17 May 2013
Next update: 24 May 2013
There were nearly a thousand laboratory-confirmed cases of Lyme disease reported to the HPA in England and Wales in 2012, according to provisional figures compiled by Public Health England (PHE) . This recorded incidence is low compared to some other European countries and North America, but the true level of infections in England and Wales is estimated to be two to three times higher than the confirmed cases.
Anticipating the increased risk associated with springtime recreational activities and the fact that untreated infections can result in serious illness, PHE has issued a seasonal warning and published new leaflets for both the general public  and health professionals .The factsheets reiterate the precautions necessary to protect against bites of infected ticks that can result in the infection. Ticks are most commonly found in dense vegetation and long grass, but can occur anywhere including gardens and urban parks which are visited by small mammals and birds. Certain holiday destinations are known to be higher risk areas (Exmoor, the New Forest, the South Downs, parts of Wiltshire and Berkshire, Thetford Forest, the Lake District, the Yorkshire moors and the Scottish Highlands). During visits to such areas, the leaflets recommend that skin should be checked regularly for ticks, which should be removed with tweezers or special tick hooks. Other precautions include:
Symptoms and diagnosis
The most common and often only symptom of Lyme disease is a rash, which gradually spreads from the site of the tick bite. However, in the UK the rash is absent in up to 30% of patients presenting with symptoms of the infection that require treatment with antibiotics. General practitioners are advised of other symptoms, in those who have a history of possible exposure, that warrant a test for Lyme disease .
1. “PHE publishes new tick leaflets to remind people to be 'tick aware'”, PHE press release, 13 May, 2013.
2. Ticks and your health: information about tick bite risks and prevention, available (in two formats). HPA legacy website: Home › Publications › Infectious diseases › Emerging Infections. Further information and resources (including a video about ticks and tick awareness in the UK) are available at: www.hpa.org.uk/ticks.
Latest data on dengue fever imported into England, Wales and Northern Ireland (EWNI) – covering 2012 and the first quarter of 2013 – have been published on the Travel Health page of this issue of Health Protection Report [1,2].
Most commonly, dengue is imported into EWNI having been acquired in Asia, south and central America or the Caribbean. The new data, produced by Public Health England's Rare and Imported Pathogens Laboratory (RIPL), reveal a number of recent clusters of imported cases including among travellers returning from Thailand and Barbados.
A NaTHNaC clinical update covering the current global epidemiology of dengue fever has also been published  and the relevant Travel Health Information Sheet updated .
1. Increase in imported dengue fever: England, Wales and Northern Ireland, HPR 7(20): Travel Health (published 14 May 2013).
2. “Travellers urged to protect themselves from insect bites as dengue fever cases triple”, Public Health England press release, 15 May 2013.
3. “Dengue fever reminder”, NaTHNaC clinical update, 15 May 2013, http://www.nathnac.org/pro/clinical_updates/dengue_remind_150513.htm.
4. Travel Health Information Sheet: Dengue Fever (updated 16 May 2013).