May 25, 2018
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What we don’t know — but should — about how to prevent, diagnosis and treat Lyme

Troy R. Bennett | BDN
Troy R. Bennett | BDN
Wildlife biologist Patrick Keenan removes 54 deer ticks from a male towhee in his hand at the Wells Reserve, June 13, 2017. The ticks were preserved and sent to Maine Medical Center's Research Institute in Scarborough.

With spring’s warmer weather comes a familiar menace: ticks and their associated diseases such as Lyme. Yet despite the widespread prevalence of Lyme, and the misery it’s caused, there is still not enough information about how to combat it on a large scale.

There is still no vaccine, no widely used test to allow for early detection and no exact understanding of what causes some patients who finish the recommended dose of antibiotics to continue to suffer long term from fatigue, pain or joint and muscle aches.

The situation is especially dire given that the number of tick-borne disease cases, including those of Lyme, anaplasmosis, babesiosis and powassan virus, doubled nationwide between 2004 and 2016, according to a new report from the U.S. Centers for Disease Control and Prevention. In Maine alone, there were 12,856 cases of tick-borne diseases in that timeframe, placing it among the worst-hit states in the nation.

The state has seen a dramatic increase in incidences of Lyme. In 2001, there were only 8.4 cases of Lyme disease reported per 100,000 people, according to the Maine Center for Disease Control and Prevention. By 2015, the rate increased more than tenfold, to 90.2 per 100,000 people.

Yet, there are still many questions about how to prevent, diagnose and treat it.

What are the specific reasons ticks are multiplying? There is some indication that the increase correlates with changing climate conditions. Also, where there was once farmland, Maine now has often fragmented forest — the perfect tick hideout. Ticks like moisture, making the state’s more populated coast and riverbanks a preferred tick habitat.

But what is really causing the spread of ticks, and can states curb their growth?

Next, how can doctors better diagnose Lyme? Because the antibodies against Lyme disease bacteria usually take time to develop, it can be four to six weeks before a test will show people are infected, according to the CDC. This delay between when people are infected and when the body creates antibodies can result in a false negative test for some people, causing a hold-up in treatment.

The CDC is studying a new way to identify early-stage Lyme, but more work must be done. If the early-detection method proves reliable, it will then have to be made practical for use in clinical settings.

“Lyme disease is a serious problem here in the United States, and we really need to find solutions to some of the limitations that we have, particularly in diagnosing this infection,” Claudia Molins, a microbiologist at the CDC, told STAT news last summer. “We want a test that can be used within the first two weeks of infection and that does not rely on antibody production.”

Finally, how can doctors better treat Lyme? It can be quelled successfully with several weeks of antibiotics, but researchers still don’t know what causes some people to continue to suffer long term. Called post-treatment Lyme disease syndrome, people may experience persistent pain, fatigue, impaired cognitive function or unexplained numbness. In studies, long-term antibiotic therapy has proven no more helpful than a placebo. Much more research is needed to understand how to help those in continual distress.

By now, you might have an anti-tick routine: wearing long sleeves and tucking your pants into your socks, applying a repellent, checking for ticks after being outside, removing them immediately if you find them and clearing tall grass in your yard, where ticks are protected.

Indeed, May is Lyme Disease Awareness Month in Maine, so you may see promotions calling on you to limit your exposure to ticks.

But don’t think that’s all that needs to happen. Demand more answers about how to fight this public health hazard.

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