Another Look at Lyme Disease

Friday, January 20, 2023

Ontario's Farm Country Still a Hotspot

By Nicholas Van Allen

Fever. Chills. Headache. Muscle aches and pains. Fatigue. Swollen lymph nodes.

As a farmer, you might be thinking that you are familiar with all these symptoms of COVID-19. But you'd be thinking about the wrong disease. In addition to muscle spasms and facial paralysis, these are in fact symptoms of something else – Lyme disease.

Half a century after the disease was first reported in Lyme, Connecticut, the numbers show no sign of slowing. In fact, risk of infection is reaching all-new heights. The disease is a concern to all Canadians, particularly rural Canadians, as a result.

The Lyme story

Lyme itself is a disease that is caused by Borrelia burgdorferi, a bacteria that is transmitted by infected ticks. In the Northern Hemisphere, it is the most common vector-borne illness – meaning the disease is transmitted by "vectors," according to a recently published news release by Pfizer (more about Pfizer later).

"While the true incidence of Lyme disease is unknown, it is estimated to annually affect approximately 476,000 people in the United States and 130,000 people in Europe," the release goes on to say.

"Left untreated, the disease can disseminate and cause more serious complications affecting the joints (arthritis), the heart (carditis) or the nervous system. The medical need for vaccination against Lyme disease is steadily increasing as the geographic footprint of the disease widens."

Lyme worldwide

Since cases exist worldwide, various global news outlets have addressed the subject. It has international proportions. Lyme is not a disease that's peculiar to the United States. Or the United Kingdom. Or to Canada.

According to The Guardian in 2020, "cases of Lyme disease … have doubled over the past two decades" in the U.S.

And as cited by The Independent, "ticks that may cause Lyme disease are found all over the U.K." today, particularly in southern and northern England and in the Scottish Highlands.

In other parts of the world, including Finland, Germany, the Netherlands, Poland, and Sweden, the disease has been noted as problematic, too.

In Canada, according to Isaac Bogoch in a CBC Radio interview with White Coat Black Art, "there are more cases being referred in Canada year over year, due to the northern migration of ticks causing Lyme disease, though many cases go undiagnosed."

Bogoch is an infectious disease specialist with the University Health Network in Toronto.

Cases are highest in Ontario, Nova Scotia, and Quebec, but they are notable in the Canadian Prairies as well – particularly Manitoba.

It's the migration and expansion of tick populations that have caused the disease to be something that needs to be addressed across farming communities.

Previous coverage

This is the not the first time Better Farming has covered this subject. In 2011 this magazine published the award-winning article, "Lyme Disease: The Painful and Hard-to-Diagnose Infection."

As this coverage showed, the first decade of the 2000s made it clear that farmers in Canada were facing difficulties with the disease, stemming from a lack of understanding and matters of public policy.

At the time, Lyme activists were struggling to teach about the subject, since the disease, they argued, was underreported and/or underdiagnosed. The article cited difficulties with obtaining proper testing, resulting from false negatives and tardy diagnoses, as part of the problem.

Published over 10 years ago, the article indicated that Lyme disease numbers were up and the risk of exposure was increasing. That has remained the case.

Increasing risk of exposure

The reason why it's 10 years later and the conclusions previously drawn are now being discussed globally is because of another unstoppable global phenomenon – climate change.

Just as global warming is endemic and not going away any time soon, problems associated with Lyme disease are only going to get worse.

Citing a Yale University study of Lyme disease, news website Green Matters recently indicated that the warming of the planet has led to scientists predicting that the upper Midwest in the U.S. is expected to see cases matching numbers historically seen in the upper Northeast.

The issue is that since temperatures are getting warmer in April each year, the ticks that carry the disease have a longer season to reproduce.

According to Minnesota's Science Education Resource Center at Carlton College, "climate change will have the following effects on Lyme disease: An acceleration of the tick's developmental cycle, a prolonged developmental cycle, increased egg production, increased population density, and a broader range of risk areas.

"The ideal habitat for these disease-carrying ticks is one with 85 per cent humidity and a temperature higher than 45°F. The tick finds a suitable microclimate by using its thermoreceptors. Once the larvae have molted into the nymphal stage, the winter forces them to remain dormant until spring. An adult tick no longer needs to hibernate during the winter, so these ticks may become active on warm winter days, yielding a larger nymph population the following year … The warmer winters will also allow for a higher survival rate of the white-footed mouse, a popular host for the ticks, meaning an increased tick population in the spring and summer."

In other words, since ticks themselves are highly adaptable and, like other arthropods and insects, are capable of using the symptoms of global warming to their demographic advantage, the result is simple. More Lyme. More disease.

Luckily, there may be a solution on the horizon.

Vaccination trials

As we have all experienced in the past two years, vaccines are often touted as the solution to a human population facing a difficult disease.

For Lyme disease, the case is no different – and the familiar name, Pfizer, is involved in the development of that vaccine.

As recently shared by Isaac Bogoch via Twitter, Pfizer and its associate Valneva have recently initiated Phase 3 study of Lyme disease vaccine candidate "VLA15."

According to Pfizer, Pfizer Research and Development are hopeful that the Phase 3 study will support positive evidence for the use of VLA15.

Collaborations are occurring across the U.S. and even in Europe. The work is important since "Lyme disease continues to spread, representing a high unmet medical need that impacts the lives of many in the Northern Hemisphere" and "the VLA15 candidate … will take us a step closer to potentially bringing this vaccine to both adults and children who would benefit from it.

"The randomized, placebo-controlled, Phase 3 VALOR study is planned to enroll approximately 6,000 participants five years of age and older. The study is being conducted at up to 50 sites located in areas where Lyme disease is highly endemic, including Finland, Germany, the Netherlands, Poland, Sweden and the United States."

Unlike the Covid vaccines which were sped through approval processes during 2020 in response the global urgency, the VLA15 Phase 3 study completion is a few years off.

Right now, VLA15 is the only Lyme disease vaccine candidate that is undergoing clinical development. The projected completion of the trials, though, is still some time in the future.

According to Pfizer, "Pending successful completion of the Phase 3 study, Pfizer could potentially submit a Biologics License Application to the U.S. Food and Drug Administration and Marketing Authorisation Application to the European Medicines Agency in 2025."

While we wait

While we await a vaccine, how can farming families protect themselves?

According to SERC: "Arming yourself with knowledge of the signs and symptoms of the infection is paramount for those who spend time outdoors.

"At the site of the tick bite will be a ‘bullseye' shaped rash (called erythema migrans) and it will grow in size over a few days. Some people do not remember having a bite or rash.

"Such rashes should be a Lyme disease suspect if they occur in the summer months. The symptoms within the first few weeks of being bitten include: flu-like symptoms, fever and chills, extreme fatigue, headaches, muscle and joint pain.

"The symptoms over one to four months can include: extreme fatigue, additional skin rashes as the infection spreads, numbness in arms and legs, brain fog, inability to control muscles in the face, and heart palpations. For a late diagnosis the symptoms may include: inflammation of the joints, numbness and tingling in hands, feet or back, severe fatigue, partial facial nerve paralysis, problems with memory, mood or sleep.

"Heart, nervous system and joint symptoms are among the first signs of the disease in people who did not have a rash."

You need to protect yourself when doing outdoor activity on your farm where ticks are present: cover exposed skin; use insect repellant; do full-body checks after each outdoor activity; and remove ticks using clean, fine-tipped tweezers.

Ontario's farm country continues to be a hotspot for the disease, so this is good knowledge to have. Protect yourself. Stay safe.

None of this article should be construed or relied upon as medical advice. All readers should discuss the matter with a qualified health practitioner. For more information about Lyme disease, see your local health unit or visit the Government of Ontario website at https://www.ontario.ca/page/lyme-disease. BF

OFA Active on Lyme Disease

To better understand how Ontario farmers ought to view the issues related to Lyme disease, Better Farming recently spoke to Peter Sykanda, farm policy analyst at the OFA.

The OFA has been following Lyme spread intently since 2013. Sykanda indicates that since he works on farm safety issues in his role, Lyme disease and its spread is an issue that reached his desk.

The increase in Lyme "risk areas" over the last four years is particularly alarming, Sykanda adds.

The OFA has responded through informational campaigns to its membership.

To the OFA, he says, "Lyme disease is serious and has many different symptoms that can go undiagnosed. We want to make sure our membership has the information they need to make decisions and take appropriate precautions."

To that end, the OFA sends out informational material every spring to remind farmers how Lyme might affect their own health and safety and that of their employees, too.

"As the OFA is a representative of farm employers, it is important for us to ensure employers know the risks that their employees may face. Under the Occupational Health and Safety Act, employers must take every reasonable precaution to protect the health and safety of their employees, including providing training and protective equipment to reduce the risk of occupational disease, like Lyme."

Further information from the OFA on Lyme is available online: https://ofa.on.ca/resources/tick-protection-prevention-information.