York Conference June 2004 - Dr David Owen

Q. Does the military exhibit any illnesses which might be the result of tick bites?

A. Well, so-called Gulf war syndrome.

A bit about Gulf war syndrome. It was the early 90s when people were coming home from the Gulf and huge numbers had similar symptoms to what definitely appeared to be an organic disease. And we've heard something about the characteristics of Gulf war syndrome. There are many symptoms, but the most common is this cluster of symptoms – fatigue, headache, aches and pains and cognitive disturbances.

This is a study from The Lancet, and once again, they've got a Political agenda – here it is really to deny the existence of Gulf war syndrome. And in this paper they said there clearly wasn't a Gulf war syndrome because similar things were found in military who hadn't served in the Gulf, but had served in the Bosnian conflicts. There was little difference in symptoms between the veterans of the Gulf war and the veterans of the Bosnian conflicts. That might go against the existence of a gulf war syndrome as such, but it really plays into the possibility of Lyme disease.

This is just a brief reference to a paper that said 85% of those considering themselves to have Gulf war syndrome met the CDC criteria for a "severe chronic multi-symptomatic illness."

Similarities between Gulf war syndrome and Lyme disease? As Dr. Donta pointed out earlier, he finds it medically very difficult to tell the difference between the two and he's looked into it in some detail.

- Both are multi-systemic with a prominence of althragias and skin rashes

- Chronic fatigue is common in both conditions

- Cognitive impairment and psychiatric feature are common in both

- Systemic symptoms such as sweats and chills are commonly reported in both conditions

- Physical findings are infrequent

You'd think that Gulf war veterans would have been tested for Lyme disease, but it didn't seem that it had been carried out on any large scale.

In one paper in 2003, in the American Journal of Public Health, they said that 9 out of 978 cases of Lyme disease were reported after the gulf war, but they relied on their own physicians for testing. There's no doubt that the perceived incidence of Lyme disease in the military is low, certainly if you look at the literature. There's another paper form the American Journal of Tropical Medicine 2001. They estimated an incidence of Lyme disease of about 6 in 100,000 based on sero-conversion - now, I'm not aware of anybody being diagnosed with Lyme disease based on sero-conversion – or 1 in 100,000 using the two -tier system. As we've seen, the two-tier system is really not good enough.

Now this is a very crude way of me trying to find out what's going on, and I'm sure the situation is far more complicated than this. I was just having an attempt to suggest what might be happening.

Patient acquires Borrelia during training before they went to the Gulf, probably when spending a lot of time in the field.

Probably, most remained asymptomatic carriers.

During active military service spirochaete load increases, driven by stress, acquisition of other infections, environmental agents, vaccinations, etc.

But they all got it after coming home – why not in active service?

Symptoms were uncovered on cessation of active service, unmasked by reduction

in stress hormone levels.

It may be that one of the functions of the adrenal crisis overload may be to mask symptoms caused by chronic bacterial infection. I think this is an interesting concept and I don't know if anyone else has looked into that.

This is just a reference to another paper which actually showed that you could differentiate between those with chronic fatigue syndrome and post-traumatic stress. Basically they said that the two things were different. So there may be some who were psychologically traumatized, but others seem to be more on a physical basis.

Conclusions:

- Knowledge about Lyme disease among the general public is extremely poor, even among those who know they've been bitten by a tick. This has important Public Health implications.

- The military are probably at high risk of Lyme disease. Investigations should be

carried out to determine the level of Lyme disease in the military and I'm pleased to say we had a member of the military talking earlier. Measures should be taken urgently in the fields of prevention and education among military personnel, especially those involved in health care. And it's happening in parts. I'm just wondering if it's happening on a wider basis.

- There has been a failure to identify a specific Gulf war syndrome, but military

personnel – especially those who have been in conflict have a high incidence of polysymptomatic, unexplained medical symptoms which in many cases could be Lyme disease.

My recommendation is that those exhibiting symptoms attributed to Gulf war syndrome or similar should be examined by a physician with a detailed knowledge about Lyme disease.