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Editor of the Reformer:

I commend the acknowledgment that Lyme disease has become an epidemic in Vermont. More education and prevention are necessary, as well as better diagnostics and treatment.

Unfortunately, the most common way to test for Lyme disease, the two-tier testing algorithm (ELISA with reflex to western blot) is often inaccurate. These tests are looking for antibodies to Borrelia burgdorferi that were made by the immune system. There is a specific criteria used by the CDC for surveillance that are often used to rule out Lyme disease. The CDC itself has stated, "This surveillance case definition was developed for national reporting of Lyme disease; it is not intended to be used in clinical diagnosis."

In fact, the two-tiered testing algorithm cannot rule out Lyme disease. If it is positive, this testing method will certainly rule it in, but if it is negative it does not mean that Lyme disease has been definitively ruled out. There have been several studies that have investigated the accuracy of this method of testing used to diagnose Lyme disease. In 1996, the New York State Department of Health studied 1,535 patients in which 81 percent of Lyme cases were missed, especially when they did not have a bull's eye rash.

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In 2005, a study was published in the Journal of Medical Microbiology showing that a comparison of three different commercially available ELISA tests provided a sensitivity that ranged from 36.8 percent and 70.5 percent. In 2007, a published study in the Journal of the Clinical Microbiology found the sensitivity of the two-tier testing was 56 percent.

In conclusion, it is important to remember that Lyme disease is a clinical diagnosis. If you get bitten by a tick, watch for new symptoms over the next 30 days: bull's eye rash, fever, flu-like symptoms, joint pain, muscle pain, headaches, palpitations, night sweats, air hunger, chest pain. If any of the symptoms arise, report them to your health care provider or seek out a Lyme literate practitioner.

Alexis Chesney,

Sojourns Community Health Clinic, May 1