Lyme disease on rise in NH; risks greater in October
Union Leader - New Hampshire
There's a bug-related illness that sickens hundreds of New Hampshire residents every year — and many of them go on to suffer long-term complications that can be crippling. And it's not West Nile virus or Eastern equine encephalitis.
October — when so many of us are outside raking leaves, hiking in the woods or just relaxing in the backyard — is one of the riskiest times of the year for Lyme disease. It's when the adult black-legged ticks that carry the bacteria are most active.
And people need to take it more seriously and protect themselves, experts say.
More than 1,100 cases of Lyme disease have been reported to the state health department in New Hampshire in the past decade. Last year alone, 228 new cases of the disease were reported, compared with just 30 cases a decade earlier.
And medical experts say the number of actual cases could be 10 times higher, since the illness is notoriously difficult to diagnose and often goes unreported.
With more than 20,000 cases reported a year, Lyme disease is the most common "vector-borne" illness in the United States. That refers to a disease that is carried from one organism to another by an intermediary; in this case, a tick picks up the bacteria after feeding on an infected bird or mouse, and later transmits it to a human or domestic animal during a bite.
Dr. Elizabeth Talbot, an infectious disease specialist at Dartmouth-Hitchcock Medical Center in Lebanon, is the deputy state epidemiologist. She said Lyme disease is definitely on the increase in New Hampshire.
The highest jump here occurred from 2001 to 2002, when both the number of cases and the incidence rate doubled; 2002 was the peak for Lyme disease reporting, with 262 cases, compared to 129 the previous year.
And the concurrent increase in incidence that year, from 10.33 cases per 100,000 residents in 2001 to 20.5 cases, left New Hampshire with the eighth highest rate in the country.
This year, through mid-September, 140 cases have been reported to the state health department, and officials expect those numbers to rise, since fall historically has been the peak reporting season.
Talbot believes several factors are contributing to the numbers. "I do think there's an increase in disease. We also have improved reporting among clinicians and increased awareness among patients."
Lyme disease is a bacterial infection caused by the bite of an infected tick. Thirty years after a mysterious form of arthritis began showing up in clusters of cases around Lyme, Conn., that's the one fact upon which everyone agrees.
But nearly everything else about the disease —which can mimic other serious illnesses such as multiple sclerosis, Parkinson's disease or Lou Gehrig's disease — remains controversial.
Medical professionals disagree about the appropriate testing, diagnosis and treatment of the disease.
While the Centers for Disease Control on its Web site states that Lyme disease should be a clinical diagnosis — based on a patient's symptoms and physical findings — it goes on to outline a two-step testing process. And patients say as a result, too many New Hampshire physicians use the blood tests to rule out the disease — despite evidence the tests are unreliable, especially in the early stage of the illness.
Long-term Lyme?
Among the most controversial topics: Whether patients who suffer long-term symptoms, even after antibiotic treatment, are actually still infected with the disease organism — as many patient advocacy groups contend — or have an auto-immune condition that is causing their symptoms — as the CDC suggests.
It's a critical question: At issue is whether physicians should continue treating these patients with long-term antibiotics, which can carry risks.
In a public information brochure about Lyme disease, the CDC states, "Longer courses of antibiotics have not been shown to be beneficial in patients who have been previously treated and have chronic symptoms."
But doctors who treat chronic patients with long-term antibiotic therapy report that symptoms do improve, often dramatically, with such treatment.
And that clash between Lyme practitioners and the prevailing medical establishmentoften leaves patients in the middle — and suffering.
While some doctors question the diagnosis of "chronic" Lyme disease, Talbot said she believes "there is more to this disease than we fully understand."
"Many people feel that they have long-term adverse effects from Lyme disease, and I just don't believe they're all wrong," she said. "I think there's something going on. I don't know what it is, but I do believe we will learn a lot more about this disease in the years to come."
Some say there is a growing awareness among the public and the medical community alike. More and more, it seems, everyone knows someone who has Lyme disease.
This past May, the state Legislature passed a resolution calling for more federal funding for Lyme disease research, and increased educational efforts directed toward both physicians and the public. Gov. John Lynch subsequently signed a proclamation for "Lyme Disease Awareness Month."
State Sen. Joseph Kenney, R-Wakefield, spearheaded the effort at the request of two high-school-era friends who have the disease and had trouble being diagnosed and treated. A conference last year in Wolfeboro about Lyme disease drew 250 people — and convinced Kenney of the need for more research and education.
Kenney, who is in the Marine Corps Reserves, is currently serving in Iraq. But in a recent e-mail exchange with the Sunday News, Kenney said he was contacted during his legislative efforts by dozens of New Hampshire residents who either have the disease or know someone who does.
One mother, who had to leave her job to care for her sick child, told Kenney in a letter that Lyme disease "has truly had a devastating and lasting impact on my family." She told of her daughter's progressive loss of motor skills, vision, speech and memory problems, joint pain, depression and nervous system disorders. "These people are suffering and are not crazy," the woman wrote.
Stories like that had an effect, Kenney said.
"We recognized that many people in New Hampshire have contracted Lyme and have had to go outside the state for treatment," he said in his e-mail. "We discovered that we need to do a better job in creating a referral system for people in state."
Talbot said the increase in Lyme disease here could be related to changing ecology, and tied to the host animals for the tick that carries Lyme bacteria: deer and mice. As more of New Hampshire is developed, she said, "It could be humans are in closer proximity to those animals and therefore have more potential contact with infected ticks."
Meanwhile, the number of infected ticks is on the rise as well.
Alan Eaton is an entomologist with the University of New Hampshire Cooperative Extension; he's been studying black-legged ticks, often called deer ticks, for years.
More sickening ticks
Last year, Eaton collaborated with a researcher at Maine Medical Center in Portland on a study to see how many of these ticks actually carry the Lyme bacteria, called spirochetes.
Eaton collected about 50 ticks each in three separate locations: Lee, Durham and Concord. "We knew the incidence of the tick was high, but we wondered how high the incidence of the spirochete was in the tick."
What they found was that more than half the ticks collected in Lee and Durham were infected — "and in the Concord site, it was over 70 percent."
"So what this tells us is that in both of these places, the Seacoast and the Concord site, it clearly has been established for quite some time," Eaton said. And he added that a similar incidence of infected ticks is likely in most of the rest of the state as well.
New Hampshire folks should take notice of those unexpectedly high numbers, especially in October, when adult black-legged ticks are most active, Eaton said. Wearing long pants and tucking them into socks, and using bug repellent, are easy ways to prevent what can become a devastating illness.
"You have it within your power to tremendously increase the odds of your getting it, or tremendously decrease the odds. It's up to you."
And Talbot said the increase in such illnesses as West Nile virus, EEE and Lyme disease should be convincing proof that we need to adopt new routines to avoid bugs, such as using repellents and doing body checks for ticks.
"Just like we brush our teeth every night, it's part of our health culture now that we need to avoid being bitten by insects, whether they're ticks or lice or fleas or mosquitoes."
