Epidemiologist Report
Keri Hall's Presentation on Lyme Disease
See program (at link below) that was presented to the VA Board of Health by a current Virginia Lyme Disease Task Force member (VA State Epidemiologist- Keri Hall) last July, after House Bill 512 (introduced by Delegate Rust) was not passed.
http://leg5.state.va.us/User_db/frmView.aspx?ViewId=834
Below is the section in the Board of Health Minutes indicating the State Epidemiologist (Keri Hall) did present this information to the Board of Health. Additionally, Keri Hall's name appears on a number of the slides.
State of Board of Health
Minutes
July 16, 2010 – 9:00 a.m.
Perimeter Center, 9960 Mayland Drive
Richmond, Virginia 23233
Lyme Disease in Virginia
Dr. Keri Hall gave this presentation. Lyme disease is spread to humans through the bite of an infected tick. VDH has tracked Lyme disease since 1982. In addition to monitoring the disease, VDH provides education concerning it. Lyme disease is a reportable disease to VDH.
There was a discussion that the number of cases has dropped in the last few years after a big increase. [See slide for reasons why it might have dropped- reporting criteria messed up].
This increase is not only due to reporting but to changes in technology and the availability of information. At one time, Lyme disease was fairly clustered tightly in the northern part of the US; it is now spreading southward, with Virginia as a border state. In 2007, there were significant increases in Northern Virginia; before that time it was more in the coastal areas.
There was a discussion about the deer population in Northern Virginia. Dr. Hall pointed out that as urban areas spread, ticks go with the deer population. There has been an increase and clustering of Lyme disease cases in those areas. There was a further discussion about the controversy concerning chronic Lyme disease.
Dr. Hall indicated that it can cause chronic arthritis and neurological effects. Lyme disease would seem to be a chronic syndrome, but there is a lot we need to learn, especially where a patient does not have a clear diagnosis. Because it is impossible to eliminate ticks, the key is to educate the public about how not to be bitten by ticks. Controlling the tick population by controlling deer population is done primarily by hunting. This is an issue that would fall under the Department of Game and Inland Fisheries. Dr. Reed stated that even if you could severely control the deer population the tick population would still be high. A 90% reduction in the population would be needed in order to have impact.
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A few quotes from Keri Hall's slide presentation
VDH Epidemiologist Keri Hall- on the Virginia Task Force- is discussing lab testing related to reporting cases of Lyme. (Note the word "Necessary" is used.)
"Necessary lab results: Positive or equivocal results from ELISA as well as positive Western Blot IgM if the blood was drawn within 30 days of onset..."
[NOTE- First of all, there is often a negative ELISA result in that early of a time frame (universally agreed upon). Second, with a negative ELISA- labs are not to perform a Western Blot.]
Source: Slide # 14- Dr. Keri Hall, Virginia Department of Health, “Lyme Disease Tracking and Prevention.” (September 28, 2010).
Slide # 5 states the CDC recommends against using "other" testing.
http://leg5.state.va.us/User_db/frmView.aspx?ViewId=834
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Sample quotes from other slides in Keri Hall's presentation.
"The [IDSA] guidelines recommend against repeated, long-term antibiotic therapy with brand name drugs in favor of generic drugs and diagnostic tests, eliminating the possibility of profit for panel members." Slide # 18
“Lyme-literate” doctors, who believe that Lyme can be a persistent and relapsing infection often treat their patients with combinations of antibiotics over a long period until symptoms resolve, not according to the short-term treatment schedules set forth by the IDSA." Slide #21
"As the debate continues, ILADS doctors who disagree with the short treatment recommendations of the IDSA sometimes find themselves investigated and tried by their state medical licensing board for breaking
with the IDSA." Slide # 23
"To date, there have been no disciplinary proceeding by Virginia Board of Medicine against a physician for treating LD with long- term antibiotics." Slide # 25 [Incorrect. A doctor in Fairfax, VA was investigated, charged and had to defend herself. The overwhelming evidence that was presented to the Virginia Board gave them no choice than to drop the charges. Additionally, a Lyme-treating doctor on the eastern shore of Virginia, another victim of a "sham peer review", was brought up on charges.]
"The case of the Eastern Shore physician recently in the news, involves being disciplined for prescribing narcotics. The physician is still able to administer long-term antibiotic treatment to Lyme Disease patients." [Sham peer-review at its finest.) Slide #25 [He was another victim of a "sham peer review".]
Presentation: