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CSTE Lyme Disease Workgroup

Dhara Shah, Director of Epidemiology Programs at CSTEBecky Lampkins, Manager, Surveillance/Informatics Program at CSTEJoel GreenspanKim SignsKatherine Feldman -MDH-Katie BrownElizabeth SchiffmanChristine MulgrewEricka KalpJen BrownJennifer WhiteRichard Taffner, EpidemiologistKim CervantesHanna OlteanTaryn Stevens, Zoonotic and Vector-borne Epidemiologist, Indiana State Department of Health +59 others
Posted by Sara Reilly ·

Lyme Surveillance Question

Hello all. We are working through some changes for our Lyme Disease Surveillance. Question- How do you all treat "repeat" cases for reporting purposes? i.e. if someone is Suspect/Probable/Confirmed in 2016 and has new labs in a new year (even several years apart) do you start a new investigation? Is it case-by-case depending on symptoms and lab results? Any input appreciated- thanks!

Comments & Events

Anne Kjemtrup Anne Kjemtrup
Response from a “low incidence” state: Case by case for us. We usually see “repeat” testing in a short time frame from physicians who incorrectly use the tests to assess response to treatment. If we get additional tests within a year and we cannot get additional clinical info (e.g. patient travelled back east and got bitten by a tick again…) then we close as “not a case” or “previously reported”. We have on rare occasions seen repeat infections – usually 5-10 years from initial infection and we ask for good medical documentation to assess clinical presentation.
Anne
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Elizabeth Schiffman Elizabeth Schiffman
Hi Sara, 

Here in Minnesota, we typically try to combine things together into one event if the reports occur in the same year, but we create new events if the reports occur in different years.  

For combining within the same year, we have a two month rule, meaning that if the lab dates on the reports are within two months of each other, we automatically combine them into one event, but if the lab dates are greater than two months apart, we follow up to see if it is repeat testing or a new onset of symptoms.  Most of the time, it is not a new onset of symptoms and is repeat testing like Anne described, but we do occasionally see people with separate EM cases within the same year.  For reports that come in for someone already in the database but in a different year, we treat it as a new event and follow up the same as we would any new report.  We do try and make note of previous events and the status of those events on the case report form, and many of those repeat people end up as not cases in subsequent years.  

I'm happy to discuss our process in more detail offline if you'd like!

Elizabeth 
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Jen Fiddner Jen Fiddner
From PA DOH:  If a patient has a previous Lyme disease investigation, begin a new investigation ONLY if new EM onset is documented; if no new EM, link lab result with prior investigation 
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Kim Cervantes Kim Cervantes
In NJ, if a lab report comes in within 180 days it is automatically appended to the previous case - no additional investigation. After 180 days, a new case is open and investigated. If the physician indicates it is follow-up testing, it is closed as NAC, otherwise it stands as a new case.
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