I propose to take Questions Nos. 340 and 371 together.
Lyme disease (also known as Lyme borreliosis) 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 Health Protection Surveillance Centre, HPSC, of the HSE has published extensive information concerning Lyme disease on its website. This contains information for the public on protection measures as well as information for healthcare professionals on diagnostics measures and clinical management. The website address is: www.hpsc.ie/a-z/vectorborne/lymedisease/.
Lyme borelliosis was made statutorily notifiable in Ireland by the Infectious Diseases (Amendment Regulations) Regulations 2011 (S.I. no 452 of 2011). The number of annual neuroborreliosis notifications over the last few years is as follows: 2012 - eight cases; 2013 - 13 cases; 2014 - 18 cases; 2015 - 12 cases; and 2016 - 21 cases (provisional). However, recent estimates suggest that, due to underreporting of mild cases, there may be up to 50-100 cases in Ireland per year. The Weekly Infectious Disease Report, published by the HPSC on 4 October 2017, indicated that for week 39-2017 (24/9/17-30/9/17) there have been ten cases notified so far in 2017 – a decrease of four on the same period last year.
Lyme borreliosis can be asymptomatic or have a range of clinical presentations. Current best advice is that diagnosis should be made only after careful consideration of the patient's clinical history, physical findings, laboratory evidence and exposure risk. The diverse nature of these symptoms, which can have both physical and psychological causes, are shared by many conditions which has implications for both diagnostic and treatment services. Exposure to ticks prior to disease manifestations is necessary for the diagnosis of Lyme borreliosis. Since an awareness or recollection of a tick-bite is not always present, however, this should not exclude the diagnosis of Lyme borreliosis. Later stages require the use of antibody detection tests (or advanced DNA detection techniques). Testing for Lyme Disease is provided routinely by all major, regional hospitals in Ireland. In undertaking Lyme testing, it is essential that the results are interpreted in the light of the clinical condition of the patient. If the result of this initial screen is equivocal, the patient's samples are referred to the U.K.'s Rare and Imported Pathogens Laboratory Service of Public Health England in the Porton Down facility which uses a two-tier system recommended by American and European authorities. This involves a screening serological test followed by a confirmatory serological test. All laboratories 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.
Testing and treatment for Lyme borreliosis is widely available in Ireland in all major hospitals. 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, then management of patients can be undertaken by infectious disease consultants in regional hospitals when intravenous antibiotics may be considered as a method of treatment.
