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Volume: 3
Issue: 10
Date: 03-Jul-95


Table of Contents:

I.    LYMENET: Finding Treatment
II.   Q&A: Neurologic Lyme Disease
III.  LYMENET: Bad Faith Claim Against Met Life
VI.   MMWR: Lyme Disease -- United States, 1994
V.    About The LymeNet Newsletter


Newsletter:

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*                  The National Lyme Disease Network                  *
*                         LymeNet Newsletter                          *
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IDX#                Volume 3 - Number 10 - 7/03/95
IDX#                            INDEX
IDX#
IDX#  I.    LYMENET: Finding Treatment
IDX#  II.   Q&A: Neurologic Lyme Disease
IDX#  III.  LYMENET: Bad Faith Claim Against Met Life
IDX#  VI.   MMWR: Lyme Disease -- United States, 1994
IDX#  V.    About The LymeNet Newsletter
IDX#



I.    LYMENET: Finding Treatment
--------------------------------------------
Sender: Gary M. Heir, DMD <heirgm@umdnj.edu>


I am very concerned over circumstances regarding the ability of
patients to receive treatment Lyme disease.  I have heard of
insurance companies who arbitrarily deny coverage for medically
necessary treatment and of physicians who have been intimidated to
the extent that they no longer treat Lyme disease patients.  I would
like to know if anyone has had or heard of similar experiences.



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II.   Q&A: Neurologic Lyme Disease
---------------------------------------------------
Sender: Bill VanDerWoude <wvanderw@asrr.arsusda.gov>


We have two young adults, (18 and 22 years old) with neurologic
lyme disease. Both have positive western blots.  Their
manifestations are mainly psychological and are responding slowly
to treatment.  Our son (18 years old) had an allergic reaction to
claforan and is taking minocycline orally until he can be tested
to see if he has allergies to other antibiotics.  He has bad
periods roughly every three weeks where he is out of touch, does
not want to sleep and will stay up for 36 hours.  These bad periods
last 8 to 10 days and he refuses his medication during these
periods.  He can not be reasoned with during these times and things
are difficult.  He also has panic attacks and wants to get away
from the house and has been gone all night walking when he does
get out.  We have had 5 of these bad periods and we are told they
are herxheimer reactions.  He has been on and off IV antibiotics
for eight months.  This has consisted of about three months of
rocephin and 5 weeks of claforan to which he recently had the

allergic reaction.  Has anyone experienced similar symptoms with
neurologic lyme?  What medication worked best? Are these bad
periods herxheimer reactions?  How many bad periods can we expect?
Is there any way to know when they will stop?


Our daughter (22 years old) has only been on IV rocephin for
two weeks.  She is very passive and does not speak unless spoken
to.  Her mind is bombarded with thoughts and they are not related
and she can not get them out of her mind.  Some thoughts play over
and over in her mind.  She hesitates when she speaks and has
difficulty focusing on her thoughts.  Has anyone had this
experience and recovered?  What are the best medications that
worked? We are desperate and need help.  Please respond to Robert
Behan at wvanderw@asrr.arsusda.gov.



=====*=====


III.  LYMENET: Bad Faith Claim Against Met Life
-----------------------------------------------
Sender: Ira M. Maurer <LymeAtty@ix.net.com>


   As an alternative to bringing a class action lawsuit against the
insurance industry, I am considering bringing a "bad faith"  claim
against Metropolitan Life on behalf of individual claimants.  
Currently, I am receiving more calls about Met Life than any other
insurer.  Anyone who is having difficulty getting Met Life to pay for
their Lyme disease treatment should E-Mail me at LymeAtty@ix.net.com.
   
   I am also interested in hearing from anyone who has volunteered
for the Lyme disease vaccine efficacy trial of Connaught Labs and
has had  an adverse reaction.
       


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VI.   MMWR: Lyme Disease -- United States, 1994
-----------------------------------------------
SOURCE: MMWR 44(24);459-462  
DATE: Jun 23, 1995


For surveillance purposes, Lyme disease (LD) is defined as the
presence of an erythema migrans rash greater than or equal to 5 cm
in diameter or laboratory confirmation of infection with Borrelia
burgdorferi and at least one objective sign of musculoskeletal,
neurologic, or cardiovascular disease (1). In 1982, CDC initiated
surveillance for LD, and in 1990, the Council of State and
Territorial Epidemiologists adopted a resolution that designated LD
a nationally notifiable disease. This report summarizes
surveillance data for LD in the United States during 1994.


In 1994, 13,083 cases of LD were reported to CDC by 44 state health
departments, 4826 (58%) more than the 8257 cases reported in 1993
(|Figure_1|). As in previous years, most cases were reported
from the northeastern and north-central regions (|Figure_2|). The
overall incidence of reported LD was 5.2 per 100,000 population.
Eight states reported incidences of more than 5.2 per 100,000
(Connecticut, 62.2; Rhode Island, 47.2; New York, 29.2; New Jersey,
19.6; Delaware, 15.5; Pennsylvania, 11.9; Wisconsin, 8.4; and
Maryland, 8.3); these states accounted for 11,476 (88%) of
nationally reported cases. Six states (Alaska, Arizona, Hawaii,
Mississippi, Montana, and North Dakota) reported no cases. Reported
incidences were greater than or equal to 100 per 100,000 in 15
counties in Connecticut, Maryland, Massachusetts, New Jersey, New
York, Pennsylvania, and Wisconsin; the incidence was highest in
Nantucket County, Massachusetts (1197.6).


Six northeastern states accounted for 95% of the increase in
reported cases for 1994: Maryland, New Jersey, New York, Rhode
Island, Connecticut, and Pennsylvania. Reported cases increased by
218 cases (121%) in Maryland, 747 cases (95%) in New Jersey, 2382
cases (85%) in New York, 199 cases (73%) in Rhode Island, 680 cases
(50%) in Connecticut, and 353 cases (33%) in Pennsylvania. Reported
cases remained stable in the states with endemic disease in the
north-central region (Minnesota and Wisconsin) and decreased in
California (36%).


Males and females were nearly equally affected in all age
groups except those aged 10-19 years (males: 55%) and those aged
30-39 years (females: 56%).


Reported by: State health departments. Bacterial Zoonoses Br, Div
of Vector-Borne Infectious Diseases, National Center for Infectious
Diseases, CDC.


Editorial Note: LD is the most commonly reported vectorborne
infectious disease in the United States. Infection with B.
burgdorferi results from exposure to nymphal and adult forms of
tick vectors of the genus Ixodes: I. scapularis (black-legged tick)
in the northeastern and upper north-central United States, and I.
pacificus (western black-legged tick) in the Pacific coastal
states.


Risk for exposure to B. burgdorferi is strongly associated
with the prevalence of tick vectors and the proportion of those
ticks that carry B. burgdorferi. The risk for exposure may be
highly focal (2) and can differ substantially between adjacent
states, counties, communities, and areas on the same residential
property (3,4). In northeastern states with endemic disease, the
infection rate of nymphal I. scapularis ticks with B. burgdorferi
is commonly 20%-35%, and even modest changes in tick numbers can
substantially affect the risk for exposure to infected vectors (5).
In one area of Connecticut where approximately 15% of I. scapularis
are infected with B. burgdorferi, changes in the annual incidence
of LD have paralleled changes in I. scapularis densities (M.
Cartter, Connecticut Department of Health and Addiction Services,
K. Stafford, Connecticut Agricultural Experimental Station,
personal communication, 1995). In 1994, tick surveillance in the
Northeast indicated increases over previous years in vector tick

density. For example, in one site in Westchester County, New York,
population density of I. scapularis nymphs increased 400% from 0.4
nymphs per square meter in 1993 to 1.6 nymphs per square meter in
1994 (T. Daniels, Fordham University, R. Falco, Westchester County
Department of Health, personal communication, 1995), and in Rhode
Island, nymphal I. scapularis density measured at sites throughout
the state increased 158% from 1993 to 1994 (T. Mather, University
of Rhode Island, personal communication, 1995).


Ascertainment of LD cases based only on passive surveillance
may result in underreporting of cases (6,7). Because of this and in
accordance with recommendations for control of emerging diseases
(8), some states in which LD is endemic have expanded surveillance
efforts. In 1994, the New York State Department of Health augmented
surveillance with additional staff, intensified active case
detection, and validated some cases reported in the previous year;
these efforts probably accounted for some of the increase in
reported cases for New York in 1994 (D. White, New York State
Department of Health, personal communication, 1995). Active
surveillance, with support from CDC, is conducted by health
departments in Connecticut, Michigan, Minnesota, New Jersey, New
York, Oregon, Rhode Island, and West Virginia.


The risk for infection among persons residing in or visiting
areas where LD is endemic can be reduced through avoidance of known
tick habitats; other preventive measures include wearing long pants
and long-sleeved shirts, tucking pants into socks, applying tick
repellents containing N,N-diethyl-m-toluamide ("DEET") to clothing
and/or exposed skin according to manufacturer's instructions,
checking thoroughly and regularly for ticks, and promptly removing
any attached ticks. Acaracides containing permethrin kill ticks on
contact and can provide further protection when applied to
clothing, but are not approved for use on skin.


Additional information about LD is available from state and
local health departments, from CDC's Voice Information System,
telephone (404) 332-4555; from CDC's Bacterial Zoonoses Branch,
Division of Vector-Borne Infectious Diseases, National Center for
Infectious Diseases, telephone (970) 221-6453; and from the Office
of Communications, National Institute of Allergy and Infectious
Diseases, National Institutes of Health, telephone (301) 496-5717.


References
1. CDC. Case definitions for public health surveillance. MMWR
1990;39(no. RR-13):19-21.
2. Piesman J, Gray JS. Lyme disease/Lyme borreliosis. In:
Sonenshine DE, Mather TN, eds. Ecological dynamics of tick-borne
zoonoses. New York: Oxford University Press, 1994:327-50.
3. Maupin GO, Fish D, Zultowsky J, Campos EG, Piesman J. Landscape
ecology of Lyme disease in a residential area of Westchester
County, New York. Am J Epidemiol 1991;133:1105-13.
4. Spielman A, Wilson ML, Levine JF, Piesman J. Ecology of Ixodes
dammini-borne human babesiosis and Lyme disease. Ann Rev Entomol
1985;30:439-60.
5. Mather TN. The dynamics of spirochete transmission between ticks
and vertebrates. In: Ginsberg HS, ed. Ecology and environmental
management of Lyme disease. New Brunswick, New Jersey: Rutgers
University Press, 1993:43-60.
6. Ley CT, Davila IH, Mayer NM, Murray RA, Rutherford GW, Reingold
AL. Lyme disease in northwestern coastal California. Western J Med
1994;160:534-9.
7. Jung PI, Nahas JN, Strickland GT, McCarter R, Israel E. Maryland

physicians' survey on Lyme disease. Maryland Medical Journal
1994;43:447-50.
8. CDC. Addressing emerging infectious disease threats: a
prevention strategy for the United States. Atlanta, Georgia: U.S.
Department of Health and Human Services, Public Health Service,
1994.



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V.    ABOUT THE LYMENET NEWSLETTER
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