In certain circumstances, physicians and employers are required to report confirmed or suspected cases of Lyme disease and other tick-borne infections.
England & Wales
Borreliosis is monitored in England and Wales through:
- Passive surveillance. Cases of Borreliosis are not statutorily notifiable by medical practitioners in England, Wales and Northern Ireland. However, since October 2010, under the Health Protection (Notification) Regulations 2010, every microbiology laboratory (including those in the private sector) in England is required to notify all laboratory diagnoses of Borreliosis to the Health Protection Agency. Previously, reporting by laboratories was on a voluntary basis.
- Enhanced surveillance. The Health Protection Agency's Lyme Borreliosis Unit (LBU) reports all laboratory-confirmed cases directly to the Zoonoses Surveillance Unit at the National Public Health Service (NPHS), Wales. The LBU also sends questionnaires to clinicians requesting additional data on laboratory-confirmed cases. The data collected helps to enhance knowledge of the disease in the United Kingdom.
In England and Wales, there were 1,053 laboratory-confirmed cases of Borreliosis in 2010. However, the Health Protection Agency states that, "Reporting levels have improved, but the data remain incomplete because they do not include cases diagnosed and treated on the basis of clinical features such as erythema migrans (the early rash of Lyme borreliosis), without laboratory tests. It is estimated that between 1,000 and 2,000 additional cases of LB occur each year in England and Wales".
In Scotland, cases are notifiable by diagnostic laboratories. In Scotland there were 308 laboratory confirmations in 2010; a 35.1% increase on the 228 Scottish cases reported in 2009. However, some doctors consider the yearly statistics to be seriously underestimated, owing to cases that are not reported, patients that are misdiagnosed with other conditions, and asymptomatic carriers of the disease.
In Northern Ireland, voluntary reporting is made to the Public Health Agency. As with other voluntary surveillance systems, the Public Health Agency recognises that cases are likely to be under recorded. From 2005 - 2009, 5 cases in Northern Ireland have been reported.
The Republic of Ireland
From September 2011, Lyme disease was listed as a notifable disease in the Republic of Ireland, where clinicians should notify cases to the Director of Public Health/Medical Officer of Health for the area of residence of the patient. Prior to it becoming a notifiable illness, there was no voluntary surveillance scheme and therefore the annual number of cases have been unknown.
In 2007, 71 specimens, referred to the UK Health Protection Agency’s Lyme Borreliosis Unit from Irish hospital laboratories, were confirmed positive, suggesting a crude incidence rate of 1.67 per 100,000 in Ireland that year. However, the Health Protection Surveillance Centre (HPSC), Ireland, considers that the incidence may be much higher. They state that, "When there is not the legal onus on practitioners to report cases of an infectious disease, the knowledge we have about such disease is, accordingly, incomplete. Notification allows identification in a more systematic way, and facilitates following trends in the disease over time".
Occupationally-acquired cases of Borreliosis / Lyme disease and other associated tick-borne infections should also be notified to the Health and Safety Executive (HSE). The Reporting of Injuries Disease and Dangerous Occurences Regulations 1995 (RIDDOR) apply to England, Scotland and Wales. These regulations required work-related accidents, disease and dangerous occurrences to be reported and this includes all work activities. It is the responsibility of employers and the self-employed to submit a report to health and safety enforcing authorities.
Occupationally-acquired Borreliosis is seldom reported (perhaps through lack of awareness of the regulations and through lack of diagnosis / misdiagnosis) but the majority of these cases occur in zookeepers, forestry workers, farmers, deer handlers and gamekeepers. Borreliosis / Lyme disease is also a reportable condition for those serving in the British Armed Forces.
The Social Security (Industrial Injuries) (Prescribed Diseases) Amendment Regulations 2005 include Borreliosis in the list of prescribed diseases. Evidence indicates that there is a greater than doubled risk of contracting Borreliosis in certain groups of workers who are exposed to Borrelia bacteria.
DACTARI (Dog and Cat Risk Information), is part of DEFRA's (Department for Environment Food and Rural Affairs) ten-year veterinary surveillance strategy which aims to quantify the occurrence of exotic diseases in imported or native pet animals in Britain. This will thereby monitor the risks of these diseases spreading in the UK, and the potential consequences for animal health should this occur.
Under the DACTARI scheme, veterinary surgeons can voluntarily report suspected or confirmed cases of exotic disease in dogs and cats. Although any exotic disease can be reported under DACTARI, it specifically targets Babesiosis, Anaplasmosis / Ehrlichiosis, along with Dirofilariasis and Leishmaniasis. These diseases are carried and transmitted by ticks, sandflies or mosquitoes, and therefore occur more commonly in warmer climates that favour vector survival. It also highlights that the diagnosis of these diseases can be difficult for various reasons, such as dual infection, sub-clinical infection and non-specific clinical signs.