I propose to take Questions Nos. 345 and 346 together.
Lyme disease is a bacterial infection transmitted to humans by bites from infected ticks with Borrelia burgdorferi. The infection is generally mild affecting only the skin but can occasionally be more severe and highly debilitating. Lyme borreliosis was made statutorily notifiable in Ireland by the Infectious Diseases (Amendment) Regulations 2011, S.I. no 452 of 2011.
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 have 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 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 UK's Rare and Imported Pathogens Laboratory (RIPL) Service of Public Health England Porton 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. All testing in Ireland is confirmed by RIPL.
It is important that people with symptoms seek appropriate medical attention, either from their family doctor or access specialist services. 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. There is no evidence that viable Borrelia burgdorferi persists in patients with prolonged, subjective symptoms following confirmed Lyme disease.
A Lyme Disease Subcommittee of the Scientific Advisory Committee of the HSE Health Protection Surveillance Centre with professional clinical, entomological, scientific and environmental health expert representation (including a representative of the Lyme Support Group, Tick-Talk Ireland) has been established to explore all possible ways of raising awareness about Lyme disease. This Subcommittees report will cover a number of areas, including initiatives undertaken to date, summary advice relating to awareness, preventive advice for the general public, preventive advice and material for those responsible for sites or locations known to have or suspected as having higher densities of ticks, and summary advice relating to clinical management of the condition.
The HPSC provides advice and information concerning developments regarding the testing and treatment of Lyme disease to my Department.