Office of Communicable Diseases

Information for Health Care Providers

Health Advisory - 7/20/05 - RI Physicians, Nurse Practitioners, Physician Assistants

CHANGES IN LYME DISEASE SURVEILLANCE

The Office of Communicable Disease is proposing to change the way it conducts Lyme disease surveillance. This decision is based on an evaluation of the functionality of past surveillance methods. As always, physicians are required to report only new onset cases of Lyme disease. However, the Rhode Island Department of Health (HEALTH) will no longer prompt health care providers to report cases in response to positive lab reports.

WHY THE CHANGE? In the past few years, for every new onset case, HEALTH had to work through 100 positive western blot reports, then invite physician reports. It is no longer feasible for HEALTH to sustain this labor-intesive process.

WHAT GETS REPORTED? Physicians, Nurse Practitioners and Physician Assistants who are required by regulation to report cases of disease should use the following criteria for selecting cases for reporting:

1. Erythema migrans (greater than 5cm) present: Case is considered confirmed. No laboratory test or report is necessary. REPORT CASE .

OR

2. EIA or IFA positive AND Western blot positive on a laboratoryreport AND one other sign or symptom of late Lyme disease (below): Case is considered confirmed. REPORT CASE.

• Arthritis (objective joint swelling---new onset)
• 2 nd or 3 rd degree heart block (new onset)
• Bell’s palsy or other cranial neuritis, radiculoneoropathy, lymphocytic meningitis, encephalomyelitis, or positive Lyme titer in CSF.

Note: Do not report cases where the Western blot results are pending or unclear.

HOW DOES ONE REPORT? :

• Fax (401-222-2488)or mail the State form: http://www.health.ri.gov/disease/communicable/providers_lyme.php

OR

• Use other reporting methods (line lists, computer print outs, electronic medical record etc.), but include the same demographic, clinical and western blot detail as found on the State form.

QUESTIONS? Please call the Office of Communicable Diseases, 401-222-2577, M-F 8:30- 4:30.

WEB RESOURCE: http://www.health.ri.gov/disease/communicable/lyme/index.php