I am writing this letter to you to express my serious concerns that your updated 2019 guidelines regarding the ‘Prevention, Diagnosis and Treatment of Lyme Disease’ are disturbingly and strangely silent to the very real documented risk of in-utero transmission of Borrelia burgdorferi. Members of your committee including Drs Steere , Wormser , Strle , Halperin,9 Aguero-Rosenfeld , and Belani have already acknowledged this alternate mode of transmission in the authorship or co-authorship of historical publications in top-tier peer-reviewed journals including primary research findings and/or commentaries or reviews of Lyme disease. Two former guidelines authors from the 2006 IDSA Clinical Practice guidelines who are not listed in the authorship of the updated guidelines, specifically Drs Dattwyler and Shapiro have also acknowledged and reported on mother to baby transmission of Borrelia burgdorferi.

Transplacental transmission, adverse outcomes and reports of congenital infection of Borrelia burgdorferi (Bb) have been clearly documented over the last 34 years (1985 to 2019) by multiple international physicians, pioneering researchers and scientists including Dr. Willy Burgdorfer (after whom Borrelia burgdorferi was named), Dr. Alan Steere (one of the primary investigators of Lyme disease in Lyme Connecticut and on your committee), Dr. Alan MacDonald
(pathologist who meticulously documented Borrelia burgdorferi in tissues of fetal autopsies) and Dr. Tessa Gardner (Pediatric Infectious Disease Specialist).