Local Physicians Lead Battle Against Lyme Disease

By Jan Howard

Two physicians from Newtown have leadership roles as part of an effort by Danbury Hospital to educate the medical community about the need for prevention efforts and to establish guidelines for management of Lyme disease and other tick-borne diseases, such as ehrlichiosis and babesiosis.

Dr Thomas Draper, director of community medicine, and Dr Ana Paula Machado co-chair the hospital’s Lyme Disease Task Force.

According to Dr Draper, approximately 143 local physicians took part in the program that ended in April with a series of lectures.

“It was quite successful,” he said. “We have touched most of the primary care doctors. The emphasis was on prevention. We shared recommendations on how people should protect themselves.”

The Lyme Disease Task Force will continue its educational program for another year.

Lyme disease is a bacterial infection spread through the bite of an infected tick. It is the most prevalent tick or mosquito transmitted infectious disease in the United States, according to the Connecticut Department of Public Health (DPH). Infected ticks are present and pose a threat to people in every county in the state.

According to DPH, the emergence of Lyme disease as an important public concern is due to the reforestation of former farmland and greater risk of tick bites among people who live increasingly in suburban and rural areas near woodlands.

The DPH was recently awarded a grant from the federal Centers for Disease Control and Prevention for research into the prevention of Lyme disease in Connecticut. The grant will support research projects to evaluate the effectiveness of using various integrated measures to reduce the risk of Lyme disease when prevention recommendations are followed.

The task force came about following a presentation by Dr Draper in June 2003, during which he described the growing occurrence of Lyme disease and other tick-borne diseases and asked for guidance on how to address the problem.

Dr Draper said problems associated with tick-borne diseases, added to other chronic illnesses, have complicated the practice of medicine and public health.

“It is a major and continuing epidemic,” Dr Draper said recently.

“Dr Draper was very visionary in having brought this up,” Dr Machado said. “I felt pretty strongly it was something to pursue. I wanted to be part of it.” As a result of her interest, she became Dr Draper’s co-chair when the task force was formed.

Dr Draper and Dr Machado and their colleagues developed a process based on clinical guidelines of the Infectious Diseases Society of America for physicians caring for patients at risk of Lyme disease and other tick-borne diseases.

Task force members, in addition to Dr Draper and Dr Machado, are Dr Anna Alshansky, Dr Richard Auerbach, Dr Theodore Blum, Dr Jerry Green, Dr Serafima Glouzgal, Dr David Gropper, Dr Charles Herrick, Dr Peter Licht, Dr Graeme Lipper, Dr Paul Nee, Dr David Pazer, and Dr Gary Schleiter. Dr Licht and Dr Auerbach have practices in Newtown.

Once the task force was formed, “We had to learn what doctors collectively knew, and educate ourselves,” Dr Draper said. “Educating the committee was the first thing we had to do. Most knew about Lyme disease but there was no methodology to share what they knew.”

Meeting monthly, the 14 task force members studied literature, raised questions, and shared experiences, Dr Draper said. “We reviewed how problems were resolved.”

Dr Machado said the task force looked at studies in regard to the evaluation and treatment of Lyme disease. Experts, such as Gary Wormser, chief of infectious diseases at New York Medical College and Westchester Medical Center in Valhalla, N.Y., and a national authority on Lyme disease, conducted a three-hour seminar last December at the hospital. Dr Wormser was one of the doctors to draw up Infectious Diseases Society of America guidelines regarding Lyme disease.

During that seminar, Dr Machado said, “Task force members spent three hours learning from him.”

In April, the task force sponsored a hospitalwide educational program featuring a series of lectures for physicians that offered recommendations for management of cases in which either Lyme disease was diagnosed or the patient was bitten by a tick. Dr Draper and Newtown’s Director of Health Donna McCarthy were among the lecturers.

Dr Machado said it is important for physicians to discuss Lyme disease with their patients and to educate them about prevention. She advises people to do tick checks after being outside and to “wear the uniform,” long sleeve shirts, long pants, and socks pulled up over pant legs.

“Remove the clothes after being outside and wash them,” she said.

She also described landscaping controls, such as a barrier of wood chips between wooded areas and tall grass and lawns. She noted children should not be allowed to play in areas of groundcovers, such as pachysandra.

Parents should check their children daily for possible rashes that could indicate a tick bite, Dr Machado said. “Be aware of the rash,” she advised.

Dr Draper noted that Connecticut has the highest degree of Lyme disease infection in the country, but people moving here from other areas are not as aware of it. Because of that, “The information has to be repeated and repeated,” he said.

Following the sessions with physicians, the task force met with public officials and health directors to tie clinicians with public health. “There was considerable participation of health agencies,” he said.

Dr Draper emphasized that there has to be an ongoing effort in regard to education about Lyme disease. “June, July, and August are the peak time for ticks,” he said.

“If you remove a tick, there may be other ticks you didn’t see,” he cautioned.

Dr Draper said that Kirby Stafford, chief scientist at The Connecticut Agricultural Experiment Station, believes there will be a large tick population this year.

Because the adult ticks are breeding on deer, “We have to confront the deer population,” Dr Draper said. It has been proven that when the deer population is reduced, the incidence of the disease goes down, he said.

“We have more woods today than 100 years ago,” he said, “and we have people living in the woods.”

He said physicians and their patients need to talk about prevention and what symptoms to look for that might ordinarily be dismissed as something else, such as the flu. It is important to diagnose and treat it as early as possible, he said.

“We have to be educated about how to answer our patients’ questions,” Dr Machado said. “It’s very important to have that discussion. The most important thing to discuss is the means of prevention.”

Physicians should be ever-vigilant in considering Lyme as a possibility in making a diagnosis, Dr Machado said. Ehrlichiosis is more a problem with adults than with children, she noted. “Doctors are seeing more of that.”

She said tick-related illnesses are on her mind constantly when making a diagnosis, adding she has to consider “what’s most likely from the symptoms? We have to put it on the list in the summertime.”

Dr Draper said Lyme disease is now the most common reason for calling doctors about illness. “People and doctors are more aware, and it becomes a major concern in June, July, and August.”

Dr Draper said the task force would review the experiences of this summer and take feedback before planning the direction of the program. The next meeting is planned for September.