Micheál Martin (Cork South Central, Fianna Fail)
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404. To ask the Minister for Health the diagnostic facilities available to public patients to test for Lyme disease; his plans to make it more freely available; if his Department is examining this issue; if the Chief Medical Officer has issued guidelines regarding adequate tests being available; if he is satisfied that public patients are receiving adequate access to diagnostics; his views regarding tests being carried out abroad; and if he will make a statement on the matter. [31254/17]

Simon Harris (Wicklow, Fine Gael)
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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 www.hpsc.ie/a-z/vectorborne/lymedisease/.

Lyme borelliosis 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 borelliosis. The HPSC of the HSE collects and collates surveillance data on notifiable infectious diseases. The number of annual neuroborreliosis notifications over the last few years is as follows:

- 2012 - 08 cases;

- 2013 - 13 cases;

- 2014 - 18 cases;

- 2015 - 12 cases;

- 2016 - 21 cases (provisional).

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 IDSA) to Medical Practitioners to ensure a standardised approach to the diagnosis and management of Lyme disease in Ireland.

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.

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. 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.

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 Sub-Committee first met on 6 May 2015 and it is expected to report in 2017.

There is significant support and extensive information for health professionals and the public on the HPSC website. These supports include a fact sheet on tick borne diseases, including Lyme Disease. This fact sheet gives information on clinical features, the disease, transmission routes, prevention measures, diagnosis, and management and treatment. There is also an erythema migrans (EM) diagnostic tool to aid health professionals in the diagnosis of EM, which is frequently the earliest clinical manifestation of Lyme borreliosis. 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.

Testing for Lyme borrelliosis is currently undertaken in most of the larger hospitals in Ireland. As testing and treatment for Lyme borreliosis is widely available in Ireland there is no requirement for people to travel to other EU Member States to access these services.