Senate Joint Resolution (SJR) 347 of the 1999 Session of the General Assembly directed the Joint Commission on Health Care, in cooperation with the Virginia Department of Health, to examine issues relating to the incidence, reporting, treatment, and prevention of Lyme disease in the Commonwealth.

Specifically, SJR 347 directed the Joint Commission's study to examine: (i) the incidence of Lyme disease in Virginia; (ii) whether Lyme disease is underreported in Virginia; (iii) if Lyme disease appears to be underreported in Virginia, why, and what steps can be taken to ensure the accurate reporting of Lyme disease; (iv) what assistance is available from the federal government for prevention, e.g., from the Centers for Disease Control, and for treatment, e.g., through the National Institutes of Health; (v) the extent to which Virginia is accessing any available federal support for the prevention and treatment of Lyme disease; (vi) the most appropriate use of and access to all available support for prevention and treatment of Lyme disease in this Commonwealth; and (vii) the most appropriate and expeditious means of publicizing the availability and benefits of the new vaccine.

Based on our research and analysis during this review, we concluded the following:

• Lyme disease is a bacterial illness transmitted by infected ticks. Humans are infected with the disease through tick bites.

• Nationwide, Lyme disease is a rapidly emerging infectious disease. However, the incidence of Lyme disease in Virginia is lower than the national average. In 1997, there were 4.7 cases reported per 100,000 population; Virginia's rate was 1.16 per 100,000. The highest reported incidence of Lyme disease is in the northeastern region of the country.

• The Centers for Disease Control designates Virginia as a "low risk" state. The number of reported cases in Virginia has been very low, ranging from 54 in 1989 to 151 in 1991.

• There is general agreement that Lyme disease is underreported in Virginia, The actual number of cases could range between 432 and 1,080. However, CDC indicates that the underreporting of Lyme disease in Virginia is no greater than in other states. The Virginia Department of Health (VDH) indicates that the underreporting of Lyme disease is no greater than other reportable diseases.

• VDH would like to conduct more "active" surveillance of reportable diseases.

• Lyme disease support groups expressed concern about the level of public education, VDH's surveillance efforts, and underreporting of the disease. Lyme disease advocates also believe very few doctors are adequately trained to diagnose and treat Lyme disease.

• A critical problem related to Lyme disease is that there is no reliable serological test to determine with certainty whether someone has Lyme disease. The lack of a reliable test fosters continuing disagreement regarding the actual incidence and proper treatment of the disease.

A number of policy options were offered for consideration by the Joint Commission on Health Care regarding the issues discussed in this report.

Our review process on this topic included an initial staff briefing, which comprises the body of this report. This was followed by a public comment period during which time interested parties forwarded written comments to us regarding the report. The public comments provide additional insight into the various issues covered in this report.