The Maryland Department of Health and Mental Hygiene has under-reported cases of Lyme disease to the Center for Disease Control since 2009, said Lucy Barnes, director of the Lyme Disease Education and Support Groups of Maryland.
In a study recently published in the 2012 International Conference on Emerging Infectious Diseases Program and Abstracts Book, Maryland DHMH stated 5,722 cases of Lyme disease went unreported in 2009.
“Considering these facts, the State of Maryland has a silent, uncontrolled growing epidemic on its hands that is destroying lives and entire families in the process,” Barnes said in a letter sent to state legislators. “We need someone responsible for overseeing this situation and the ability to, at the least, have the DHMH comply with state and federal regulations. I am afraid that unless our legislators get involved the status quo will prevail and the situation will only worsen.”
The state database included 4,768 Lyme disease reports in 2009. Of those reports, 2,029 (43 percent) were classified “Confirmed” or “Probable” by local health departments, with the remainder deemed “Suspect” or “Not a Case.”
Maryland reported 1,466 confirmed Lyme cases to the CDC in 2009, just under 31
percent of the total cases in the state database, and had an incidence rate of 25.7 cases per 100,000 people in 2009. Delaware had the highest incidence rate in the nation that year at 111.2 cases per 100,000.
If the percentage of confirmed cases within the 5,722 unreported cases was consistent with that of the cases in the state database, roughly 1,757 more cases would have been reported to the CDC in 2009, bringing the total to 3,223 and increasing the state’s incidence rate to 56.5.
The CDC notes possible reasons for Maryland’s under-reporting.
“Under-reporting and misclassification are features common to all surveillance systems,” according to www.CDC.gov. “Not every case of Lyme disease is reported to CDC, and some cases that are reported may be due to another cause. Under-reporting is more likely to occur in highly endemic areas, whereas over-reporting is more likely to occur in non-endemic areas.”
In 2010, 94 percent of all Lyme disease cases reported to the CDC came from 12 states: Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Hampshire, New York, Pennsylvania, Virginia and Wisconsin.
“Surveillance data numbers are subject to each state’s abilities to capture and classify cases, which are dependent upon budget and personnel and varies not only between states, but also from year to year within a given state,” the CDC said.
The DHMH report mentions decreases in Lyme disease surveillance staff throughout the state as an explanation for the under-reporting.
“Seven (29 percent) LHDs (local health departments) lost LD surveillance staff in the past 2 years; one lost all staff and does not currently investigate LD,” the report said. “In 2008, 16 (75 percent) LHDs investigated each LD report while 5 (21 percent) investigated only if sufficient laboratory evidence of infection. By 2011, 10 (42 percent) LHDs investigate LD reports only if sufficient evidence.”
Information on Lyme disease is available at www.cdc.gov/lyme or www.marylandlyme.com.
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