Lyme Disease Testing

Lyme Disease Testing By: Nicole Dube, Principal Analyst July 23, 2018 | 2018-R-0186 Issue Does Connecticut law specify the circumstances under which a health care provider must test a patient for Lyme disease? When is the test generally performed? Is a health care provider required to test for Lyme disease upon a patient’s request? If not, has the General Assembly considered legislation to enact such a requirement? Have other states enacted Lyme disease testing legislation? Lyme Disease Testing What is Lyme Disease? In the United States, Lyme disease is Neither Connecticut law nor regulation specifies when a health caused by the Borrelia burgdorferi care provider must test a patient for Lyme disease, and and Borrelia mayonii bacteria and is providers are not required to order such testing if a patient transmitted to humans through the requests it. Those treatment decisions generally fall within a bite of infected blacklegged ticks (i.e., deer ticks). These ticks may also health care provider’s professional practice standards. transmit other tick-borne diseases. Lyme disease is generally considered difficult to test for, as it is Lyme disease causes a range of symptoms, including a bulls-eye common for a person with Lyme disease to test negative for the shaped skin rash and flu-like disease, particularly in the first month after infection. Testing is symptoms such as fever, headache, more reliable a few weeks after infection when the person’s chills, and fatigue. If left untreated, immune system has had time to produce antibodies to the the infection may spread to a person’s heart, nervous system, and bacteria that cause the disease (see sidebar). The federal joints (CDC website and Mayo Clinic Centers for Disease Control and Prevention (CDC) recommends website). that providers use their two-tier Lyme disease testing decision tree shown in Figure 1 below. Specifically, it recommends that patients first be tested using an enzyme-linked immunoassay (ELISA) or immunofluorescence assay blood test. If the test yields www.cga.ct.gov/olr Connecticut General Assembly (860) 240-8400 [email protected] Office of Legislative Research Room 5300 Stephanie A. D’Ambrose, Director Legislative Office Building positive or equivocal results and the patient experiences signs or symptoms of the disease within 30 days after the test, the CDC recommends testing the patient again using a Western blot blood test to confirm the diagnosis. Figure 1: CDC-Recommended Testing for Lyme Disease Connecticut Legislation In recent years, the General Assembly has considered legislation related to Lyme disease, including testing for the condition. Most recently, in 2016 and 2017, the legislature: 1. enacted bills that (a) designate May of each year to be Lyme Disease Awareness Month to heighten public awareness of Lyme disease’s symptoms and available treatments (PA 17- 204) and (b) authorize advanced practice registered nurses to document in a medical record if prescribing, administering, or dispensing long-term antibiotic therapy for Lyme disease (PA 16-39) and 2. considered, but did not enact, proposed legislation that would require the state to set Lyme disease testing standards for when patients exhibit disease symptoms (2017 SB 329). For information on Lyme disease-related legislation considered by the General Assembly between 2010 and 2015, see OLR Report 2015-R-0255. 2018-R-0186 July 23, 2018 Page 2 of 3 Legislation in Other States Because Lyme disease testing is often viewed as unreliable, some states, such as Maryland and Virginia, have passed legislation requiring health care providers who order Lyme disease testing to provide patients with a written notice explaining the accuracy of Lyme disease lab tests and the potential for false negative results (Md. Code Ann. Ch. 450 § 20-1701 and Va. Code Ann. § 54.1- 2963). New Hampshire recently considered, but did not enact, similar legislation (SB 475). Additionally, the New York legislature recently considered, but did not pass, a bill that would require the state’s public health commissioner to establish a standard protocol for diagnosing and treating Lyme disease and other tick-borne illnesses. Under the proposed bill, the protocol must require that each patient being treated for Lyme disease or other tick-borne diseases receive a written notice with information on these diseases, including their symptoms, risk factors, and diagnoses (2017- 2018 SB 6926). ND:bs 2018-R-0186 July 23, 2018 Page 3 of 3 .

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