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Health: Tick-borne Encephalitis

Volume 800: debated on Tuesday 5 November 2019


Asked by

To ask Her Majesty’s Government what assessment they have made of the appearance in England of a tick-borne encephalitis virus, and what plans they have to include advice about such a virus alongside that given on the tick-borne Borreliosis bacteria and associated Lyme disease.

My Lords, the risk from tick-borne encephalitis virus is assessed as very low for the general public and low for those visiting, living and working in areas where infected ticks have been found. Lyme disease is the most common tick-borne infection in the United Kingdom. Tick awareness campaigns are planned for early 2020, ahead of the seasonal increase in tick activity in the UK, and will include information on tick-borne encephalitis and Lyme disease.

My Lords, the history of Lyme disease, a bacterial infection called Borreliosis, has been riddled over many years with mistakes of understanding, recognition, testing, diagnosis and treatment. Tick-borne encephalitis—a viral infection—has now reached the UK for the first time, having been steadily spreading westwards across Europe for several years. What are the Government doing to make sure that the mistakes that have been made—and are still being made—on Lyme disease are not made on TBE, and in particular that new instances of TBE are not mistaken for Lyme?

The noble Lord is right to raise this issue. We have been making sure that action is taken quickly. Tick bite avoidance is a key message in this area and is the same for TBEV as for Lyme disease. PHE has worked with local authorities and key stakeholders in the relevant areas, informing them about TBE and the tick toolkit documents and guidance, so that they can remind the public, their staff and visitors to be tick aware. Specific awareness campaigns will come forward in spring 2020. The material for these will include information on Lyme disease and TBE. In addition, there will be research programmes on TBE, to ensure that we in the UK are as aware as we can be about it. To be clear, there has been only one probable case of TBE infection diagnosed —a European visitor bitten by a tick in the UK. At the moment, this is a very low risk to anyone in the UK and a low risk to those in the areas.

My Lords, I do not want to be alarmist but the discovery of tick-borne encephalitis virus in the UK is worrying. The tick vectors of this viral infection are widespread throughout the UK and are maintained on a variety of animal hosts, including wild deer, which are now extremely common in lowland as well as upland areas. The number of clinical cases in Europe has been steadily increasing and, while it is true that something like two-thirds of cases are non-clinical, as many as up to 10% of those affected may suffer severe neurological sequelae, especially children and—noble Lords may like to know—the elderly. I ask the noble Lord: will the Government reintroduce the mandatory tick treatment of pets imported into the UK under the pet travel scheme? Is the noble Lord satisfied that we are doing all we can in the UK, in terms of research and preventive actions with regard to biosecurity, to safeguard animal and human health in this era of climate change and globalisation?

I thank the noble Lord for that question, although I generally identify as a noble Baroness. We are continuing surveillance studies for TBEV in ticks and wildlife, and we plan to monitor its prevalence, distribution, maintenance and spread in the UK to ensure oversight of the situation. We have based our understanding of the risk assessment on recent experience in the Netherlands, where TBEV was recently identified. The estimated risk there of Lyme disease from a tick bite is 1:50, while the estimated risk of TBEV from a tick bite is 1:500,000. As regards us doing enough work, we have a national contingency plan written to deal with vector-borne diseases and understanding the effect of climate change, which gives us a sense of the challenges that we face.

My Lords, will my noble friend recognise the work of the national Encephalitis Society, which is based in Malton in North Yorkshire, of which I have the honour to be a vice-president? Will she update the House on what work has been undertaken to help doctors identify the difference between meningitis and encephalitis so that the swiftest possible treatment can be given? My husband was one of those who suffered encephalitis in his 20s; many are less fortunate and do not make the recovery that he made.

The noble Baroness is absolutely right, and I am happy to recognise the organisation that she mentioned. In the first place, the tick toolkit and the work of PHE is in place to raise awareness, and work goes into providing advice to professionals so that early diagnosis is possible.

My Lords, one of the problems with Lyme disease is that the symptoms that it causes mimic a whole range of different viral infections, many of which are much more common. Does the Minister feel that the Government are doing enough to raise awareness of Lyme disease among general practitioners, and is she satisfied that the screening tests—I think that they cost around £60 a time—are sufficient?

The noble Lord is quite right, and he understands this a lot better than I do. NICE published guidelines for health professionals in 2018 in an effort to ensure prompt diagnosis of Lyme disease. Obviously if it is recognised promptly and treated with antibiotics, acute Lyme disease is usually resolved without further complications. I will take away the question about the cost of the test to consider whether that has been a barrier; we have no evidence about that at this time.

My Lords, raising awareness is critical, and many are completely unaware of the risk when they go out for a walk. What actions will the Government take to ensure that organisations such as national parks, national forests and the National Trust have a part to play?

We will run tick awareness campaigns in the spring. Material for these campaigns will include information about Lyme disease and TBE. They will be run in all areas identified as at risk as part of the surveillance campaign.

My Lords, how much research is the UK doing with other European countries, which may know much more about these conditions?

As part of our surveillance work and the work of PHE, there is constant contact between the UK and other public health bodies across Europe to understand not only the risks but the most effective interventions. Two specific studies are looking at evidence of past TBEV infection in people and to understand the best interventions among the general population.