Brendan Griffin (Kerry, Fine Gael)
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187. To ask the Minister for Health the reason a person (details supplied) in County Kerry who has been formally diagnosed here and in Germany as being a sufferer of Lyme disease has not received any further contact from the HSE since November 2016 despite having informed the HSE of the positive diagnosis at that time; if he will intervene with the HSE to ensure the person receives the treatment that is required immediately; and if he will make a statement on the matter. [10868/17]

Simon Harris (Wicklow, Fine Gael)
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As this matter relates to an individual case, it has been referred to the Health Service Executive for a direct reply to the Deputy.

Brendan Griffin (Kerry, Fine Gael)
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188. To ask the Minister for Health the reason diagnostics here for Lyme disease appear to be at odds with those of other countries such as Germany; the measures he is taking to ensure that persons with Lyme disease are accurately diagnosed; his views on cases in which persons with Lyme disease are being told in error that they are Lyme disease negative; and if he will make a statement on the matter. [10869/17]

Brendan Griffin (Kerry, Fine Gael)
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189. To ask the Minister for Health the efforts he is making to make the public aware of the risk of Lyme disease; if he will increase public awareness of the methods of contraction, the symptoms, the treatments available and the consequences of not treating the condition; the amount the HSE spends annually on public awareness surrounding Lyme disease; and if he will make a statement on the matter. [10870/17]

Simon Harris (Wicklow, Fine Gael)
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I propose to take Questions Nos. 188 and 189 together.

Lyme disease (also known as Lyme borreliosis or LB) is an infection caused by a spiral-shaped bacterium called 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 occasionally be more severe. Lyme disease is the commonest cause of tick-borne infection in Europe.

Lyme borreliosis can be asymptomatic or have a range of clinical presentations. Current best advice is that diagnosis should be made only after careful examination of the patient's clinical history, physical findings, laboratory evidence and exposure risk evaluation. Exposure to ticks prior to disease manifestations is necessary for the diagnosis of Lyme borreliosis. Since an awareness or recollection of a tick-bite is not always present, however, this should not exclude the diagnosis of Lyme borreliosis. Later stages require the use of antibody detection tests (or advanced DNA detection techniques). Testing for Lyme Disease is undertaken in most of the larger hospitals in Ireland. In undertaking Lyme testing, it is essential that the results are interpreted in the light of the clinical condition of the patient. If the result of this initial screen is equivocal, the patient's samples are referred to the U.K.'s Public Health England Porton Down facility which uses a two-tier system recommended by American and European authorities. This involves a screening serological test followed by a confirmatory serological test.

Some laboratories abroad do not use antibody tests like the EIA (screening ELISA test) and Western Blot and instead will use other types of tests, for example, testing for levels of a specific white blood cell (CD-57) or lymphocyte transformation tests (tests to measure how specific cells in a person's immune system respond when exposed to antigens against Borrelia burgdorferi - the bacterium responsible for Lyme disease). These types of tests are not currently recommended by international groups such as the CDC, IDSA or BIA for a number of reasons:

1. There is not enough scientific evidence that they are suitable tests to diagnose Lyme disease.

2. There is no standard method to perform and interpret these kind of tests and

3. Positive results in these kinds of tests may be due to other illnesses or conditions and not just Borrelia infection.

Since 2013, the HPSC has held an annual ‘Lyme Awareness Week’ at the beginning of the tick biting season, the purpose of which is to draw attention - particularly in the media - to Lyme disease and the ticks that can spread this disease. Lyme cases tend to appear in Ireland with greater frequency after April, hence the choice of this time of year for Lyme Awareness Week.

The literature on the HPSC website points out that campers, walkers and certain occupational groups such as forestry workers, conservation workers, deer cullers and farmers are at particular risk of exposure to ticks (and therefore LB). That said, anyone walking or hiking in the countryside is at risk of biting ticks. The ticks responsible for LB are generally hard-bodied ticks (Ixodidae). Ixodes ticks are hosted by a wide range of mammals including deer, sheep and cows, and occasionally birds; their tiny size (less than 2mm unfed) means they can remain undetected for long periods.

Ixodes ticks are most likely to be found in:

- Shady and humid woodland clearings with grass;

- Open grassland, walking paths (especially those bordered by long grasses);

- Wooded and forested areas;

- Vegetation close to lakes and seaside beaches;

- Parkland areas; and

- Open fields and bushes.

They are present in both urban and rural environments and are active from spring to autumn.

Both the Health Protection Surveillance Centre 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, particularly between May and October:

- Arms and leg should be covered; 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. DEET or permethrin (insect repellents) can be used – advice can be obtained from pharmacies.

- 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. Only if the area becomes inflamed may treatment be required; and advice should be sought from a doctor.

- People should see their doctor if they develop a rash or become unwell with other symptoms, letting the doctor know of exposure to ticks.

Further advice can be obtained from the HPSC website (www.hpsc.ie) and the HPSC produced a leaflet on “Protecting Yourself Against Tick Bites and Lyme Disease” which is available for the public to download.

A Lyme Borreliosis Sub-Committee of the Scientific Advisory Committee of the HPSC has been established to look at methods of raising awareness especially in those areas (including recreation areas) where Lyme carrying ticks can be most expected to be found. The aim of this Sub-Committee 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, an Environmental Health Officer, and member of Tick Talk has been invited to be the patient representative on the Sub-Committee. The initial 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.