Interview #1 Randi Eikeland

Randi Eikeland is a neurologist and leader of the Norwegian National Advisory Unit on Tick-borne Diseases. Eikeland is also the project leader of work package 5 in the NorthTick project, which involves management of tick-borne diseases in the North Sea Region. 

Firstly, what kind a tick-borne diseases are there in the NSR?

In humans Lyme disease, or borreliosis as we call it in Europe, is by far the most common tick-borne disease in the North Sea Region, followed by TBE, a disease caused by the Tick-borne Encephalitis virus.  Other microbes have also been discovered in ticks in the North Sea Region such as anaplasma, neoehrlichia, babesia, rickettsia, tularemia, but few human cases have been reported.

What is the risk of getting sick after a tick-bite?

Even though a tick bite may cause disease, several large studies have shown that the risk of getting sick after a tick bite is actually very low – around 2%. An even if you get infected the disease is mostly mild.

How many people in the NSR get a tick-borne disease every year?

It is difficult to be exact, as the countries have different criteria for what is notifiable. But, if I say at least 10 000 every year, that is probably an underestimate. During the last decades, ticks carrying microorganisms that can cause disease in humans and animals have increased in numbers and spread to new areas. Thus, the number of people and animals afflicted by tick-borne diseases in the North Sea Region are on the rise. The reasons are complex and may include climate change, increased urbanisation and other human influences on ecosystems. 

Can you tell us a little bit about your current role in Northtick?

I am in charge of one of the work packages which involves  management of tick-borne diseases. The recommendations for diagnosis and treatment of tick-borne diseases in the North Sea Region are essentially the same. Nevertheless, many people who relate their aliments to  tick-borne diseases find that their health problems are not attended to well enough. On the internet, there is also a lot of misinformation about the diagnosis and treatment of tick-borne diseases. It is difficult to know what is right and wrong, both for patients and health professionals. Many people seek out alternative health services for diagnosis and treatment. Experiences from my own workplace, and also from clinics in Denmark and Sweden, indicate that this applies to at least several hundred people annually in the Nordic countries alone. This is problematic as alternative treatment is not subjected to the same requirements for quality assurance compared to evidence based medicine. There is a need for a joint recommendation for the diagnosis, treatment and follow-up of persons with long-term ailments after suspected tick-borne diseases.

So, the focus in one of your projects will be patients who have long-term ailments after suspected TBD. You have a PhD on long-term complaints after tick-borne diseases. Why is this patient group important to you?  

There are several reasons for this. Ticks are very common in the region where I live, and I am also an outdoors person, getting tick bites as most of the people living here. During my years of practicing medicine with focus on neurology, I met a number of people who had severe infection with tick-borne pathogens. Some of them get long term complaints that reduce their quality of life and that needs to be addressed and understood. I also think it is very problematic that many people who really suffer from unexplained complaints are mislead to think that their complaints are due to tick-born diseases when they are not, and that they are offered diagnostics and treatments that are wrong, expensive and sometimes dangerous.

What is the benefit of working in this project?

All the brilliant professionals with different skills are brought together. The work on managing tick-borne diseases has a bigger impact when we find good solutions together. And, of course, even if the funding is not enormous, it certainly helps a lot

What is the plan forward?

So far, we have formed a good group of experts with clinical experience. We have collected guidelines, recommendations and clinical practise from all North Sea Region countries, and we have worked through them to find similarities, differences and knowledge gaps. A writing group is now working on the first draft of the joint recommendations, and we hope to present it for the stakeholders next year. This will give the patients and health care workers/ administrators the possibility to respond and comment on the suggested recommendations. In the end we will publish and present the recommendations ata public meeting.