Disease Management

Thursday, 4 May 2017

Questions (169, 188, 189, 190)

Fergus O'Dowd

Question:

169. Deputy Fergus O'Dowd asked the Minister for Health if he will address the concerns raised in correspondence (details supplied) on Lyme disease; and if he will make a statement on the matter. [21176/17]

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Gerry Adams

Question:

188. Deputy Gerry Adams asked the Minister for Health the current HSE protocol for identifying Lyme disease; the treatment options; if Lyme disease is classified as a chronic disease; if consideration will be given to classifying it as such; and if he will make a statement on the matter. [21251/17]

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Gerry Adams

Question:

189. Deputy Gerry Adams asked the Minister for Health if his attention has been drawn to the German model of detecting Lyme disease; and if consideration will be given to introducing a similar model here. [21252/17]

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Gerry Adams

Question:

190. Deputy Gerry Adams asked the Minister for Health the number of persons with Lyme disease here; and if he will provide a breakdown of diagnoses of Lyme disease in each year for the past five years. [21253/17]

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Written answers

Minister for Health

I propose to take Questions Nos. 169 and 188 to 190, inclusive, together.

Lyme disease (also known as Lyme borrelliosis) is an infection caused by a spiral-shaped bacterium called Borrelia burgdorferi. It is transmitted to humans by bites from ticks infected with the bacteria. The infection is generally mild affecting only the skin but can occasionally be more severe and highly debilitating. Lyme Disease is the commonest cause of tick-borne infection in Europe.

In general, it is accepted clinical practice in Ireland, the UK, Europe and North America that laboratory confirmation is unnecessary for a confidently-made, clinical diagnosis of erythema migrans (the initial primary skin lesion of Lyme borrelliosis). For later presentation Lyme borrelliosis, the two-tier system is necessary to ensure that false-positive rates are kept to a minimum. Serological testing for antibodies to Borrelia burgdorferi is the mainstay of diagnostic testing. There have been significant improvements in antibody testing in recent years, making diagnosis more certain than in the past. Testing for Lyme borrelliosis is currently undertaken in most of the larger hospitals in Ireland. The standard approach to Lyme diagnostics is a two-stage process and involves using a sensitive enzyme immunoassay (EIA – a test to detect proteins found in the Borrelia bacterium) as an initial, screening step. Screening EIAs can be insufficiently specific, giving false-positive reactions (i.e. leading to over diagnosis) in the presence of other infections such as syphilis, and certain viral infections including glandular fever. In addition, false-positive results can also occur in patients with autoimmune disorders and other inflammatory conditions including, rheumatoid arthritis, scleroderma, diabetes or ulcerative colitis. Samples giving reactive or equivocal results in screening tests are further investigated in a second-stage, confirmatory immunoblot (such as Western blot) tests. Use of immunoblot testing greatly increases specificity (i.e. it reduces the likelihood of these false positive results). Using this two stage approach gives a considerably great degree of certainty around the diagnosis of Lyme. All clinical (and other) laboratories in Ireland, must undergo continuous quality assurance to ensure that the quality of the laboratory tests they provide is maintained at conform to the highest internationally-accepted standards.

The HSE-Health Protection Surveillance Centre has established a Lyme Borreliosis Sub-Committee with the primary aim to examine best practice in prevention and surveillance of Lyme Disease and to develop strategies to undertake primary prevention in order to minimise harm caused by Lyme Borreliosis in Ireland. This will involve raising awareness among clinicians and the general public. The initial work packages of the Lyme Borreliosis Sub-committee involves a survey of laboratory methods for the diagnosis of Lyme borreliosis in Ireland, the development of Lyme borreliosis guidance for general practitioners and the publication of medical media articles to highlight diagnostics and laboratory methods relating to Lyme borreliosis available in Ireland for general practitioners. It is intended that the Sub-Committee will publish a final report on its findings.

Lyme borelliosis was made been statutorily notifiable in Ireland by the Infectious Diseases (Amendment Regulations) Regulations 2011 (S.I. no 452 of 2011). The notifiable entity is Lyme neuroborreliosis, the more severe neurological form of Lyme borelliosis. The Health Protection Surveillance Centre (HPSC) of the HSE collects and collates surveillance data on notifiable infectious diseases. The number of annual neuroborreliosis notifications over the last few years is as follows:

- 2012 – 8 cases;

- 2013 – 13 cases;

- 2014 – 18 cases;

- 2015 – 12 cases;

- 2016 - 21 cases (provisional).

There is extensive information available on the HPSC website http://www.hpsc.ie/A-Z/Vectorborne/LymeDisease/ including extensive general information on Lyme disease, Information for Healthcare Professionals, illustrations showing the characteristic rash of erythema migrans and relative tick sizes, and a new set of FAQs to answer the commonest questions about Lyme testing. Since 2013, the HPSC has held an annual ‘Lyme Awareness Week’ at the beginning of the tick biting season, the purpose of which is to draw attention - particularly in the media - to Lyme disease and the ticks that can spread this disease. This year Lyme Disease week will take place on 15 - 22 May.