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CDC Study: Significantly Higher Lyme Disease Rates Among Older Adults Than Previously Reported

The AHA! Team — Mon, 23 Sep 2024 08:24:32 +0000

Dr. Sanchari Sinha Dutta, Ph.D. via News-Medical – The U.S. Centers for Disease Control and Prevention (CDC), in association with the University of Iowa, USA, has conducted an epidemiological study to determine the incidence rate of Lyme disease among older adults in the United States. The study is published in the CDC’s Emerging Infectious Diseases journal. Background Lyme disease, also known as Lyme borreliosis, is a vector-borne bacterial infection caused by a species of Borrelia bacteria that spreads to humans by the bite of infected black-legged ticks (Ixodes scapularis). The main symptoms are fever, headache, fatigue, and a specific type of skin rash called erythema migrans. While Lyme disease can present with a characteristic erythema migrans rash, it can also lead to severe complications if left untreated, including facial nerve paralysis, arthritis, and even heart rhythm irregularities. In the United States, Lyme disease most commonly occurs in the Northeast, mid-Atlantic, and upper-Midwest regions. Previous studies estimating the prevalence of the disease have used employer-sponsored insurance claims data to quantify the disease diagnoses. However, this type of data does not include information on individuals aged 65 years and above who exhibit higher susceptibility to Lyme disease than their younger peers. In this study, scientists have determined the incidence of Lyme disease among older adults in the United States using Medicare fee-for-service data that includes information on individuals aged 65 years and above. Study design The study analyzed Medicare fee-for-service data together with drug treatment data to identify Lyme disease diagnoses among individuals aged 65 years and above. The data collected during 2016 – 2019 was included in the analysis. The Medicare fee-for-service study population was compared with the 2019 US Census estimation data for individuals aged 65 years and above to ensure that the two groups were age-, sex-, race-, ethnicity- and region-matched. Lyme disease diagnoses identified in the Medicare fee-for-service data were compared with the confirmed and probable cases among individuals aged 65 years and above obtained through national surveillance. However, the study also notes certain limitations, such as slight differences between the Medicare fee-for-service population and the U.S. Census population regarding race, ethnicity, and sex. These differences, though small, were stable throughout the study period. Important observations The Medicare fee-for-service population included in the study was estimated to have a median of 17,872,466 person-years during the study period, as compared to the US Census population of 51,561,372 individuals aged 65 years and above. Person-years refer to the number of years for which persons contribute data. The proportion of individuals from neighboring high-incidence states was higher in the Medicare population than in the US Census population. Incidence of Lyme disease A total of 88,485 Lyme disease cases were identified in the Medicare population during the 2016-2019 study period. This corresponded to an average incidence of 123.5 diagnoses per 100,000 person-years. The total number of Lyme disease cases reported through public health surveillance during the same period was 34,183. This corresponded to an average incidence of 16.6 cases per 100,000 persons. Symptoms include fever, headache, fatigue, and a bullseye rash. Approximately 82% of Lyme disease cases were identified among individuals residing in high-incidence states. The median incidence of Lyme disease diagnoses was 346.9 per 100,000 person-years among residents of high-incidence states, 35.3 per 100,000 person-years among residents of states or jurisdictions neighboring high-incidence states, and 29.4 per 100,000 person-years among residents of low-incidence states. Public health surveillance data revealed that about 93% of Lyme disease cases were among residents of high-incidence states. The median incidence of these cases was 57.1 per 100,000 persons among residents of high-incidence states, 3.6 per 100,000 persons among residents of states or jurisdictions neighboring high-incidence states, and 0.6 per 100,000 persons among residents of low-incidence states. The majority of Lyme disease diagnoses occurred in the summer months. Among residents of low-incidence states, a large proportion of disease diagnoses occurred in winter months. According to Medicare and surveillance data, the majority of Lyme disease cases were identified among men. In high-incidence states, men had the highest incidence of Lyme disease for all age groups. In low-incidence states, women had a slightly higher incidence than men only in the 65–69-year age group and 75–79-year age group. Study significance The study identified more than 88,000 adults aged 65 years and above diagnosed and treated with Lyme disease during 2016 – 2019 in the United States. Most Lyme disease cases have been identified among residents of high-incidence states. The study reports a 7-fold higher incidence of Lyme disease diagnoses compared to that reported through public health surveillance. These findings are similar to the findings reported in previous claims analyses. The study also acknowledges the issue of overdiagnosis, which may partly explain the differences observed between the Medicare data and public health surveillance data. Overdiagnosis has been reported in other analyses and may contribute to the higher incidence rates observed in this older population. A variation in Lyme disease seasonality has been observed when Medicare fee-for-service data is compared with surveillance data. Some differences in gender-specific disease susceptibility have also been observed when this study is compared with previous claims analyses. Antibiotics like doxycycline are effective treatments. In previous claims analyses, male children have shown higher susceptibility to Lyme disease in both high- and low-incidence states. In contrast, male older adults have shown higher susceptibility in high-incidence states. Overall, the study findings add insight into Lyme disease patterns unique to this older population in the United States. Journal reference: Schwartz AM. 2024. Epidemiology of Lyme Disease Diagnoses among Older Adults, United States, 2016–2019. Emerging Infectious Diseases. https://wwwnc.cdc.gov/eid/article/30/9/24-0454_article To read the original article click here.

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A New Sign of COVID-19: A Rash in the Mouth

AHA Publisher — Tue, 28 Jul 2020 07:00:43 +0000

Angela Betsaida B. Laguipo, BSN via News-Medical Net – The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has wreaked havoc across the globe, with more than 14.89 million people infected. Coronavirus disease (COVID-19), caused by SARS-CoV-2, has a string of symptoms that include cough, fever, and difficulty of breathing. As the disease evolved, many patients reported the loss of smell and taste as other accompanying symptoms. Now, a new study reveals that the novel coronavirus may also trigger the appearance of a rash inside the mouth. A handful of patients in Spain has manifested rash-like lesions inside their mouths, baffling doctors if these could be included in the list of potential symptoms tied to SARS-CoV-2 infection. The study, conducted by the researchers at Ramon y Cajal University Hospital in Madrid, describes a potential addition to the list of signs and symptoms exhibited by patients infected with the novel coronavirus. The study is published in the journal JAMA Dermatology. COVID-19 Symptoms The U.S. Centers for Disease Control and Prevention (CDC) first listed that the signs and symptoms of COVID-19 disease include fever, cough, aches, and difficulty of breathing. Loss of smell, loss of taste, sore throat, and headaches were added to that list later. In June, the CDC also included other symptoms that were seen in COVID-19 patients, including nausea, diarrhea, and runny nose. However, in April, a separate group of researchers in Spain found lesions on the feet of patients, which were also tied to the novel coronavirus infection. The Study To arrive at the findings in this new study, the researchers examined 21 consecutive patients that had presented with both a skin rash and COVID-19 at the Ramon y Cajal University Hospital in Madrid between March 30 and April 8. The team aimed to determine whether the patients developed the enamthem, a term used to describe the lesions on mucous membranes, inside their mouths. The oral cavities of the patients who had the enamthems were systematically examined and categorized into four groups – petechial, macular, macular with petechiae, or erythematovesicular. In the studied group, enamthems or skin rash-like lesions inside the mouths were seen in six of 21 patients with COVID-19, who were between the ages of 40 and 69 years old. Of these, four of the six affected patients were females. The researchers noted in the study that many cases of enamthems were tied to viral infections. These lesions may present with petechia, macules, vesicles, and papules in the mouth. However, the most common ones tied to viral infections are erythemato-vesicular and petechial patterns. Further, these lesions are commonly seen in adults. The team also reported that these lesions were unlikely to be a drug side effect, but more linked to the infection itself. Also, the team said that due to concerns on the safety of healthcare workers and clinicians, many patients suspected to have the SARS-CoV-2 infection or are known to be infected, do not have their mouths examined. The new symptom is now added to the list of symptoms found in patients today. “This work describes preliminary observations and is limited by the small number of cases and the absence of a control group. Despite the increasing reports of skin rashes in patients with COVID-19, establishing an etiological diagnosis is challenging. However, the presence of enanthem is a strong clue that suggests a viral etiology rather than a drug reaction, especially when a petechial pattern is observed,” the team concluded in the study. Global Coronavirus Toll As the disease evolves and spreads across the globe, much information about the virus is being revealed and discovered. The virus is still actively spreading, with the global case toll topping 14.89 million. The death toll has now reached 615,000. The United States reports the highest number of infections, with 3.89 million confirmed cases, followed by Brazil, whose case toll has doubled in the past weeks, reaching 2.15 million. India has reported 1.15 million confirmed cases, while Russia has more than 782,000 cases. One of the major concerns of the World Health Organization (WHO) is the spread of the virus in South Africa due to concerns that the high infection rate may take a toll on the nation’s health system. The country has more than 381,000 infections. This article has been modified. To read the original article click here.

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Skin Rash May Be a Symptom of COVID-19

AHA Publisher — Tue, 14 Jul 2020 07:00:30 +0000

Sally Robertson, B.Sc. via News-Medical Net – Researchers at King’s College London and Zoe Global Ltd have conducted a study suggesting that skin rashes could be valuable predictors of coronavirus disease 2019 (COVID-19). In a large community-based study, 8.8% of people who had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) also reported having a skin rash. Among people who had not tested positive, but did report at least one classic symptom of COVID-19 symptom based on NHS guidelines, 8.2% also reported skin rashes. According to NHS guidelines, the three most common signs of COVID-19 are fever, persistent cough, and a reduced sense of smell (anosmia). Skin-related symptoms are not included, even though these can be easily spotted by patients, say Mario Falchi and team. The researchers say their findings strongly support including skin rashes, adding that although skin rashes are far less common than fever, they are much more specific and last longer. “Recognizing rashes is important in identifying new and earlier COVID-19 cases,” says the team. A pre-print version of the paper is available on the server medRxiv*, while the article undergoes peer review. The Link with Skin Manifestations Has Been Slow to Emerge It has become apparent during the COVID-19 pandemic that while the disease is primarily a respiratory illness, it also targets multiple organs, including the skin. Some studies have previously reported urticaria, chicken pox-like body rashes, and chilblains on the toes or fingers (acral rashes), possibly due to minor thrombotic events or damaged endothelium in small vessels of the digits. However, the link between COVID-19 and skin manifestations has been slower to emerge than it has for organs such as the heart, intestine, and brain. “COVID-19 rashes may present in many forms and at different stages of the disease. The heterogeneous presentations, the time delay, as well as the focus on severely ill patients during the early phases of the pandemic, led to the skin being overlooked as an important target organ for COVID-19,” say Falchi and colleagues. Now the researchers have used data available for 336,847 UK users of the COVID Symptom Study app to investigate the diagnostic value of skin rashes for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The team also used data available for 11,546 people who participated in an independent survey on COVID-19-related skin symptoms. Skin Rashes Increased the Odds of SARS-CoV-2 Positivity More Than Fever Of 27,157 app users who provided swab test results, 2,021 (7.4%) were positive for SARS-CoV-2, and 25,136 (92.6%) were negative. Of the swab-positive individuals, 178 (8.8%) reported skin rashes (138 body rashes; 62 acral and 22 both body and acral), compared with 1357 (5.4%) of swab-negative individuals. Association analysis showed that the presence of body or acral rashes increased the likelihood of being swab positive for SARS-CoV-2 by 67%. This compares with fever increasing the odds of SARS-CoV-2 positivity by 47%, and fever is commonly used to screen for COVID, points out the team. Skin Rashes Were Also Predictive in Untested, But Symptomatic Users Among the 334,690 app users who did not provide a swab test result, 17,371 reported one of the three main symptoms (fever, persistent cough, and anosmia), which according to NHS guidelines, would require isolation and SARS-CoV-2 testing. Of those reporting one of the three typical symptoms, 8.2% also reported a skin rash, compared with 6% of untested users who did not report any of the three symptoms. Association analysis revealed that among untested users who reported one of the three main symptoms, the likelihood of having a body rash was 46% greater compared with those who did not report one of the symptoms. The increased likelihood of acral rash among those reporting a symptom was not statistically significant. The Findings Support the Inclusion of Skin Rashes as a Suspected Symptom To capture more information about the type, duration, and timing of rashes, the team analyzed data available for people 11,546 with a rash who participated in an independent survey on COVID-19-related skin symptoms. Among 694 responders who were positive for SARS-CoV-2 by swab or antibody test and provided information on COVID-19-related symptoms, the rash appeared before any other symptom in 17% of cases and in 21% of cases, the rash was the only symptom. “Twenty-one percent of the SARS-CoV-2 positive surveyees presented with skin symptoms alone and would have been missed if using the NHS classic symptoms alone,” write Falchi and colleagues. The researchers say the findings strongly support the inclusion of skin rashes as a suspected COVID-19 symptom. “Although, it is less prevalent than fever, it is more specific of COVID-19 and last longer,” they add. “An increased awareness from the public and healthcare professionals regarding COVID-19 skin changes will allow more efficient identification of new and earlier clusters of the disease,” concludes the team. *Important Notice medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information. To read the original article click here.

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