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Grounded in evidence-based science, the Department of Health and Human Services introduced Healthy People 2020 with the goal of increasing the quality of life and endorse healthy behaviors in all ages of Americans (Healthy People 2020, 2018). It is a project that encompasses 42 topics and objectives that influence community well-being and plans to achieve results within a 10-year period. This author’s topic of interest is tick-borne illnesses with much interest in Lyme disease (LD). LD is the most frequent tick-borne infection in the United States US (Ross, 2018).
When this author searched for LD on Health People 2020 she only found two references to it. The first one is “to raise the percentage of tribal and state community health organizations that deliver or guarantee complete laboratory services that support reference and specialized testing (Healthy People 2020, 2018).” The second mention of LD in Healthy People 2020 (2018) is “to grow the percentage of federal, tribal, state, and local community health organizations that integrate core competencies for community health professionals into job descriptions and performance appraisals.
LD has been discovered nationwide and is currently occurring in parts where it was believed uncommon probably due to phenomena like global warming and damage to the environment (Ross, 2018). For this reason, it is vital to be well versed and ready to be competent to combat this tick-borne illness worldwide pandemic (Stricker & Johnson, 2016). This author finds it very disappointing that such epidemic is not a bigger a priority for Healthy People 2020.
The Centers for Disease Control and Prevention (CDC) indicate that LD is more prevalent than official numbers show, with around 300,000 new LD incidents and as many as 1,000,000 incidents detected every year in the US as well as over 65,000 cases in Europe.
(Davidson, 2018). In contrast, HIV/AIDS is detected at a rate of 55,000 yearly incidents, making LD incidence 6 times more common in the US (Davidson, 2018). This projected amount of yearly infections is greater than other diseases like hepatitis C, HIV, colon cancer, and breast cancer (Center for Disease Control and Prevention, 2015). LD is anticipated to proliferated and is expected that over half of the world’s population will be exposed to the pathogen (Garrett, 2017). Recently there has been more LD coverage seen in the media, this author just saw a report in her local television station in which several physicians are forecasting a LD epidemic in eastern central Florida region (Daly, 2017) which is where this author resides.
The amount of LD patients is astounding and display the significance of bringing this public health epidemic information to the public. Knowing the CDC figures of as many as 1,000,000 LD cases diagnosed yearly, it is critical for healthcare workers to comprehend the degree of the LD epidemic. One must bear in mind that this epidemic is greater than hepatitis C, HIV, colon cancer, and breast cancer (Center for Disease Control and Prevention, 2015). When LD is promptly identified, it can be effectively treated with a high percentage of positive outcomes. Nevertheless, many cases do not get identified properly, letting the pathogen to circulate throughout the body allowing the bacteria to evade the immune system and as a consequence the development of a chronic illness difficult to treat.
LD is a multi-systemic zoonotic illness caused by the spirochete Borrelia burgdorferi and its communicated to humans by the bite of nymph or adult ticks of the Ixodes ricinus and an I. scapularis species (Stricker & Johnson, 2014). LD can be contracted by people from all age groups. In 2015, 95% of LD incidents in the US occurred in Connecticut, Delaware, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, and Wisconsin. Most cases of LD occur in June, July, and August (Kornusky & Karakashian, 2017). According to Kornusky and Karakashian (2017), the incidence of LD in the US is greatest in males between the ages of 5–9 years and in both males and females between 60–64 years of age. The disease was infrequent in the early 1980’s but apparently grew in occurrence and geographic distribution through the late 1980s, leading experts to conclude that the disease was growing southward (Brinkerhoff, Gilliam, & Gaines, 2014). LD risk factors include spending time outdoors in wooded or green areas and/or being exposed to animals known to contain ticks such as deer, dogs, and horses. The possibility of getting bitten by ticks is higher in the spring and fall.
Sadly, present diagnostics for LD, as endorsed by the CDC, have poor sensitivity and can reveal negative results in more than 50% of the testing in people who are infected (“center Disease Diagnosis,” n.d.). A meta-analysis of the American literature regarding the accuracy of LD testing estimates the sensitivity of the test to 46% and the specificity to 99% (Ferguson, 2012). A study just published by Horowitz and Freeman (2018) states that the current diagnostic two-tiered testing approach utilized for surveillance reasons is known to have a sensitivity/specificity averaging around 56% and according to the CDC, the surveillance case designations “are not intended to be used by healthcare providers for making a clinical diagnosis (Horowitz & Freeman, 2018).”
In addition, Horowitz and Freeman (2018) explain that other species of Borrelia are now found across the US including Relapsing Fever Borrelia, Borrelia miyamotoi as well as Borrelia bissetti, which will not be detected on standard two-tiered testing approaches for LD. The faulty diagnostic testing results in lack of antibiotic therapy leading to an increasing build-up of the bacterial infection and worsening symptoms of the illness as the bacterium proliferates. Once correctly diagnosed, this prolonged infection results in the need for more extensive and probably unsuccessful treatment of the disease. On average, and as this author herself experienced, patients, visit between 10-15 doctors over the course of a 2 years period before the correct diagnosis is made, making it harder to fully recover. As a result, 40% of LD patients experience long-term health problems (ILADS, n.d.).
In the Tampa Bay area, all 15 doctors that this author saw told her that there is no Lyme in Florida. Sadly, the notion that LD is not happening or occurs very little in the southern US continues to be restated by countless journals citing flawed case report figures and backed by articles interested in proving the belief (Herman-Giddens, 2014). Herman-Giddens (2014) states many patients lab results meet the CDC definition for LD surveillance however many are concluded to be false positives as circular thinking believes that there is hardly to no LD in the southern US; therefore, the positives have got to be false. Education healthcare practitioners should be a priority.
The CDC and the Infectious Disease Society of America (IDSA) prescribe to a one size fits all therapy guidelines for all LD people who suffer from LD and believes that LD can be eradicated effectively with 14 to 28 days of antibiotic therapy (Center for Disease Control and Prevention, 2015). Also, the IDSA asserts there is an absence of evidence on the persistence of chronic B burgdorferi infection; therefore, prolonged usage of antibiotic treatment is not recommended (Moore, 2015). Due to the lack of timely diagnosis and treatment, this author went without proper treatment for 15 months. An International Lyme and Associated Diseases Society (ILADS) nurse practitioner form Connecticut diagnosed her and prescribed extended oral and intravenous antibiotic therapy that resulted in 90% of symptom resolution and inspired this author to getting her family nurse practitioner degree. ILADS endorses the existence of chronic Lyme disease (CLD), as opposed to post-treatment LD syndrome, and insists that CLD necessitates an extended therapy with antibiotics till the patient conforms subjective recovery (The ILADS Working Group, 2004).
While waiting for better test to be developed and additional studies take place, educating communities in the usage of insecticides sprays containing DEET to spray shoes and clothing, wearing long white socks and pants, using closed shoes, staying on hiking trails and avoid brushing with the leaves and vegetation are good primary prevention methods. Education regarding how to perform a thorough tick check along with instruction of how to remove an attached tick is vital in preventing the disease. When it comes to LD primary prevention is the best tactic. Fortunately, scientists are currently working on a LD vaccine that should protect against some strains of the disease, however, this vaccine does not consider the many co-infections a person can contract to from a tick bite including Babesia, Mycoplasma, Anaplasma, Tularemia, Rocky Mountain Spotted Fever, Ehrlichia, and Bartonella just to name a few. Ticks are natures dirty needle and can be compared to getting pricked by a used needle, there are many illnesses that can be contracted. When dealing with the LD epidemic it is important to stay up to date and follow the literature and the latest evidence-based to be able to eradicate and treat the LD epidemic.
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