Infectious Disease

An evaluation discovered that just about 500,000 Individuals are identified with Lyme illness annually

January 13, 2021

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It is estimated that nearly half a million Americans were diagnosed with Lyme disease each year from 2010 to 2018. This emerges from a new analysis published in Emerging Infectious Diseases.

Lyme disease is often underreported in the United States. For example, in 2017 the US reported a record number of tick-borne diseases – nearly 60,000, most of which were Lyme disease – but the CDC found that the actual number of cases was much larger.

Almost half a million Americans get Lyme disease each year, which is commonly transmitted by the black-legged tick.

To get a better estimate, Kiersten J. Kugeler, PhD, MPH, an epidemiologist in the CDC’s Bacterial Disease Department and colleagues The IBM Watson Health MarketScan commercial claims and encounters databases were used to identify Lyme disease diagnoses by associating specific patient encounters billing codes with antimicrobial prescriptions.

A similar analysis published in 2015 found that around 329,000 people were diagnosed with Lyme disease annually in the United States from 2005 to 2010.

In the new analysis, Kugeler and colleagues identified 118,780 people with a required code for Lyme disease from 2010 to 2018. Of these diagnoses, 81% occurred in residents of 14 high-incidence states in the Northeast, the Mid-Atlantic, and the upper Midwest to an additional 8% among residents in the adjacent states.

The researchers reported that an average of 205,000 patients were coded and treated for Lyme disease each year. After making another correction for omitting Lyme disease-specific codes from patient records, they estimated that from 2010 to 2018, an average of 476,000 people were diagnosed with Lyme disease annually (95% CI, 405,000-547,000) – a significant increase from that the 2005-2010 estimate.

“Although both estimates were calculated using similar methods, we implemented a somewhat more restrictive approach that prohibited any patient diagnosed with Lyme disease from being counted more than once during the 9-year study period,” wrote Kugeler and colleagues. “The observed increase in Lyme disease diagnoses between these two time periods corresponds to an increase in the number of cases reported through surveillance.”

They said the estimates “underscore the great clinical burden associated with diagnosing Lyme disease in the United States.”

“The advancement of electronic medical and laboratory systems should help fill detectable data gaps and enable more robust and reliable monitoring of changes in the extent and spread of the disease,” they write. “Effective interventions are needed, and better awareness among clinicians and the general public is of paramount importance to promote early and accurate diagnosis and appropriate treatment.”

A second study by Amy M. Schwartz, MPH, also an epidemiologist in the CDC’s Bacterial Disease Division, and colleagues rated MarketScan as the source of information for diagnosing Lyme disease in the United States and found that it “provides a stable data source for monitoring trends in the diagnosis of Lyme disease , but certainly important features ”- such as For example, which conditions, signs or symptoms in some areas are often confused with Lyme disease – “require further investigation. “

“As access to electronic data sources for health-related information increases, more diverse data can be queried to provide more comprehensive information on the epidemiology of Lyme disease,” the authors write. “When using novel data sources, however, volume, stability and representativeness must be considered before conclusions can be drawn.”

The clinical guidelines for Lyme disease were recently updated for the first time in 14 years.

References:

Kugeler KJ et al. Emerg Infect Dis. 2021; doi: 10.3201 / eid2702.202731.

Schwartz AM et al. Emerg Infect Dis. 2021; doi: 10.3201 / eid2702.202728.

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Paul G. Auwaerter, MD

Paul G. Auwaerter

The study by Kugeler and colleagues is similar in design to their earlier study. At the very least, the data suggests that more patients are receiving antibiotics for Lyme disease. Undoubtedly, a significant part of the increase is due to newly acquired infections. However, Lyme disease is also overdiagnosed, especially in people with chronic symptoms like fatigue and pain. The researchers tried to limit this effect by only counting patients if they had encountered Lyme disease multiple times. The Schwartz paper suggests that the diagnosis of Lyme disease in conditions with low incidence and outside of spring or fall may represent misdiagnosed cases. Such data, which both studies use, are more important for finding trends in the diagnosis and treatment of the infection than for understanding the number of defined cases of Lyme disease.

Paul G. Auwaerter, MD

Clinical Director, Infectious Diseases Department

Johns Hopkins University Medical School

Disclosure: Auwaerter does not report any relevant financial information.

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