LYME DISEASE - QUEEN'S SPEECH HOUSE OF LORDS

• Lord Astor of Hever (Con)

  My Lords, I want to speak briefly on the specific health issue of Lyme disease, which is a rapidly increasing health risk in the United Kingdom. If Lyme disease is not treated early, it can cause significant illness and devastate affected patients’ lives. This is what life has been like for my daughter, and I declare this personal interest.

  Many noble Lords will be aware that ticks harbour Lyme disease, as well as many other equally serious infections. These infections are passed to humans and animals via the bite of an infected tick, due to and during their method of feeding. The danger is no longer confined to rural areas, with ticks now being found in every county of the United Kingdom, and increasingly so in urban parks and people’s gardens. If Lyme is diagnosed and treated early, the chances of a full recovery are good. However, failure to diagnose early and treat adequately can result in serious consequences to the patient. Tick-borne diseases that are misdiagnosed or neglected result in complicated infections, which have devastating and multisystemic consequences. Patients can be left with extremely debilitating and chronic symptoms, needing a wheelchair or completely bedridden, and enduring intense and relentless suffering.

  Despite the increasing threat that Lyme disease poses to public health, there remain no suitable UK official guidelines for diagnosis or treatment. What we do have is outdated National Health Service guidance, relying on guidelines written by the Infectious Diseases Society of America and supported by the CDC. According to the National Guideline Clearinghouse of America, the IDSA-CDC guidelines are not fit for purpose. They are outdated and do not take into account recent developments in the understanding of these complex infections.

  The absence of adequate guidelines is closely linked to the fact that insufficient levels of training are available to our doctors. Even if a positive test is obtained, expertise is seriously lacking, both in value of interpretation and in dealing appropriately with the illness. That stark statement is in accordance with multiple testimonies from patients. Expert patient input is crucial in turning the situation into a positive solution, not only for patients themselves but for the National Health Service as a whole.

  Failure to meet the challenges of Lyme disease has led to unknown numbers of people becoming infected, but not diagnosed or treated. It could amount to tens or even hundreds of thousands of people. The UK now finds itself in a situation where patients with diverse illnesses and symptoms might actually have unrecognised Lyme disease. In these patients, the infection could have reached a stage where treatment will be difficult and lengthy and will require the supervision of expert physicians, trained and experienced in this complex disease and the frequently occurring co-infections.

  The cost to the Exchequer in terms of numbers of patients unable to work and using the NHS for serious health problems must be a truly staggering amount. Neither this country, nor affected patients, can afford this. Early recognition of symptoms and early treatment would save our National Health Service a great deal of money.

  Given the huge cost, both in terms of the impact on the patient’s quality of life and, in practical terms, on our health service, it is clear how important it is to prevent as many cases as possible reaching this stage. Improvements in the training available to our doctors should be made a top priority. However, awareness among the general public of the risk posed by ticks should also be prioritised. There are some very simple measures that can be taken to reduce one’s chance of becoming infected with Lyme disease. However, few people have any knowledge of this. How can we safely, and with a clear conscience, encourage children to play outside and make the most of the outdoors if we are carelessly allowing them to risk their health by contracting one of these insidious, infectious diseases?

  Outdated guidelines, unreliable blood tests, insufficient training for doctors, a lack of tick-borne specialists of calibre and a widespread lack of awareness among the general public of preventive measures are all factors that are leaving us alarmingly ill-equipped to tackle a problem that poses a rapidly increasing risk to every UK citizen. In the light of this, I ask my noble friend what his department is doing to ensure that GPs receive training in Lyme disease that is mandatory and thorough enough to allow them to make clinical diagnoses. Proper awareness will prevent the number of Lyme disease sufferers growing.

  Lyme patients want to regain their health. They want to get back to work. They wish for nothing more than to regain control over their lives and take part in all the activities they enjoyed before they became ill. Most Lyme patients have the will and determination to achieve this. But none of these aims can happen if they are sidelined and hobbled by misguided opinion—which includes the current health system situation, with its constraints and limitations
• https://hansard.parliament.uk/Lords/2017-06-29/debates/B1D5D245-3ECF-46D9-A187-088A50888D00/Queen%E2%80%99SSpeech#contribution-865EC7B8-F112-420B-97C1-739ECE3BB091    
• 
  
• 
  

IGNORANCE OF PUBLIC HEALTH DANGERS- LYME DISEASE

Tick abundances in South London parks and the potential risk for Lyme borreliosis to the general public 

C. NELSON, 

S. BANKS, 

C. L. JEFFRIES,

T. WALKER and

J. G. LOGAN 

Abstract

Tick abundances and prevalences of infection with Borrelia burgdorferi sensu lato, the causative agent of Lyme disease, were investigated in four South London parks. A total of 360 transects were sampled using three methods of collection (blanket, leggings and flags) simultaneously. No ticks were found on Wimbledon Common or at Hampton Court, but 1118 Ixodes ricinus (Ixodida: Ixodidae) ticks were collected at Richmond and Bushy Parks. At Richmond Park, lower canopy humidity [odds ratio (OR) 0.94; P = 0.005], increased mat depth (OR 1.15; P < 0.001) and increased soil moisture (OR 1.40; P = 0.001) predicted the presence of I. ricinus, and increased sward height [incidence rate ratio (IRR) 1.01; P = 0.006] and decreased ground temperature (IRR 0.90; P = 0.009) predicted increased abundance. At Bushy Park, thicker mat depth predicted tick presence (OR 1.17; P = 0.006) and increasing temperature correlated with tick absence (OR 0.57; P = 0.023). A total of 279 ticks were screened for the presence of B. burgdorferi using quantitative polymerase chain reaction. Point prevalences of 0% for larvae (n = 78), 2.14% for nymphs (n = 174) and 0% for adult ticks (n = 7) related to an acarological risk of 0.22 infected ticks per 40 m transect in Richmond Park. The abundance of ticks and the acarological risk, particularly at Richmond Park, highlight the need for appropriate communication of the associated risk to the general public frequenting these recreational areas.

http://onlinelibrary.wiley.com/doi/10.1111/mve.12137/abstract

Interesting research on ticks in London Parks by researchers from the London school of Hygiene & Tropical medicine.

James Logan has discussed his research in the media recently to help raise awareness of ticks and possible tick borne infections - Lyme Disease.

 Science daily - 'Dr James Logan, Senior Lecturer in Medical Entomology at the London School of Hygiene & Tropical Medicine, senior author of the study said: "The overall risk of Lyme disease in London parks is very low, but precautions should be taken. Check yourself and your pets after frequenting parkland areas, and remove any ticks as quickly as possible using a tick removal tool. To minimise the risk stick to footpaths and wear an insect repellent."

Hopefully more such important work will be done and more awareness raised of Lyme Disease.

In 1994 

Evidence for Lyme disease in urban park workers: a potential new health hazard for city inhabitants.Rees DH1, Axford JS.

Abstract

In the UK, cases of Lyme disease have only been reported from rural areas. Recently, however, Ixodes ticks infected with Borrelia burgdorferi have been found in London parks. To determine whether this constituted a health hazard, we questioned 44 workers from Richmond and Bushey parks to assess their exposure to tick bites and whether they had a clinical history of Lyme disease. Their serum was subsequently investigated for antibodies to two different preparations of Borrelia burgdorferi (whole cell sonicate and flagellin) and the specificity of these antibodies determined by immunoblotting. Comparison was made to zoo keepers (n = 27) from a wildlife park outside London. Tick bites were reported in 23% of park workers and of these, three described symptoms compatible with Lyme disease. Raised antibody levels were found in 10 (24%) of the park workers compared with one (4%) of the zoo keepers using ELISA with whole cell sonicate as antigen (P = 0.02) and 6 (14%) of park workers and none of the zoo keepers using purified flagellin as antigen (P < 0.05). Analysis of the immunoblots revealed more bands were detected in park workers (mean 1.8, range 0-6) than in the zoo keeper controls (mean 0.8, range 0-4); P < 0.001 and 14 (32%) of the park workers had reactivity with three or more protein bands, whilst only one of the zoo keepers showed this level of antigen binding (P < 0.005). These data suggest previous infection with B. burgdorferi in London park workers which has important health implications for these individuals, other park workers and possibly park visitors.

20 years later and still no signage in the London parks.

Anecdotal comments from patients infected in the London Parks show that there is still little doctor awareness too in that area. 

Concerns that knowledge of tick borne disease in the UK will frighten people away from visiting the great outdoors seems to have been the policy of HPA but this is assumption and research does not support that concern. 

So for 20 years the public are left ignorant and doctors are ill informed and ill equipped to help diagnose and treat Lyme Disease. 

The human health burden rises year on year rarely seeming to magically resolve without treatment leaving a miserable existence for those infected and left untreated and a burden on our Health care costs benefit costs and economy. 

Yesterday a meeting at the House of Lords on Lyme Disease asked the Health minister to respond to concerns - lack of awareness, public signage in the London Parks and lack of doctor awareness were just some of the many concerns.
http://www.parliament.uk/business/publications/hansard/lords/todays-lords-debates/read/grandcommittee/674/