Lyme Disease Task Force Issues Report with 16 Prevention, Awareness, and Surveillance Recommendations

In 2014, there were 7,400 cases of Lyme disease in Pennsylvania, a number that jumped from 5,900 the year before. Many say that key to decreasing the incidence of Lyme disease across the state is increasing prevention, awareness and education, and surveillance initiatives. Pennsylvania is now one step closer to this goal with the release of a new report by the state Task Force on Lyme Disease and Related Tick-Borne Illnesses.

Created by Act 83 of 2014, the task force was established to investigate and issue recommendations to the Pennsylvania Department of Health (DOH) regarding education and awareness, prevention, and surveillance.  The Pennsylvania Medical Society (PAMED) strongly supported this law enacted in June 2014.

PAMED member John Goldman, MD, an infectious disease expert at PinnacleHealth in Harrisburg, was PAMED’s representative on the task force.

“The task force, which engaged in vigorous discussions, was intended to reflect both sides of the debate, which were equally represented in its report,” said Dr. Goldman. “While there are areas of disagreement, there are, more importantly, several areas of agreement that should be focused on. These include that Lyme disease is increasing in Pennsylvania, initial testing for Lyme is not accurate, and that there needs to be an increase in awareness.”

The Task Force’s Recommendations

The 64-page report provides 16 recommendations, as well as rationale and further guidance. These include for DOH to:

1. Develop and implement a protocol and funding strategy for schools located in high-risk areas to implement personal protection and property actions (Integrated Tick Management strategies like spraying, various deer management methods, landscape modifications, based on a review of the available evidence on tick reduction approaches) to reduce the risk of tick exposure on school properties and during school activities.
2. Develop and implement a protocol for federal, state and local park staff and properties to include communicating risk awareness (tick presence, tips for personal protection), and taking property actions (Integrated Tick Management strategies like spraying, use of deer management methods, landscape modifications, vehicle spraying, protective clothing and other methods based on a review of the available evidence on tick reduction approaches) to reduce risk to the staff and the public.
3. Develop and implement a standard brochure (based on the Virginia model) that physicians ideally should provide to patients when they are evaluated, either by clinical exam or lab testing, for potential Lyme and related tick-borne infections.
4. Develop and implement strategy to reduce risk of transfusion transmitted Babesiosis (TTB) resulting from donors with tick-borne infection.
5. Develop and implement comprehensive multimedia public awareness campaign targeting the general public and at-risk population to improve awareness and understanding of TBDs in Pennsylvania, and establish working relationships with partners that represent key stakeholders.
6. Develop and implement an initial and ongoing education program for health care providers to include prevention of tick bites, and prevention of disease progression from acute to later stages of infection.
7. Adjust and periodically review the Pennsylvania notifiable disease list. Add Babesiosis and specifically include Powassan virus as an arboviral infection to the state’s notifiable disease list and conduct periodic reviews of the list for TBDs. Report TBDs not included on the Pennsylvania notifiable disease list. Encourage providers to report new and emerging TBDs (i.e., B. miyamotoi) not included on the list regardless of whether or not they were acquired in the state using the unusual disease occurrence reporting mandate.
8. Increase the public, medical, and scientific community’s awareness of tick populations, and the diseases they carry through a broad and comprehensive statewide environmental survey.
9. Earmark state budgeted appropriations to conduct research and share information for tick distribution, control, infectivity rates, and pathogen load.
10. Obtain funding to support observational epidemiologic studies to provide more detailed data on the burden and cost of TBDs among Pennsylvania residents. Observation studies may include use of prevention practices and risk factors for tick-borne disease, self-reported tick-borne disease illness, and long-term patient outcomes.
11. Provide annual updates for, and enhance availability of, a broad array of diagnostic tests for tick-borne disease, as well as encourage the development of innovative and more accurate diagnostic tests.
12. Improve health care provider and veterinarian participation in tick-borne disease surveillance by disseminating annual advisories on the recognition, diagnosis and reporting of TBDs in PA and by utilizing technology to streamline and enable electronic tick-borne disease case reporting.
13. Enhance and ensure tick-borne disease surveillance case investigations used by local health department and health district staff to include questions that can identify potential co-infections with other tick-borne pathogens, and help identify potential risk factors for infection.
14. Use a centralized, publically-accessible website to disseminate summaries of human, other animal, and ecologic tick-borne disease surveillance data at a statewide and county level.
15. Convene a task force that reports to the Secretary of Health and operates as an independent advisory group on Lyme disease and other TBDs.
16. Obtain independent cost analysis of implementing key recommendations contained in the report by the independent and bi-cameral Legislative Budget and Finance Committee (LBFC), including any potential sources of public or private grant funding.

The report was released at a press conference held by Secretary of Health Karen Murphy, PhD, RN, on Oct. 14.

Comments from State Officials

Sec. Murphy said that we must address this serious public health issue, and that DOH is focusing its efforts on education, prevention, and surveillance. Going forward, she said, DOH intends to review the recommendations to determine what can be implemented immediately and what needs to be included in a long-term approach.

She said one of the first things they intend to do is work with the LBFC to determine the cost of implementing the report’s recommendations. It can’t all be done at one time, she said, but we can take steps and continue to work to eradicate this disease.

At the press conference, Sen. Stewart Greenleaf (R-Bucks/Montgomery), prime sponsor of the bill signed into law last year, said the bad news is that we’re facing an epidemic in Pennsylvania, but the good news is that we’re doing something about it and putting the spotlight on it. He spoke of the challenges of Lyme disease going undiagnosed, often misdiagnosed, commenting that tests are often inaccurate with no fault of the practitioner. He said the most important thing is that we educate the public and that’s what the task force has recommended, what DOH is doing, and what it should be doing.

Sen. Andrew Dinniman (D-Chester) also spoke, saying he comes from an area of Pennsylvania where Lyme disease is at epidemic and growing proportions. He said there is a need to dedicate ourselves to making sure the recommendations of the report become a reality in Pennsylvania, and that the report doesn’t just sit on a shelf somewhere.

Finally, Sen. Sean Wiley (D-Erie) spoke about how we must educate the public, but we must also strive to educate health care providers. “When this disease goes unnoticed, it leads to tragic consequences,” he said.