The article “Lyme disease in British Columbia: Are we really missing an epidemic?” [BCMJ 2011;53:224-229] sends an important message to the public and physicians regarding the prevalence and risk of Lyme disease in BC.
For some years, the lower incidence of Lyme disease in Canada (especially in BC) compared with some areas of the US has been attributed by many to be due to “disinterest” and lack of training of Canadian physicians resulting in misdiagnosis, mistreatment, and failure to treat the condition.[1-3]
In 1994, Rees and Axford theorized that a lower incidence of Lyme disease in the UK and Europe compared with the US might be due to pathogenic differences in the causative organism, B. burgdorferi. In 1995 I reported a case of Lyme arthritis in BC and speculated that the paucity of cases in BC was further evidence of geographic variation in Lyme disease incidence but for unknown reasons.
Now, Henry and Morshed have noted that in populous areas of BC there are low numbers of ticks with a low rate of bacterial infestation as well as a low prevalence of infected deer mice, the major mammalian reservoir. Further, they suggest that the low incidence of Lyme disease in BC might be related to a difference in vectors with I. pacificus, the most common vector in BC being a less competent vector than I. scapularis, which is the commonest vector in areas of high disease incidence.
In my view, these reports support a geographic difference in the incidence of Lyme disease that is likely due to multiple factors. Given this kind of information, the repeated accusations that this difference is due to disinterest and ignorance on the part of BC physicians are unwarranted.
—George E. Price, MD
1. LeBourdais E. Activists decry physician disinterest in Lyme disease during Vancouver conference. CMAJ 1995;154:822-824.
2. Price GE. Lyme disease may be uncommon in BC. CMAJ;1996:154:764.
3. Fayerman P. Most BC doctors not trained to diagnose Lyme disease. Vancouver Sun. 29 March 2011.
4. Rees DH, Axford JS. Lyme arthritis. Ann Rheum Dis 1994;53:553-556.
5. Price GE, Banerjee SN. Lyme arthritis in British Columbia. J Spriochetal Tick-Borne Diseases 1995;2:52-54.
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