It's time for Western Pennsylvania residents to pick up a new habit, according to the Allegheny Health Network: checking for ticks after spending time outside.
Fotios Koumpouras, a rheumatologist and the network’s associate division director for rheumatology, is starting a center focused on Lyme disease. He said he began noticing an increase in cases of the tick-borne illness beginning in 2011, and said the number has been rising ever since, to the point that he now sees two to three cases a week.
"It's pretty clear that the numbers of Lyme disease are definitely climbing in the region," he said.
It's clear to the Allegheny County Health Department, as well. Last week, the department issued advice to county residents about steps to take to avoid ticks, which can transmit the bacteria that causes Lyme disease in humans.
Lyme disease is indicated by a red rash around a tick bite mark, often in the shape of a bull’s-eye. According to the county health department, early symptoms are usually mild and similar to the flu, and the disease can usually be treated successfully with antibiotics.
But Health Director Karen Hacker warned that the disease can cause complications such as chronic arthritis and neurological problems if left untreated.
In 2013, the official Lyme disease case count for the county was 145, although officials believe that is a “vast underestimate,” Health Department epidemiologist Kristen Mertz said. Still, it’s a large increase from the mid-2000s, when cases fluctuated from 16 to 35 a year between 2004 and 2008, according to health department figures.
It's also a large increase from 2012, when there were 59 reported cases, from 2011 and 2010, when there were 24 cases each, and from 2009, when there were 32 cases, Dr. Mertz said. But she said the disease is underreported clinically, and the health department believes their numbers for those years do not reflect the actual -- and possibly much higher -- number of cases in the county.
This year, the upward trend for Lyme disease is continuing, she said.
"We are definitely seeing more than last year," she said.
In 2012, the year for which the most recent figures are available from the Centers for Disease Control and Prevention, there were 22,014 confirmed cases of Lyme disease nationally, with 95 percent of them originating from just 13 states.
According to the CDC, Pennsylvania’s 4,146 confirmed cases led the country in number of confirmed cases for 2012, although data shows Massachusetts may be the leader by about 100 cases if confirmed and probable cases were combined.
Lyme disease became a reportable disease in Pennsylvania in 1987, according to the state Department of Health. Department spokesman Wes Culp said Lyme disease first appeared in the southeastern part of the state and has been moving westward.
He said the state's data, which varies from data on Lyme disease reported by Allegheny County’s department, suggests that Lyme cases are increasing in the southwestern, northwestern and north central regions of Pennsylvania.
Dr. Mertz, with the county health department, said it seems there are more ticks carrying the bacteria that causes Lyme disease, Borrelia burgdorferi.
"We think that there's more ticks, and we think that the bacteria that causes the disease has moved into the ticks in this area," said Dr. Mertz. A test performed by the Department of Environmental Protection tested 56 deer ticks for the bacteria in 2013, and found that 34 percent were infected.
The disease has been under-reported in the past, and Dr. Mertz said the county health department, in addition to warning people to take care to avoid tick bites, is focusing this year on obtaining more accurate numbers for confirmed cases of Lyme disease.
Part of the problem is that "a lot of time" doctors miss cases that turn out to be Lyme disease, said Dr. Koumpouras. He said one case he saw was clearly Lyme disease, but was treated as cellulitis.
"I think the doctors are getting the gist of it, but there's still a lot of confusion," he said.
Andrew Nowalk, assistant professor of pediatrics in the infectious disease division at Children’s Hospital of Pittsburgh of UPMC, said doctors are getting better.
"As time is going on, we are seeing doctors in the area get more and more familiar and better at diagnosing it appropriately," he said.
It’s partly because they are seeing more of it. Children's Hospital was seeing four or five cases a year of Lyme disease back in 2002, Dr. Nowalk said. Last year, the hospital saw more than 400 cases, though not all involved Allegheny County residents.
Children, particularly boys, are susceptible to catching the disease, since they are more likely to be playing outside, Dr. Nowalk said.
Heather Bondi of South Park still isn’t quite sure how her son Dominic, 3,caught Lyme disease.
She said the family hadn't been camping, or hiking. But a few months ago, she noticed what looked to be a mosquito bite on his chest, with some redness around it, though not the bull's eye rash.
It didn't itch, but the rash grew, and then he had a fever. Ms. Bondi said she took her son to their doctor, who didn't think it was a tick bite, either, but took a picture of the rash and sent it to another doctor for a second opinion. That doctor believed it was Lyme disease, and blood work confirmed it, Ms. Bondi said.
Dominic started an antibiotics regimen the last day of May and has completely recovered, Ms. Bondi said. Her best guess is that he had a tick bite from playing in her family's backyard, or visiting South Park.
"I kind of get the sense that a lot of people still don't really grasp how prevalent it is this year," she said.
Her family gets it, however. And since Dominic's diagnosis, they've been avoiding subsequent tick encounters by using bug spray with DEET.