Dr. John Lambert:

I would say that 80% of acute Lyme disease has been missed. We explained some of those scenarios to the committee. That is number one. It should be a clinical diagnosis and we educate GPs, but for the 80% who go on to develop chronic disease, the opinion of many people until recently was that there is no such thing as chronic Lyme disease. The belief was that it just spontaneously goes away or, if it is treated for a couple of weeks and the patient is still sick, it is post infectious because the patient was given antibiotics. The new WHO guidelines have changed all of that, but at present, the National Institute for Health and Care Excellence, NICE, guidelines in the UK have not acknowledged this new acknowledgement that there is such a thing as chronic persistent Lyme disease that needs longer treatment with antibiotics. The challenges are that early diagnosis is missed and those who go on to develop chronic disease are told it is post infectious and that there is no such thing as chronic Lyme disease. That was the opinion until now, including in the Irish guidelines, and in its new guidelines, Ireland is saying the same thing. We are suggesting that this is bad medicine and that those guidelines should be changed.