Lyme Update NSHA Public Health Notice

Ld Estimated Areas Risk Map

·        Cape Breton County has been moved from a lower risk to a higher risk area due to two locally acquired human cases of Ld.  This is noted on the revised Nova Scotia Ld Estimated Risk Areas Map https://novascotia.ca/dhw/CDPC/lyme.asp.

·        The key message to the public remains to take preventative measures regardless of where people are outdoors in Nova Scotia.

·        For clinicians, the map is intended to be used in conjunction with the Infectious Disease Expert Group (IDEG) Guidance for Primary Care and Emergency Medicine Providers in the Management of Lyme Disease in Nova Scotia https://novascotia.ca/dhw/CDPC/documents/statement_for_managing_LD.pdf

to assist in decisions regarding the diagnosis, treatment and prophylaxis of individuals with tick bites and/or with symptoms suggestive of Ld.

Ld Prophylaxis

·        As a reminder, prophylaxis is generally not recommended but may be offered when criteria outlined in the Guidance for Primary Care and Emergency Medicine Providers in the Management of Lyme Disease in Nova Scotia are met (https://novascotia.ca/dhw/CDPC/documents/statement_for_managing_LD.pdf).

·        Doxycycline is the recommended medication for prophylaxis for both adults and children if the criteria are met and it is otherwise not contraindicated. Amoxicillin is not recommended due to its short half-life.

·        More information and recommended dosage can be found in the Guidance for Primary Care and Emergency Medicine Providers in the Management of Lyme Disease in Nova Scotia.

Addressing Ld misinformation

·        Alternative views on the diagnosis and treatment of Lyme disease are actively promoted online and through local media and community presentations, despite the fact that theses views are not supported by current scientific and medical evidence. 

·        Much of the misinformation on Lyme disease centres around the use of alternative testing methodologies by some private U.S. laboratories, prolonged antibiotic treatment for persistent infection and a belief that congenital Lyme disease is a proven entity. 

·        Recently the Association of Medical Microbiology and Infectious Disease (AMMI) Canada released its position paper (https://www.ammi.ca/Content/03.17.19%20AMMI%20Canada%20Position%20Statement%20%28EN%29.pdf) on individuals with persistent symptoms attributed to Lyme disease in an attempt to provide accurate information for patients and health-care providers.

·        A Fact Sheet about Ld which may be helpful for you to address misinformation with patients is available (https://www.ammi.ca/Content/03.17.19%20-%20Fact%20Sheet%20%28EN%29.pdf) 

Emerging Tick Borne Diseases

To date there have been two reported human cases of Human Granulocytic Anaplasmosis (HGA) acquired in Nova Scotia (1 in 2017 and 1 in 2018).  An overview of this and other tick-borne diseases can be found at: https://www.cdc.gov/ticks/tickbornediseases/overview.html

Tick surveillance activities continue to inform our understanding of the emergence of other pathogens in the province. As a reminder, Ld and other rare or unusual diseases must be reported to public health under the province’s Health Protection Act.