Getting Serious on Lyme (Washington Post 6-17-08)

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Getting Serious on Lyme

By Lori Aratani

Washington Post Staff Writer

Tuesday, June 17, 2008

Washington area health departments are stepping up Lyme disease

education and prevention efforts in response to a steep rise in the

number of reported cases of the tick-borne illness in land,

Virginia and the District.

Some of the rise is attributable to better disease reporting due to

increased awareness about the disease, according to Griffith, a

medical epidemiologist with the Centers for Disease Control and

Prevention, but more people are also being infected. Local health

departments want residents to know that even if they are bitten by a

tick carrying Lyme disease, they can greatly reduce the risk of

infection by removing the insect promptly, said.

The number of reported Lyme disease cases in Virginia almost tripled

last year to 945, from 357 in 2006. In land, the count reached

2,576, more than double the 1,248 reported in 2006. And in the

District, the number jumped to 116, up from 64 in 2006. As of early

June, District health officials had confirmed 36 new cases. land

and Virginia don't have numbers yet for 2008.

One thing that's probably not responsible, say experts: the region's

unusually rainy spring. Tick numbers are more dependent, they say, on

other, complex factors, such as the local deer population and ticks'

two-year life cycle.

The jump in reported cases comes as debate continues over the best

strategy for diagnosing and treating the sometimes painful bacterial

disease. The conflict, which has spilled over onto blogs and into

state legislatures and spawned charges of conspiracy and coverup, pits

the medical establishment against patient activists, some of whom

claim to suffer from a chronic form of the ailment. Activists say this

form should be treated with long-term antibiotic therapy; mainstream

experts generally oppose such treatment as ineffective and possibly

dangerous.

Lyme disease, estimated to affect about 20,000 Americans each year, is

the most common tick-borne infection in the Northern Hemisphere. In

2006, President Bush was treated for a rash that may have been caused

by Lyme disease.

Transmitted through the bite of the tiny deer tick, Lyme often causes

a bull's-eye rash in the area of the bite. Those infected may suffer

from flulike symptoms, such as muscle aches, fever and fatigue. If not

treated promptly, the infection can potentially lead to heart, joint

and nervous system damage, according to the CDC, which has been

collecting data on Lyme infections since 1991.

People who receive prompt antibiotic treatment often recover in a few

weeks, although symptoms such as fatigue can last for several months,

said Wormser, chief of infectious diseases at New York Medical

College and the lead author of Lyme treatment guidelines published by

the Infectious Diseases Society of America in 2006.

The guidelines use the term " post Lyme syndrome " for cases in which

the lingering symptoms are severe. However, the guidelines do not

recognize " chronic " Lyme because there is no evidence the disease's

bacteria remain alive in humans after a standard course of antibiotic

therapy and because there is no good evidence that repeated or

prolonged courses of antibiotics help patients.

Antibiotic therapy is usually given for two weeks but may be given for

up to four weeks for certain manifestations. The guidelines allow for

re-treatment for relapses that occur infrequently. Because insurers

often won't pay for treatment outside the guidelines, activist groups

are fighting to have the rules changed.

Gregg Skall, general counsel for the National Capital Lyme and

Tick-Borne Disease Association, a McLean-based nonprofit advocacy

group for Lyme patients, said groups like his want the medical

community to recognize that there are cases in which long-term

treatment offers relief.

Some individuals believe they suffer long-term symptoms related to

Lyme disease even though they have never been diagnosed with Lyme.

Some believe they may have been given faulty tests or have symptoms

similar to those of people who were given a Lyme diagnosis. Absent a

diagnosis followed by the recommended treatment, the IDSA guidelines

do not recognize their problem as any form of Lyme, chronic or

otherwise.

Lyme advocates also maintain that sometimes the tests are faulty and

do not pick up all Lyme infections.

Last year, Connecticut Attorney General Blumenthal launched an

investigation of the process by which the IDSA compiled the

guidelines, charging conflicts of interest by several review panel

members. Poretz, president of the IDSA, denied the charge. In

May, activists were cheered when the IDSA agreed to review the

guidelines rather than continue to fight the investigation.

" We viewed the settlement as a victory for patients, in the sense that

patients [who considered the guidelines inadequate] felt vindicated,''

said Pat , president of the Lyme Disease Association.

Poretz, a physician based in ndale, said a new IDSA panel will

review the guidelines this summer and determine whether research

supports a rethinking of current treatment strategies.

" We're always willing to change if science shows there is new

research,'' Poretz said.

Former panel members, he said, opposed long-term treatment with

antibiotics because patients " can develop drug resistance, infections

in their [intravenous lines] and allergic reactions. And there are

extraordinary costs.''

Connecticut has long been a battlefield in the debate over the

treatment of Lyme disease. It was in the Connecticut town of Old Lyme

that the infection was discovered in 1975. Last year Connecticut led

the nation in the rate of Lyme infections: 51 cases per 100,000

people; other northeastern states also report relatively high rates.

Local officials are focusing on public education to reduce the risk of

infection.

Fairfax County has one of the most ambitious outreach efforts. In

April, county health officials sent a 19-page color booklet to every

household in the county with advice on protection against Lyme

disease, West Nile virus and other insect-borne diseases. People who

are bitten by a tick are invited to bring it to health officials for

inspection. The booklet is also downloadable at

http://www.fairfaxcounty.gov/hd/westnile/wnvpamp.htm.

Arias, an environmental health supervisor for the Fairfax County

Health Department, said that although several varieties of ticks bite

humans, only one carries the bacterium that causes Lyme disease. While

infections have been reported countywide, most have occurred in

Fairfax's less developed western part, Arias said.

Last month, Montgomery County officials posted " Tick Awareness " signs

on information kiosks in parks, with advice about how to avoid

infection. Among the tips: Avoid tick-prone areas, such as wooded and

bushy spots with high grass and leaf litter. Walk in the center of

trails when in wooded areas or areas with high grass. The county

offers more information at

http://www.montgomerycountymd.gov/hhstmpl.asp?url=/content/hhs/lyme_disease.as

p.

Extensive information about Lyme is available from the CDC at

http://www.cdc.gov/ncidod/dvbid/lyme/index.htm.

District resident Baranovics knows it pays to be vigilant.

In May Baranovics went on a camping trip with her son's class in

Prince County. She figured her risk of being bitten was low

because she'd worked in the kitchen for most of the trip.

But about four days after she returned, she discovered a tick about

the size of a sesame seed on the back of her thigh. She didn't think

much of it until about two weeks later, when she developed a low-grade

fever, chills and the worst body aches she said she'd ever had.

Because she didn't get a bull's-eye rash, she thought perhaps she had

the flu. But when a visit to the doctor confirmed she had Lyme, her

doctor prescribed antibiotics. Now Baranovics said she feels much

better.

" I know what to look for now,'' she said. " How that thing got on me, I

don't know.''

Comments:health@....

Coughlan, President

MA Lyme Disease Awareness Assoc.

Cape Cod, MA

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