Lyme disease in children : data from the Canadian Paediatric Surveillance Program

Abstract

BACKGROUND: Lyme disease (LD) is an infectious disease that is emerging in eastern and central Canada associated with the spread of the tick vector Ixodes scapularis. National surveillance shows that children are an at-risk age group. OBJECTIVES: To study the epidemiology of LD in Canadian children using the Canadian Paediatric Surveillance Program (CPSP) to better understand exposure history, clinical manifestations, diagnosis and treatment of paediatric LD cases in Canada. METHODS: A structured questionnaire was completed by paediatricians for each LD case reported as part of the Canadian Paediatric Surveillance Program from 2014 to 2017. RESULTS: There were 95 cases that met inclusion criteria as confirmed or probable cases. The median age was 7 years; 38 % were 5-9 years and 35 % were 10-15 years of age. Most cases were acquired in known Canadian endemic locations; 5 were acquired during travel to the US. Most cases were reported from Nova Scotia and Ontario (46 % and 38 % respectively). The most common clinical presentation was arthritis (59 % of all cases), which is a manifestation of the late disseminated stage of LD. Late disseminated disease presented through the year, whereas early LD (Erythema migrans) and early disseminated LD presented during the summer and fall. Antibiotic choice and duration of therapy generally followed accepted guidelines. CONCLUSION: This study of the clinical spectrum of LD in Canadian children underlines the need for preventive measures to protect children in Canada from emerging LD, and the need for health care provider awareness.