Lyme Dicease Debate – Dail Eireann – Introduced by Dan Neville TD
Deputy Dan Neville: I thank the office of the Ceann Comhairle for facilitating me in raising this matter and the Minister for Health Dr. James Reilly TD for responding.
Lyme disease, known as borreliosis, is a bacterial infection transmitted by the bite of hard-bodied ticks. Not all ticks are infected but vigilance is recommended where ticks are present to reduce the risk of Debate on Lyme Disease in Ireland introduced by Dan Neville TD. Dail transmission to humans and pets. Lyme disease can cause a variety of symptoms, ranging from mild to severe. Known as the great imitator, Lyme disease can mimic other diseases such as Parkinson’s disease, multiple sclerosis and chronic fatigue syndrome. Early treatment is vital so as to prevent serious consequences.
There are three stages to the development of the disease. Within days to weeks of a bite from an infected tick, an expanding rash may occur. This is the first stage. Sometimes the rash will appear as multiple concentric rings forming a bull’s eye. It is important to note that the rash may not develop or be noticed in some patients. A flu-like illness may also occur in the early stages of the disease.
Stage two, otherwise known as disseminated disease, has symptoms that may include migratory joint pain, head and neck pain, sore throat, swollen glands, Bell’s palsy and severe fatigue. Cardiac problems may occur also, in addition to bladder irritation in the form of interstitial cystitis. Some patients may miss stage one of the illness and develop disseminated disease within months to years of the initial bite.
The stage-three symptoms for late stage Lyme disease may include neurological changes such as tingling, numbness and tremors.
Nerve pain, poor temperature control, brain fog and disturbed sleep patterns are common. Complications may include optic neuritis, depression, panic attacks, muscle weakness, tissue damage, meningitis and chronic arthritis. Lyme disease was named after the town of Lyme in Connecticut. Studies by the University of Bath, however, have identified that Lyme disease has been present since the ice age in Europe.
The length of treatment with antibiotics depends on the severity and stage of the disease and existing co-infections. Intravenous antibiotics may be required for treatment of late stage, disseminated disease.
What does one do if one is bitten by a tick? The ticks embed themselves into the skin for feeding. They use cement-like material in their saliva to latch on. It is important when removing the tick not to leave the mouth parts behind as this could cause a secondary infection. It should be removed gently with a tick twister or fine tipped tweezers, ensuring one pulls upwards very close to the skin. One should wipe the area clean with an antiseptic wipe. One should not smother, burn or squash the tick as it may regurgitate its stomach contents if placed under stress, which could increase the chance of infection. Place the tick safely in a sealed plastic bag and write the date it was removed.
There is debate among some medical people about the disease. Some people cast doubt on whether there is such a disease, but the medical profession in general has now accepted that it is a disease that requires treatment. I welcome the opportunity to raise awareness of Lyme disease. One of the most important things we must do is raise awareness of how it occurs and of the treatment for it.
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Minister for Health (Deputy James Reilly): I thank the Deputy for raising this Topical Issue as it provides me with an opportunity to update the House on the matter.
Lyme disease, also known as Lyme borelliosis, is an infection caused by a bacterium called Borrelia burgdorferi. It is transmitted to humans by bites from ticks infected with the bacteria. Lyme borelliosis was made statutorily notifiable in Ireland by the Infectious Diseases (Amendment Regulations) Regulations 2011.
Three cases of Lyme borelliosis have been notified up to 25 January 2014. There were 20 cases of Lyme borelliosis notified in 2013 and eight cases notified in 2012, the first year in which notification was compulsory. However, due to the diverse and unspecific nature of the symptoms a number of the less serious cases may not be diagnosed, leading to an under-reporting of cases. Recent estimates suggest that there may be up to 50 to 100 cases in Ireland per year. The increase in reported cases since 2012 is likely to reflect the fact that Lyme disease is now a notifiable disease and there is increased public awareness of the condition, rather than an increase in incidence of the disease. I agree with the Deputy that the purpose of this debate is to make people aware of this. Often, as the initial infection might not manifest itself strongly and there is a time delay, people might forget that they were bitten by a tick by the time they present to their doctor with various symptoms.
The infection is generally mild affecting only the skin, but can occasionally be more severe and highly debilitating. Many infected people have no symptoms at all. The most common noticeable evidence of infection is a rash called erythema migrans, commonly called a bulls-eye rash. That is seen in 80% to 90% of patients. People can also complain of influenza-like symptoms such as headache, sore throat, neck stiffness, fever, muscle aches and general fatigue. One can see how it would be very easy to miss the cause of such symptoms if one forgets to tell one’s doctor that one was bitten by a tick. Occasionally, there may be more serious symptoms involving the nervous system, joints, the heart or other tissues.
Common antibiotics such as doxycycline or amoxicillin are effective at clearing the rash and helping to prevent the development of complications. They are generally given for up to three weeks. If complications develop, intravenous antibiotics might have to be used.
Both the health protection surveillance centre, HPSC, and Tick Talk Ireland provide guidance on protection against contracting Lyme disease. The best protection is to prevent tick bites when walking in grassy, bushy or woodland areas, particularly between May and October. Arms and legs 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. 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. Further advice on tick removal can be obtained from the HPSC website. However, the Deputy has given us an in-depth description of what to do.
It is not recommended that antibiotics are given to prevent the transmission of Lyme disease following a tick bite. People should see their doctors 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 and the HPSC has produced a leaflet, “Protecting Yourself Against Tick Bites and Lyme Disease”, which is available online to download.
I again thank the Deputy for raising this important issue.
Deputy Dan Neville: I thank the Minister for his comprehensive response. He has highlighted that prevention is better than cure. It can be an issue for people who travel abroad, particularly those who participate in mountaineering and outdoor activities. They can return, feel ill and sometimes it is difficult to identify that Lyme disease is the cause.
Does the Minister agree that many in the medical profession are not aware of or fully appreciate the fact that one of these symptoms could be due to Lyme disease? Is the medical profession advised to identify Lyme disease if one of these symptoms is presented? Is there a programme to advise and update the medical profession on the developments surrounding Lyme disease? When representatives of the association appeared before the Oireachtas Joint Committee on Health and Children there was some concern about awareness of the disease among the medical profession and even a level of denial, on occasion, regarding the identification and treatment of the disease. I accept that the Department of Health has identified it as a notifiable disease, which means it is a very serious disease in that context. That is very helpful, but what is required is the dissemination of information, understanding by the medical profession, the awareness of the general population to look out for the symptoms and ensuring that the protections the Minister mentioned, which are very important, are used by the general public when they travel into areas where there is a high chance of contracting the disease.
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Deputy James Reilly: This is an important issue and the purpose of the House in discussing it today is to raise awareness among the public and among general practitioners. Lyme disease is not very common in this country and given the general nature of its symptoms such as headache, fatigue, sore throat and so forth, we must heighten awareness of it. It is a matter for the Irish College of General Practitioners to highlight it with its members. We are pleased to have made funding available in 2012 to Tick Talk Ireland to help highlight the issue also.