The economic burden of Lyme disease and the cost-effectiveness of Lyme disease interventions: A scoping review

Mac, Stephen; Silva, Sara R. da; Sander, Beate

doi:10.1371/journal.pone.0210280

Cited by 70 publications

(59 citation statements)

References 40 publications

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“…Lyme borreliosis, a tick-borne multisystemic illness caused by the spirochete Borrelia burgdorferi sensu lato, has grown into a major public health problem [1][2][3][4][5]. The frontline treatment for Lyme disease is the administration of antibiotics [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

The Long-Term Persistence of Borrelia burgdorferi Antigens and DNA in the Tissues of a Patient with Lyme Disease

et al. 2019

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Whether Borrelia burgdorferi, the causative agent of Lyme disease, can persist for long periods in the human body has been a controversial question. The objective of this study was to see if we could find B. burgdorferi in a Lyme disease patient after a long clinical course and after long-term antibiotic treatment. Therefore, we investigated the potential presence of B. burgdorferi antigens and DNA in human autopsy tissues from a well-documented serum-, PCR-, and culture-positive Lyme disease patient, a 53-year-old female from northern Westchester County in the lower Hudson Valley Region of New York State, who had received extensive antibiotic treatments during extensive antibiotic treatments over the course of her 16-year-long illness. We also asked what form the organism might take, with special interest in the recently found antibiotic-resistant aggregate form, biofilm. We also examined the host tissues for the presence of inflammatory markers such as CD3+ T lymphocytes. Autopsy tissue sections of the brain, heart, kidney, and liver were analyzed by histological and immunohistochemical methods (IHC), confocal microscopy, fluorescent in situ hybridization (FISH), polymerase chain reaction (PCR), and whole-genome sequencing (WGS)/metagenomics. We found significant pathological changes, including borrelial spirochetal clusters, in all of the organs using IHC combined with confocal microscopy. The aggregates contained a well-established biofilm marker, alginate, on their surfaces, suggesting they are true biofilm. We found B. burgdorferi DNA by FISH, polymerase chain reaction (PCR), and an independent verification by WGS/metagenomics, which resulted in the detection of B. burgdorferi sensu stricto specific DNA sequences. IHC analyses showed significant numbers of infiltrating CD3+ T lymphocytes present next to B. burgdorferi biofilms. In summary, we provide several lines of evidence that suggest that B. burgdorferi can persist in the human body, not only in the spirochetal but also in the antibiotic-resistant biofilm form, even after long-term antibiotic treatment. The presence of infiltrating lymphocytes in the vicinity of B. burgdorferi biofilms suggests that the organism in biofilm form might trigger chronic inflammation.

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Section: Introductionmentioning

confidence: 99%

The Long-Term Persistence of Borrelia burgdorferi Antigens and DNA in the Tissues of a Patient with Lyme Disease

et al. 2019

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“…Using the cost-per-ED visit estimate from that study, the Wisconsin ED visits would have cost $2.9 million, compared to our $3.1 million estimate (2018 dollars). Recent studies quantified the national burden of Lyme disease at $786 million to $1.3 billion annually (Adrion et al, 2015;Mac et al, 2019); our estimate for Michigan ($8.0 million) reflects the burden of a single, low-incidence state. For allergenic oak pollen, our estimate of ED costs in North Carolina ($0.6 million) is consistent with a comparable national estimate ($12.2 million in 2018 dollars; Anenberg et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Estimating the Health‐Related Costs of 10 Climate‐Sensitive U.S. Events During 2012

et al. 2019

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Climate change threatens human health, but there remains a lack of evidence on the economic toll of climate‐sensitive public health impacts. We characterize human mortality and morbidity costs associated with 10 climate‐sensitive case study events spanning 11 US states in 2012: wildfires in Colorado and Washington, ozone air pollution in Nevada, extreme heat in Wisconsin, infectious disease outbreaks of tick‐borne Lyme disease in Michigan and mosquito‐borne West Nile virus in Texas, extreme weather in Ohio, impacts of Hurricane Sandy in New Jersey and New York, allergenic oak pollen in North Carolina, and harmful algal blooms on the Florida coast. Applying a consistent economic valuation approach to published studies and state estimates, we estimate total health‐related costs from 917 deaths, 20,568 hospitalizations, and 17,857 emergency department visits of $10.0 billion in 2018 dollars, with a sensitivity range of $2.7–24.6 billion. Our estimates indicate that the financial burden of deaths, hospitalizations, emergency department visits, and associated medical care is a key dimension of the overall economic impact of climate‐sensitive events. We found that mortality costs (i.e., the value of a statistical life) of $8.4 billion exceeded morbidity costs and lost wages ($1.6 billion combined). By better characterizing health damages in economic terms, this work helps to shed light on the burden climate‐sensitive events already place on U.S. public health each year. In doing so, we provide a conceptual framework for broader estimation of climate‐sensitive health‐related costs. The high health‐related costs associated with climate‐sensitive events highlight the importance of actions to mitigate climate change and adapt to its unavoidable impacts.

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“…Public health burdens due to Lyme disease are not unique to the USA. A recent comprehensive review found Lyme disease-associated expenditures of tens of millions of euros in several European countries [10]. The combined public health impact of all tick-borne diseases remains mostly unquantified.…”

Section: Introductionmentioning

confidence: 99%

Emerging tick-borne pathogens of public health importance: a mini-review

Rochlin

Toledo

2020

Journal of Medical Microbiology

225

130

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Ticks are the most important vectors of human pathogens, leading to increased public health burdens worldwide. Tick-borne pathogens include viruses (e.g. tick-borne encephalitis and Powassan); bacteria, such as the causative agents of Lyme disease, spotted fever rickettsiosis and human anaplasmosis; and malaria-like protozoan parasites causing babesiosis. Tick-borne diseases are emerging due to the geographical expansion of their tick vectors, especially in the northern hemisphere. Two examples of this phenomenon are Ixodes scapularis and Amblyomma americanum, which have expanded their ranges in the USA in recent decades and are responsible for the continuous emergence of Lyme disease and human ehrlichiosis, respectively. This phenomenon is also occurring worldwide and is reflected by the increasing number of tick-borne encephalitis and haemorrhagic fever cases in Europe and Asia. In this review, we provide a concise synopsis of the most medically important tick-borne pathogen worldwide, with a particular emphasis on emerging public health threats.

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The economic burden of Lyme disease and the cost-effectiveness of Lyme disease interventions: A scoping review

Cited by 70 publications

References 40 publications

The Long-Term Persistence of Borrelia burgdorferi Antigens and DNA in the Tissues of a Patient with Lyme Disease

The Long-Term Persistence of Borrelia burgdorferi Antigens and DNA in the Tissues of a Patient with Lyme Disease

Estimating the Health‐Related Costs of 10 Climate‐Sensitive U.S. Events During 2012

Emerging tick-borne pathogens of public health importance: a mini-review

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