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Volume 21, Number 10—October 2015

Epidemiology of Lyme Disease, Nova Scotia, Canada, 2002–2013

Todd F. HatchetteComments to Author , B. Lynn Johnston, Emily Schleihauf, Angela Mask, David Haldane, Michael Drebot, Maureen Baikie, Teri Cole, Sarah Fleming, Richard Gould, and Robbin Lindsay
Author affiliations: Nova Scotia Health Authority, Halifax, Nova Scotia, Canada (T.F. Hatchette, B.L. Johnston, D. Haldane); Dalhousie University, Halifax (T.F. Hatchette, B.L. Johnston, D. Haldane); Public Health Agency of Canada, Ottawa, Ontario, Canada (E. Schleihauf, A. Mask); Public Health Agency of Canada, Winnipeg, Manitoba, Canada (M. Drebot, R. Lindsay) Government of Nunavut, Iqaluit, Nunavut, Canada (M. Baikie); Nova Scotia Department of Health and Wellness, Halifax (T.J. Cole, S. Fleming); York Region Public Health, Newmarket, Ontario, Canada (R. Gould)

Main Article

Table 1

LD case definitions used in Nova Scotia, Canada*

Case classification
Case definition
EM or other clinical evidence and laboratory evidence of infection (based on CDC criteria) (8)
Clinical evidence of illness with a history of residence in, or visit to, an endemic region and laboratory evidence of infection (8)
2008–2015 Probable Clinical evidence of illness without a history of residence in, or visit to, an endemic region and laboratory evidence of infection (8)
OR clinician-observed EM without laboratory evidence but with history of residence in, or visit to, an endemic region

*CDC, Centers for Disease Control and Prevention; EM, erythema migrans; LD, Lyme disease.

Main Article

  1. Kuehn  BM. CDC estimates 300,000 US cases of Lyme disease annually. JAMA. 2013;310:1110 . DOIPubMedGoogle Scholar
  2. Ogden  NH, Koffi  JK, Pelcat  Y, Lindsay  LR. Environmental risk from Lyme disease in central and eastern Canada: a summary of recent surveillance information. Can Commun Dis Rep. 2014;40:7483.
  3. Henry  B, Roth  D, Reilly  R, MacDougall  L, Mak  S, Li  M, How big is the Lyme problem? Using novel methods to estimate the true number of Lyme disease cases in British Columbia residents from 1997 to 2008. Vector Borne Zoonotic Dis. 2011;11:8638 . DOIPubMedGoogle Scholar
  4. Public Health Agency of Canada. Lyme disease and other tick-borne diseases: information for healthcare professionals [cited 2015 Mar 26].
  5. Steere  AC, Sikand  VK, Schoen  RT, Nowakowski  J. Asymptomatic infection with Borrelia burgdorferi. Clin Infect Dis. 2003;37:52832. DOIPubMedGoogle Scholar
  6. Health Canada. Consensus conference on Lyme disease. CMAJ. 1991;144:162732 .PubMedGoogle Scholar
  7. Wormser  GP, Dattwyler  RJ, Shapiro  ED, Halperin  JJ, Steere  AC, Klempner  MS, The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43:1089134. DOIPubMedGoogle Scholar
  8. Canadian Public Health Laboratory Network. The laboratory diagnosis of Lyme borreliosis: guidelines from the Canadian Public Health Laboratory Network. Can J Infect Dis Med Microbiol. 2007;18:1458 .PubMedGoogle Scholar
  9. Centers for Disease Control and Prevention. Recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. MMWR Morb Mortal Wkly Rep. 1995;44:5901 .PubMedGoogle Scholar
  10. Statistics Canada. Table 051–0001—Estimates of population, by age group and sex for July 1, Canada, provinces and territories, annual (persons unless otherwise noted) [cited 2013 Jul 31].
  11. Bacon  RM, Kugeler  KJ, Mead  PS; Centers for Disease Control and Prevention. Surveillance for Lyme disease—United States, 1992–2006. MMWR Surveill Summ. 2008;57:19 .PubMedGoogle Scholar
  12. Steere  AC, Sikand  VK. The presenting manifestations of Lyme disease and the outcomes of treatment. N Engl J Med. 2003;348:24724. DOIPubMedGoogle Scholar
  13. Petersen  LR, Sweeney  AH, Checko  PJ, Magnarelli  LA, Mshar  PA, Gunn  RA, Epidemiological and clinical features of 1,149 persons with Lyme disease identified by laboratory-based surveillance in Connecticut. Yale J Biol Med. 1989;62:25362 .PubMedGoogle Scholar
  14. Shapiro  ED. Lyme disease. N Engl J Med. 2014;370:172431 . DOIPubMedGoogle Scholar
  15. Steere  AC, Schoen  RT, Taylor  E. The clinical evolution of Lyme arthritis. Ann Intern Med. 1987;107:72531. DOIPubMedGoogle Scholar
  16. Tory  HO, Zurakowski  D, Sundel  RP. Outcomes of children treated for Lyme arthritis: results of a large pediatric cohort. J Rheumatol. 2010;37:104955. DOIPubMedGoogle Scholar
  17. Daikh  BE, Emerson  FE, Smith  RP, Lucas  FL, McCarthy  CA. Lyme arthritis: a comparison of presentation, synovial fluid analysis, and treatment course in children and adults. Arthritis Care Res (Hoboken). 2013;65:198690 . DOIPubMedGoogle Scholar
  18. Nadelman  RB, Wormser  GP. Erythema migrans and early Lyme disease. Am J Med. Am J Med. 1995;98:15S23S. DOIPubMedGoogle Scholar
  19. Müllegger  RR, Glatz  M. Skin manifestations of Lyme borreliosis: diagnosis and management. Am J Clin Dermatol. 2008;9:35568. DOIPubMedGoogle Scholar
  20. Thompson  A, Mannix  R, Bachur  R. Acute pediatric monoarticular arthritis: distinguishing Lyme arthritis from other etiologies. Pediatrics. 2009;123:95965. DOIPubMedGoogle Scholar
  21. Kowalski  TJ, Tata  S, Berth  W, Mathiason  MA, Agger  WA. Antibiotic treatment duration and long-term outcomes of patients with early Lyme disease from a Lyme disease–hyperendemic area. Clin Infect Dis. 2010;50:51220 . DOIPubMedGoogle Scholar
  22. Steere  AC, Taylor  E, Wilson  ML, Levine  JF, Spielman  A. Longitudinal assessment of the clinical and epidemiological features of Lyme disease in a defined population. J Infect Dis. 1986;154:295300. DOIPubMedGoogle Scholar
  23. Hanrahan  JP, Benach  JL, Coleman  JL, Bosler  EM, Morse  DL, Cameron  DJ, Incidence and cumulative frequency of endemic Lyme disease in a community. J Infect Dis. 1984;150:48996. DOIPubMedGoogle Scholar
  24. Wormser  GP, Schriefer  M, Aguero-Rosenfeld  ME, Levin  A, Steere  AC, Nadelman  RB, Single-tier testing with the C6 peptide ELISA kit compared with two-tier testing for Lyme disease. Diagn Microbiol Infect Dis. 2013;75:915. DOIPubMedGoogle Scholar
  25. Branda  JA, Linskey  K, Kim  YA, Steere  AC, Ferraro  MJ. Two-tiered antibody testing for Lyme disease with use of 2 enzyme immunoassays, a whole-cell sonicate enzyme immunoassay followed by a VlsE C6 peptide enzyme immunoassay. Clin Infect Dis. 2011;53:5417. DOIPubMedGoogle Scholar
  26. Wormser  GP, Levin  A, Soman  S, Adenikinju  O, Longo  MV, Branda  JA. Comparative cost-effectiveness of two-tiered testing strategies for serodiagnosis of Lyme disease with noncutaneous manifestations. J Clin Microbiol. 2013;51:40459. DOIPubMedGoogle Scholar
  27. Steere  AC, McHugh  G, Damle  N, Sikand  VK. Prospective study of serologic tests for Lyme disease. Clin Infect Dis. 2008;47:18895 and. DOIPubMedGoogle Scholar
  28. Aguero-Rosenfeld  ME, Nowakowski  J, Bittker  S, Cooper  D, Nadelman  RB, Wormser  GP. Evolution of the serologic response to Borrelia burgdorferi in treated patients with culture-confirmed erythema migrans. J Clin Microbiol. 1996;34:19 .PubMedGoogle Scholar
  29. Salkeld  DJ, Cinkovich  S, Nieto  NC. Tick-borne pathogens in northwestern California, USA. Emerg Infect Dis. 2014;20:4934. DOIPubMedGoogle Scholar
  30. Dibernardo  A, Cote  T, Ogden  NH, Lindsay  LR. The prevalence of Borrelia miyamotoi infection, and co-infections with other Borrelia spp. in Ixodes scapularis ticks collected in Canada. Parasit Vectors. 2014;7:183. PMID: 24731287
  31. Krause  PJ, Narasimhan  S, Wormser  GP, Rollend  L, Fikrig  E, Lepore  T, Human Borrelia miyamotoi infection in the United States. N Engl J Med. 2013;368:2913. DOIPubMedGoogle Scholar
  32. Osborne  K, Gay  N, Hesketh  L, Morgan-Capner  P, Miller  E. Ten years of serological surveillance in England and Wales: methods, results, implications and action. Int J Epidemiol. 2000;29:3628. DOIPubMedGoogle Scholar
  33. Kelly  H, Riddell  MA, Gidding  HF, Nolan  T, Gilbert  GL. A random cluster survey and a convenience sample give comparable estimates of immunity to vaccine preventable diseases in children of school age in Victoria, Australia. Vaccine. 2002;20:31306 . DOIPubMedGoogle Scholar

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Page updated: September 22, 2015
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