By Lori Aratani
Washington Post Staff Writer
Tuesday, June 17, 2008
Washington area health departments are stepping up Lyme disease education and prevention efforts in response to a steep rise in the number of reported cases of the tick-borne illness in Maryland, Virginia and the District.
Some of the rise is attributable to better disease reporting due to increased awareness about the disease, according to Kevin Griffith, a medical epidemiologist with the Centers for Disease Control and Prevention, but more people are also being infected. Local health departments want residents to know that even if they are bitten by a tick carrying Lyme disease, they can greatly reduce the risk of infection by removing the insect promptly, Griffin said.
The number of reported Lyme disease cases in Virginia almost tripled last year to 945, from 357 in 2006. In Maryland, the count reached 2,576, more than double the 1,248 reported in 2006. And in the District, the number jumped to 116, up from 64 in 2006. As of early June, District health officials had confirmed 36 new cases. Maryland and Virginia don't have numbers yet for 2008.
One thing that's probably not responsible, say experts: the region's unusually rainy spring. Tick numbers are more dependent, they say, on other, complex factors, such as the local deer population and ticks' two-year life cycle.
The jump in reported cases comes as debate continues over the best strategy for diagnosing and treating the sometimes painful bacterial disease. The conflict, which has spilled over onto blogs and into state legislatures and spawned charges of conspiracy and coverup, pits the medical establishment against patient activists, some of whom claim to suffer from a chronic form of the ailment. Activists say this form should be treated with long-term antibiotic therapy; mainstream experts generally oppose such treatment as ineffective and possibly dangerous.
Lyme disease, estimated to affect about 20,000 Americans each year, is the most common tick-borne infection in the Northern Hemisphere. In 2006, President Bush was treated for a rash that may have been caused by Lyme disease.
Transmitted through the bite of the tiny deer tick, Lyme often causes a bull's-eye rash in the area of the bite. Those infected may suffer from flulike symptoms, such as muscle aches, fever and fatigue. If not treated promptly, the infection can potentially lead to heart, joint and nervous system damage, according to the CDC, which has been collecting data on Lyme infections since 1991.
People who receive prompt antibiotic treatment often recover in a few weeks, although symptoms such as fatigue can last for several months, said Gary Wormser, chief of infectious diseases at New York Medical College and the lead author of Lyme treatment guidelines published by the Infectious Diseases Society of America in 2006.
The guidelines use the term "post Lyme syndrome" for cases in which the lingering symptoms are severe. However, the guidelines do not recognize "chronic" Lyme because there is no evidence the disease's bacteria remain alive in humans after a standard course of antibiotic therapy and because there is no good evidence that repeated or prolonged courses of antibiotics help patients.
Antibiotic therapy is usually given for two weeks but may be given for up to four weeks for certain manifestations. The guidelines allow for re-treatment for relapses that occur infrequently. Because insurers often won't pay for treatment outside the guidelines, activist groups are fighting to have the rules changed.
Gregg Skall, general counsel for the National Capital Lyme and Tick-Borne Disease Association, a McLean-based nonprofit advocacy group for Lyme patients, said groups like his want the medical community to recognize that there are cases in which long-term treatment offers relief.
Some individuals believe they suffer long-term symptoms related to Lyme disease even though they have never been diagnosed with Lyme. Some believe they may have been given faulty tests or have symptoms similar to those of people who were given a Lyme diagnosis. Absent a diagnosis followed by the recommended treatment, the IDSA guidelines do not recognize their problem as any form of Lyme, chronic or otherwise.
Lyme advocates also maintain that sometimes the tests are faulty and do not pick up all Lyme infections.
Last year, Connecticut Attorney General Richard Blumenthal launched an investigation of the process by which the IDSA compiled the guidelines, charging conflicts of interest by several review panel members. Donald Poretz, president of the IDSA, denied the charge. In May, activists were cheered when the IDSA agreed to review the guidelines rather than continue to fight the investigation.
"We viewed the settlement as a victory for patients, in the sense that patients [who considered the guidelines inadequate] felt vindicated,'' said Pat Smith, president of the Lyme Disease Association.
Poretz, a physician based in Annandale, said a new IDSA panel will review the guidelines this summer and determine whether research supports a rethinking of current treatment strategies.
"We're always willing to change if science shows there is new research,'' Poretz said.
Former panel members, he said, opposed long-term treatment with antibiotics because patients "can develop drug resistance, infections in their [intravenous lines] and allergic reactions. And there are extraordinary costs.''
Connecticut has long been a battlefield in the debate over the treatment of Lyme disease. It was in the Connecticut town of Old Lyme that the infection was discovered in 1975. Last year Connecticut led the nation in the rate of Lyme infections: 51 cases per 100,000 people; other northeastern states also report relatively high rates.
Local officials are focusing on public education to reduce the risk of infection.
Fairfax County has one of the most ambitious outreach efforts. In April, county health officials sent a 19-page color booklet to every household in the county with advice on protection against Lyme disease, West Nile virus and other insect-borne diseases. People who are bitten by a tick are invited to bring it to health officials for inspection. The booklet is also downloadable at http://www.fairfaxcounty.gov/hd/westnile/wnvpamp.htm.
Jorge Arias, an environmental health supervisor for the Fairfax County Health Department, said that although several varieties of ticks bite humans, only one carries the bacterium that causes Lyme disease. While infections have been reported countywide, most have occurred in Fairfax's less developed western part, Arias said.
Last month, Montgomery County officials posted "Tick Awareness" signs on information kiosks in parks, with advice about how to avoid infection. Among the tips: Avoid tick-prone areas, such as wooded and bushy spots with high grass and leaf litter. Walk in the center of trails when in wooded areas or areas with high grass. The county offers more information at http://www.montgomerycountymd.gov/hhstmpl.asp?url=/content/hhs/lyme_disease.asp. Extensive information about Lyme is available from the CDC at http://www.cdc.gov/ncidod/dvbid/lyme/index.htm.
District resident Linda Baranovics knows it pays to be vigilant.
In May Baranovics went on a camping trip with her son's class in Prince William County. She figured her risk of being bitten was low because she'd worked in the kitchen for most of the trip.
But about four days after she returned, she discovered a tick about the size of a sesame seed on the back of her thigh. She didn't think much of it until about two weeks later, when she developed a low-grade fever, chills and the worst body aches she said she'd ever had. Because she didn't get a bull's-eye rash, she thought perhaps she had the flu. But when a visit to the doctor confirmed she had Lyme, her doctor prescribed antibiotics. Now Baranovics said she feels much better.
"I know what to look for now,'' she said. "How that thing got on me, I don't know.''