BCCDC responds

We thank Ms Souch for her ongoing dialogue with the BC Centre for Disease Control about Lyme disease in British Columbia.

We thank Ms Souch for her ongoing dialogue with the BC Centre for Disease Control about Lyme disease in British Columbia. Our article published in the June 2011 BCMJ provides an overview of the many Lyme-related studies that have been done in BC and was intended to provide physicians with an update and a reminder about the very real risks of Lyme disease in this province. The article was not in response to the book indicated, as we were not aware of this book, or any other specific story.

We do remind readers that an independent panel, convened at the direction of the Attorney General in Connecticut, reviewed the 2006 Infectious Diseases Society of America (IDSA) guidelines for managing Lyme disease. 

This independent panel was vetted by an ombudsman for potential conflicts of interest as agreed upon by both the ISDA and the Lyme advocacy community in the US. This panel fully and completely endorsed the scientific validity of these guidelines last spring.[1] These guidelines are also consistent with recent guidance from other agencies, most notably from the UK, in providing physicians with advice on management of Lyme disease.

With respect to the data we presented, the results of tick testing were from over 10 years of collection at 125 different sites in BC. Dr Teng’s project investigated areas where people were most often exposed or most likely to be exposed to ticks, and was not designed to be specific for any particular species of ticks. It is an important finding that Ixodes were not common in the areas where people were most likely to be exposed.

The statement regarding culture refers to human samples where very low levels of Borrelia can be found in tissue or blood. However, the culturing of an entire tick midgut is a well-established method of testing and is used internationally for research into tick-borne illness.[2]

BCCDC continues to follow the evidence and accepted best international practice around the surveillance of and laboratory testing for Lyme disease and will continue to innovate and change practice as the evidence and guidelines dictate. We are also committed to acquiring and passing on new knowledge, and will continue to do so with respect to Lyme disease. 

We encourage physicians and other public health providers to consider the diagnosis of Lyme disease in people who present with appropriate signs and symptoms and have a history of tick bites. Lyme disease should be diagnosed through a clinical evaluation of the patient’s symptoms and risk of exposure to infected ticks. Laboratory testing may support a clinical diagnosis, but results must be in­terpreted in light of the patient’s symptoms. This is consistent with guidelines across Canada, the US, and Europe.

For more information on Lyme disease, we encourage individuals to visit our website at www.bccdc.ca
—Bonnie Henry, MD
—Muhammad Morshed, MD


1. Lantos PM, Charini WA, Medoff G, et al. Final report of the Lyme disease review panel of the Infectious Diseases Society of America. Clin Infect Dis 2010;51:1-5.
2. Peavy CA, Lane RS, Kleinjan JE. Role of small mammals in the ecology of Borrelia burgdorferi in a peri-urban in north California. Exp Appl Acarol 1997;21:569-584.


Bonnie Henry, MD, MPH, FRCPC, Muhammad Morshed, PhD, SCCM. BCCDC responds. BCMJ, Vol. 53, No. 8, October, 2011, Page(s) 396 - Letters.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

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For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

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