Dr. Ronan Glynn:

I am deputy chief medical officer and recently appointed lead in health protection at the Department of Health. First, my colleagues and I wish to acknowledge that Lyme disease has been the subject of significant attention in recent years. The matter has been regularly highlighted in the Oireachtas by means of Leaders' Questions, parliamentary questions and Topical Issue debates and has previously been discussed by this committee. I thank the committee for inviting us to discuss the issue. I am joined by my colleagues: Dr. Paul McKeown, Dr. Cillian De Gascun, Professor Karina Butler, and Dr. Gerard Sheehan.

Lyme disease, also known as Lyme borreliosis, is an infection caused by a bacteria called Borrelia burgdorferi. It is transmitted to humans by bites from ticks infected with the bacteria and is the most common tick-borne infection in the US, Canada, and Europe. Lyme disease infection is generally mild, affecting only the skin. The most common noticeable evidence of infection is a rash called erythema migrans. This is seen in up to 90% of patients. Occasionally, there may be more serious symptoms involving the nervous system, the joints, the heart or other tissues.

Lyme disease was made statutorily notifiable in Ireland by the Infectious Diseases (Amendment) Regulations 2011. The notifiable entity is the more severe neurological form of Lyme disease, Lyme neuroborreliosis. The choice of Lyme neuroborreliosis as the notifiable entity was based on scientific advice from the European Centre for Disease Control and followed wide consultation with experts across EU member states. Since first becoming notifiable, between eight and 21 cases of Lyme neuroborreliosis have been notified each year in Ireland. One of the major advantages of using Lyme neuroborreliosis as the notifiable entity is that the relationship of the proportion of neuroborreliosis cases to other cases of Lyme disease is well described and relatively stable; nervous system involvement arises in between 10% and 15% of Lyme infections. We can estimate, therefore, that there could be up to 300 total cases of Lyme disease in Ireland each year.

One of the reasons for making a disease notifiable is that it helps to raise awareness of that disease, and awareness of Lyme disease has been steadily increasing since it was made notifiable. For example, a recent scientific paper reported that, over the five years from 2011, the number of requests for Lyme testing in the west of Ireland increased by almost 80%. However, despite this increase in testing, no significant increase in the number of positive tests was detected.

Lyme disease is diagnosed by medical history and physical examination. The infection is confirmed by a standard two-stage set of blood tests. A 2016 survey reported that all laboratories offering this testing in Ireland are appropriately accredited and are testing in accordance with best international practice. Lyme disease is normally treated using common antibiotics. My colleague, Professor Butler, will make a more in-depth statement regarding the diagnosis and treatment of Lyme disease but the vast majority of clinicians in Ireland base their treatment approach on the guidelines produced by the Infectious Diseases Society of America, IDSA. In addition, a consensus statement on the clinical management of Lyme disease, which endorses the IDSA guidance, 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 best protection against Lyme disease is to prevent tick bites when walking in grassy, bushy or woodland areas, particularly between May and October.

Both the Health Protection Surveillance Centre, HPSC, and Tick Talk Ireland provide guidance on protection against the contraction of Lyme disease and the HPSC runs a Lyme disease awareness campaign each year. A Lyme disease subcommittee established at the HPSC aims to examine best practice in prevention and surveillance of Lyme disease and to produce a report to identify the best strategies for the prevention of the disease in Ireland. The HPSC delayed the publication of its report to incorporate the findings of an extensive systematic review of the evidence on Lyme disease published earlier this year by the National Institute for Health and Care Excellence in the UK. The HPSC report is now due to be published early in the new year.

I am happy to hand over to my colleague, Professor Butler, who will address the committee in more detail about Lyme disease. The panel of witnesses will then answer any queries members may have.