We thank Ms Souch [10] for her ongoing dialogue with the BC Centre for Disease Control about Lyme disease in British Columbia. Our article [11] 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 [12]. 
—Bonnie Henry, MD
—Muhammad Morshed, MD

References

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.