Dr. Colette Bonner:

I thank the Chairman and members of the joint committee for inviting me here today to speak on the issue of Lyme disease. My two colleagues already have been introduced, namely, Dr. Darina O’Flanagan and Dr. Paul McKeown, director of and specialist in public health medicine, respectively, at the health protection surveillance centre.
Lyme disease, also known as Lyme borelliosis, is an infection caused by a spiral-shaped bacterium called borrelia burgdorferi. It is transmitted to humans by bites from ticks infected with the bacteria. Lyme borelliosis was made statutorily notifiable in Ireland in 2011 by the Infectious Diseases (Amendment) Regulations 2011. The notifiable entity is the more severe neurological form known as Lyme neuroborreliosis. In 2012, there were nine cases of neuroborreliosis and, in 2013, there were 13 cases. Up to December of 2014, we have had 20 reported cases that have been provisionally notified in 2014. However, it is expected that this number is likely to fall following validation of the numbers. Due to the diverse and unspecific nature of the symptoms, a number of the less serious cases may not be diagnosed, leading to an under-reporting of cases. Recent estimates suggest there may be up to 50 to 100 cases in Ireland per year. The infection is generally mild, affecting only the skin, but can occasionally be more severe and highly debilitating. Many infected people have no symptoms at all. Complications following Lyme borelliosis, while uncommon, do occur, though less frequently in Europe than in North America.

They tend to occur sometimes after initial infection and are more common in people who did not realise they had been infected or who were not initially treated.

Lyme borelliosis is diagnosed by medical history and physical examination. It can be difficult if there has been no rash. The rash is known as erythema migrans. The infection is confirmed by blood tests, which look for antibodies 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 stage of disease.

Common antibiotics such as doxycycline or amoxicillin are effective at clearing the rash and helping to prevent the development of complications. They are generally given for up to three weeks. If complications develop, intravenous antibiotics may be required. In order to produce a harmonised approach to the testing and treatment of Lyme borelliosis in Ireland, a consensus statement on the clinical management of Lyme borelliosis has been issued jointly from the scientific advisory committee of the health protection surveillance centre, the Infectious Diseases Society of Ireland, the Irish Society of Clinical Microbiologists, the Irish Institute of Clinical Neuroscience and the Irish College of General Practitioners. The purpose of the consensus is to ensure that patients in Ireland are clinically managed in a harmonised fashion using guidance produced with the most up-to-date evidence.

The health protection surveillance centre is establishing a Lyme borreliosis sub-committee with the primary aim of examining best practice in prevention and surveillance of Lyme disease and developing strategies to undertake primary prevention to minimise harm caused by Lyme borreliosis in Ireland. This will involve raising awareness among clinicians and the public. I hope the sub-committee will have its inaugural meeting during 2015.

Each year, as part of its ongoing awareness raising about Lyme disease and methods of prevention or minimising potential exposure through tick bites, the health protection surveillance centre holds a Lyme disease awareness week, in which media releases are sent out with the intention that media outlets would take up the important Lyme prevention messages. This year as part of the Lyme disease awareness week information was made available to the public and attention was drawn to a tick-borne disease toolkit, developed by the European Centre for Disease Prevention and Control. This is available on the centre's website. The European Centre for Disease Prevention and Control has informed the health protection surveillance centre that Ireland is the first European Union member state to make such extensive use of this material. I will hand over to my colleagues, who may answer any queries from committee members.