Mexico Not Taking It Lying Down!

Topics with information and discussion about published studies related to Lyme disease and other tick-borne diseases.
duncan
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Re: Mexico Not Taking It Lying Down!

Post by duncan » Wed 4 Mar 2015 19:27

I want to know to whom or what hv808ct was referring when he/she spat out "amateurs." :D

Lots of hostility in that word, if you ask me. Repressed rage. Venom.

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LHCTom
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Re: Mexico Not Taking It Lying Down!

Post by LHCTom » Wed 4 Mar 2015 20:37

Just one humble amatuers observations. :mrgreen:

I certianly don't have AGB and SJN's expertise but I can see problems in the way they state their case.

Maybe they are right, maybe they are not. Maybe their motives are not based in balanced science. Lets wait for the response based on ALL the data before deciding and retracting.

Lots of hostility in that word, if you ask me. Repressed rage. Venom.
:bonk:

It sure seems like rage and venom hv808ct . How about doing some real work and doing a fair and balanced review yourself before the venom rushes out of the fangs! :evil:

http://retractionwatch.com/2014/11/05/l ... eer-ticks/

The motivation for the paper:
There are a number of organizations here in texas that are sort of Lyme disease support groups, and they saw this as being evidence that Lyme disease is much more prevalent in Texas than had been thought previously. So because we thought this had profound implications on perception to the public and agencies such as public health, we decided to go ahead and contact the journal editor and publisher and to express our concerns. So we sent a letter first to them requesting retraction under the criteria put forth by COPE, and then shortly thereafter we made it a letter for publication.
Retraction Watch

Lyme disease researchers call for retraction of paper on deer ticks in Texas

A paper suggesting that 45% of deer ticks in Texas have Lyme disease was raked over the coals in a letter to the editor in a recent issue of Parasites and Vectors, though it doesn’t seem like a retraction is forthcoming.

Steven Norris, a Lyme researcher at the University of Texas at Houston, became concerned when he read the study, which overturned the more commonly acknowledged rate of 1% infection in Texas ticks. He sent the paper around to three other researchers; together, they requested the raw sequencing data from the original group, led by Maria Esteve-Gassent at Texas A&M. That’s how they discovered it was nearly identical to the positive control, making them believe the only differences were the results of sequencing errors.

In their letter published in the journal, they write (emphasis ours):

We support continued studies clarifying the etiology and epidemiology of Lyme disease, Southern Tick-Associated Rash Illness (STARI) and other tick-borne illnesses in Texas and the southern United States in general. However, we believe that the technical flaws in the article by Feria-Arroyo et al. obviate the potential usefulness of the reported results in illuminating the picture of tick-borne illnesses in this region. We further believe that this article provides false information that will mislead public health agencies, physicians and the public, and that it must be rectified. The information included in this letter was provided to the authors three months prior to the letter’s publication, but to date they have not made available information that addresses our concerns regarding the accuracy of the data in their article. Therefore, we have recommended retraction of the article to both the authors and the journal, in keeping with the criteria established by the Committee on Publication Ethics

http://publicationethics.org/files/retr ... elines.pdf

BioMed Central, the publisher of Parasites and Vectors, adheres to these guidelines.


We spoke with Norris for more details:


The article said that 45% of their specimens from Ixodes scapularis ticks in Texas and Northeastern Mexico had Borrelia burgdorferi, the organism that causes Lyme disease in North America. What had been reported previously is less than 1% of ticks in texas had Borrelia burgdorferi in them.

I contacted Dr. Esteve-Gassent. My first email to her was on May 8th 2014, and I think the paper was published in April. At that time I sent her a fairly extensive email expressing my concerns and asking for the sequences.

A group of four [unrelated tick experts] discussed the article and decided there were serious scientific flaws, so we requested the sequence information. After several email exchanges, Dr. Esteve-Gassent agreed to post the sequences on NCBI and Genebank. At that time we analyzed the sequences and determined that they were virtually identical to the positive control used in their PCR reactions…It was also clear the sequences were poor quality…based on that we came to a consensus that the only differences that were present between their positive control and the sequences they were reporting were due to sequence errors.

We wrote a letter to Dr. Esteve-Gassent on June 27 that contained all the information in the letter to the editor. At that time we recommended to them that they retract the paper, but they insisted that the paper was primarily on the ecology of ticks…but in reality most of the attention was directed towards the fact that Borrelia burgdorferi was identified in the samples.

There are a number of organizations here in texas that are sort of Lyme disease support groups, and they saw this as being evidence that Lyme disease is much more prevalent in Texas than had been thought previously. So because we thought this had profound implications on perception to the public and agencies such as public health, we decided to go ahead and contact the journal editor and publisher and to express our concerns. So we sent a letter first to them requesting retraction under the criteria put forth by COPE, and then shortly thereafter we made it a letter for publication.


Obviously none of us wants to consider retraction, but in the face of what I think is pretty strong scientific evidence that the information they published is inaccurate, I think that would be the best approach.

We also asked the P.I. from the initial study, Esteve-Gassent, about the letter. She told us that her group is writing a response letter, forthcoming in Parasites and Vectors, though she declined to give us a timeline.
45% of Ixodes scapularis ticks collected from 12 locations in the region were infected with strains of Borrelia burgdorferi sensu stricto.
In Northwestern CA, the tick infection rate varies from about 1% to over 40% in Mendocino. So what if one or more of the locations were hot-spots like Mendocino?
The results reported by Feria-Arroyo et al. [1] are contrary to all prior studies, in which the frequency of detection of Borrelia sequences in ticks from Texas has been less than 3%.
1% in interview above.
Independent analyses of the 21 IGS GenBank entries (KJ826414 through KJ826434) submitted to NCBI were conducted by two of us (AGB and SJN). The sequences were retrieved from GenBank database in FASTA format. For comparison, the corresponding IGS regions were also obtained from this database for the following North American B. burgdorferi strains: B31, 297, N40 and SGE03-1.
What about the other strains which are nearly identical to large sections of the 16s sequences. AGB and SJN released this before getting the response ( what's the hurry?), the FlaB sequences and the the chromatographs from the Sanger sequencing reactions?
Three additional reference North American B. burgdorferi strains were included in the alignment for comparison (Additional file 1: Figure S1).
What about all the strains as opposed to only 3 in NCBI nucleotide?
To give the benefit of the doubt, we can assume that the population structure of the hypothetical B. burgdorferi in Texas and northeastern Mexico is more similar to that of the northeastern U.S. than in the midwestern U.S. In the Northeast,
What about CA382 for example?
Therefore, it is not plausible that all 21 sequences arose from the tick specimens collected in Texas and exhibited such a high level of sequence identity with the B31 sequence. This finding places doubt on all of the results obtained, including the flaB PCR positive results reported in the article.
What about all the strains in NCBI?
There are several additional concerns about the study design with regard to the collection and identification of ticks. The density of host-seeking nymphal stage I. scapularis infected with B. burgdorferi is the standard measure of Lyme disease risk
Maybe the "standard measure of Lyme disease risk" needs reconsideration like the CDC 30K versus 300K booboo?

all 13 host-seeking ticks appear to have been collected from human subjects at deer hunter check stations.
Maybe there is something unique about the case of ticks on humans that should be considered in the "standard measure of Lyme disease risk". Maybe these deer hunters were sitting on logs or in leaves and picked up hot spot nymphs? The rate of nymph infection in CA is higher than adult ticks.
In Texas, the deer hunting season spans September 27 to February 1, which would be expected to overlap with the host-seeking activity period for adult I. scapularis, but not for nymphs.
How do they know these people were actually hunting versus other reasons for being in these areas? This is an assumption.
In addition, infection prevalence in ticks removed from animal hosts would reflect as much, if not more, the infection status of the host as it would the host-seeking tick population, since most, if not all, feeding ticks would acquire infection from a reservoir host. Therefore, the study, as designed, would not provide a clear-cut indication of the human risk for Lyme disease, even if the PCR results accurately reflected the tick infection rate.
So this is an acknowledgement that this might not be a provide a "clear-cut indication of the human risk for Lyme disease" but rather a special case hotspot like Mendocino CA.
In summary, we believe that the PCR-based results regarding the presence of B. burgdorferi in a high percentage of ticks collected in Texas and Mexico are not reliable for several reasons. First, the resultant IGS DNA sequences are identical or nearly identical to those of the B31 strain used as the positive control over large stretches of the PCR product length. Second, the ends of the sequences do not match any known Lyme disease Borrelia sequences, indicating poor quality sequence data.
If its so poor quality, how do we know their custom cutting and comparing to 3 ( not all ) and claiming its contamination is correct?
Fifth, the authors have not made the flaB sequence results available, and it is standard practice to make all sequences described in a publication available.
Maybe they didn't wait long enough for ALL the data for fear doctors and activists might be mislead?
In the absence of public access to the flaB sequences, readers are justified in concluding that the authors’ flaB analysis exhibits similar errors in methodology and inaccuracies in interpretation.
If I was attacked so vigorously by these people knowing their possible motives, it makes sense they would wait for their own response before providing more ammunition that could be spun given the motive of fear of misleading doctors and activists. We wouldn't want that?

Nobody attcked the wide variation in tick infection rates here in CA which ranged from below 1% in LA to 3% to 40% on the Northcoast. The doctors here just blew it off. One small Mendocino area had over 100 people who had lived in a rural area for many years tested for Lyme antibodies and 24% of them were infected. If this can happen in CA, it certianly plausible in the Texas Mexic area.
We support continued studies clarifying the etiology and epidemiology of Lyme disease, Southern Tick-Associated Rash Illness (STARI)
Still not willing to use the scary "Lyme" word for STARI. How about dropping Lyme and using borreliosis so this silly distinction can be removed from these analysis. It distorts the picture like the 30K versus 300K booboo.
We further believe that this article provides false information that will mislead public health agencies, physicians and the public, and that it must be rectified. The information included in this letter was provided to the authors three months prior to the letter’s publication, but to date they have not made available information that addresses our concerns regarding the accuracy of the data in their article.
Maybe its not false but rather unique and unusual. "Rectified". How about just mentioning this might reflect a hotspot irregularity so may doesn't reflect a good stastical Lyme risk that might mislead doctors and activists. An alternative theory of the case.
Therefore, we have recommended retraction of the article to both the authors and the journal, in keeping with the criteria established by the Committee on Publication Ethics
How about we give them time to respond before saying this. Too much fear of misleading doctors and activists for 6 months?
The article by Feria-Arroyo et al. has been publicized as an indication of a significant risk of Lyme disease in Texas. During the past decade, an average of 66 cases of Lyme disease in Texas has been reported to the CDC
We already know the CDC surveilance numbers are off by at least 10X and in Texas, due to bias, it could be worse. Just a thought.
The paucity of B. burgdorferi isolates from ticks, wildlife and humans in this region compared with the high endemicity areas in the Northeastern and North Central United States further supports this conclusion.
Its funny how the California example is always ignored. 1%. No 3% No 40%... Seems to vary a lot here. Just a counterpoint not even mentioned.
The greater the ignorance, the greater the dogmatism.

Attributed to William Osler, 1902

velvetmagnetta
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Re: Mexico Not Taking It Lying Down!

Post by velvetmagnetta » Thu 5 Mar 2015 6:46

hv wrote:
It could be that Sapi et al. are just incompetent hacks with an agenda they make no pains to hide.
Well...If you'd rather a hidden agenda...then I guess it's just a matter of taste ;)!

Lorima
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Re: Mexico Not Taking It Lying Down!

Post by Lorima » Tue 10 Mar 2015 15:23

Don't forget Durland Fish. He is at Yale, an entomologist who pronounces on public health issues, and is heavily implicated in the false maps that convince unsuspecting people that most of the US doesn't have to worry about guarding themselves against LD and other TBIs. His agenda is very un-hidden:

Fish in the Hartford Courant:
http://articles.courant.com/2007-08-24/ ... sh-chronic

Fish in the FOIA emails:
http://archive.poughkeepsiejournal.com/ ... s/fish.pdf

A person could, of course, theoretically, be a propagandist in one context, and yet be committed to publishing only high-quality science in another. But Fish isn't one of those people. I am not at all impressed (in fact, am rather shocked) by the map produced by Fish, Duik-Wasser, Barbour, and others, purporting to show geographical LD risk across the entire US:
http://www.ajtmh.org/content/86/2/320.long

There is no way that an accurate map of this sort, could be produced, based on the actual research that was done here (or has been done anywhere, ever). Everybody, including the average dog owner, knows that tick populations are spotty and variable - they can seem to explode in one park near where I live and yet stay low to moderate in another nearby park. You (or your dog) can take the left fork in a path and end up covered in ticks, while someone who takes the right fork on the same day doesn't encounter any. Producing a map of LD risk of the entire US, based on the actual amount of surveillance that has been done, seems patently absurd to me, scientifically; and an outright disaster, for public health. If this field were dominated by scientific rather than political motivations (in the peer reviewers as well as the author/scientists) this paper wouldn't be publishable. If anything needs to be retracted, it is this paper and its fake map. That it is cited at all, shows how low the field has sunk.

This recent letter by Norris et al., calling all of Texas a low incidence state, based on the work that has been done so far, is absurd in the same way, as LHCTom has pointed out. What is wrong with these people? Are they all as emotionally disturbed as Fish and hv808ct? Or are they just gullible, untrained, and/or untalented? Whatever the cause, aggressively telling clinicians that there is a negligible risk for contracting LD in all of Texas (and the other supposedly low-risk states) is asking for trouble, in the form of more undiagnosed, untreated, late-stage LD. Think of all the time, money, and anguish wasted by the patients, their families, and those doctors who care for them and about them, with no idea what is causing this disabling mystery illness. And think of all the inappropriate treatment they endure, after some diagnosis of exclusion has been given, instead.
"I have to understand the world, you see."
Richard Feynman

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LHCTom
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Re: Mexico Not Taking It Lying Down!

Post by LHCTom » Sun 15 Mar 2015 0:16

Norris et al stick foot in mouth.... Oops! :bonk:

Maybe it would have been more polite to wait a few weeks for a response and be civil.

http://www.parasitesandvectors.com/cont ... 0739-z.pdf

When I checked, I could see other strains similar - the blind leading the angry

In a recent Letter to the Editor, Norris et al. questioned the validity of some of our data reported by Feria-Arroyo et al. The main issue investigated by us was the potential impact of climate change on the probable distribution of the tick vector Ixodes scapularis in the Texas-Mexico transboundary region. As an ancillary issue, an analysis of sequence data for the intergenic spacer of Borrelia burgdorferi was conducted. In the present letter, we provide further evidence supporting our original results, and advocate that extensive study of the population genetics of B. burgdorferi is needed in the Texas-Mexico transboundary region.
Norris et al. [1] argued that the infected ticks reported in our study were found infected with B. burgdorferi likely due to contamination of the PCR reactions with DNA from the strain B31 of B. burgdorferi, the positive control used in the study. Nevertheless, B. burgdorferi B31 flaB gene has a cytosine (C) at position 75 in this alignment (Figure 1) while the Texas isolates had an adenine (A). The A in the Texas isolate makes them more similar to strains N40 and 297 than to B31. Contamination of our samples with strains N40 and 297 is impossible, since these strains are not present in the laboratory in which molecular analyses were carried out.
This is kind..... Maybe Norris needs therapy...

Norris et al. suggest that the Feria-Arroyo et al. [4] publication is advocating a high LD risk in Texas and Mexico but this cannot be further from the truth. Unlike publications that have aimed to create disease risk maps based on questing infected nymphs [16,17,19] the Feria- Arroyo et al. [4] presents a habitat suitability model for the presence of the vector in the studied area, and no predictions are made in regards to the density and prevalence of infected ticks. We agree with Norris et al. that it is unfortunate that the “Feria-Arroyo et al. [4] has been publicised as an indication of a significant Lyme disease risk in Texas” but misinterpretations of that paper in media outlets are not the responsibility of the authors.
And maybe just maybe.... they ran into hotspots.... Due!
Norris et al. go a step further and even ask for the paper to be removed from the literature, but we claim this move is unwarranted for two main reasons. First, it will be naïve to think that a whole public health strategy will be swayed based on a study that does not address human risk for the disease. Secondly, the main findings of the Feria-Arroyo et al. paper [4], which are the vector distribution models, remain unchanged independently of the disputed B. burgdorferi prevalence rates. Removing the contribution of these vector distribution models from the literature would be a step backwards for the continued study of tick-borne illnesses in the southern United States, a goal that we agree with Norris et al. is worthy of further academic work.
The greater the ignorance, the greater the dogmatism.

Attributed to William Osler, 1902

lou
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Re: Mexico Not Taking It Lying Down!

Post by lou » Sun 15 Mar 2015 1:23

Impressed with some of the analysis here and thinking it deserves to be seen in print. Tom? Others. Not the one, as usual, full of venom.

And did Barbara Johnson leave CDC? This was news to me.

velvetmagnetta
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Re: Mexico Not Taking It Lying Down!

Post by velvetmagnetta » Sun 15 Mar 2015 10:09

Hi Lou! It's nice to *read* you again. Yes, this is scientific misconduct (not to mention a major faux-pas!) and should be officially noted somewhere, but Feria-Arroyo et al. did a damn good job in responding to the fraudulent allegations put forth by Norris et al. And, here we are talking about it - posting on a public forum is publishing, in a sense.

LHCTom - Very thorough analysis. I failed to emphasize one very important point - I haven't been feeling very well and cannot research or find the words to explain it - but I think you may find it interesting. If you investigate further the difference between active and passive collection of ticks and what a difference it makes to use both methods of collection, you will find the real meat and bones of how incredibly Norris et al. have failed miserably in their task of keeping up with the rate of Bb infection. I believe Feria-Arroyo et al. go into some detail in the original paper. (The active collection of questing ticks, I believe, is the collection of ticks in all stages including nymphs looking for a host.)

It was in this way that Norris et al. failed to gather an accurate picture of the actual amount of Borrelia burgdorferi out there. If Norris wants to insist that the magnitude of infected ticks has no bearing on the magnitude of spreading infection rates, then...well...I guess it must be nice living out there in Never-Never Land.

As for the rest of us, we may not be able to scientifically conclude with absolute certainty that finding a hell-of-a-lot more Bb than previously thought probably means a hell-of-a-lot more infected humans and animals than previously thought, but we sure as hell can consider that may the case.

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LHCTom
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Re: Mexico Not Taking It Lying Down!

Post by LHCTom » Sun 15 Mar 2015 18:35

Another way of looking at the silliness of "risk maps" is think about how other conditions are dealt with. Can you imagine a lung cancer map? No. A map makes no sense and is useless since lung cancer rates are aligned with smoking and jobs like working in coal mines. I know the tick collection infection work in CA varies dramatically from park to park and terrain to terrain. It varies considerably from adult ticks that quest on tall grasses and nymphs that hang out in leaves and logs in moist forests. Nymphs are typically higher than adults. It varies by season and a whole host of human behavior over time. If you own a dog in a rural area, your risk is higher. Maybe you own a cat who likes too sleep in your bed. Maybe you had never heard of Lyme so disn't check for ticks or rashes.

Its about behavior with maps being very high level gross contributors that are not at the top of the list!

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3413889/


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2880809/
In the far-western United States, the nymphal stage of the western black-legged tick, Ixodes pacificus, has been implicated as the primary vector to humans of Borrelia burgdorferi sensu stricto (hereinafter referred to as B. burgdorferi), the causative agent of Lyme borreliosis in North America. In the present study, we sought to determine if infection prevalence with B. burgdorferi in I. pacificus nymphs and the density of infected nymphs differ between dense-woodland types within Mendocino County, California, and to develop and evaluate a spatially-explicit model for density of infected nymphs in dense woodlands within this high-incidence area for Lyme borreliosis. In total, 4.9% (264) of 5431 I. pacificus nymphs tested for the presence of B. burgdorferi were infected. Among the 78 sampling sites, infection prevalence ranged from 0 to 22% and density of infected nymphs from 0 to 2.04 per 100 m2. Infection prevalence was highest in woodlands dominated by hardwoods (6.2%) and lowest for redwood (1.9%) and coastal pine (0%). Density of infected nymphs also was higher in hardwood-dominated woodlands than in conifer-dominated ones that included redwood or pine. Our spatial risk model, which yielded an overall accuracy of 85%, indicated that warmer areas with less variation between maximum and minimum monthly water vapor in the air were more likely to include woodlands with elevated acarological risk of exposure to infected nymphs. We found that 37% of dense woodlands in the county were predicted to pose an elevated risk of exposure to infected nymphs, and that 94% of the dense-woodland areas that were predicted to harbor elevated densities of infected nymphs were located on privately-owned land.

So if you happen to visit a certain park versus another, your risk could vary by 10:1. If you visit a moist forest park and sit on logs or leaves for a picnic, the risk varies dramatically depending on where the park is and type of forest. Lizards reduce the risk while western grey squirrels increase it.

Lizards and squirrels -> http://www.ncbi.nlm.nih.gov/pubmed/20380218

The genotype and genospecies you might encounter also varies dramatically. The standard CDC 2 tiered test is renowned for missing genospecies other than Bb. So maybe a doctor should consider adding a C6 just in case.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3067736/

http://www.ncbi.nlm.nih.gov/pubmed/25129859
The diversity of Lyme disease (LD) and relapsing fever (RF)-group spirochetes in the metropolitan San Francisco Bay area in northern California is poorly understood. We tested Ixodes pacificus, I. spinipalpis, and small mammals for presence of borreliae in Alameda County in the eastern portion of San Francisco Bay between 2009 and 2012. Analyses of 218 Borrelia burgdorferi sensu lato (Bb sl) culture or DNA isolates recovered from host-seeking I. pacificus ticks revealed that the human pathogen Bb sensu stricto (hereinafter, B. burgdorferi) had the broadest habitat distribution followed by B. bissettii. Three other North American Bb sl spirochetes, B. americana, B. californiensis and B. genomospecies 2, also were detected at lower prevalence. OspC genotyping of the resultant 167 B. burgdorferi isolates revealed six ospC alleles (A, D, E3, F, H and K) in I. pacificus. A novel spirochete belonging to the Eurasian Bb sl complex, designated CA690, was found in a questing I. spinipalpis nymph. Borrelia miyamotoi, a relapsing-fever (RF) group spirochete recently implicated as a human pathogen, was detected in 24 I. pacificus. Three rodent species were infected with Bb sl: the fox squirrel (Sciurus niger) with B. burgdorferi, and the dusky-footed wood rat (Neotoma fuscipes) and roof rat (Rattus rattus) with B. bissettii. Another spirochete that clustered phylogenetically with the Spanish R57 Borrelia sp. in a clade distinct from both the LD and RF groups infected some of the roof rats. Together, eight borrelial genospecies were detected in ticks or small mammals from a single Californian county, two of which were related phylogenetically to European spirochetes.
So you walk into your doctor with Lyme like symptoms and he or she looks at the CA risk map and ignores Lyme. But if the doctor asked about your behavior, it could vary the risk by 100 times. If you live in SF and never visit the parks or rural areas, your risk is extremely low. But say you live 20 miles from SF in a north bay county in a rural area, your risk is far larger. Say you live on acreage with a high host count and are forced to visit your acreage to perform maintenance work. You might sit on a log or down on the ground when tired. Say you have lived in rural Mendocino for 20 years on acreage without lizards and moist forest habitat and have a dog who sleeps near you. Lets say you are not even aware of Lyme or TBDs so don't check for ticks. Some might laugh but that is reality. A person in New York City who never leaves the city and hates parks, has a much lower risk than someone from CA with the risk factors I've mentioned.

Your risk goes way up but you might be seeing the same doctor who lives in Mill Valley, half way in between. So these maps do a dis-service if used in Physician education like:

http://www.nbcms.org/en-us/about-us/son ... &tabid=747

Which was authored by the so called Sonoma County expert IDSA doctor. Not only is it filled with errors and old data, it essentially tells doctors in this area that the risk of Lyme and TBDs is so low it can be ignored. That's the overall message and its wrong. What happened to "First do no harm".... This article single handely will harm 100" of people due to this biased message.


Oh and the season makes a big difference:

http://www.ncbi.nlm.nih.gov/pubmed/25113980


So using risk maps is a bit like not asking a person if they smoked or worked with asbestos during a cancer screen. Overall maps might be useful for epidemiologists who calculate total healthcare costs but is useless for a doctor who might be encountering a patient with a 1000:1 risk.

The one area in a rural community in Hopland, Mendocino had 24% of the 114 people tested positive for Lyme after years in the community.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3067736/
In North America, Lyme borreliosis (LB) is a tick-borne disease caused by infection with the spirochete Borrelia burgdorferi. We studied the genetic diversity of LB spirochetes in north-coastal California residents. Spirochete DNA was detected in 23.7% (27/114) of the study subjects using a PCR protocol optimized for increased sensitivity in human sera. Californians were most commonly infected with B. burgdorferi ospC genotype A, a globally widespread spirochete associated with high virulence in LB patients. Sequence analysis of rrf-rrl and p66 loci in 11% (3/27) of the PCR-positive study subjects revealed evidence of infection with an organism closely related to B. bissettii. This spirochete, heretofore associated with LB only in Europe, is widely distributed among ticks and wildlife in North America. Further molecular testing of sera from residents in areas where LB is endemic is warranted to enhance our understanding of the geographic distribution and frequency of occurrence of B. bissettii-like infections.


But if you tested 110 people in SF who rarely visited the rural areas, the infection rate might be zero. Just think about it.

So many individual variables make large scale maps useless.
The greater the ignorance, the greater the dogmatism.

Attributed to William Osler, 1902

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