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Lyme disease testing by large commercial laboratories in the United States.

ABSTRACT: Laboratory testing is helpful when evaluating patients with suspected Lyme disease (LD). A 2-tiered antibody testing approach is recommended, but single-tier and nonvalidated tests are also used. We conducted a survey of large commercial laboratories in the United States to assess laboratory practices. We used these data to estimate the cost of testing and number of infections among patients from whom specimens were submitted.Large commercial laboratories were asked to report the type and volume of testing conducted nationwide in 2008, as well as the percentage of positive tests for 4 LD-endemic states. The total direct cost of testing was calculated for each test type. These data and test-specific performance parameters available in published literature were used to estimate the number of infections among source patients.Seven participating laboratories performed approximately 3.4 million LD tests on approximately 2.4 million specimens nationwide at an estimated cost of $492 million. Two-tiered testing accounted for at least 62% of assays performed; alternative testing accounted for <3% of assays. The estimated frequency of infection among patients from whom specimens were submitted ranged from 10% to 18.5%. Applied to the total numbers of specimens, this yielded an estimated 240 000 to 444 000 infected source patients in 2008.LD testing is common and costly, with most testing in accordance with diagnostic recommendations. These results highlight the importance of considering clinical and exposure history when interpreting laboratory results for diagnostic and surveillance purposes.

SUBMITTER: Hinckley AF

PROVIDER: S-EPMC4646413 | biostudies-literature | 2014 Sep

REPOSITORIES: biostudies-literature

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Lyme disease testing by large commercial laboratories in the United States.

Hinckley Alison F AF Connally Neeta P NP Meek James I JI Johnson Barbara J BJ Kemperman Melissa M MM Feldman Katherine A KA White Jennifer L JL Mead Paul S PS

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20140530 5

<h4>Background</h4>Laboratory testing is helpful when evaluating patients with suspected Lyme disease (LD). A 2-tiered antibody testing approach is recommended, but single-tier and nonvalidated tests are also used. We conducted a survey of large commercial laboratories in the United States to assess laboratory practices. We used these data to estimate the cost of testing and number of infections among patients from whom specimens were submitted.<h4>Methods</h4>Large commercial laboratories were ...[more]

PMID: 24879782

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Project description:Promoting health equity is a fundamental public health objective, yet health disparities remain largely overlooked in studies of vectorborne diseases, especially those transmitted by ticks. We sought to identify health disparities associated with Lyme disease and human monocytic ehrlichiosis, two of the most pervasive tickborne diseases within the United States. We used general linear mixed models to measure associations between county-level disease incidence and six variables representing racial/ethnic and socioeconomic characteristics of counties (percent white non-Hispanic; percent with a bachelors degree or higher; percent living below the poverty line; percent unemployed; percent of housing units vacant; per capita number of property crimes). Two ecological variables important to tick demography (percent forest cover; density of white-tailed deer) were included in secondary analyses to contextualize findings. Analyses included data from 2,695 counties in 37 states and the District of Columbia during 2007-2013. Each of the six variables was significantly associated with the incidence of one or both diseases, but the direction and magnitude of associations varied by disease. Results suggested that the incidence of Lyme disease was highest in counties with relatively higher proportions of white and more educated persons and lower poverty and crime rates; the incidence of human monocytic ehrlichiosis was highest in counties with relatively higher proportions of white and less educated persons, higher unemployment rates and lower crime rates. The percentage of housing units vacant was a strong positive predictor for both diseases with a magnitude of association comparable to those between incidence and the ecological variables. Our findings indicate that racial/ethnic and socioeconomic disparities in disease incidence appear to be epidemiologically important features of Lyme disease and human monocytic ehrlichiosis in the United States. Steps to mitigate encroachment of wild flora and fauna into areas with vacant housing might be warranted to reduce disease risk.

Project description:Importance:The incidence and geographic range of Lyme disease continues to increase in the United States because of the expansion of Ixodes scapularis, the species of tick that is the main Lyme disease vector. Currently, no dynamic model for the disease spread exists that integrates information of both acarological and human case surveillance data. Objective:To characterize the spatiotemporal spread of Lyme disease in humans among counties in US endemic regions. Design, Setting, and Participants:This cross-sectional study modeled the spread of Lyme disease county-level case reporting, accounting for county-level demographic factors, environmental factors associated with tick presence and human exposure, and the spatiotemporal association between counties. The analyses were conducted between January and August 2019. The setting was 1405 counties in the following regions of the United States: West North Central, East North Central, New England, Middle Atlantic, and the South. Assessments were based on publicly available Lyme disease case data reported to the US Centers for Disease Control and Prevention (CDC) between January 2000 and December 2017. Main Outcomes and Measures:Probability of reporting the first case of Lyme disease by county by year. Results:Between 2000 and 2017, a total of 497?569 Lyme disease cases were reported to the CDC in the study area. Reporting a first case of Lyme disease was associated with a county's and county's neighbors' forest coverage, elevation, percentage of population living in the wildland-urban interface, tick presence, county's population size, proportion of neighbors reporting cases, and neighbors' years since first reporting. The model that included these variables showed high predictive power, with a mean area under the receiver operating characteristic curve of 81.1 (95% CI, 68.5-86.2). The model predicted the first reported Lyme disease case a mean (SD) of 5.5 (3.5) years earlier than was reported to the CDC, with a mean spread velocity estimated at 27.4 (95% CI, 13.6-54.4) km per year. Among 162 counties without reported cases, 47 (29.0%) had a high probability of reporting Lyme disease by 2018. The estimated mean time lag between the first reported case in a neighboring county and any county was 7 (95% CI, 3-8) years. Conclusions and Relevance:This study's findings suggest that, if updated regularly and expanded geographically, this predictive model could enable states and counties to develop more specific Lyme disease prevention and control plans, including improved sensitization of the general population and medical community.

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Lyme disease testing by large commercial laboratories in the United States.

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Lyme disease testing by large commercial laboratories in the United States.

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