Dan Neville (Limerick, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Acting Chairman for facilitating me in raising this matter. Lyme disease, known as Lyme borelliosis, is a bacterial infection transmitted by the bite of hard-bodied ticks. Not all ticks are infected but vigilance is recommended where ticks are present to reduce the risk of transmission to humans and pets. Lyme disease can cause a variety of symptoms, ranging from mild to severe. Known as the great imitator, it can mimic other diseases such as Parkinson's disease, multiple sclerosis and chronic fatigue syndrome. Early treatment is vital to prevent serious consequences.

There are three stages to the development of the disease. Within days to weeks of a bite from an infected tick, an expanding rash may occur. This is the first stage. Sometimes this rash will appear as multiple concentric rings forming a bulls-eye. It is important to note that the rash may not develop or be noticed in some patients. A 'flu-like illness may also occur in the early stages of the disease. Stage two, otherwise known as the disseminated disease, has symptoms that may include migratory joint pain, head and neck pain, sore throat, swollen glands, Bell's palsy and severe fatigue. Cardiac problems may also occur, in addition to bladder irritation in the form of cystitis. Some patients may miss stage one of the illness and develop disseminated disease within months to years of the initial bite. The stage three symptoms for late-stage Lyme disease may include neurological changes such as tingling, numbness and tremors. Nerve pain, poor temperature control, brain fog and disturbed sleep patterns are common. Complications may also include optic neuritis, depression, panic attacks, muscle weakness, tissue damage, meningitis and chronic arthritis.

Lyme disease was named after the town of Lyme in Connecticut, however studies by the University of Bath have identified that it has been present in Europe since the ice age. The length of treatment with antibiotics depends on the severity and stage of the disease and co-existing co-infections. Intravenous antibiotics may be required for treatment of late-stage disseminated disease.

Patients feel an urgent need that a group be established by the HSE to examine the whole area of Lyme disease. This group should include a range of expertise including infectious disease consultants, GPs, international Lyme disease experts and patients' representatives. It should also consult with a number of other experts on patient symptoms including chronic pain specialists, neurologists, rheumatologists, paediatricians and obstetricians. Patients also feel that up-to-date training on Lyme disease should be offered to GPs as part of their continuing professional development. Public health nurses should also receive training on the effects of the disease, particularly on children. The teaching of medical students about Lyme borelliosis symptoms should be standardised. Students should be taught about the problems with diagnostic tests and about treatment options including the long-term treatment aspect.

Lyme disease is officially a notifiable disease since 2011 but if a hospital consultant denies a diagnosis from another EU state, this blocks GPs in reporting cases, leading to the data on a number of cases in Ireland being underestimated. Quite a number of patients travel to Europe for full diagnosis of Lyme disease.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank Deputy Neville for raising this topic. Lyme disease, also known as Lyme borelliosis, is an infection caused by the bacterium Borrelia burgdorferi. It is transmitted to humans by bites from ticks infected with the bacterium.

Lyme borelliosis was made a statutorily notifiable disease in Ireland by the Infectious Diseases (Amendment Regulations) Regulations 2011. There were 20 cases of Lyme borelliosis notified in 2013 and 8 cases notified in 2012, the first year for which notification was compulsory. However, 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 that there may be up to 50 to 100 cases in Ireland per year. The increase in reported cases since 2012 is likely to reflect the fact that Lyme borelliosis is now a notifiable disease and hence there is increased public awareness of the condition, rather than an increase in incidence of the disease.

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. The commonest noticeable evidence of infection is a rash called erythema migrans, commonly called a bulls-eye rash, which is seen in 80-90% of patients. People can also complain of 'flu-like symptoms such as headache, sore throat, neck stiffness, fever, muscle aches and general fatigue.

Occasionally, there may be more serious symptoms involving the nervous system, joints, the heart or other tissues.

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 approximately three weeks. If complications develop, intravenous antibiotics may need to be used. Both the Health Protection Surveillance Centre, HPSC, and Tick Talk Ireland provide guidance on protection against contracting Lyme borelliosis.

The best protection is to prevent tick bites when walking in grassy, bushy or woodland areas, in particular between May and October. Arms and legs should be covered and wearing long trousers tucked into socks or boots and long-sleeved shirts with cuffs fastened is advised. Shoes or boots should be worn rather than open-toed sandals.

The use of insect repellent on clothes is recommended or on limbs, if it is not practicable to cover up. Skin and clothing should be inspected for ticks every three to four hours and children's skin and clothes checked frequently. Ticks should be removed as soon as they are seen attached to the skin. Further advice on tick removal can be obtained from the HPSC website. It is not recommended that antibiotics are given to prevent the transmission of Lyme disease following a tick bite. People should see their doctor if they develop a rash or become unwell with other symptoms, letting the doctor know of exposure to ticks.

There is an ongoing publicity campaign in regard to Lyme disease. The HPSC is finalising the establishment of a Lyme borelliosis sub-committee with the primary aim to examine best practice in prevention and surveillance of Lyme disease and to develop strategies to undertake primary prevention in order to minimise harm caused by Lyme borelliosis in Ireland. This will involve raising awareness among clinicians and the public. It will also explore ways to ensure that these messages are brought to the attention of the general public with the frequency and in forms in which they can be most effective. The sub-committee is expected to meet later this month.

Each year, as part of its ongoing awareness raising regarding prevention and treatment of Lyme disease, the HPSC 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. As part of last year's awareness week, a supply of information was made available to the public and attention was drawn to a tick-borne disease toolkit, developed by the European Centre for Disease Control, ECDC. This toolkit was modified for use in Ireland and posted on the HPSC website. Indeed, the ECDC informed the HPSC that Ireland was the first European member state to make such extensive use of this material. Following the awareness week, a 100% increase of web traffic to the various Lyme disease sections of the HPSC website was noted.

I am pleased to inform the House that the number of notified cases of Lyme borelliosis will most probably be down on those for 2013. As I said, there were 20 cases notified for 2013 and while there are also 20 notified for 2014, it is expected that this figure will reduce on validation. Indeed, in the first seven weeks of 2015, two cases have been notified compared to four for the first seven weeks of 2014.

Dan Neville (Limerick, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Minister for his comprehensive reply. He highlighted that prevention is better than cure. This can be an issue for people who travel abroad, in particular for those who participate in mountaineering and outdoor activities. They can return home feeling ill and sometimes it is difficult to identify that Lyme disease is the cause, as the Minister outlined. I welcome the fact awareness week raised awareness of Lyme disease. The Lyme disease group appeared before the Oireachtas Joint Committee on Health and Children approximately 12 months ago and asked for a committee to be set up, so I welcome the fact the Minister has established a sub-committee to look at this issue.

Does the Minister agree that many medical professionals are not aware of, or do not fully appreciate, the fact that one of the symptoms could be due to Lyme disease? Is the medical profession advised to identify Lyme disease if one of the symptoms is presented? Is there a programme to advise and update the medical profession on the developments surrounding Lyme disease? When representatives of the group appeared before the Joint Oireachtas Committee on Health and Children last year, they raised some concern about the awareness of the disease among the medical profession and a level of denial on occasion in regard to the identification and treatment of the disease.

I accept the Department of Health has identified that it is a notifiable disease and that means it is identified as a very serious one, which is welcome. However, what is required is more dissemination of information, which the Minister has commenced, understanding among the medical profession, raising awareness among the general population to look out for the symptoms and ensuring that the very important protections the Minister mentioned are used by the public when travelling into areas where there is a high chance of contracting the disease.

When this issue was presented to the Oireachtas Joint Committee on Health and Children, most members were unaware of the presence of such a disease. The session we had with experts and the group were very informative.

Leo Varadkar (Dublin West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

It is fair to say there is greater and growing awareness among clinicians and doctors about Lyme disease. One of the difficulties is that there is not full consensus. I cannot speak for the medical profession; I am only here as Minister for Health and not as somebody speaking for the medical profession. However, I would like to refer from the National Institutes of Health in America, one of the international bodies which is expert on infectious disease. It states that physicians sometimes ascribe patients who have non-specific symptoms, like fatigue, pain, joint and muscle aches after the treatment of Lyme disease as having post-treatment of Lyme disease syndrome, or post-Lyme disease syndrome. The term "chronic Lyme disease" has been used to describe people with different illnesses. While the symptoms are sometimes used to describe illnesses in patients with Lyme disease, on many occasions it has been used to describe symptoms in people who have no evidence of a current or past infection with borrelia burgdorferi, according to the Infectious Disease Clinics Journal of North America. In view of confusion on how the term "chronic Lyme disease" is employed, experts in this field do not support its use, according to The New England Journal of Medicine.

Carefully designed placebo-controlled studies have failed to demonstrate that prolonged antibiotic therapy is beneficial. Although isolated success stories are always good to hear, such reports alone do not create sufficient ground to support a therapeutic approach. A positive response to prolonged antibiotic therapy may be due to the placebo effect, which is reported as high as 40% in some studies.

It is important to make a distinction between acute Lyme disease where somebody gets a tick bite, a rash and an illness thereafter, which everyone accepts happens all the time and of which people need to be more aware in terms of prevention and treating it, and the separate issue around the concept of chronic Lyme disease, which is a long-term condition. Currently, there is no medical consensus. The published evidence in the journals does not support the idea that long-term treatment with antibiotics for this condition is a treatment. There is much controversy around this and it is not my job as Minister for Health to adjudicate on medical controversies or to decide whether a minority opinion in medicine is correct over the majority opinion.