In response to Gwen Barlee’s commentary “B.C. needs to move ahead on Lyme disease,” (June 17), I would like to state that the B.C. health-care system is very aware of Lyme disease and that agencies such as the B.C. Centre for Disease Control are committed to following the evidence and providing the best scientifically based testing, treatment, advice and support that is available for both individuals who contract Lyme disease and to their physicians.
We do know that climate change in North America is increasing the range of habitat in which the ticks that harbour Borrelia — the bacteria that cause Lyme disease — are found. So far, our active and enhanced tick testing in B.C. shows that these ticks are not infected to the extent that ticks in other parts of Canada are. Nor are other strains of Borrelia seen in B.C. ticks.
The reason is that B.C. ticks are of a species less likely to either harbour or transmit the organism. Just as with West Nile virus, British Columbia does not have the same epidemiology or disease experience as other parts of Canada or the U.S. However, as British Columbians are travelling to other parts of Canada and the U.S., their risk of encountering infected ticks when they are in the outdoors is increased and they need to be aware of ways of avoiding being infected.
To assume that risk in North America is equally distributed across the continent is clearly inappropriate — 95 per cent of U.S. cases come from east and central states. The rates of infection decrease in states along the border, and rates in the northern parts of contiguous U.S. states are very similar to rates in Canada.
The reporting of Lyme disease by physicians clearly only captures perhaps 10 per cent of cases. This is not really different from any other clinically diagnosed disease, but B.C. surveys do show that between 200 and 300 people are treated for acute Lyme, or Lyme exposure, every year.
Our diagnostics in B.C. are those recommended by the Center for Disease Control in Atlanta and the National Microbiology Laboratory in Winnipeg. They are not recommended for diagnosis in early acute infection.
B.C. physicians have, for some years, been advised to make a diagnosis and treat acute infections on clinical grounds. Our advice to physicians to do that actually predates this same advice from the Public Health Agency of Canada.
The Complex Chronic Disease Program treats each patient individually and is not willing to offer blanket one-size-fits-all antibiotic therapy to patients, as that would be irresponsible. If needed, patients with Lyme disease are treated with antibiotics. Use of long-term antibiotics is reviewed on a case-by-case basis according to guidelines that were adopted by infectious-diseases specialists in Canada.
There is a great deal of controversy over the existence of what patient advocates call “chronic Lyme disease.” Untreated Lyme disease does have serious chronic health impacts, and we do know that even when adequately treated, acute infections can leave individuals with persistent problems. However, the evidence that this is due to ongoing infection is not accepted by the vast majority of infectious-disease specialists and a number of randomized control trials have failed to show any benefit of long-term antibiotic treatment.
There is much more to learn about Lyme disease and other complex chronic illness, and how diagnostics and treatments can be improved, and the B.C. Ministry of Health has provided the Provincial Health Services Authority with funding to research cause, cure and care.
Dr. Perry Kendall is B.C.’s provincial health officer.
