Alarm at sharp rise in tick disease

Times Online - UK
By Valerie Elliott, Countryside Editor

HEALTH experts are concerned at a sudden increase in the number of British cases of Lyme disease, an infection carried by ticks that can be fatal.

In Scotland the number of sufferers went up 35 per cent between 2003 to 2004. In England and Wales there were 97 cases 10 years ago and 320 in 2003. Specialists believe that the true incidence could run into thousands because people, doctors and vets do not know much about it and do not seek treatment.

Patricia Hewitt, the Health Secretary, is under pressure to raise public awareness of the disease and to ensure that GPs and medical students are taught about it.

Some believe that she should make it a notifiable disease in England and Wales, as it is in Scotland. British military personnel and their families already have to notify their medical service if they get it.

Anyone who goes to the countryside is at risk of infection. The disease can also be picked up in parkland where there are deer. City-dwellers who visit parks such as Richmond, Bushy or Victoria are at the same risk as a stalker in the Highlands or a visitor to a stately home.

British hotspots are Thetford forest in Norfolk, the New Forest in Hampshire, the Lake District, the Yorkshire Moors, the Scottish Highlands and the uplands of Wales.

But it is also widespread in the United States, Germany, Hungary and the Netherlands and exists on every other continent too. Between 10 and 20 per cent of British victims are thought to have contracted the disease abroad.

Many people may be carrying the antibody after a tick bite years ago, but showing no symptoms. In those cases the full-blown disease can be triggered by another illness or severe stress.

It causes a rash and stiffness in the joints and, left unchecked, it can affect the central nervous system, causing tingling in hands and feet, or facial palsy. In the worst cases the disease can also affect the heart, liver and spleen and even lead to encephalitis, which can kill. Depression and chronic fatigue grip many patients and ruins their lives.

The symptoms are not identical for every sufferer though — Lyme disease imitates other diseases, which makes it difficult to diagnose.

People should be alert for ticks attaching to the skin and remove them as quickly as possible.

In particular, it is necessary to take care if you are near cattle, sheep, deer, horses and even game birds and seabirds. They can be carried also on hedgehogs, mice and voles.

Dr Darrel Ho-Yen, a Lyme disease expert based in Inverness, spoke of his concern about the rise in the number of cases in this month’s edition of The Field magazine. He believes that the known number of proven cases should be multiplied by ten “to take account of wrongly-diagnosed cases, tests giving false results, sufferers who weren’t tested, people who are infected but not showing symptoms, failures to notify and infected individuals who don’t consult a doctor”.

He believes therefore that in a year in Scotland the numbers have gone up from 430 to 580. Applying his multiplier to England suggests that there are 3,200 cases today.

The Ramblers’ Association has issued urgent guidelines and a new leaflet has been sent to riding schools and trekking centres by the British Horse Society. The UK Lyme Disease Association will hold a special conference at Sheffield University next month.

THE SPREAD OF INFECTION

- Lyme disease is caused by the bacterium Borrelia burgdorferi. It is also known as Lyme borreliosis and was named after a cluster of cases that occurred in Old Lyme, Connecticut, in the United States, in 1974

- People get infected after being bitten by hard-body ticks (Ixodes species) that have the disease. Ticks get it from birds and mammals carrying the bacterium in their blood

- The most common symptom is a rash called erythema migrans, though some patients have flu-like symptoms. This is treated with antibiotics such as doxycycline or amoxicillin

- Infection can lead to facial palsy, “viral type” meningitis and nerve inflammation that may lead to tingling in hands and feet, pain or clumsiness. Some people develop arthritic symptoms, which can settle with antibiotics, others experience persistent arthritis

- It may be a trigger for chronic fatigue syndrome (ME) or fibromyalgia, a post-infection syndrome

- There is no vaccine for Lyme disease

- Peak exposure in Britain is April to October

- Ticks are tiny spider-like creatures that cannot fly and are common in woodland, heathland and moorland. Unfed ticks are the size of a poppy seed but they blow up to the size of a grape pip when they have been feeding. Larvae are smaller than a pinhead

- The risk of infection from an infected tick is low if it is removed from the body within 24 hours of attachment