A recent article discussed a legislator's fight against Lyme disease ("The retired legislator continues to serve in telling his story," column Sturdevant, July 22). And while coverage of tick-borne diseases is welcome, it's discouraging to know that it's only one of the few thousand cases that occur each year in Minnesota.

The financial and health costs of the disease are important for individuals and society. Approximately 380,000 new cases of Lyme disease are diagnosed each year in the United States. The 2015 Johns Hopkins study estimated that the average cost of direct medical care was $ 3,000 per case, or $ 1.2 billion per year. While this is staggering, the addition of indirect costs puts the average expense at $ 11,248. Most cases treated early in the disease cost much less; The costs of suffering are impossible to calculate

That is why public health officials, physicians and the public must seize every opportunity to encourage and engage in prevention practices. As part of my work on tick-borne diseases, I offer recognized continuing medical education to doctors and I speak to the public; I have published articles in peer-reviewed medical journals and have sat on a subcommittee of the Task Force on Tick Disease, mandated by Congress. Here are some suggestions:

• The Minnesota Department of Health should develop a year-round media campaign on the dangers of tick-borne diseases on all popular platforms. It should include messages for the general public and targeted information for high-risk groups such as campers, hunters, exposed workers, residents in wooded housing estates and people whose risk is often overlooked, for example golfers. The equation of risk only with "woods" is an error

• The campaign should strongly advocate the use of permethrin on clothing and gear by all people potentially exposed to ticks as this insecticide is very effective, durable, safe and inexpensive.

• The message must raise some concern about the possibility of a prolonged illness, because fear is a powerful factor of behavioral change.

• Every Minnesota should identify and minimize potential sources of risk in his or her life by avoiding tick habitat as much as possible, using permethrin and repellents, performing thorough checks of ticks and by quickly reporting known bites and / or symptoms of Lyme disease to a physician. Since patients with late illness do worse than those treated for erythema-revealing migraine (EM) or flu-like symptoms of early disease, those who hesitate may actually be lost.

• Clinicians need to improve their diagnosis and treatment skills. Serological tests, although highly specific, are insufficiently sensitive to exclude Lyme. This is true for early diseases and neurological presentations. The serology module on LymeCME.info presents the details. Lyme disease is a multisystem disease that produces a wide range of symptoms. In many cases, clinicians looking for swollen joints, AV conduction malformations, facial nerve palsies, and skin rashes do not see the target

. and GRADE analyzes of the therapeutic evidence have determined that it is of low / very low quality. Single-dose doxycycline is approximately 50% effective for the primary prevention of Lyme disease; therefore, high-risk bites may deserve a 10-day course. More aggressive management of early illnesses can reduce the risk of prolonged illness (secondary prevention). Most US trials for EM patients used 20 days of first-line agents, not 10. Given that some presentations – multiple EM lesions, presence of neurological symptoms, more serious illness, and persistent symptoms in the end active treatment – were associated with a higher risk of long-term failure, it seems prudent to consider extending the duration of treatment in these groups. The goal of antibiotic management is not simply to limit antibiotics, but to use them appropriately in a given situation.

• The scientific understanding of tick-borne diseases has changed considerably over the 10 years that I have written and taught. these diseases. Still, vaccines for this group of infections are still far away.

Meanwhile, an ounce of permethrin is worth a pound of antibiotics. Use it.

Elizabeth Maloney is a physician in Wyoming, Minnesota.