Dáil Éireann Debate, Thursday - 14 June 2018
162. Deputy Eamon Scanlon asked the Minister for Health his plans to follow the example of the Canadian government and implement guidelines (details supplied); and if he will make a statement on the matter. [26032/18]
Amharc ar fhreagraLyme disease (also known as Lyme borelliosis) is an infection caused by a spiral-shaped bacterium called Borrelia burgdorferi. 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.
Lyme borelliosis is diagnosed by medical history and physical examination. The infection is confirmed by blood tests which look for antibodies to Borrelia burgdorferi 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 spirochaete infections including syphilis, and certain viral infections including glandular fever. In addition, sera from patients with autoimmune disorders and other inflammatory conditions can also lead to false-positive results. 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 (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 clinical (and other) 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. This two tier approach gives a great degree of certainty around the diagnosis of Lyme.
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.
The Health Protection Surveillance Centre of the HSE (HPSC) is responsible for the surveillance of notifiable infectious diseases such as Lyme Disease. The Scientific Advisory Committee (SAC) of the 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 a representative from Tick Talk Ireland. The Subcommittee report on 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 GP management of the condition.
Following the establishment of the Lyme Borreliosis Subcommittee, a thorough review was performed to ensure existing material was fully up to date, comprehensible and appropriately presented to assist members of the public to obtain the necessary knowledge to protect their and their family’s health. In addition, material to support clinicians (primarily GPs) in identifying Lyme disease was also developed.
The members of the Subcommittee identified the need to accurately describe and map laboratory practice relating to Borrelia diagnostics in Ireland. HPSC undertook a Borrelia Burgdorferi laboratory Survey in 2016, and following development and analysis, the survey was published in Epi-Insight in 2017. The following are the additional resources that have subsequently been identified, and developed by the Subcommittee, and are now hosted on the HPSC website:
- Laboratory testing for Lyme Disease: FAQs for general public
- Borrelia burgdorferi diagnostic methods in Ireland: microbiology laboratory survey (2016) – this laboratory survey, had a 75% response rate. All the major laboratories participated, and all laboratories participating were accredited to the important ISO 15189 standard. The full results were published in Epi-Insight (August 2017)
- Erythema Migrans Diagnostic Support Tool
- Erythema migrans image slide set
- Map of Lyme neuroborreliosis in Ireland, 2012-2016 cumulative incidence
During the preparation of the Final Report, the HPSC learned that National Institute for Health and Care Excellence (NICE) in the UK were undertaking a systematic review of Lyme disease. This process resulted in the NICE Lyme disease guideline. This guideline is based on the most exhaustive systematic review yet undertaken, of the evidence around Lyme disease and focused on producing recommendations based on best available evidence relating to awareness raising, and on the diagnosis and management of Lyme disease. We delayed the final production of the report, to enable us to undertake a review of the final NICE Lyme Guideline which was finally published in mid-April 2018.
Since then the guideline and the associated evidence and papers has been reviewed, to determine if there were any aspects of this review that would be of relevance or possibly require mention/inclusion in the Subcommittee’s Final Report. This was important as a significant element of the Guideline relates to the evidence around raising awareness of Lyme disease. This review indicated that the approach that we had been undertaking, both in HPSC before the establishment of the Subcommittee, and subsequent to the Subcommittee coming into being, was very much in line with that recommended by NICE. Where appropriate, reference will be made in the Final Report to the NICE Guideline.
The report is in the final stages of preparation it is planned to circulate to the members of the Lyme Subcommittee with a view to having a final sign-off meeting of the Subcommittee in late June or early July. Following this the report will be sent for consideration to the SAC (the Lyme Group is a Subcommittee of HPSC’s SAC), with a view to then being sent out for consultation. It would be inappropriate to consider changes to the testing or treatment and management of the condition until the report has been finalised and published.
