Maryland Department of Health

"In 2009, there were 120% more LD reports in

Maryland than had been entered in the state database."

ICEID 2012 Conference Report- Board 253.

Understanding Lyme Disease Surveillance in Maryland, 2009

H.J. Rutz1, S.B. Wee1, M.E. Brett2, A.B. Kay2, A.F. Hinckley2, K.A. Feldman1; 1Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA, 2Centers for Disease Control and Prevention, Fort Collins, CO, USA.

Background: Maryland ranks in the top ten states for reported Lyme disease (LD) cases; it is likely that LD in Maryland is underreported as a result of many surveillance factors.

Positive laboratory results are reported to the state’s 24 local health departments (LHDs) who investigate and classify LD cases as Confirmed, Probable, Suspect or “Not a Case” in the state surveillance database.

In 2009, 4,768 LD reports were in the state database; 2,029 (43%) were Confirmed or Probable. To better understand the burden of LD and LD surveillance and to explore alternative surveillanceapproaches, we conducted a survey of LHDs and sought additional billing codes and medical chart data for a sample of cases.

Methods: In July 2011, LHDs completed an online survey about LD surveillance, including number of reports not entered in the state database, staffing availability, and investigational approach. Healthcare Providers (HCPs) were requested to supply billing codes for a 10% random sample of reported LD cases (N=474) from 2009.

The predictive value of specific codes was evaluated. A medical chart review (N=149) was conducted on all sampled Suspect and select Not a Case reports for additional clinical and diagnostic data. The additional data was used, when available, to reclassify cases as Confirmed and to calculate a more accurate estimate of LD cases for the state.

Results: LHDs [local health departments] did not enter an additional 5,722 LD reports in the state database during 2009. Seven (29%) LHDs lost LD surveillance staff in the past 2 years; one lost all staffand does not currently investigate LD. In 2008, 16 (75%) LHDs investigated each LD report while 5 (21%) investigated only if sufficient laboratory evidence of infection.

By 2011, 10 (42%) LHDs investigate LD reports only if sufficient evidence. LHD staff make 2 (range 1-4) attempts to contact HCPs to investigate reports. LHDs expressed concerns about burden of LDsurveillance with fewer resources and the utility of LD surveillance. The billing code assessment and medical chart review are ongoing.

Conclusions: In 2009, there were 120% more LD reports in Maryland than had been entered in the state database. Resources for LD surveillance vary by LHD, but have diminished overall. LHDs question the utility of LD surveillance and are eager for alternative approaches, such as querying billing databases.

See study on page 148 by clicking here.

Last Updated- April 2019

Lucy Barnes