Mary Upton (Dublin South Central, Labour)
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Question 107: To ask the Tánaiste and Minister for Health and Children if her attention has been drawn to the risk of Lyme disease from deer ticks; if arrangements will be made to have notices placed in appropriate settings where the risk from this infection is possible; if a publicity campaign will be initiated to inform the public of the risks; and if she will make a statement on the matter. [38532/05]

Mary Harney (Dublin Mid West, Progressive Democrats)
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Lyme disease, also known as Lyme borelliosis, is an infection caused by a spiral shaped bacterium borrelia burgdorferi that is transmitted to humans by bites from ticks infected with the bacteria. The infection is generally mild affecting only the skin, but can sometimes be more severe. Lyme disease has been reported from North America, Europe, Australia, China and Japan. Ticks feed by biting and attaching to the skin and sucking blood, normally from animals such as sheep and deer. Infected ticks are most likely to be encountered in heath land and lightly forested areas of North America and northern Europe. Ramblers, campers and those who work in such areas especially if they come into contact with large animals are at greatest risk of being bitten by ticks and of going on to develop disease. Cases of Lyme disease appear in Ireland every year.

Many infected people have no symptoms at all. The commonest noticeable evidence of infection is a rash called erythema migrans that is seen in about three quarters of infected people. This red, raised skin rash develops between three days and a month after a tick bite and spreads outwards from the initial bite site. This rash can last up to a month and be several inches in diameter. 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..

Lyme disease is not a notifiable infectious disease in Ireland. This means that there is no legal requirement on doctors to report cases to their local director of public health. In Ireland, researchers have tried to determine levels of Lyme borreliosis; it has been estimated that there were about 30 human cases per year in the mid-1990s. Data, however, from the National Virus Reference Laboratory, which is responsible for undertaking testing for B. burgdorferi, have confirmed that there were only 11 positive cases in 2003; these numbers have been steady at that level for the last couple of years. There were, however, more than 1,000 requests for testing for B. burgdorferi in 2003.

Over the last several years, the NVRL confirms that virtually all positive cases were associated with travel in the US. It is felt that there is some unknown degree of under-reporting and under-diagnosis of this condition. In Britain, about 300 laboratory-confirmed cases are reported to the Health Protection Agency annually; however, estimates suggest that the true figure could be between 1,000 and 2,000 cases annually. In the US, there are about 15,000 to 20,000 cases each year.

More than 100,000 cases have been reported in the US, with highest rates in New England; more than 17,000 cases were reported during 2000 alone. In Europe, similarly high rates are seen in Germany, but forested regions of Austria, Sweden and Slovenia frequently report cases as well. In England, Lyme borreliosis is considered to be endemic in the New Forest area of Hampshire.

In Britain, it has been estimated that there may be as many as 1,000 human cases each year, however, in 1993, only 44 infections were voluntarily reported by laboratories in England and Wales while four were reported for Scotland. Since then, about 50 cases are reported each year in England and Wales; the true incidence, while unknown, is increasing. Over the last three years, Scotland has been detecting considerably more cases: 28 in 2001, 85 in 2002 and, provisionally, 71 in 2003.

Lyme disease can affect anyone but is commonest among ramblers, hill-walkers, hikers, campers and others whose leisure activities or work takes place in heath land or light woodland areas or brings them in contact with certain animals, for example, deer. Summer and autumn is the period when most cases occur.

Common antibiotics such as doxycycline, amoxicillin or erythromycin are effective at clearing the rash and helping to prevent the development of complications. Currently, there is no vaccine available against human Lyme disease in Ireland. A US human vaccine was withdrawn in 2002. Research into vaccine development is taking place in Europe and the US.

It would therefore appear on initial review that despite confirmed Irish cases of Lyme borelliosis having been principally associated with travel to North America, there is the potential for individuals to be exposed to biting ticks in Ireland. It would seem sensible for this reason to recommend that simple, straightforward information should be made available that will assist those who may potentially be exposed whether as a result of occupational or leisure activities to take necessary precautions.

As a response to this in 2004, the vector-borne sub-committee of the scientific sub-committee of the Health Protection Surveillance Centre's scientific advisory sub-committee was established. One of its terms of reference was to identify and determine the burden of certain significant vector-borne diseases in Ireland and to make recommendations in relation to the provision of advice and guidance. One of the diseases to be considered in the work of the vector-borne sub-committee was Lyme disease.

As part of the initial risk assessment the available information on Lyme disease was collated and reviewed. As in common with many other countries, estimation of true levels of this condition is rather difficult. In Ireland a number of cases appear every year and a proportion of these are likely to have been acquired in Ireland. This condition is not among the scheduled list of notifiable diseases laid out in the Infectious Diseases (Amendment) (No. 3) Regulations, SI 707 of 2003, and therefore data on Lyme disease are not subject to systematic collection as is the case for notifiable diseases.

A fact sheet on Lyme disease has been made available on the HPSC's website to provide members of the general public and media with advice on minimising the risk of Lyme disease. In addition, part of the work of the vector-borne sub-committee in the new year will be the development of clinical guidance on the management of Lyme disease and raising awareness of this condition among clinicians.