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Lyme Disease: What Life Underwriters Need to Know

lyme-disease-underwriters

Thirty-six. Remember that number.

What is Lyme disease? How is it contracted? Can it be treated, and what is Lyme carditis?

We will delve into the realm of Lyme disease, answering all the above questions, as well as noting underwriting points to consider and identifying the significance of the number 36.

Let’s get started, shall we?

What is Lyme disease and how is it transmitted?

Lyme disease is an infectious disease caused by four main species of bacteria. Borrelia burgdorferi and Borrelia mayonii cause Lyme disease in the USA. Borrelia burgdorferi causes it in Canada, and Borrelia afzelii and Borrelia garinii are the leading causes in Europe and Asia. The bacteria are transmitted to people through the bite of an infected blacklegged tick (commonly known as a deer tick).

Two types of ticks can spread Lyme disease in Canada: the blacklegged (or deer tick, Ixodes scapularis) in the southeastern and south-central regions of western Canada and the blacklegged tick (Ixodes pacificus) in British Columbia. Lyme disease can be found in the following provinces: British Columbia, Manitoba, Ontario, Quebec, New Brunswick, and Nova Scotia.

The infected ticks can attach to any part of your body, although they are commonly found in hard-to-see areas (scalp, armpits, and the groin area). Adult ticks can transmit Lyme disease bacteria, but as they are the approximate size of a sesame seed, they are more likely to be found and removed before they have had time to transmit the bacteria. Most people are infected through the bites of immature ticks called nymphs. Nymphs are quite small (less than 2 mm), or approximately the size of a poppy seed. They feed during the spring and summer months, whereas the adults are most active during the cooler months.

Ticks cannot fly or jump, so how do they attach themselves to humans? They rest on the tips of grass and shrubs in a questing position. While questing, the ticks hang onto the leaves and grass by their lower legs. They hold their upper pair of legs outreached, waiting for a host to come by so that they can quickly climb aboard. Once aboard, they look for a good place to bite their host.

As Lyme disease is transmitted by an infected deer tick’s bite, people are more likely to develop Lyme disease if they live or spend time in grassy or heavily wooded areas – where ticks carrying Lyme disease thrive. Those with domesticated animals who visit wooded areas have a higher risk of developing Lyme disease. To contract Lyme disease, an infected deer tick must bite you. The bacteria enter your skin through the bite and eventually make their way into your bloodstream.

Lyme disease was first recognized in the town of Old Lyme, Connecticut, in 1975. It is the most common tick-borne illness in Europe and North America. According to Dr. Gregory Poland (Vaccine Research Group, Mayo Clinic), there are approximately 300,000 new cases of Lyme disease each year in the United States. There are no current plans at this time for a new Lyme vaccine in the United States, but a vaccine, VLA15, is being developed in Europe. It has been through phase 2 testing, although it might take five years or more before a Lyme disease vaccine is ready for humans. At least four other non-Lyme disease tick-borne diseases are emerging in Canada: Anaplasmosis, Babesiosis, Powassan virus, and Borrelia miyamotoi disease.

These are anticipated to increase because of climate change.

Do you remember that number: thirty-six? Here’s why it is significant. In most cases, a deer tick must be attached for a minimum of 36–48 hours to transmit Lyme disease. The bacteria are not inherited by the tick; they are acquired during one of the two bloodmeals that must take place before a larva develops into a reproductive tick. The tick-transmitted pathogens are metabolically dormant and noninfectious in the host tick. The pathogens simply “go to sleep” so that they don’t negatively impact the tick. When the tick finds a warm-blooded animal, its skin temperature is greater than that of the environment, and this signals the pathogen to “wake up.” The pathogen reactivates and begins to replicate with the new blood energy source coming in as the tick feeds. Therefore, it takes 36 hours or more for the pathogen to reactivate and replicate enough to get into the tick saliva to be transmitted into the skin. If you find an attached tick that looks swollen, it may have fed long enough to transmit the bacteria.

Is Lyme disease contagious?

Currently, there is no evidence that Lyme disease can be transmitted from person to person, either by touching and kissing or engaging in sexual intercourse with a person who has Lyme disease.

Although there have not been any cases of Lyme disease transmission through blood transfusion, scientists have found that Lyme disease bacteria can live in blood stored for donation. Therefore, those individuals being treated with antibiotics for Lyme disease should not donate blood. Those who have completed their course of antibiotics may be considered for blood donation, but they should contact the blood donation clinic for the specific criteria.

It is important to note that untreated Lyme disease in pregnant women can lead to infection of the placenta. The spread of disease from mother to fetus, although rare, is possible. With appropriate antibiotic treatment, there is no increased risk of adverse birth outcomes. To date, no published studies have assessed the development of children whose mothers acquired Lyme disease during pregnancy.

Symptoms

People with Lyme disease may react differently, and the symptoms can vary in severity. Lyme disease is divided into three stages – early localized, early disseminated, and late disseminated – but symptoms can overlap. Some people may not have any symptoms until the later stage.

Early signs:

Once you are bitten by a tick, you may develop a small red bump, not unlike a mosquito bite. It appears at the site of a tick bite or tick removal, but it resolves in a few days. This bump is normal and does not indicate Lyme disease.

Alternatively, a rash can form from days 3–30, after an infected tick bite. There is an expanding red area that is sometimes clear in the middle – a bullseye pattern. This rash (erythema migrans) expands slowly over days and can spread up to 12 inches, or 30 cm, across. Although it is neither itchy nor painful, it may be warm to the touch. Although not everyone develops this rash, erythema migrans is considered one of the hallmarks of Lyme disease. It is important to note that some people develop this rash at more than one place on their bodies.

Other early signs/symptoms include fever, chills, fatigue, body aches, headache, neck stiffness, and swollen lymph nodes, with or without the rash. However, the rash develops in approximately 70–80 percent of infected people.

Later signs and symptoms:

Erythema migrans rash may appear on other areas of the body. Severe joint pain and swelling are other signs. The knee joints are most likely to be affected, and the pain and swelling can shift from one joint to another. Lyme arthritis, a late-stage symptom, is treated with oral antibiotics for 28 days.

Neurological problems can appear weeks, months, or even years after the initial infection. People experiencing them may develop meningitis, Bell’s palsy, limb numbness or weakness, and impaired muscle movement.

Less common signs and symptoms that may appear several weeks after infection include heart problems such as heart palpitations or irregular heartbeat (Lyme carditis), eye inflammation, hepatitis, and severe fatigue. Other symptoms can include nerve pain, shooting pains, inflammation of the spinal cord, intermittent pain in tendons, muscles, joints, and bones, as well as severe headaches.

What is Lyme Carditis?

Lyme carditis occurs when Lyme disease bacteria enter the tissues of the heart. They can interfere with the normal movement of electrical signals from the heart’s upper to lower chambers. This interference is called heart block and can vary in degree and change rapidly. Lyme carditis occurs in approximately one out of one hundred Lyme disease cases reported to the Center for Disease Control (CDC).

Lyme carditis can cause light-headedness, fainting, shortness of breath, heart palpitations, and chest pain. People usually experience other symptoms, such as fever and body aches, and they may have erythema migrans rash as well.

Lyme carditis is treated with antibiotics, either orally or administered intravenously, depending on the severity. Mild Lyme carditis (1st degree AV block with PR interval <300 milliseconds) is commonly treated with Doxycycline, Amoxicillin, or Cefuroxime orally. Severe Lyme carditis (symptomatic, 1st degree AV block with PR interval =/> 300 milliseconds, 2nd or 3rd degree AV block) is commonly treated with ceftriaxone IV. Some people may also require a temporary pacemaker. People generally recover in 1–6 weeks. Eleven cases of fatal Lyme carditis were reported worldwide between 1985 and 2019.

If a person has been treated with antibiotics for Lyme disease but continues to experience symptoms, it is referred to as post-Lyme disease syndrome (or post-treatment Lyme disease syndrome).

Post-Lyme disease syndrome

Post-Lyme disease syndrome affects approximately 10–20 percent of people with Lyme disease (according to a 2016 article published in the New England Journal of Medicine).

It can affect mobility and cognitive skills. Treatment primarily focuses on relieving pain and discomfort. Although most people recover, it can take months or years.

The symptoms of post-Lyme disease syndrome are like those that occur in the earlier stages of the disease. These symptoms may include fatigue, difficulty sleeping, aching joints or muscles, pain or swelling in the large joints (knees, shoulders, and elbows), difficulty concentrating, short-term memory problems, and speech problems.

Lyme disease prevention

The best way to prevent Lyme disease is to avoid the areas where deer ticks live, especially wooded, bushy areas with long grass.

Should you visit such an area, you should take precautions. First of all, cover-up. Wearing shoes, long pants, socks, long-sleeved shirts, hats, and gloves are recommended to decrease your risk. Applying insect repellent with at least a 20 percent concentration of DEET to your skin is another precaution you can take. It has been found that lemon eucalyptus oil provides the same protection as DEET when used in similar concentrations.

When leaving the area, ensure that you check your clothing, and don’t forget to check your pets. Deer ticks are often no bigger than the head of a pin, so search carefully.

What life underwriters need to know

The diagnosis of Lyme disease is based upon a combination of clinical evidence and enzyme-linked immunosorbent assay (ELISA) testing for serum antibodies against the bacteria B. burgdorferi. Western blot testing may be useful in confirming questionable ELISA results. Serum IgM antibodies may appear within 2–4 weeks following the infection and return to normal after 4–6 months. IgG antibody levels appear 6–8 weeks after infection and may remain indefinitely elevated in patients with continued infection. Antibodies in the cerebrospinal fluid are strong evidence for CNS infection.

Remember that antibodies can take several weeks to develop, so people may test negative if only recently infected. Antibodies normally persist for months or years after the infection is gone; therefore, the test cannot be used to determine a cure.

Lyme disease is frequently overdiagnosed. The presence of vague chronic symptoms without objective physical findings or laboratory abnormalities should prompt consideration of alternative diagnoses (chronic fatigue syndrome, fibromyalgia, or depression), especially when underwriting disability benefits. You should also note that infection with other diseases (tick-borne diseases and some viral, bacterial, and autoimmune diseases) can cause a false-positive test result.

Always consult your company’s underwriting guidelines and philosophies to navigate considerations for an applicant with Lyme disease.

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Resources

  1. https://www.healthline.com/health/lyme-disease 
  2. https://www.mayoclinic.org/diseases-conditions/lyme-disease/symptoms-causes/syc-20374651 
  3. https://www.cdc.gov/lyme/signs_symptoms/index.html 
  4. https://www.mayoclinic.org/diseases-conditions/lyme-disease/multimedia/mayo-clinic-minute-will-there-be-a-lyme-disease-vaccine-for-humans/vid-20439848 
  5. https://lymescience.org/lyme-24-36-48-hours-transmission/ 
  6. https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2019-45/issue-4-april-4-2019/article-2-increased-risk-tick-borne-diseases-climate-change.html 

Written by: Karen McLeod

Karen McLeod is the Director of Underwriting Services at RGAX. She is responsible for managing a team of life underwriters and providing superior service to current and prospective clients. In addition to fifteen years’ experience in the insurance industry, she has extensive experience in life, critical illness, and disability insurance and in structured settlements, life valuations, and providing invaluable coaching to underwriters of all levels. Karen holds FALU and FLMI designations and is currently the Assistant Director for the CIU’s program committee.