Lyme cases on increase in the state

Incidents of disease rose by 33% last year over 1997, agency says

`We had a mild winter'

Health officials urge precautions be taken to avoid tick bites

May 07, 1999|By Scott Shane | Scott Shane,SUN STAFF

With summer approaching, Maryland health officials reported yesterday that cases of Lyme disease increased by 33 percent last year and warned people to take precautions to avoid the tick bites that cause the illness.

Last year, 659 cases of Lyme disease were confirmed by the state Department of Health and Mental Hygiene, up from 494 the year before and from 66 in 1988. The increase mirrors the national trend, with about 18,000 cases reported to the national Centers for Disease Control and Prevention last year.

If treated with antibiotics within a few weeks of the tick bite, Lyme disease often is no more serious than a case of the flu. But if left untreated, it can produce chronic health problems, including arthritis, nerve damage and heart trouble.

Dr. Clifford I. Johnson, the state public health veterinarian, said weather conditions this year promise a bumper crop of tiny deer ticks. "We had a mild winter and plenty of moisture, and that's what they like," he said.

Johnson and other experts say that despite approval by the Food and Drug Administration in December of the first Lyme disease vaccine, the most important precautions people can take are the simplest. When walking outside in the woods, tall grass or brush, where deer ticks are common, wear long sleeves and long pants, tucking pants into socks, they say.

Check your body or your child's body for ticks at the end of the day, looking carefully enough to find the speck-sized ticks in their nymphal stage, which feed most actively in June and July.

Remove any ticks with tweezers using a slow, steady pull. A tick must remain attached to a human body for at least 24 hours to transmit the spiral-shaped Lyme bacterium, so even after a bite, removing the tick can prevent infection.

The classic symptom of Lyme disease is a circular, bull's-eye rash around the bite, appearing reddish on light-skinned people and darker than surrounding skin on dark-skinned people. Flulike complaints -- headache, fever, chills, fatigue and muscle aches -- often appear three to 32 days after the bite.

A new vaccine

The new, heavily advertised vaccine requires three shots over the course of a year and has a number of drawbacks. Johnson said the state advises people who spend a lot of time outdoors in potentially tick-infested areas to consult their physician about whether to get the vaccine.

Each shot costs $75 to $125, an expense not covered by most health insurance plans, said Susan Tobias, spokeswoman for the American Lyme Disease Foundation in Somers, N.Y. It has been approved only for people between the ages of 15 and 70, and it is only about 80 percent effective after all three shots. Researchers believe booster shots will be necessary to maintain the protection.

Because of the vagueness of many of the symptoms, CDC estimates that about one in three cases of Lyme disease is diagnosed and reported. Other illnesses are mistakenly identified as Lyme. More than 1,300 suspected cases were reported to the Maryland health department last year, about half meeting the CDC's official definition.

Dr. Allan C. Steere, a Boston physician who first identified the disease in 1975 in Lyme, Conn., has written in recent years that he believes Lyme is being overdiagnosed and overtreated. But his stance has angered some patients and has been rejected by other doctors.

Experts say part of the increase in reported cases of Lyme is undoubtedly because of growing awareness of the disease on the part of patients and physicians. But most believe that the disease is becoming more common, for reasons that remain mysterious.

"Something happened that led to the explosion of cases in this country," said Dr. John Meyerhoff, a rheumatologist at Sinai Hospital and expert on Lyme disease. "My hunch is it may well be the growth of the deer population in the suburbs."

First described in 1909

Meyerhoff said a skin rash that almost certainly was Lyme disease was first described in Europe in 1909, so the disease is not new. But he believes the disease has become far more common in the eastern United States since it was identified and named two decades ago.

Deer, along with some varieties of mice, are the major carriers of the ticks. The infection is passed back and forth between the insects and the mammals.

"These ticks are sitting on the grass, waiting for a carbon dioxide-producing mammal to walk by," said Karon Damewood, chief of zoonotic disease at the state health department. "They say `mealtime' and hop on board."

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