A Vulnerable North: Lyme disease in Canada

December 8, 2014 - In recent years, the habitat of deer ticks from the south has begun to edge into more northern environments. This expansion, estimated at up to 46km/yr, is believed to have resulted from a combination of climate change and transport by ticks using white-footed mice and migratory birds[i]. With the ticks, comes a burgeoning threat to northerners, namely the potentially debilitating pathogens that reside within a percentage of the tick population (varying from 1% to over 60% depending on host availability)[ii]. The most concerning of these is the spirochete (corkscrew-shaped bacterium) borrelia burgdorferi, the causative agent of Lyme disease, an illness on the rise in Canada due to the spread of deer ticks.

Early stages of Lyme disease include a ‘bulls-eye’ rash (erythema migrans) at the site of the tick bite and moderate to severe flu-like symptoms[iii]. These symptoms, if left undetected or untreated, may lead to severe cardiac, rheumatoid, or neurological dysfunction later on. While the disease may be easily cured with a series of antibiotics, 10-20% of patients with a confirmed diagnosis may develop a condition called post-treatment Lyme disease syndrome (PTLDS), with symptoms as incapacitating as the later stages of these disease. To complicate matters further, controversy over the diagnosis and treatment of Lyme disease has split the medical community in Canada and elsewhere, with some adopting the established dogma that infections are rare and can be treated without difficulties, while others question all aspects of the disease.

Despite the controversy surrounding Lyme disease, what has brought this fractured medical community together is the growing number of “legitimate” cases. In 2009, Lyme disease became a nationally reportable disease in Canada with 128 cases reported that year[iv]. In 2012, there were 315 cases reported. Worse still, many organizations, including the Centre for Disease Control (CDC), believe that under-reporting is rampant by both doctors and patients due to poor diagnostic measures and misconceptions about the disease. It is estimated that the actual number of cases is likely in the thousands[v] (for a look at the spread of confirmed cases in the states and an example of quickly Lyme disease is spreading, see http://www.cdc.gov/lyme/stats/maps/interactiveMaps.html). Thankfully, years of petitioning by patients and patient advocates on the spread of ticks, their pathogens, and the rising tide of confirmed Lyme disease cases has led to progress in the form of the private member’s bill, Bill C-442[vi].

Bill C-442, An Act respecting a Federal Framework on Lyme Disease (formerly, the National Lyme Disease Strategy Act) represents a first step in managing the issue of Lyme disease in Canada in a meaningful way. The bill was put forth by Green party leader Elizabeth May with the support of both the Canadian Medical Association (CMA) and the College of Family Physicians and had its second reading in the Senate on September 30th, 2014. If enacted, Bill C-442 would require all provincial and territorial health ministers to convene with representatives from both the medical community and patient advocacy groups with the aim of developing a federal framework that would effectively and appropriately acknowledge the issues and challenges associated with Lyme disease diagnosis and treatment. In time, Bill C-442 would result in the development of unanimously agreed-upon best practices surrounding Lyme disease founded in evidence-based research. Additionally, the Public Health Agency of Canada has released an action plan to help educate the Canadian public on how to be proactive in managing ticks and Lyme disease (via tick-checks, reducing exposed skin in wooded areas, and what to do if bitten) in their communities, as well as develop new protocols and knowledge through the funding of research[vii]. Although both Bill C-442 and the Public Health Agency’s action plan have received some criticism[viii] [ix], few disagree that the bill could be a significant step forward in the battle to understand and combat Lyme disease on a grander scale than ever before.

Though voices from southern Canada have been largely responsible for the progress towards Lyme disease issues in the country, the impact of Bill C-442 may be particularly significant for the north. The reason for this is two-fold. First, in the south, if an individual finds they have been bitten by a tick they can almost immediately go to a clinic or family doctor who will complete their testing in a timely manner and provide the appropriate treatment if needed. In some northern communities, access to health services may be delayed, prolonging the time to diagnosis. This delay may allow the spirochetes additional time to disseminate to other parts of the body, complicating diagnosis and compromising treatment outcomes. Secondly, individuals living in rural, less developed areas are far more exposed to potential tick habitats than those in southern parts of the country, putting future northerners at greater risk of tick bites as a whole as the disease spreads. This decreased capacity to manage possible Lyme cases coupled with increased exposure to potential tick habitats places the north in an especially vulnerable position. If the situation is left unattended, Lyme cases in the north will inevitably boom leading to significant personal, social, and economic burdens.

With luck, Bill C-442 will promote greater awareness and responsiveness in all communities in Canada while simultaneously producing more extensive research, interventions, and policies for combatting Lyme disease. For the time being, proactive approaches to avoid ticks should be practiced by all and health organizations should promote or continue to promote campaigns for awareness and safety.

In Sudbury, ON, for example, the Sudbury & District Health Unit has supplied a ‘check for ticks’ ad warning of Lyme disease in the Greater Sudbury region. This advertisement[x] and their webpage outlining the disease, symptomatology, and prevention measures follows from concerns regarding two cases of Lyme disease reported in Sudbury in the past two years[xi].

Authored by Eric Gloster, a student Intern with Northern Policy Institute.

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[i] Leighton, P. A., Koffi, J. K., Pelcat, Y., Lindsay, L. R., & Ogden, N. H. (2012). Predicting the speed of tick invasion: An empirical model of range expansion for the lyme disease vector ixodes scapularis in canada. Journal of Applied Ecology, 49(2), 457-464. doi:10.1111/j.1365-2664.2012.02112.x

[ii] Percentage of Infected Ticks http://www.phac-aspc.gc.ca/id-mi/tickinfo-eng.php  

iii] Public Health Agency of Canada – Lyme disease symptoms http://www.phac-aspc.gc.ca/id-mi/lyme/symptoms-symptomes-eng.php

[iv] Public Health Agency of Canada – Surveillance http://www.phac-aspc.gc.ca/id-mi/lyme/surveillance-eng.php

[v]Lyme disease: Tiny tick, big problem” CBC Health http://www.cbc.ca/news/health/lyme-disease-tiny-tick-big-problem-1.1325529

[vi] Bill C-442 http://www.parl.gc.ca/HousePublications/Publication.aspx?Language=E&Mode=1&DocId=6646210

[vii] Public Health Agency of Canada – Action Plan http://www.phac-aspc.gc.ca/id-mi/lyme-plan-eng.php

[viii]Elizabeth May’s Lyme Disease Bill Needs Science, Not Emotion” by Michael Kruse http://www.huffingtonpost.ca/michael-kruse/lyme-disease-elizabeth-may_b_4878629.html

[ix]Health Canada’s new Lyme disease plan: You act, we’ll watch” by Annie Kingston http://www.macleans.ca/society/health/health-canadas-new-lyme-disease-plan-you-act-well-watch/

[x] Sudbury & District Health Unit Lyme disease Web page http://www.sdhu.com/content/search/doc.asp?doc=8539&q=lyme&lang=0

[xi] Sudbury Lyme disease Cases http://www.nomj.ca/2014/07/01/health-unit-urges-vigilance-for-lyme-disease.html

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