Up until recently, Lyme disease was dismissed as non-existent by most physicians and medical authorities in British Columbia so, perhaps, it is not that surprising that a recent report found that almost two-thirds of doctors in BC admitted not reporting the last case of Lyme disease they treated, with many saying they simply forgot, or that their patient was from out of town or was not registered at their practice. Why does under-reporting of Lyme disease in BC matter, and what can be done about it?
3% of Doctors Treat Patients for Lyme Disease They Don’t Have
The BC Centre for Disease Control conducted the study which analyzed the returned reports from 111 doctors in the Pacific Northwest province asked if they believed that the last patient they treated for Lyme disease actually had the illness. 14% were sure that their patient had Lyme disease, 59% said they probably did, 24% said probably not, and 3% said definitely not. 77 doctors answered a question asking if they reported the disease and 61% said they did not, with negative Lyme disease test results, unavailable test results, low disease likelihood, or insufficient evidence the most commonly cited reasons for under-reporting. There were some cases that were reported as chronic Lyme disease that had already been submitted for the official figures.
Ticks in BC
The western black-legged tick can be found in many areas of British Columbia, particularly in grassy and wooded regions and the popularity of outdoor pursuits in the Pacific Northwest province exposes many BC residents and visitors to Lyme disease infection. Lyme disease symptoms may be dismissed as a flu-like illness, fatigue after a camping or hiking trip, or even as arthritis. Left untreated however, Lyme disease can result in significant tissue damage, progressive symptoms, and may even be fatal in cases where heart problems arise or the infection spreads to the central nervous system.
Lyme Disease Cases Double in BC Between 2010 and 2011
Lyme disease goes unreported most of the time it seems, with only twenty cases reported in the whole of BC in 2011, and just seven and ten in 2010 and 2009 respectively. The figures may show twice as many cases of Lyme disease in BC in 2011 compared to 2010 but the figures are still very low and many consider them to be just a fraction of the real number of Lyme disease cases in BC. This latest survey follow on from a report in 2008 which found that nearly two thirds of doctors knew Lyme disease was a reportable infection but that many still failed to report it. This study found that the doctors surveyed remembered diagnosing 221 cases of Lyme disease but the public health officials only received thirteen reports, despite regulations stating that doctors are supposed to fill in a disease surveillance form and submit it to the BC CDC. Lyme disease cases in Alberta are also expected to rise for 2012 as wet and warm weather extends the tick lifecycle and opportunities for transmission of Lyme disease bacteria.
Recruiting Lyme Disease Monitors
Unfortunately, the under-reporting of Lyme disease in BC is not the only case of under-reporting of infectious and communicable diseases, according to Dr Perry Kendall, provincial health officer. Nearly sixty reportable diseases exist in the current guidelines and Kendall suggests that it may be time to recruit certain physicians to help monitor Lyme disease, just as there are similar professionals tracking cases of influenza in the province.
Lyme Disease Treatment Affected by Under-Reporting
Lyme disease advocates in BC have acknowledged that this poor record of reporting Lyme disease means that the relative rarity of Lyme disease in BC is a myth much perpetuated amongst health professionals and the general public. This leads people to not even consider Lyme disease as an explanation of their symptoms, and to neglect to take Lyme disease precautions. Patients may also be wary of seeing their physician as they worry about being taken seriously, and doctors are less likely to consider a differential diagnosis of Lyme disease when assessing a patient with joint pain, fever, gastrointestinal disturbances, and even cognitive symptom. A similar phenomenon is currently being challenged by protests in Australia, calling for official recognition of Lyme disease.
Lyme Disease Infection Outside BC
Lyme disease has been reportable in British Columbia since 1994 and the doubling of reported Lyme disease cases between 2010 and 2011 has some suggesting progress has been made. It may be that many cases of Lyme disease treated in BC are not actually attributable to tick bites received in BC itself however, as there were a number of travel-related cases. Doctors may be unwilling, or even unable to make time to report Lyme disease, particularly when the patient does not appear to have been infected in BC. It does appear that when patients are diagnosed with Lyme disease that they are treated appropriately with antibiotics but a report last year found that many physicians remain sceptical about the existence of chronic Lyme disease and that Lyme disease tests remain inadequate for diagnosing the illness.
New Lyme Disease Clinic to Open in BC
Patients and Lyme disease advocates in BC were vindicated by the report and welcomed the approval of $2million in funding for a new chronic and complex disease clinic in Vancouver at BC’s Women’s Hospital. The new clinic would take cases where bacterial, viral, or fungal infections are suspected of causing a complicated illness. Unfortunately, the clinic’s opening has been delayed while appropriate staff are hired. Meanwhile, cases of Lyme disease will likely continue to be under-reported but at least this recent survey suggests hope for the future, with increasing recognition of Lyme disease in British Columbia.