Lyme Disease in Texas

Lyme disease is the fastest-growing infectious disease in the country and the most common vector-borne disease in Texas.[i] The cost to society measures in the billions of dollars. Lyme disease is endemic in Texas and physicians need to be familiar with it. In Texas, there are 11 public health regions. Patients with Lyme disease reside in every public health region in Texas. Borrelia burgdorferi, the agent of Lyme disease has been detected in Texas ticks. [ii]

Epidemiological evidence suggests Amblyomma americanum, the “Lone Star” tick, is the vector of Lyme disease in Texas. This is an aggressive species that will feed on a variety of hosts including humans. In a Texas Department of Health study conducted in 1990 and 1991, A. americanum ticks were gathered from nine Texas areas. Of the over 28,000 ticks collected, 26,901 or 95% were A. americanum. Visitors to any area with high vegetation are at considerable risk of being bitten by lone star ticks and are at risk of acquiring Lyme disease. [iii]

There are four reportable tick-borne illnesses in Texas: ehrlichiosis, Lyme disease, rocky mountain spotted fever and tick-borne relapsing fever. Patients in Texas have also been diagnosed with babesiosis, a malaria-like, tick-borne illness with recurring fevers. [iv]

“Lyme disease is a much greater risk in Texas than most people realize. Between 1994 and 2006, an average of 74 cases was reported annually. Case reporting is based on the strict surveillance criteria set by the CDC which, by CDC’s own estimates, means that only about 10 percent of cases, and probably less, are actually reported. Lyme advocates believe that many more cases are probably not reported because they are never diagnosed.” [v]

Lyme disease is not a simple, rare illness that is easy to avoid, difficult to acquire, simple to diagnose and easily treated and cured. It is best to rely on exposure history and compatible signs and symptoms for the diagnosis of Lyme disease. The longer the time between tick bite infected with Borrelia burgdorferi and diagnosis and treatment of Lyme disease, the more likely the illness will be serious and increase the cost of treatment. [vi]

Many doctors in Texas believe Lyme Disease is not endemic in Texas; patients are often told by doctors in Texas that there is no Lyme disease in the state. Many patients must go out of state to get proper diagnosis and treatment of Lyme disease. Tick-borne illnesses can be extremely debilitating and even deadly. Physicians and the public need to be educated about tick-borne illnesses.

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[i] Senate Resolution no. 791, Texas Senate, May 4, 1999

[ii] Texas Lyme Disease Association, “Texas Lyme Facts,” http://www.txlda.org/facts.htm

[iii] Ibid

[iv] Ibid

[v] Suzanne Schaps, Director, Texas Lyme Disease Association

http://www.standupforlyme.org/getinformed/proclomation_speech.html

[vi] Texas Lyme Disease Association, “Texas Lyme Facts,” http://www.txlda.org/facts.htm

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Links & Information

Texas Lyme Disease Association
http://www.txlda.org

An affiliate of the Lyme Disease Association, the Texas LDA provides physician and public education, as well as a resource center and support network for patients with tick-borne diseases.

Lyme Disease in Texas Brochure
http://www. txlda.org/txlda_brochure.pdf

Tick-borne Illness Website Sponsored by State of Texas Entities
http://www.ticktexas.org

TickTexas.org states, “This Web site is dedicated to informing Texans about tick-borne diseases…If you contract a tick-borne disease, recognize the symptoms, and promptly seek medical assistance, these diseases can almost always be successfully treated. If you don’t recognize the symptoms and seek treatment, these diseases can be serious or even fatal.” Sponsors of this site include: Texas Senate Committee on Administration; Texas Parks and Wildlife Department; Texas Department of State Health Services; Texas Department of Agriculture; Texas Medical Association; University of North Texas Health Science Center; Texas Animal Health Commission; Texas Department of Insurance

Stand Up For Lyme
http://www.standupforlyme.org

Stand Up For Lyme is a small, focused group of Texas patients working to promote Lyme awareness and education to other patients, the public, and medical professionals; and to act as a resource for Texas legislators and agencies.

Publication—Disease Prevention News: Lyme Disease in Texas
Texas Department of Health (now Texas Department of State Health Services), 1999 (PDF)
http://www.dshs.state.tx.us/idcu/health/dpn/issues/dpn59n10.pdf

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Senate Committee on Administration – Interim Report on Tick-borne Illness in Texas

77th Legislature, November 2000
http://www.senate.state.tx.us/75r/senate/commit/archive/c500/pdf/ADTick.pdf

Excerpt: “The Senate Committee on Administration submits its Interim Report in accordance with the Interim Charges that were issued September 28, 1999. The committee was given the charge to study the effects of tick-borne illnesses on the citizen’s of Texas. In order to gain a clear understanding of the issues, the Committee held public hearings in Austin and Fort Worth which included invited testimony from experts in the field, as well as testimony from the general public.

“The Committee also organized a working group of several interested public and private entities to evaluate options for enhancing the state’s prevention and education efforts. The goal was to develop a comprehensive strategy for educating the medical community and general public with regard to these types of illnesses.

“…These proposals are intended to provide a framework for improving the quality of information and raising awareness regarding tick-borne illnesses in Texas.”

Executive Summary:

“Tick-borne illnesses have become a growing concern and source of controversy for the medical community and the general population of Texas. These diseases, which are acquired from the bite of a tick, include: Lyme disease, Rocky Mountain spotted fever, babesiosis, ehrlichiosis, and relapsing fever, among others. These maladies can be extremely debilitating, and have been known to be fatal.

“Historically, the amount of useful information regarding the effective diagnosis and treatment of some tick-borne illnesses has been insufficient to foster a consensus within the scientific and medical communities. Compounding this problem has been the inability of these communities to develop and disseminate information which is specific to tick-borne illnesses in Texas. In fact, some health care providers are still unaware that many of these diseases actually exist in the State of Texas.

“As a result, relatively little has been accomplished within the state with regard to prevention measures or educating the public about the existence and potential harm of these diseases. Research efforts have been slowed by the lack of fundamental knowledge of tick-borne illnesses, while prevention efforts have been hampered by budget limitations.

“The Senate Committee on Administration was given the charge to study the impact of tick-borne illnesses on the citizens of Texas. The goal of this study was to identify the issues and formulate recommendations for use in developing policy to minimize the effect of these potentially hazardous diseases. These recommendations include educational and preventive measures, as well as, development of useful diagnostic and treatment tools for combating tick-borne illnesses. These recommendations have been identified by the committee as the best course of action in achieving these goals.

“This report is a compilation of the information gathered during the course of this study and includes: a brief overview of the history and status of tick-borne illnesses; an analysis of the related issues; summaries of testimony given during committee hearings; summary of findings and actions by the working group; and the Committee’s conclusions based on these factors.

“Accordingly, the Committee has developed the following areas of recommendation to address the deficiencies identified by the examination of tick-borne illnesses in the State of Texas.

A few of the committee’s recommendations:

RECOMMENDATION FIVE
The Committee recommends that providers of continuing medical education (CME) offer courses involving tick-borne illnesses with information on proper prevention, diagnosis and treatment. It was determined during the course of the study that some members of the medical community are uninformed to the issues of tick-borne illnesses in Texas. As noted earlier, physicians are using inappropriate methods such as the Center for Disease Control case definition criteria as diagnostic guidelines. This recommendation would furnish health care providers with the accurate information necessary to properly diagnose and treat these diseases.

RECOMMENDATION SIX
The Committee recommends that public medical and nursing schools include accurate information regarding tick-borne illnesses in their curriculum. This should include specific information on proper prevention, diagnosis, and treatment of tickborne illnesses. Likewise, the Committee recommends that hospitals and hospital districts include this same information in the course of study of their residency programs. This again would insure future medical providers have accurate information in diagnosing and treating these diseases.

RECOMMENDATION SEVEN
The Committee recommends that the Texas Board of Medical Examiners (BME) become involved in education efforts of doctors with regard to tick-borne illnesses. The focus of these efforts should be on providing doctors with information which will aid in the diagnosis and treatment of these types of diseases. It should be noted that BME has published information on tick-borne illnesses in the agency newsletter in the past. This effort should be augmented and continued since BME regulates the entire physician community and has the ability to disseminate useful information through several available conduits.

RECOMMENDATION EIGHT
The Committee recommends the Texas Board of Medical Examiners (BME) develop guidelines in the regulation of medical care providers when treatment of tick-borne illnesses is involved. Because so little is known about these diseases and the field of treatment is underdeveloped, the BME should provide fair and beneficial guidelines for treatment so that treating physicians are able to deliver optimal healthcare. This will ensure that doctors who treat these diseases may do so without fear of undue reprisal.

RECOMMENDATION TEN
The Committee recommends that research efforts begin to help facilitate the creation of a diagnostic laboratory, and that the appropriate state agencies be given directives to administer such research…

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Research

Texans Involved in Research:

Microbiologist Norris Honored by UT System for Lyme Disease Test
University of Texas Health Science Center
http://publicaffairs.uth.tmc.edu/media/newsreleases/nr2007/norris.html

University of Texas Health Science Center, Department of Pathology and Laboratory Medicine
http://publicaffairs.uth.tmc.edu/media/newsreleases/nr2007/norris.html

Texas A&M Health Science Center
http://medicine.tamhsc.edu/basic_sciences/mmp/skare.html

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Lyme Disease Awareness Month

May is Lyme Disease Awareness Month in Texas
Senate Resolution No. 791, Adopted by Senate in 1999
http://www.ticktexas.org/talk/sr791.htm

House Resolution No. 775, Adopted by House in 1999
http://www.ticktexas.org/talk/hr775.htm

2007 State of Texas Proclamation:
http://www.standupforlyme.org/getinformed/state_proclamation.pdf

2007, City of Austin delivers proclamation announcing May as Lyme Disease Awareness Month
Proclamation: http://www.standupforlyme.org/getinformed/proclamation.pdf

Speech by Suzanne Schaps, Director, Texas Lyme Disease Association http://www.standupforlyme.org/getinformed/proclamation_speech.html

Speech excerpt:
“…Lyme disease is a much greater risk in Texas than most people realize. Between 1994 and 2006, an average of 74 cases was reported annually. Case reporting is based on the strict surveillance criteria set by the CDC which, by CDC’s own estimates, means that only about 10 percent of cases, and probably less, are actually reported. Lyme advocates believe that many more cases are probably not reported because they are never diagnosed.

Because Lyme disease is so complex, and because there do not yet exist any definitive tests, Lyme disease is first and foremost a clinical diagnosis, made by a doctor based on a patient’s symptoms and history. Because Lyme remains largely unrecognized in Texas, doctors do not know to look for it, and patients do not know to ask about it, so many diagnoses are simply missed. It is also not unusual for a Lyme patient to be told, “It’s all in your head,” and sent to a psychiatrist.

Think about that. A bacteria related to but much more potent than the one that causes syphilis is invading your organs, tissues, and even your central nervous system, and you are sent to a psychiatrist for anti-depressants. This is happening regularly in Texas.

As a result, most Lyme patients in Texas are forced to travel out of state for medical care. Many others remain untreated, and even undiagnosed and misdiagnosed, because doctors are not looking for Lyme disease. The Texas Department of State Health Services considers Lyme to be endemic to Texas, but many patients are still told by their doctors, “There is no Lyme in Texas.” We are working to change that, and by declaring May as Lyme Disease Awareness Month, you are helping us to spread a very important message.”

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Miscellany

Charles Crist, M.D. (Natalie’s physician)
www.drcharlescrist.com
Dr. Crist is a Family Practice medical doctor whose primary focus is on patients with Lyme borreliosis. This website is designed to shed light on this very complex, very serious illness. In 1988 [Dr. Crist] joined a group of medical doctors in Cape Girardeau, Missouri.  The group included Edwin J. Masters, M.D., for whom Master’s disease is named–a disease that could also be called Midwestern Lyme disease.  During the five years he practiced medicine with Dr. Masters, he became heavily involved in helping patients with Lyme disease. Dr. Crist stays abreast of the latest research and treatments available for the disease.