Disease Management

Dáil Éireann Debate, Tuesday - 20 June 2017

Tuesday, 20 June 2017

Ceisteanna (1016, 1017, 1136, 1141, 1144, 1555, 1560)

Catherine Connolly

Ceist:

1016. Deputy Catherine Connolly asked the Minister for Health the system for identifying Lyme disease; the treatment options; and if he will make a statement on the matter. [26573/17]

Catherine Connolly

Ceist:

1017. Deputy Catherine Connolly asked the Minister for Health if his attention has been drawn to a method (details supplied) of detecting Lyme disease; if consideration will be given to introducing a similar system here; and if he will make a statement on the matter. [26574/17]

Richard Boyd Barrett

Ceist:

1136. Deputy Richard Boyd Barrett asked the Minister for Health the adequate tests which are done to diagnose Lyme disease; if Lyme disease is diagnosed, the supports and treatments offered to those who are suffering from the disease; and if he will make a statement on the matter. [26994/17]

Seán Sherlock

Ceist:

1141. Deputy Sean Sherlock asked the Minister for Health if the HSE will consider recognition of the ELISPOT test on Lyme disease completed by an organisation (details supplied) in Germany, which holds ISO15189:2014 certification to carry out examinations in this area. [27000/17]

Jan O'Sullivan

Ceist:

1144. Deputy Jan O'Sullivan asked the Minister for Health if he will develop a strategy on Lyme disease in co-operation with stakeholders including the areas of education for health workers, testing and diagnosis and treatment protocols; and if he will make a statement on the matter. [27004/17]

Robert Troy

Ceist:

1555. Deputy Robert Troy asked the Minister for Health his views on a matter (details supplied) in relation to Lyme disease. [28917/17]

Eugene Murphy

Ceist:

1560. Deputy Eugene Murphy asked the Minister for Health the steps he will take regarding the lack of adequate testing for the diagnosis of Lyme disease in view of the fact that many persons are forced to travel abroad to receive a diagnosis; and if he will make a statement on the matter. [28923/17]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 1016, 1017, 1136, 1141, 1144, 1555 and 1560 together.

Lyme disease is diagnosed by medical history and physical examination. The infection is confirmed by blood tests which look for antibodies produced by an infected person's body in response to the infection. These normally take several weeks to develop and may not be present in the early stages of the disease. The standard approach to Lyme diagnostics is a two-stage approach and involves using a sensitive enzyme immunoassay (EIA) as an initial, screening step. Screening EIAs can be insufficiently specific, giving false-positive reactions in the presence of other similar bacteria, and certain other viral infections, including glandular fever. In addition, blood samples from patients with autoimmune disorders and other inflammatory conditions can also lead to false-positive results. Samples giving positive or equivocal results in screening tests are further investigated in a second-stage immunoblot (Western blot) tests. Use of immunoblot testing greatly increases specificity. Using this two stage approach will give a 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 diagnostics they provide is maintained at the highest international level for human diagnostics. Some laboratories abroad do not use antibody tests like the EIA (screening ELISA test) and Western Blot and instead will use other types of tests, for example, testing for levels of a specific white blood cell (CD-57) or lymphocyte transformation tests (tests to measure how specific cells in a person's immune system respond when exposed to antigens against Borrelia burgdorferi - the bacterium responsible for Lyme disease). These types of tests are not currently recommended by international groups such as the CDC, Infectious Diseases Society of America (IDSA) or BIA for a number of reasons:

I. There is not enough scientific evidence that they are suitable tests to diagnose Lyme disease;

II. There is no standard method to perform and interpret these kind of tests; and

III. Positive results in these kinds of tests may be due to other illnesses or conditions and not just Borrelia infection.

Lyme disease can be very successfully treated using common antibiotics. These antibiotics are effective at clearing the rash and helping to prevent the development of complications. Antibiotics are generally given for up to three weeks. If complications develop, intravenous antibiotics may be considered.

In Ireland, treatment by most clinicians is based on that laid out in evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis published by the Infectious Diseases Society of America (IDSA) in 2006. This pharmacological regime can be summarised thus:

- Doxycycline, amoxicillin or cefuroxime for the treatment of adults with early localized or early disseminated Lyme disease associated with erythema migrans, in the absence of specific neurologic manifestations (ceftriaxone in early Lyme disease for adults with acute neurologic disease manifested by meningitis or radiculopathy);

- Doxycycline, amoxicillin, or cefuroxime for adults with Lyme arthritis but without clinical evidence of neurologic disease;

- For late neurological disease in adults - intravenous ceftriaxone, cefotaxime or Penicillin G.

The Scientific Advisory Committee of the Health Protection Surveillance Centre (HPSC) has established a Lyme Borreliosis Sub-Committee, the aim of which is to develop strategies to undertake primary prevention in order to minimise the harm caused by Lyme Borreliosis in Ireland. In addition to staff from the HPSC, the membership of the Sub-Committee includes specialists in Public Health Medicine, Consultants in Infectious Diseases, Clinical Microbiology, Occupational Health an Entomologist from the Parks and Wildlife Service, a representative from the Local Government Management Agency, an Environmental Health Officer and, very importantly, a representative from Tick Talk Ireland, the primary Support Group for Lyme disease in Ireland.

The initial work of the Lyme Borreliosis Sub-committee involved a survey of laboratory methods for the diagnosis of Lyme borreliosis in Ireland, the development of Lyme borreliosis guidance for general practitioners, the publication of medical media articles to highlight diagnostics and laboratory methods relating to Lyme borreliosis available in Ireland. Material has been produced which is aimed both at the general public and General Practitioners. The Sub-Committee first met on 6 May 2015 and it is expected to report in 2017.

There is significant support and extensive information for health professionals and the public on the HPSC website. These supports include a fact sheet on tick borne diseases, including Lyme Disease. This fact sheet gives information on clinical features, the disease, transmission routes, prevention measures, diagnosis, and management and treatment. There is also an erythema migrans (EM) diagnostic tool to aid health professionals in the diagnosis of EM, which is frequently the earliest clinical manifestation of Lyme borreliosis. Information for the public includes:

- Lyme Disease Frequently Asked Questions;

- Laboratory testing for Lyme Disease: FAQs for general public;

- Lyme Disease Illustrations; and

- CDC's instructions on how to remove a tick.

As testing and treatment for Lyme borreliosis is widely available in Ireland there is no requirement for people to travel to other EU Member States to access these services.