John McGuinness (Carlow-Kilkenny, Fianna Fail)
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231. To ask the Minister for Health the action he will take in support of persons with Lyme disease; his views on a television documentary screened recently and if he will address all of the issues raised; his views on a submission made by a support group (details supplied); if his attention has been drawn to the fact that over 40 new persons joined the support group immediately following the television documentary, indicating the large number of persons affected by Lyme disease; and if he will make a statement on the matter. [34192/16]

Simon Harris (Wicklow, Fine Gael)
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Lyme disease (also known as Lyme borreliosis) is an infection transmitted to humans by bites from ticks infected with the bacterium Borrelia burgdorferi. The infection is generally mild affecting only the skin, but can occasionally be more severe and debilitating. 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 80 to 90% of patients. This red, raised skin rash (often called a bulls-eye rash) develops between 3 days and a month after a tick bite and spreads outwards from the initial bite site. 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 the commonest cause of tick-borne infection in Europe.

Lyme borreliosis is a notifiable infectious disease, the notifiable entity being the more severe neurological form, Lyme neuroborreliosis. The Health Protection Surveillance Centre (HPSC) collects and collates surveillance data on the condition. The Weekly Infectious Disease Report, published by the HPSC on 26 October 2016, indicated that for week 42-2016 (16/10/16-22/10/16) there have been 16 cases notified so far in 2016 – an increase of 5 on the same period last year. However, the diverse and unspecific nature of the symptoms means that a number of the less serious cases may not be diagnosed, leading to an underreporting of cases. Recent estimates suggest that there may be up to 50-100 cases in Ireland per year.

Lyme disease can be very successfully treated using common antibiotics. These antibiotics are effective at clearing the rash and helping to prevent the development of complications. Antibiotics are generally given for up to three weeks. If complications develop, intravenous antibiotics may be considered. In Ireland, treatment by most clinicians is based on that laid out in evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis published by the Infectious Diseases Society of America (IDSA) in 2006. This pharmacological regime can be summarised thus:

- Doxycycline, amoxicillin or cefuroxime for the treatment of adults with early localized or early disseminated Lyme disease associated with erythema migrans, in the absence of specific neurologic manifestations (ceftriaxone in early Lyme disease for adults with acute neurologic disease manifested by meningitis or radiculopathy);

- Doxycycline, amoxicillin, or cefuroxime for adults with Lyme arthritis but without clinical evidence of neurologic disease;

- For late neurological disease in adults - intravenous ceftriaxone, cefotaxime or Penicillin G.

The Scientific Advisory Committee of the HPSC has established a Lyme Borreliosis Sub-Committee, the aim of which is to develop strategies to undertake primary prevention in order to minimise the harm caused by Lyme Borreliosis in Ireland. In addition to staff from the HPSC, the membership of the Sub-Committee includes specialists in Public Health Medicine, Consultants in Infectious Diseases, Clinical Microbiology, Occupational Health an Entomologist from the Parks and Wildlife Service, a representative from the Local Government Management Agency and an Environmental Health Officer. representation has also been sought from a Lyme Disease advocacy group.

The Terms of Reference of the Sub-Committee are:

- To raise awareness in Ireland of Lyme Borreliosis amongst clinicians and the general public;

- To identify and highlight best international practice in raising awareness about Lyme Borreliosis for the general public;

- To develop policies of primary prevention of Lyme Borreliosis in Ireland based on best international practice;

- To explore ways in which to improve surveillance of neuroborreliosis in Ireland;

- To develop strategies to raise awareness among the general public particularly in areas of higher tick populations;

- To produce a Final Report covering all the above areas.

The initial work of the Lyme Borreliosis Sub-committee involves a survey of laboratory methods for the diagnosis of Lyme borreliosis in Ireland, the development of Lyme borreliosis guidance for general practitioners, the publication of medical media articles to highlight diagnostics and laboratory methods relating to Lyme borreliosis available in Ireland for general practitioners, and ongoing work in drawing together the Final Report of the Sub-committee.The Sub-Committee is expected to report in 2017.