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Law targets Lyme disease

Del. Tim Hugo’s kids have had Lyme disease. His neighbors’ kids have had Lyme.

The tick-borne disease is so prevalent, Hugo said kids can’t play outdoors in the summer without needing head-to-toe tick checks when they come back indoors.

Hugo and other Northern Virginia lawmakers say the disease is an epidemic in Northern Virginia. But they also say tests for the disease can give the wrong results—something they hope new legislation will make more people understand.

This year, Hugo and other lawmakers—many from Northern Virginia—backed a bill that will require doctors to tell patients that Lyme tests can be unreliable. Gov. Bob McDonnell has signed it, and the law will take effect in July.

Hugo, a Republican from Fairfax, said he knows a woman who spent years thinking she had multiple sclerosis, after testing negative for Lyme. Later tests, he said, finally showed she had the infection rather than the deadly nerve disease.

Hugo said he wants more people to know that the tests can sometimes be inaccurate.

“It’s impacting people’s lives,” he said.

Lyme is more easily treated in the early stages, so a false negative that leaves a patient searching for other causes of their symptoms—while the infection gets worse—can be harmful to that person’s health, Hugo said.

There’s no question that Lyme is a growing problem in Virginia, especially Northern Virginia. Data from the Virginia Department of Health shows that statewide, the incidence of Lyme has jumped from fewer than two cases per 100,000 in 1990 to almost 16 per 100,000 in 2010. The biggest jump has come since 2005.

In 2005, there were 25–49 reported cases of Lyme per 100,000 residents of Loudoun County, and none in neighboring Clarke County. By 2010, Loudoun had 50–99 cases per 100,000 residents, and Clarke had more than 100 per 100,000.

Maps from the health department show relatively few localities reporting cases in 2005, and showcase the disease’s spread to the west and south between 2005 and 2010.

The disease still hadn’t reached most localities in, say, far Southwest Virginia, but all of Northern Virginia’s localities reported anywhere from 10 to 100 cases per 100,000 residents in 2010.

The maps suggest the disease is spreading faster to the west of the Fredericksburg area; Stafford, for example, showed no change in its rate of cases (between 5 and 9.9 per 100,000) from 2005 to 2010, and Caroline didn’t report any cases in either year.

But to the west, in Rockingham County, there were no cases reported in 2005 but a rate of 25–49.9 per 100,000 in 2010.

The bill Hugo helped sponsor will require any doctor’s office that orders a Lyme disease test to also inform that patient that the Centers for Disease Control and Prevention calls Lyme disease the sixth-fastest growing disease in the U.S.

The doctor or his office staff must also tell the patient that current lab testing for Lyme “can be problematic and standard laboratory tests often result in false negative and false positive results, and if done too early, you may not have produced enough antibodies to be considered positive.”

The doctor must advise patients that if they continue to have symptoms, they should check into re-testing or other treatment options.

Early on in the legislative process, the bill had a lot of support. But it became controversial as it progressed and was amended.

Del. Bobby Orrock, R–Caroline, initially voted for the bill but was a no vote on its last vote in the House.

At first, he said, the bill had the Board of Medicine working out the details, and required doctors to receive more training on Lyme disease. But it transformed into a requirement that specific language be used with patients, and dropped the training requirement, and doctors in the General Assembly opposed it.

Orrock said he doesn’t deny there’s a problem with Lyme testing, but that the doctors in the General Assembly had issues with the mandated warning language.

While the earlier version he voted for would warn patients that lab tests are “not perfect” and that their accuracy may vary, the final version refers to “problematic” tests and speaks specifically of false negative and false positive results.

“So while it’s designed to address a real problem on the one hand, it creates a problem on the other hand,” he said. “The doctors, and I concurred, felt ‘yes there needs to be a communication but we have to make sure it’s done properly.’”

The final version of the bill easily passed the Senate, 38–2, and passed the House 56–40.


Tips on dealing with ticks from the Centers for Disease Control and Prevention


Before You Go Outdoors

• Know where to expect ticks. Ticks live in moist and humid environments, particularly in or near wooded or grassy areas. You may come into contact with ticks during outdoor activities around your home or when walking through leaf litter or near shrubs. Always walk in the center of trails in order to avoid contact with ticks.

• Products containing permethrin kill ticks. Permethrin can be used to treat boots, clothing and camping gear and remain protective through several washings.

• Use a repellent with DEET on skin. Repellents containing 20% or more DEET (N, N-diethyl-m-toluamide) can protect up to several hours. Always follow product instructions. Parents should apply this product to their children, avoiding the hands, eyes, and mouth. For detailed information about using DEET on children, see recommendations from the American Academy of Pediatrics.

• For detailed information about tick prevention and control, see Avoiding Ticks. Detailed information for outdoor workers can be found at NIOSH Safety and Health Topic: Tick-borne Diseases.

After You Come Indoors

Check your clothing for ticks. Ticks may be carried into the house on clothing. Any ticks that are found should be removed. Placing clothes into a dryer on high heat for at least an hour effectively kills ticks.

Shower soon after being outdoors. Showering within two hours of coming indoors has been shown to reduce your risk of getting Lyme disease. Showering may help wash off unattached ticks and it is a good opportunity to do a tick check.

Check your body for ticks after being outdoors. Conduct a full body check upon return from potentially tick-infested areas, which even includes your back yard. Use a hand-held or full-length mirror to view all parts of your body. Check these parts of your body and your child’s body for ticks:

• Under the arms

• In and around the ears

• Inside belly button

• Back of the knees

• In and around the hair

• Between the legs

• Around the waist

What to Do if You Find an Attached Tick

Remove the attached tick as soon as you notice it by grasping with tweezers, as close to the skin as possible, and pulling it straight out. For detailed information about tick removal, see the tick removal page.

Watch for signs of illness such as rash or fever in the days and weeks following the bite, and see a health care provider if these develop. Your risk of acquiring a tick-borne illness depends on many factors, including where you live, what type of tick bit you, and how long the tick was attached. If you become ill after a tick bite, see a health care provider.

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