As result of climate change, black-legged ticks are becoming more common in our province and more Nova Scotians are being diagnosed with Lyme disease. We expect this to continue, and it is important that Nova Scotians have accurate, evidence-based information. Therefore, we are compelled to respond to recent misinformation.
It is not true to suggest our provincial health system is unable to appropriately diagnose and treat Lyme disease, and that Nova Scotians need to seek care in the United States. A Maine physician, Dr. Richard Dubocq, has also been quoted in local media saying, “… there does not exist a laboratory test that tells you for sure if you do or do not have active Lyme disease.”
This is incorrect.
A significant focus of the provincial tick-borne disease response plan is building capacity in primary care providers to diagnose and treat individuals with possible Lyme disease. The Department of Health and Wellness has annual communication with family physicians, as well as periodic continuing education opportunities — all of which are based on internationally accepted, evidence-based approaches to the diagnosis and treatment of Lyme disease.
Laboratory testing for Lyme disease in Nova Scotia is based on these same internationally accepted, validated protocols. For patients with possible early Lyme disease, we know the current blood test only detects about 50 per cent of cases. Therefore, clinicians are advised to treat patients they suspect have early infection without testing. In people who have had symptoms suggestive of late Lyme disease, like arthritis, the blood test is accurate. In these people, if the test is negative, clinicians should be looking for other causes for their symptoms.
Nova Scotia also has experienced infectious-disease and other specialists available to work with primary care providers on the diagnosis and treatment of Lyme disease.
In short, Nova Scotia’s health system has the appropriate clinical and laboratory abilities to diagnose and treat individuals with potential Lyme disease.
Another misconception being reported is that Lyme disease infection is commonly passed from mother to fetus. There is no evidence of this. Like many infections during pregnancy, including common ones like influenza, Lyme disease does increase the risk of miscarriage, but this is due to effects in the mother (such as fever) and not from infection being passed to the fetus.
It is important for Nova Scotians to be aware that current scientific and medical evidence does not support Lyme disease infection continuing after appropriate treatment. People labelled as having ongoing symptoms from Lyme disease based on alternative diagnostic protocols have very real and often debilitating symptoms. They can feel abandoned when physicians cannot provide them with a diagnosis or treatment plan. However, diagnostic protocols used by alternative care providers in the United States are not evidence-based and have a high rate of false positive tests (a test that is “positive” but in which the person does not have the disease).
Relying on such protocols carries a significant risk of patients missing an opportunity for their symptoms to be appropriately diagnosed, and the potential of harmful side-effects from unnecessary drugs, such as antibiotics.
Nova Scotians are encouraged to follow the effective steps to prevent exposure to tick-borne diseases and to seek medical advice if they’re concerned they may have Lyme disease. Information is available at https://novascotia.ca/dhw/CDPC/lyme.asp
Dr. Robert Strang is Nova Scotia’s chief medical officer of health. On this subject, he also writes on behalf of the NSHA and IWK divisions of pediatric and adult infectious diseases.
