator who died of complications of Powassan in 2019. It is now awaiting votes on the final version. The act allocates $150 million over five years to researchers and local health departments as they work to address vector-borne diseases.
“America’s tick problem is growing and the size of the federal investment we make in combatting ticks needs to keep pace,” Sen. Jack Reed, a Democrat from Rhode Island and one of the bill’s co-sponsors, said in a statement. “The Kay Hagan Tick Act has already improved public health knowledge and prevention strategies, but we’ve got to do more.”
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John Reagan has been off the breathing tube for a while but still gets most of his nutrition through a tube inserted into this abdomen.
Doctors had hoped he might be able to return home by the end of August, but new pain in his shoulder and back has scuttled that plan. For now, he’ll continue with rehab in the hospital.
Even with setbacks, there has been progress to celebrate. This week, doctors cleared John to eat ice cream, “which he was pretty happy about,” Jeff Reagan said. Coffee is one of his favorite flavors.
Jeff thinks his dad will still need the feeding tube after he comes home, at least for a while. They’ve also built a ramp in front of their house and installed grab bars to help him get around more easily.
But the Reagans know that John is one of the lucky ones: He’ll make it home.