Lyme disease is being tested and treated properly in Nova Scotia, says NSHA physician

Pictou, NS - People are getting the best testing and treatments available for Lyme Disease in the province, said Nova Scotia’s Regional Medical Officer of Health in the Northern Zone for the Nova Scotia Health Authority.

Dr. Ryan Sommers told the Municipality of Pictou County’s finance committee that no one is disputing the fact the Lyme disease is being diagnosed and treated in Nova Scotia including here locally. Pictou County was identified as a risk area for Lyme disease in 2010 and now most of the province has the presence of the black legged ticks that carry the harmful bacteria.

“Lyme disease is real and it’s here and this is nothing new to people in Pictou County,” said Dr. Sommers. “It is an emerging infectious disease. It Is something that is coming to our region or already established. It is hard to say if it will flatten out. As ticks expand to more geographies and humans get outdoors more, the tick cases will go up. People will also be more educated and as the public understands the signs and symptoms of a tick bite these numbers will go up as well.”

Dr. Sommers said physicians follow evidence-based research when they are diagnosing someone who might have Lyme disease which includes looking for symptoms such as a bullseye rash, fever, flu- like symptoms and joint pain. However, only 70 to 80 per cent of cases have a rash and there is a small percentage of people who get bit by a black legged tick and never develop any symptoms.

There is also another 10 to 15 per cent of the population that can have ongoing symptoms such as fatigue, difficulty concentrating or pain, and are diagnosed with Post Treatment Lyme Disease Syndrome. He said researchers are unsure why this happens and are continuing their research.

“There is a lot of conflicting information and messages out there and this is something we deal with all the time in public health,” he said. “The problem is we have a very complex issue and then there is a lot of misconceptions out there as well. The thing we know for sure is that people who have chronic symptoms are suffering from something that is real and what they are looking for is an explanation. Unfortunately, our health care system is set up in a way where we tend to look at people in disease buckets. If you have a heart problem you see a cardiologist, for people who have these chronic complex conditions, our system is not well designed to adequately investigate or treat them to figure out what is going on with them. About 1.3 million Canadians suffer from undiagnosed physical symptoms and they do overlap with other illnesses. Trying to figure that out is challenging for physicians. I understand how patients are frustrated by this and looking for answers.”

He cautioned everyone about relying on information from the internet because articles cannot be validated, nor can Lyme disease tests that are being done in labs outside of Canada. He said a two-tier test is done in Canada which has proven to be more effective in diagnosing Lyme disease in later stages once the symptoms start to appear rather than immediately after a person finds a tick on them. Once a diagnosis is made, antibiotics are prescribed, and treatment begins based on medical guidelines that have been researched and tested in Canada.

“There are huge markets around treatment and diagnoses for Lyme disease,” he said. “A variety of treatments are proposed and there is no proof of scientific effectiveness and people are making money off this most often in United States.”
Dr. Sommers said he has heard criticism on the internet and from the public about physicians not being forthcoming with information about Lyme disease, but he believes Nova Scotians are being treated properly by physicians based on the guiding principals of medicine.

“I can talk about the challenges physicians have everyday to keep on top of the most recent evidence,” he said. “The number of research articles out there is large and evidence is doubling in 12 to 18 months, so it is challenging for them to keep up on top of the most up to date information, so physicians rely on colleagues and specialist who develop these guidelines. “

He said misconceptions about Lyme disease are present and are no different than the argument surrounding vaccines which some people believe are harmful even though they have been proven to work and have saved lives. Some common misconceptions are that Lyme disease can be passed to a child through breast feeding or to another person during sexual relations. He said there is no evidence to confirm that Lyme disease during pregnancy has any adverse effects for the fetus.

“There is a large portion of information out there that may not be reflective of what the science says. As physicians, we need to do a better job to explain how we come to our decisions.”

He said prescribing long-term antibiotics to treat Lyme disease is not a practice followed in Canada. 
“Even for me as a family doctor, morally and ethically, I cannot put a patient on antibiotics for several months. Antibiotics are very powerful medications and they can wipe out all the bacteria in our body and cause significant side effects. The trend in medicine is to use less antibiotics.”

Dr. Sommers said doing tick checks and preventing attachment is key to not getting Lyme disease. 
“Tuck you pant legs into your socks and your shirts into pants, use long sleeve shirts and no sandals. Put your clothing in the dryer when you come in from outside and you can use repellents with Deet.”

In addition to his presentation, Dr. Sommers also provided Council with information outlining some of the most frequently asked questions about Lyme disease and answers by the Association of Medical Microbiology and Infectious Disease Canada.

The Facts about Lyme disease: What You Need to Know

Question: If I am bitten by a tick will I get Lyme disease?
Answer: Not necessarily. The risk of getting Lyme from a tick depends on:

1. The type of tick that has bitten you - In Canada, blacklegged or western blacklegged ticks (also called deer ticks or lxodes ticks) are the main types of ticks that transmit the infection.
2. Whether the tick has the bacteria - not all black legged ticks in Canada are infected. Check the maps on your Provincial website or the Public Health Agency of Canada's web site for up to date information:
https://www.canada.ca/…/se…/diseases/lyme-disease/risk-lyme­disease.html#map
3. How long the tick has been attached. The bacteria must move from the gut of the tick to its saliva glands in order to infect humans. This takes at least 24 hours to occur.
If the tick was infected, the longer the tick stays attached, the higher your risk of becoming infected. lf the tick has been removed within a day (24 hours), the chances of getting the infection is very low.

Question: Do the bacteria that cause Lyme disease cause chronic infection after antibiotic treatment?
Answer: No. There are no studies at this time in humans that prove the bacteria that causes Lyme disease can survive in the body after antibiotic treatment as recommended by the Infectious Disease Society of America. AMMI Canada, the CDC in the US or the National Institute for Health and Care Excellence guidelines in the United Kingdom.
1. Oliveira CR, Shapiro ED. Update on persistent symptoms associated with Lyme disease.
Curr Opin Pediatr. 2015 Feb;27(1):100-4.

Question: Are the tests used in Canada accurate?
Answer: Yes, these tests are very accurate except in detecting early infection. The current lab test for Lyme disease (something called serology) looks for antibodies that your body makes when exposed to the bacteria. It takes time for your body to make enough antibodies for the test to detect that you have been infected. This is true for all infections, not just Lyme disease. Therefore, the ability of the Lyme antibody test to pick up early infection is poor (it misses it 50% of the time). However, if you do not get treated, your body continues to react to the bacteria and develops more antibodies so that people who have infection for weeks to months (like those who have Lyme arthritis) are close to 100% likely to have a positive test. That means that if you have had symptoms for months to years and have a negative antibody test done by a Canadian lab, Lyme disease is very unlikely. Some laboratories in the US or Europe use alternative tests or read tests differently than what is recommended by expert laboratories in the US (the Centres for Disease Control (CDC)) and Canada (National Microbiology Laboratory (NML)). These alternative tests can have falsely positive results in over half of the patients tested. That means for every 100 people tested for Lyme disease, these alternative tests are positive in SO people who do not have Lyme disease. This makes it impossible to say a positive result using these alternative tests is due to Lyme disease.
1. Waddell LA, GreigJ, Mascarenhas M, Harding S, Lindsay R, Ogden N. The Accuracy of Diagnostic Tests for Lyme Disease in Humans, A Systematic Review and Meta-Analysis of North American Research. PLoS One. 2016 Dec 21;11(12}: e0168613.
2. Fallon BA, Pavlicova M, Coffino SW, Brenner C. A comparison of Lyme disease serologic test results from 4 laboratories in patients with persistent symptoms after antibiotic treatment. Clin Infect Dis. 2014 Dec 15;59(12):1705-1

Question: Why am I still tired and have pain after I have been treated for Lyme disease?
Answer: Most people who get treated for Lyme disease get better after recommended courses of antibiotic treatment. However,10-15% of people can have ongoing symptoms such as fatigue, difficulty concentrating, or pain and are diagnosed with Post Treatment Lyme Disease Syndrome. It is not exactly clear why this happens in some people, and many researchers are looking into this, but it takes time for the body to heal and individuals get better without further antibiotic treatment.
1. Wills AB, Spaulding AB, Adjemian J, Prevots DR, Turk SP, Williams C, Marques A. Long¬ term Follow-up of Patients with Lyme Disease: Longitudinal Analysis of Clinical and Quality-of-life Measures. Clln Infect Dis. 2016 Jun 15;62(12):1546-1551

Question: Should people with chronic symptoms and a negative test for Lyme disease in Canada go to the United States to be diagnosed with Lyme disease and get treatment?
Answer: No. testing for Lyme disease, with the antibody test used in Canada, is accurate in ruling out infection if individuals have had symptoms for months. Studies have shown that
laboratories that use alternative tests or read tests differently than what is recommended by expert laboratories in the US (the Centres for Disease Control (CDC)) and Canada (National Microbiology Laboratory (NML)) can have very high rates of false positive results (over
50%). For patients who have persistent symptoms and negative tests in Canadian labs, positive results in these laboratories are most likely false-positive tests. Other individuals are being told they have Lyme disease based on symptoms alone with no positive laboratory tests and may be given Jong and costly treatments that have not been shown to work or have been shown to be no better than taking a placebo. Patients and their health care providers need to look for other causes for the symptoms. A "false-positive" test result could also, in some cases, delay the diagnosis and treatment of the true cause of the individual's symptoms.

Question: If long term antibiotics are not effective, why do we hear about people getting better with them?
Answers: Although there are some reports of people getting better with prolonged courses of antibiotics, well designed studies looking at this have not shown that it works. In these studies, where people were given up to 70 days of antibiotics or placebo to treat their persistent symptoms, people felt better even when they received the placebo (like a sugar pill). The placebo effect is a well-known phenomenon, which is why it Is important to do studies where the participants and the researchers do not know what medication is being given. Without these studies, we cannot be sure whether the reason people feel better is because of the drug treatment or the placebo effect.

Question: Other than costing a lot of money, what Is the downside to getting months or years of antibiotics?
Answer: If you keep taking antibiotics when they have not been shown to work, you run the risk of side effects including allergic reactions, serious bowel infections, such as C. difficile, and infections with antibiotic resistant bacteria. While AMMI Canada does not support the use of prolonged courses of antibiotics to treat patients with persistent symptoms attributable to Lyme disease, we strongly encourage people suffering from these symptoms to see their healthcare provider to look for other possible causes and to work with their healthcare provider to come up with a plan to manage their symptoms.

Question: Where can I find good quality information on Lyme disease?
Answer: The internet can be a valuable source of information; it can also be difficult sometimes to tell what information is backed up by good science. Here are some reliable sites that can help answer your questions:
https://www.canada.ca/…/public-health/services/diseases/lym…
https: //www .ni ai d.nih. gov/diseases-condi tions/chroni c-lyme-disease
https: //www.cdc.gov{lyme/faq/i ndex. html
https://www.aldf.com/mvths-about-lyme-disease/ 
https://www.nice.erg.uk/guidance/ng95