Nova Scotia’s top doctor sees no end to spread of Lyme disease
The province’s chief medical officer says he’s not surprised by new statistics showing a sharp increase in reported Lyme disease cases in the province, nor does he anticipate a decline in infections.
“Some of us know that with a change in our climate, and this has been discussed nationally and internationally, there will be increased numbers of ticks, and we know there will be more human exposure and more cases of Lyme disease,” Dr. Robert Strang said in a recent interview.
Reported cases of Lyme disease in the province nearly doubled in 2017, jumping to 586 from 325 in 2016. The statistics come from the provincial Health Department’s 2017 report on notifiable diseases.
Strang said he doesn’t expect those numbers to drop. Strang would not offer an estimate on how many cases could be present in the province, and which have not been reported.
“We’re not going to have the cases come down and we have to accept that Lyme disease is here to stay,” said Strang. “Ticks have been here forever and we have to make sure that people follow the proper prevention steps.
“I couldn’t say how many cases there are in the province. We don’t need to know every single case to have a robust Lyme disease response plan. I would not want to venture a guess. We go on our labconfirmed cases. That’s more than adequate for surveillance purposes.”
The Chronicle Herald recently spoke to a Maine-based doctor, Richard Dubocq, who said he’s currently treating 50 Nova Scotians for Lyme disease. He said there’s currently no test that can conclusively diagnose the disease. He said it comes down to clinical diagnoses measuring trademark symptoms, such as headache, fever and swollen joints. Dubocq offers long-term antibiotic therapy that can last anywhere from six weeks to four years. The treatment is not widely accepted in the North America community, though it’s recognized in The International Lyme and Associated Diseases Society’s guidelines for treatment.
Strang says the science does not show long-term antibiotic treatment to be effective and does not reflect courses recommended by the Infectious Disease Society of America’s (IDSA) treatment guidelines. But he stopped short of guaranteeing current diagnoses and treatment practices are 100 per cent effective.
“In the early stages, diagnoses are based on clinical symptoms. When people have longer-term symptoms, the testing methodology that we use is highly accurate. The early stages aren’t entirely accurate to make a clinical diagno- sis and treat. No lab test is 100 per cent accurate.
“But short courses of antibiotics will effectively deal with Lyme disease. There are some people who have residual symptoms postLyme disease, but that does not mean they have ongoing infection.”
Strang said the department has worked closely with primary-care providers to ensure they’re able to diagnose and treat.
“We continue to do a lot of work with the public. If they have symptoms they’re more likely to seek care. Early Lyme disease is very treatable with antibiotics. We’ve done a lot of work with primary care providers to recognize Lyme disease. I disagree that we don’t have the ability to diagnose and treat.”