The Australian Government is aware of the distressing nature of this issue and acknowledges the large number of Australians who are experiencing chronic debilitating symptoms that are causing them hardship. The Australian Government is also aware of the Senate inquiry and the report that the committee tabled on 30 November 2016. The report has twelve recommendations, which the Australian Government is currently considering.
The Australian Government is concerned for Australian patients who are sharing their stories about chronic debilitating illnesses some of which they associate with tick bites. Some Australians and their health care providers have ascribed this to chronic Lyme disease. However, this is a disputed diagnosis, unlike classical Lyme disease which is regarded as an acute or short-lived infection which is known to occur in endemic areas overseas such as Europe and North America.
In Australia, the presence of Borrelia burgdorferi, the bacterium that causes classical Lyme disease, has not been confirmed. Therefore, it is not possible to diagnose Lyme disease in a person who has not travelled to an endemic area overseas, on clinical signs and symptoms alone. There are many other diseases (infectious and non-infectious) that can have similar clinical features. Emerging Australian research has uncovered some newly identified microorganisms in Australian ticks, which may, or may not, be associated with this chronic, debilitating illness.
The Department of Health has worked with state and territory health authorities to provide public health messages associated with tick bites including prevention and treatment. In addition, the Department has also developed a tick bite prevention sheet for health professionals and the public on tick bite prevention and first aid which is available on its website.
To help doctors in Australia diagnose classical Lyme disease, the Department of Health has also developed an Australian guideline on the diagnosis of overseas acquired Lyme disease/borreliosis, which is available on the website.
In relation to laboratory diagnosis, accredited Australian diagnostic laboratories are able to diagnose classical Lyme disease in patients who have returned from endemic areas overseas.
Different approaches to the laboratory diagnosis of Lyme disease worldwide can lead to different results for the same patient. In the absence of an identified causative organism of Lyme disease in Australia, differing results can lead to confusion. The Australian Government is investigating this matter and has contracted the National Serology Reference Laboratory to evaluate the serological assays used to diagnose Lyme disease in specialist laboratories in Australia and overseas, as well as accredited pathology laboratories in Australia. The specimens being tested are from individuals in Australia and overseas both with and without symptoms. The results will be used to examine the performance characteristics of these laboratory tests and will hopefully provide an explanation as to why results differ between laboratories in Australia and overseas.
Because of the disputed nature of the diagnosis and the controversy in the community, the diagnosis and treatment of patients presenting with chronic, nonspecific, debilitating symptoms is often difficult. In a case of suspected chronic tick bite illness, an appropriate referral could be to a hospital with an infectious diseases clinic. Outpatient appointments at public hospitals are free-of-charge to the individual. In Australia, infectious diseases physicians are the appropriate specialists to support patients with questions and concerns about tick-borne diseases. In Australia, the antibiotics for treating confirmed tick-borne infections are readily available.
The Australian Government is working with primary care providers to ensure that people presenting with these symptoms are receiving the best possible treatment and care. There is also more work to do with raising awareness with states and territories and the Australian Government will be seeking to take a leadership role.
There is a need to ensure that all patients with chronic debilitating symptoms can be appropriately assessed and receive appropriate care. The Department’s written submission (number 495) and verbal evidence to the inquiry has explained the need for each patient to be assessed by a team of medical practitioners representing relevant clinical expertise. This multidisciplinary team approach has been recommended by the Senate committee in its report.
Patients should be assessed thoroughly by a consultant general physician who can call upon relevant clinical expertise from other medical specialists so that a provisional diagnosis can be made and patients can be cared for appropriately.
The Australian Government remains concerned about Australians suffering from debilitating symptom complexes and will continue to monitor the situation and encourage research to identify the cause. The Department's web page will continue to be updated with new information as it arises.