Borrelioositapausten määrä on noussut viimeisen 25 vuoden aikana. Tauti on todennäköisesti suuresti aliraportoitu. Sairastuneiden todellinen määrä saattaa olla kymmenkertainen. USA:ssa lopetettiin kuitenkin tapausten seuranta v. 2003 rahavaikeuksien vuoksi. Nyt tapausten raportointivelvollisuutta harkitaan palautettavaksi esim. Connecticutin osavaltiosssa jossa borrelioosia esiintyy runsaasti. Lisäksi lisätään yhteistyötä borrelioositestiä suorittavan laboratorion kanssa, parannetaan tiedotusta yleisölle ja lisätään lääkäreiden koulutusta asiaan.
State aims to improve Lyme care
Advocates say the action is 'too little, too late'
By Robert Miller Staff Writer
Article Last Updated: 11/24/2007
In 2003, the state told medical laboratories to stop reporting Lyme disease, in part because the tests the labs used were too inaccurate to give a true picture of the number of Lyme cases in the state and in part, because the state didn't have the money to process these lab results.
Immediately, the number of cases the state reported to the federal Centers for Disease Control and Prevention dropped by two-thirds -- from 4,631 in 2002 to 1,403 in 2003.
Now the state is gearing up again to check on lab results from at least 5,500 patients. For area Lyme advocates, that approach is a day late and a dollar short.
"It's good they're going to be doing this,'' Maggie Shaw, of the Newtown Lyme Disease Task Force, said Friday. "But it's too little, too late.''
The state Department of Public Health and Gov. M. Jodi Rell announced this month that Connecticut is planning a three-step program to improve Lyme disease care in the state.
One step will involve a partnership between the state health departments and Quest Diagnostics, the state's largest medical laboratory firm. Quest will provide the department with the findings from about 5,500 blood samples that tested positive for Lyme. The department will then call the physicians who cared for the patients who had the lab work to see if the patients showed clinical symptoms of the disease before adding any numbers to the Lyme disease rolls.
The second step will be to begin a public Lyme disease education program in Windham County, which has the highest per-capita rate of Lyme disease in the state -- in 2005, 173 cases per 100,000 people -- and in Fairfield County which has the most cases -- in 2005, 426 cases.
The third step will involve a partnership with the Connecticut State Medical Society to teach physicians about Lyme disease. Dr. Randall Nelson, state veterinarian with the public health department and coordinator of its tick-borne disease program, said the state stopped trying to track lab results for Lyme disease after 2002 because it lacked the money to do the work. Instead, it shifted money in federal grants to create public education programs for the health districts in Torrington, Westport and New London.
But the state has now created an electronic reporting system for laboratories, Nelson said. Because Quest is the largest laboratory company in the state, it is most logical to start using Quest results for Lyme.
Nelson said, however, the state doesn't necessarily need the lab results to see trends in Lyme disease in the state. Even without them, state Lyme disease numbers are doing the same zig-zagging, steadily upward pattern they have in since the state started recording Lyme numbers about 25 years ago.
Nelson also acknowledged that Lyme disease is greatly under-reported. Some Lyme advocates say the actual number of people with Lyme disease in Connecticut, and nationally, may be 10 times the number reported.
But Shaw of the Newtown Lyme Disease Task Force and Jennifer Reid of the Ridgefield Lyme Disease Task Force said the state should be gathering data from smaller labs, and from out-of-state labs that test Connecticut citizens as well.
"This eliminates all the labs in the state except Quest,'' Reid said.
Reid also said that after the state gets a positive result, it will check with a the doctor who ordered the test to see if the patients actually had Lyme symptoms.
"Can you guess how many doctors will actually do this work?'' Reid asked.
Shaw said the state regulations will let the department only consider a small range of observable symptoms -- arthritis Bell's palsy, cardiac irregularities -- as clinical proof of Lyme disease. That ignores many other symptoms many doctors believe the disease can cause.
Reid and Shaw also questioned why the state is only creating a public awareness campaign for Fairfield and Windham counties.
"This is such a small state,'' Shaw said.
"We could be doing state-wide public service announcements, we could be doing school programs,'' Reid said. "We really need to roll this out.''
Finally, Shaw said, she's worried the state's work to educate physicians on Lyme disease will only discuss the Lyme disease treatment standards established by the Infectious Diseases Society of America. That group recommends short courses of antibiotics to treat Lyme disease and questions the validity of long-term, chronic Lyme infection.
The International Lyme and Associated Diseases Society has established its own standards. It insists chronic Lyme infection exists and allows doctors to prescribe several types of antibiotics for long periods of time to treat it.
"There are two standards of care,'' Shaw said. "I wonder if the state will permit discussion of that.''
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