On today's episode, ASTHO member Robert Goldstein discusses why Massachusetts recently made alpha-gal syndrome a reportable condition and the benefits of expanded case surveillance.
A tick bite that can trigger a lifelong allergy to red meat sounds almost unbelievable, but public health officials are taking the growing threat of alpha-gal syndrome seriously. Robert Goldstein, ASTHO member and commissioner of the Massachusetts Department of Public Health, shares why Massachusetts recently made alpha-gal syndrome a reportable condition and what the state hopes to learn through expanded surveillance. Goldstein explains how the spread of the lone star tick into parts of Massachusetts, including Cape Cod, Martha’s Vineyard, and Nantucket, has led to an increase in diagnoses of the condition. The conversation explores how public health agencies are adapting traditional infectious disease surveillance systems to monitor a non-infectious condition, what the reporting data could reveal about emerging tick-borne risks, and how public health and wildlife officials are working together to better understand the relationship between deer populations and tick exposure.
Leading Change Workshop - July 2026
JOHN SHEEHAN:
This is Public Health Review Morning Edition for Thursday, June 11, 2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials.
Today, why Massachusetts is monitoring the growing tick-borne threat, alpha-gal syndrome. Dr. Robert Goldstein, ASTHO member and the commissioner of the Massachusetts Department of Public Health, tells us why Massachusetts recently made alpha-gal syndrome a reportable condition, and what the state hopes to learn through expanded surveillance.
ROBERT GOLDSTEIN:
Alpha-gal syndrome is an allergic disease that people develop after the bite of a lone star tick. It's actually a chemical in the saliva of the lone star tick that goes into the human body and generates an immune response, and that immune response results in an allergy to red meat, things like beef, right? And even products from mammals, like milk and cheese, can trigger the same allergic response.
SHEEHAN:
And Massachusetts only recently began treating it as a reportable condition, so what are the implications of that?
GOLDSTEIN:
That's correct. Over the past few years, we've seen an increase in alpha-gal syndrome diagnoses in Massachusetts. We're actually seeing the lone star tick move up the East Coast and come here to Massachusetts, in particular to Cape Cod, Martha's Vineyard, and Nantucket. The reason we made this a reportable condition, the reason why we're trying to increase our surveillance, is that as this disease comes into our population, we want to understand who's at risk, who is being diagnosed with the disease, and where does it exist in our geography here in Massachusetts. As I mentioned, it really started on Cape Cod, Martha's Vineyard in Nantucket, and we want to see, is this going to move and shift across Massachusetts, maybe into the western parts of the state.
SHEEHAN:
And will this new, you know, this new reporting, will this have an impact on other non-infectious diseases?
GOLDSTEIN:
Well, we track a lot of infectious diseases here in Massachusetts. We have a lot of reportable infectious diseases. I think that what we are likely to see as we begin to see new diagnoses of alpha-gal syndrome, it will raise awareness about other tick-borne illnesses that we see in Massachusetts: Lyme disease, anaplasmosis, ehrlichiosis, tularemia. And so, just generally increasing awareness about tick-borne illnesses, what ticks carry, what those diseases look like in humans, that will increase the reporting that we see across the state, and that's a good thing. We want to understand. We need the surveillance data to understand what's happening in Massachusetts.
SHEEHAN:
Yeah, absolutely. And is the hope that this additional reporting across categories will also help the understanding of alpha-gal syndrome?
GOLDSTEIN:
Yes, I think we're learning about this disease, although I want to know that folks in the Southeast part of the country have been dealing with alpha-gal for a very long time. Folks in the Mid-Atlantic have recently seen increases in alpha-gal, but all of us need to do more to understand how this disease plays out. To understand what we can do to prevent the disease, and also to understand what is happening in our close interactions with ticks. You know, here in Massachusetts and in the Northeast, we have a lot of ticks that are all around, and we need to understand what's happening as those tick populations spread.
SHEEHAN:
Yeah, and it seems like such a confounding disease, you know. I think public health systems and certainly the public have sort of been used to watching out for Lyme disease and those kinds of tick-borne illnesses. And so, this is a new wrinkle. How do you suggest that public health systems adapt their surveillance and their diagnosis, and also their education, to get the word out?
GOLDSTEIN:
I think what's important to note is we're using our quote "infectious disease surveillance model" to understand what's happening with alpha-gal, which is not an infectious disease, but this is not the first time that we've done that. We think about the vaping crisis and EVALI. We use the same surveillance structure, that same model to understand a non-infectious disease, to make it reportable, and to make sure that public health could respond appropriately to what we were seeing on the ground. What we're doing with alpha-gal is about surveillance, and I think that's a really important point here. We're using a surveillance definition. We are not thinking about individual patient diagnoses. What we learn from the surveillance, what we learn can help us adapt our surveillance infrastructure. It can help us improve our surveillance in the future, and can also help us with provider education on the broader level, the public health level, in the same way that we use surveillance from infectious disease to help us outreach to particular provider types and particular parts of our state.
SHEEHAN:
And so, Dr. Goldstein, it seems like this syndrome is also tied to non-public health-related factors, like, like deer populations. How are you working with partners in in wildlife control to sort of mitigate these risks?
GOLDSTEIN:
So, we have a really close relationship with MassWildlife, which is the agency here in Massachusetts that helps us with wildlife and helps us with the deer population. I think it's important to note there are some data that suggests that decreasing the deer population may reduce tick populations in regions, but we don't have data to fully understand how low the deer population has to be, so that we can achieve meaningful reductions in tick populations. And therefore, a decrease in diseases like Lyme, anaplasma, and even alpha-gal. What we've done here in Massachusetts is worked really closely between our department of public health, in particular with our state public health veterinarian, and the wildlife team over at MassWildlife, so that we're messaging appropriately, not to say to folks if we get rid of all deer, we'll get rid of all ticks, but rather to say we are working jointly to address the deer population. And also putting out appropriate public health messaging about how to prevent tick bites and avoid ticks in the first place.
SHEEHAN:
And so, it's really more of an information gathering partnership, because you don't know.
GOLDSTEIN:
We don't know, and importantly, we have such a good relationship that we actually can study this here in Massachusetts, as we make changes to how we manage deer populations, and that is mostly controlled out of MassWildlife. The Department of Public Health can step in with our surveillance data and help understand: did those policy changes result in a meaningful decrease in tick-borne diseases and in things like alpha-gal syndrome.
SHEEHAN:
Do you have any advice for other states that are maybe going through a similar situation, you know, states that are highly wooded in the Northeast?
GOLDSTEIN:
Yeah, I guess I'd say I have two pieces of advice. The first is to emphasize that relationship that we have here with MassWildlife, with our wildlife colleagues. I think public health and wildlife working hand in hand is how we end up with the right policy and the ability to adjust policy when we need to. And then the second piece of advice I would have is that here in Massachusetts we made the decision to make alpha-gal syndrome reportable, but we did so on a pilot basis, meaning it's reportable for the next year, we may extend that for an additional year, and then, we're going to take a step back and see, does surveillance for alpha-gal syndrome actually result in a public health benefit? If it does, we'll move forward with a permanent reporting structure for alpha-gal syndrome, if it doesn't, we have to take a step back and recognize what else do we need to do to address alpha-gal syndrome, and to understand its impact here in Massachusetts.
SHEEHAN:
It sounds like the logical approach of like pilot this reporting system, see if it works. If not, reconsider, but is there a reason why it wouldn't be in the benefit to sort of continue to monitor it or have a classification for it?
GOLDSTEIN:
So, I think in Massachusetts we're really thoughtful about what diseases are reportable diseases and for how long we want those diseases to be reported. Right now, as alpha-gal is being introduced into our geography and as we're seeing it spread to different parts of the state, it is really helpful to have reporting and surveillance, so that we can see when new counties are affected by the disease. Once something becomes endemic, and once something is very well-known by our providers, the utility of surveillance of understanding every single case may change. And so, we want to be very thoughtful, and we want to reevaluate on a regular basis, what are we reporting, and how are we using the data that are reported, because on the other side of this is the burden on our providers in Massachusetts, our laboratories in Massachusetts that have to do the work of filling out the important case reports, getting them to our epidemiologists at the Department of Public Health. And then collecting those data and analyzing those data. If we're not going to use them for anything, if they're not going to have a real impact, then we shouldn't be asking folks to go through those steps simply to report the case.
SHEEHAN:
Gotcha, you're adding steps to something that might not be worth the reporting effort.
GOLDSTEIN:
Exactly.
SHEEHAN:
Dr. Robert Goldstein, thanks so much.
GOLDSTEIN:
Thanks for having me.
SHEEHAN:
Dr. Robert Goldstein is an ASTHO member and the commissioner of the Massachusetts Department of Public Health.
Leading Change is an ASTHO workshop designed specifically for professionals in clinical and non-clinical public health roles. This in-person opportunity on July 28 and 29 will equip participants with strategies and skills to navigate change and uncertainty as individuals, team members, and organization-wide leaders, emphasizing actionable instruction and resources. It enables leaders to create and implement real-world initiatives in their agencies for 2026 and beyond. Learn more at the link in the show notes.
This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.
