Written answers

Tuesday, 9 May 2017

Department of Health

Infectious Disease Screening Service

Photo of Declan BreathnachDeclan Breathnach (Louth, Fianna Fail)
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483. To ask the Minister for Health if his attention has been drawn to the fact that testing for Lyme disease here uses the inaccurate standardised test called ELISA, which is at best 35% accurate thereby resulting in missed diagnosis; if his attention has been further drawn to the fact that German and other EU laboratories are using a more accurate test which cost the European Union €1.1 million to develop and which is a highly sensitive and specific low-cost lab on a chip system for Lyme diagnosis (details supplied); if he will arrange for the implementation of this system here to save persons the expense of travelling to Germany for diagnoses; and if he will make a statement on the matter. [22015/17]

Photo of Willie PenroseWillie Penrose (Longford-Westmeath, Labour)
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502. To ask the Minister for Health the steps he is taking to encourage awareness, prevention and treatment of Lyme disease here; if his attention has been drawn to the fact that there are specific high-risk areas here and that the risk of Lyme disease here may increase as a result of climate change; and if he will make a statement on the matter. [22120/17]

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I propose to take Questions Nos. 483 and 502 together.

Lyme disease (also known as Lyme borreliosis) is an infection caused by a spiral-shaped bacterium called Borrelia burgdorferi. It is transmitted to humans by bites from ticks infected with the bacteria. The Health Protection Surveillance Centre (HPSC) of the HSE has extensive information concerning Lyme disease on its website . I have appended a copy of the Frequently Asked Questions (FAQ) from the website for your information.

Lyme borreliosis was made been statutorily notifiable in Ireland by the Infectious Diseases (Amendment Regulations) Regulations 2011 (S.I. no 452 of 2011). The notifiable entity is Lyme neuroborreliosis, the more severe neurological form of Lyme boreliosis and the average number of annual neuroborreliosis notifications has been 14 over the last few years However, the diverse and unspecific nature of the symptoms means that a number of the less serious cases may not be diagnosed, leading to under reporting of cases. It is likely that there are between 150 and 250 cases of Lyme disease in Ireland per year, making Ireland a low to medium incidence country (the highest incidence of Lyme disease in Europe is seen in Alpine and Scandinavian countries). It is estimated in most Western European countries that between 5% and 20% of the population have positive Lyme blood tests, indicating that they have been bitten by an infected tick and either did not develop symptoms of Lyme disease or developed such mild symptoms that these were not recollected.

Lyme disease is diagnosed by medical history and physical examination. The infection is confirmed by blood tests which look for antibodies produced by an infected person's body in response to the infection. These normally take several weeks to develop and may not be present in the early stages of the disease.

The standard approach to Lyme diagnostics is a two-stage approach and involves using a sensitive enzyme immunoassay (EIA) as an initial, screening step. Screening EIAs can be insufficiently specific, giving false-positive reactions in the presence of other similar bacteria, and certain other viral infections, including glandular fever. In addition, blood samples from patients with autoimmune disorders and other inflammatory conditions can also lead to false-positive results.

Samples giving positive or equivocal results in screening tests are further investigated in a second-stage immunoblot (Western blot) tests. Use of immunoblot testing greatly increases specificity. Using this two stage approach will give a great degree of certainty around the diagnosis of Lyme.

All clinical (and other) laboratories in Ireland must undergo continuous quality assurance to ensure that the quality of the diagnostics they provide is maintained at the highest international level for human diagnostics.

The Scientific Advisory Committee of the HPSC, the Infectious Diseases Society of Ireland, the Irish Society of Clinical Microbiologists, the Irish Institute of Clinical Neuroscience and the Irish College of General Practitioners agreed a Consensus Statement on the Clinical Management of Lyme Borreliosis, which endorsed the previously referenced, internationally recognised set of guidelines (those of the Infectious Diseases Society of America) to Medical Practitioners to ensure a standardised approach to the diagnosis and management of Lyme disease in Ireland.

The HPSC have published Frequently Asked Questions on Testing for Lyme Disease on their website, .

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, an Environmental Health Officer and, very importantly, a representative from Tick Talk Ireland, the primary Support Group for Lyme disease in Ireland.

The initial work of the Lyme Borreliosis Sub-committee involved 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. Material has been produced which is aimed both at the general public and General Practitioners.

There is extensive information for the public and health professionals on the HPSC website. This information for the public includes:

- Lyme Disease Frequently Asked Questions;

- Laboratory testing for Lyme Disease: FAQs for general public;

- Lyme Disease Illustrations; and

- CDC's instructions on how to remove a tick.

The website also contains factsheets, information, clinical guidance and an Erythema Migrans Diagnostic Support Tool for health professionals.

As a result of climate change there is likely to be an increase in the incidence of Lyme disease in Ireland. The predicted warmer temperatures and altered rainfall are likely to result in a longer tick season and increased numbers of the small rodents that the ticks feed upon. This is the likely picture in Ireland and would be replicated in the UK, the US and Canada. Campers, walkers and certain occupational groups such as forestry workers, conservation workers, deer cullers and farmers are at particular risk of exposure. The risk of infection is greatest in late spring and early summer, so Springtime is the time to ensure that parents, children and doctors are aware of the risks posed by ticks. Since 2013, the Health Protection Surveillance Centre (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. This year Lyme Disease Awareness Week will take place on 15-22 May.


Kerry Lawless
Posted on 11 May 2017 6:27 pm (Report this comment)

The Minister's answer states "The initial work of the Lyme Borreliosis Sub-committee involved a survey of laboratory methods for the diagnosis of Lyme borreliosis in Ireland". What were the terms of reference for the survey? Who was consulted? Were all best practice testing mechanisms currently available included in this survey? Was the economic cost of not using adequate laboratory methods considered? If as the Minister suggests the survey is completed when will the results be made public?

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