Connecticut's War on Lyme Disease

 

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Nearly 40 years after its dramatic emergence in southeastern Connecticut, Lyme  disease—an infection caused by the bite of Ixodes scapularis, or black-legged “deer” tick—is epidemic in Connecticut. Though it’s readily curable (primarily with a two to three-week course of  doxycycline), we’ve had less luck coming up with ways to prevent the new cases that break out each year. The different strategies that have been undertaken range from encouraging personal responsibility (wearing protective clothing, spraying with the tick repellents DEET and Permethrin, showering after a walk in the woods, building “tick-free” zones in our yards) to broader public health (vaccine development) and policy (culling of deer  populations) initiatives—with varying levels of success.

According to certain researchers, Lyme has existed in America for thousands of years. But it wasn’t fully described—or given its name—until 1975, when a cluster of cases in Southeastern Connecticut (including Lyme and Old Lyme), thought to be juvenile rheumatoid arthritis, were investigated by doctors David Snydman and Allen Steere of the Epidemic Intelligence Service (a branch of the federal Centers for Disease Control and Prevention) and others from New Haven’s Yale University. Ten years later, a Lyme disease-testing program conducted by the Connecticut Agricultural Experiment Station and Connecticut Department of Public Health found the greatest prevalence of the disease was still limited to towns east of the Connecticut River.

“Throughout the 1980s, we’d see cases in the high hundreds per 100,000 population in eastern Connecticut, sometimes even more than 1,000,” says state etymologist Kirby Stafford, who’s also vice-director and chief entomologist at New Haven’s Connecticut Agricultural Experiment Station. In the 1990s, however, the disease started moving north and west. “It was like a wave effect,” Stafford says. “For a number of years, the highest reported incidence of Lyme disease was in Litchfield County, while the cases in eastern Connecticut fell to about 300 or so. Now it’s dropped in Litchfield County, too.”

While the disease now affects all parts of Connecticut—as it spread to other states, ours long reported the greatest number of new cases each year—Stafford says we’ve reached “kind of a saturation point. The general trend for many years was upward, but the numbers have actually gone down for a couple of years.”

In September, the Centers for Disease Control (CDC) reported that as of 2011—the last year for which all the numbers are in—the states with the highest incidence of Lyme are Delaware (with 85 cases per 100,000 population) and Vermont (with 76 per 100,000). Connecticut is now ranked at No. 5 (56 per 100,000, as compared to a relatively whopping 134 cases in 2002). But a month earlier, the CDC had already stated how misleading these estimates can be, pointing out that the nationwide incidence of Lyme disease each year is not 30,000, as routinely reported, but closer to 10 times that number.

Attempts to get a grip on accurate case counts are foiled by a number of factors, beginning with whether doctors bother to report their Lyme patients to local health departments. Numbers generally go up when these departments do active surveillance (actually seeking out case reports from labs and doctors) as opposed to passive surveillance (waiting for these reports to come to them). The discrepancy can be striking: “When we did active surveillance,” says Dr. James McDonald of the Rhode Island Department of Health, “we counted about 800 cases a year. Now, it hovers around 150 to 200.”

Compounding the problem is that there’s no reliable diagnostic indicator for Lyme.Peter Wild, executive director of the Lyme Research Alliance in Stamford, notes that the blood test currently in use “is only 65 percent effective.” He adds that the bullseye rash that’s considered a classic “tell” that one has been infected with Lyme-causing bacterium (Borrelia burgdorferi) may or may not appear. In addition, it’s long been known that early symptoms of Lyme disease—fatigue, aches and pains, low-grade fever—mimic the symptoms of other illnesses.

“Not everyone who is treated for Lyme has a blood test,” says Randall Nelson, state veterinarian and senior-level epidemiologist for the Connecticut Department of Public Health. “Oftentimes, doctors who are treating it are doing so simply based upon their best guess.”
 

Connecticut's War on Lyme Disease

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