Lyme Disease Action comments upon House of Lords questions dated 22 October 2007

Click here to read the questions and answers on They Work For You Website

We welcome the fact that Lord Darzi, speaking on behalf of the Department of Health, has given more information upon Lyme disease to the House of Lords. However, we note several areas within Lord Greaves’ questions that have not been addressed by the answers given.

Lyme Disease Action would like to comment upon the following points that might usefully have been included.

• That the answer given addressed the case reports kept by the Health Protection Agency (HPA) which reflect only those cases in England and Wales confirmed by laboratory testing and this may be an incomplete picture.
  
  The HPA itself admit that this does not reflect the true number of cases per annum which for the past few years they have estimated to be up to 2000 cases, and very recently this estimate has been raised to indicate that up to 3000 cases may occur annually. Lyme Disease Action is on record as suggesting that case numbers may be higher than this and has requested that the methodology behind HPA estimates be made public. However, we do note that the recent official figures show a steep increase in recorded cases. Lyme Disease Action feels that the apparently relentless rise is a great cause for concern.
  
  
• That the answer given addressed only Lyme disease and did not address the question regarding any other tick-borne diseases. The question however, asked whether any other tick-borne diseases were increasing?
  
  Lyme Disease Action has long been asking for more investigation to be given to other tick-borne diseases in the United Kingdom. We note that there are various co-infections, such as infections by Babesia spp, that can be found to be passed by the same ixodid ticks that carry Lyme disease. Not enough is known about the occurrence of tick-borne co-infections in the UK except that some of these infections are present in UK ticks. We also note that no mention was made of the diversity and complexity of the tick-borne members of the genus of bacteria, Borrelia spp, that cause Lyme disease. These bacteria are not easy to study owing to their fugitive nature in the laboratory. Therefore total confidence that enough is known about the potential for causing disease exhibited by this group might be misplaced. That the distribution of Borrelia burgdorferi infection amongst ticks in the UK is unknown is an acknowledgment that much remains outside science at present. Lyme Disease Action has always highlighted that the large areas that remain unknown about tick-borne disease is a potential cause for concern.
  
  
• That the answer given (q.v.) regarding why case numbers are on the rise includes many possible factors but did not comment upon some questions that are currently the subject of much speculation not only in the media but in the scientific community.
  
  Lyme Disease Action comments that cases of Lyme have been recorded all over the UK and are not in strict association with deer habitat as such. The real warm-blooded reservoir species from whence ticks regularly pick up infection are small mammals and birds and these are ubiquitous in the UK. It would also have been useful to mention that the enhanced surveillance scheme mentioned in the answer only addressed cases already confirmed by laboratory testing, so did not actually contribute to the increase in recorded cases. Interestingly, no mention was made of a factor that other scientific sources do speculate upon, that is, our increasingly warm and wet climate and whether this has any impact on tick survival. Lyme Disease Action comments that the public needs much more information on many of these points since greater public education will be the main weapon by which to reduce the numbers acquiring this avoidable disease.
  
  
• That the answer given indicated that the main source of information upon tick-borne disease for GPs and other physicians is the Health Protection Agency.
  
  Lyme Disease Action feels that in view of the increasing occurrence of Lyme disease, that GPs and other UK doctors need to receive more information and clinical training about this disease. Busy doctors may rarely have time to be aware of information on Lyme disease unless their attention is specifically drawn to it. We would like to see training programmes for doctors based within the NHS in order to build up their knowledge of Lyme disease. Training needs to include clinical experience of patients who have acquired Lyme disease or other tick-borne disease. This should occur along with a widely based public education programme and this would start to bring case numbers down.
  
  
  
• That the answer given cites the recent US Treatment Guidelines for Lyme disease produced by the Infectious Disease Society of America.
  
  Lyme Disease Action notes that this is included within UK advice although several of the infecting bacterial species differ in Europe and are known to have slightly differing characteristics. Lyme Disease Action is also on record as having reservations about the IDSA guidelines and these are expressed in our letter to the Department of Health (dated 17/10/07). Lyme Disease Action is on record as having asked the Department for guidelines to be developed for doctors in the UK. (link)