Prevention And Control Of Lyme Disease

Reducing exposure to ticks is the best defence against acquiring Lyme disease and other tick-borne infections (CDC). There are a number of strategies you can adopt to avoid or manage your exposure to ticks in Lyme-endemic or suspected endemic areas. The best precaution against is to avoid contact with soil, leaf litter and vegetation as much as possible. However, if you garden, hike, camp, work outdoors or otherwise spend time in the bush, brush or overgrown fields, you should use a combination of precautions to dramatically reduce your chances of getting Lyme disease:

  • Avoid sitting directly on the ground or on stone walls (havens for ticks and their hosts);
  • Walk in the center of trails;
  • Keep long hair tied back, especially when gardening;
  • Wear enclosed shoes and light-colored clothing with a tight weave to spot ticks easily;
  • Scan clothes and any exposed skin frequently for ticks while outdoors;
  • Use insect repellent containing DEET (N, N-diethyl-m-toluamide) on skin or permethrin on clothes if you intend to go off-trail or into overgrown areas. Treat clothing and gear, such as boots, pants, socks and tents with products containing 0.5% permethrin. It remains protective through several washings. Pre-treated clothing is available and may provide longer-lasting protection.

After you have returned home you should also (CDC):

  • Bathe or shower as soon as possible after coming indoors (preferably within 2 hours) to wash off and more easily find ticks that are crawling on you;
  • Conduct a full-body tick check using a hand-held or full-length mirror to view all parts of your body upon return from tick-infested areas. Parents should check their children for ticks under the arms, in and around the ears, inside the belly button, behind the knees, between the legs, around the waist, and especially in their hair;
  • Examine gear and pets. Ticks can ride into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and day packs;
  • Tumble clothes in a dryer on high heat for an hour to kill remaining ticks. (Some research suggests that shorter drying times may also be effective, particularly if the clothing is not wet).

If you do find a tick, don’t panic, it can be removed effectively with a set of plain fine-pointed tweezers (CDC):

How to remove a tick

  1. Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible.
  2. Pull upward with steady, even pressure. Don’t twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal.
  3. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water.
  4. Dispose of a live tick by submersing it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers.

If you develop the bulls-eye rash or a fever within several weeks of removing the tick see a doctor and let them know of the tick bite. However, not all ticks are infected even in Lyme endemic areas.

Lyme Disease Vaccine

For a short time in the late 1990s and the early 2000s there was a Lyme disease vaccine available in the US. In what is a case of a vaccine removed from the market largely due to the fears of the anti-vaccination movement, there remains no vaccine for the prevention of Lyme disease. Despite the need, due to that minority’s rather vocal unfounded fears of vaccines, it may be unlikely that one could reach the market any time soon in the US or Europe (Willyard, 2014, Kaaijk and Luytjes, 2016, Plotkin, 2016). However, there have been several reports of certain vaccines preceding onset of ME/CFS (Lloyd et al., 1988, Appel et al., 2007, Ortega-Hernandez and Shoenfeld, 2009).

In the early 1990s SmithKlineBeecham (now GlaxoSmithKline) developed the recombinant vaccine called LYMErix, based on the outer surface protein A (OspA) of B. burgdorferi as the immugen. Its efficacy was approx 76-80% after 3 doses over 12 months in adults. It was approved by the FDA in late 1998 (Nigrovic and Thompson, 2007). Initially the vaccine was popular in areas in which Lyme disease is endemic. However, that popularity was short-lived as within a year of licensure, media coverage began of reports of adverse reactions after the vaccine. Several side-effects were mentioned, although the majority were arthritis related. The media put a human face on this suffering by carrying the stories of these “vaccine victims” (Nigrovic and Thompson, 2007).

Inspired by the controversy a law firm launched a class action in late 1999, against SmithKlineBeecham on behalf of the “vaccine injured”.

To monitor ongoing safety, physicians report all adverse events temporally related to vaccine administration in the USA to the Vaccine Adverse Events Reporting System (VAERS). Established in 1990, this cooperative programme of the CDC and FDA provides post-marketing safety surveillance for all US-licensed vaccines. By 2001, with over 1·4 million LYMErix doses distributed in the United States the VAERS database included 905 reports of mild self-limited reactions and 59 reports of arthritis associated with vaccination (Lathrop et al., 2002). The arthritis incidence occurred at the same rate as the background in unvaccinated individuals (Nigrovic and Thompson, 2007).

After further research by SmithKlineBeecham and a meeting of the FDA and several stakeholders in early 2001, the FDA continued its licensure of LYMErix. However, after further public concerns over vaccine safety and ongoing litigation, the sales of LYMErix fell off sharply and in early 2002 then GlaxoSmithKline decided to withdraw the vaccine from sale citing poor market performance (Nigrovic and Thompson, 2007).

Following removal of the vaccine from the market GlaxoSmithKline settled with the law firms’ class action suits in mid 2003. A figure of over $US1 million for legal fees of the prosecuting lawyers but no financial compensation for the “vaccine injured”. The plaintiffs’ attorneys stated that removal of LYMErix from sale was the main objective of the suit (Nigrovic and Thompson, 2007).

 

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Websites And Links

Centers for Disease Control and Prevention (CDC) page on Lyme Disease

American Lyme Disease Foundation

Infectious Diseases Society of America

University of Sydney’s Tick Borne Diseases Unit

US National Institute of Health

US National Institute of Allergy and Infectious Diseases (Lyme Disease Page)

Books

Institute of Medicine (US) Committee on Lyme Disease and Other Tick-Borne Diseases: The State of the Science. Critical Needs and Gaps in Understanding Prevention, Amelioration, and Resolution of Lyme and Other Tick-Borne Diseases: The Short-Term and Long-Term Outcomes: Workshop Report. Washington (DC): National Academies Press (US); 2011. Available from: http://www.ncbi.nlm.nih.gov/books/NBK57020/

Lyme Disease: the Great Controversy Halperin, J.J., Baker, P., and Wormser, G.P. In, “Lyme Disease: An Evidence-based Approach”(American Lyme Disease Foundation) (Link to Chapter 17 pdf)

Wang, G. (2015). Chapter 104 – Borrelia burgdorferi and other Borrelia species, Molecular Medical Microbiology (Second Edition), Pages 1867–1909, Elsevier Ltd.

Radolf, J. D., et al. (2010). Lyme disease in humans, Caister Academic Press.

Journal Articles

Halperin, J. J. “Nervous system Lyme disease, chronic Lyme disease, and none of the above.” Acta Neurol Belg, 2016, 116(1): 1-6.

Lantos, P. M. “Chronic Lyme disease.” Infect Dis Clin North Am, 2015, 29(2): 325-340.

Kaaijk, P. and W. Luytjes. “Vaccination against Lyme disease: Are we ready for it?” Hum Vaccin Immunother, 2016, 12(3): 757-762.

Plotkin, S. A. “Need for a New Lyme Disease Vaccine.” N Engl J Med, 2016, 375(10): 911-913.

Aucott, J. N. “Posttreatment Lyme disease syndrome.” Infect Dis Clin North Am, 2015, 29(2): 309-323.

Mayne, P. J. “Clinical determinants of Lyme borreliosis, babesiosis, bartonellosis, anaplasmosis, and ehrlichiosis in an Australian cohort.” Int J Gen Med, 2015, 8: 15-26.

Gofton, A. W., et al. “Inhibition of the endosymbiont “Candidatus Midichloria mitochondrii” during 16S rRNA gene profiling reveals potential pathogens in Ixodes ticks from Australia.” Parasit Vectors, 2015, 8: 345.

Gofton, A. W., et al. “Bacterial profiling reveals novel “Ca. Neoehrlichia”, Ehrlichia, and Anaplasma species in Australian human-biting ticks.” PLoS One, 2015, 10(12): e0145449/0145441-e0145449/0145416.

Patrick, D. M., et al. “Lyme Disease Diagnosed by Alternative Methods: A Phenotype Similar to That of Chronic Fatigue Syndrome.” Clin Infect Dis, 2015.

Ostfeld, R. S. and J. L. Brunner. “Climate change and Ixodes tick-borne diseases of humans.” Philos Trans R Soc Lond B Biol Sci, 2015, 370(1665).

Aguero-Rosenfeld, M. E. and G. P. Wormser. “Lyme disease: diagnostic issues and controversies.” Expert Rev. Mol. Diagn., 2015, 15(1): 1-4.

Halperin, J. J. “Chronic Lyme disease: misconceptions and challenges for patient management.” Infect Drug Resist, 2015, 8: 119-128.

Borchers, A. T., et al. “Lyme disease: a rigorous review of diagnostic criteria and treatment.” J Autoimmun, 2015, 57: 82-115.

Mayne, P., et al. “Evidence for Ixodes holocyclus (Acarina: Ixodidae) as a Vector for Human Lyme Borreliosis Infection in Australia.” J Insect Sci, 2014, 14(1).

Lantos, P. M. and G. P. Wormser. “Chronic coinfections in patients diagnosed with chronic lyme disease: a systematic review.” Am J Med, 2014, 127(11): 1105-1110.

DeBiasi, R. L. “A concise critical analysis of serologic testing for the diagnosis of lyme disease.” Curr Infect Dis Rep, 2014, 16(12): 450.

Brissette, C. A. and R. A. Gaultney. “That’s my story, and I’m sticking to it–an update on B. burgdorferi adhesins.” Front Cell Infect Microbiol, 2014, 4: 41.

Groshong, A. M. and J. S. Blevins. “Insights into the biology of Borrelia burgdorferi gained through the application of molecular genetics.” Adv. Appl. Microbiol., 2014, 86: 41-143.

Lantos, P. M., et al. “A systematic review of Borrelia burgdorferi morphologic variants does not support a role in chronic Lyme disease.” Clin Infect Dis, 2014, 58(5): 663-671.

Pavia, C. S. and G. P. Wormser. “Culture of the entire mouse to determine whether cultivable Borrelia burgdorferi persists in infected mice treated with a five-day course of ceftriaxone.” Antimicrob. Agents Chemother., 2014, 58(11): 6701-6703, 6704 pp.

O’Day, D. H. and A. Catalano. “A lack of correlation between the incidence of lyme disease and deaths due to Alzheimer’s disease.” J Alzheimers Dis, 2014, 42(1): 115-118.

Strle, K., et al. “Elevated Levels of IL-23 in a Subset of Patients With Post-Lyme Disease Symptoms Following Erythema Migrans.” Clin. Infect. Dis., 2014, 58(3): 372-380.

Willyard, C. “Resurrecting the ‘yuppie vaccine’.” Nat. Med. (N. Y., NY, U. S.), 2014, 20(7): 698-701.

Halperin, J. J., et al. “Common misconceptions about Lyme disease.” Am J Med, 2013, 126(3): 264.e261-267.

Klempner, M. S., et al. “Treatment trials for post-Lyme disease symptoms revisited.” Am J Med, 2013, 126(8): 665-669.

Kobayashi, Y., et al. “A novel macrolide solithromycin exerts superior anti-inflammatory effect via NF-κB inhibition.” J Pharmacol Exp Ther, 2013, 345(1): 76-84.

Ajamian, M., et al. “Serologic markers of lyme disease in children with autism.” JAMA, J. Am. Med. Assoc., 2013, 309(17): 1771-1772.

Burbelo, P. D., et al. “Lack of serum antibodies against Borrelia burgdorferi in children with autism.” Clin. Vaccine Immunol., 2013, 20(7): 1092-1093.

Krut, J. J., et al. “Cerebrospinal fluid Alzheimer’s biomarker profiles in CNS infections.” J. Neurol., 2013, 260(2): 620-626.

Barbour, A. “Remains of infection.J. Clin. Invest., 2012, 122(7): 2344-2346.

Bockenstedt, L. K., et al. “Spirochete antigens persist near cartilage after murine Lyme borreliosis therapy.J. Clin. Invest., 2012, 122(7): 2652-2660.

Embers, M. E., et al. “Persistence of Borrelia burgdorferi in rhesus macaques following antibiotic treatment of disseminated infection.PLoS One, 2012, 7(1): e29914.

Huyshe-Shires, S. “Lyme disease antiscience.” Lancet Infect Dis, 2012, 12(5): 361; author reply 362-363.

Perronne, C. “Lyme disease antiscience.” Lancet Infect Dis, 2012, 12(5): 361-362; author reply 362-363.

Tuttle, C. “Lyme disease antiscience.” Lancet Infect Dis, 2012, 12(5): 362; author reply 362-363.

Auwaerter, P. G., et al. “Lyme disease antiscience – Authors’ reply.” Lancet Infect Dis, 2012, 12(5): 362-363.

Bastos, L. F. S., et al. “Tetracyclines and pain.” Naunyn-Schmiedeberg’s Arch. Pharmacol., 2012, 385(3): 225-241.

Auwaerter, P. G., et al. “Antiscience and ethical concerns associated with advocacy of Lyme disease.” Lancet Infect Dis, 2011, 11(9): 713-719.

Chandra, A., et al. “Anti-Borrelia burgdorferi antibody profile in post-Lyme disease syndrome.” Clin. Vaccine Immunol., 2011, 18(5): 767-771.

Stricker, R. B. and L. Johnson. ““Lyme literacy” and physicians in Connecticut.” J Pediatr, 2011, 158(3): 518-519; author reply 519-520.

Lantos, P. M. “Chronic Lyme disease: the controversies and the science.” Expert Rev Anti Infect Ther, 2011, 9(7): 787-797.

Halperin, J. J. “Nervous system lyme disease: is there a controversy?” Semin Neurol, 2011, 31(3): 317-324.

Schutzer, S. E., et al. “Distinct cerebrospinal fluid proteomes differentiate Post-Treatment Lyme disease from Chronic Fatigue syndrome.” PLoS One, 2011, 6(2): e17287.

Kanjwal, K., et al. “Postural orthostatic tachycardia syndrome following Lyme disease.” Cardiol J, 2011, 18(1): 63-66.

Alvarez, J. I., et al. “Disruption of central nervous system barriers in multiple sclerosis.” Biochim. Biophys. Acta, Mol. Basis Dis., 2011, 1812(2): 252-264.

Johnson, M. and H. M. Feder, Jr. “Chronic Lyme disease: a survey of Connecticut primary care physicians.” J Pediatr, 2010, 157(6): 1025-1029.e1021-1022.

Holzbauer, S. M., et al. “Death due to community-associated Clostridium difficile in a woman receiving prolonged antibiotic therapy for suspected lyme disease.” Clin Infect Dis, 2010, 51(3): 369-370.

Feder, H. M., Jr. “Reply.” J Pediatr, 2010, 158(3): 519-520.

Berende, A., et al. “Activation of innate host defense mechanisms by Borrelia.” Eur. Cytokine Network, 2010, 21(1): 7-18.

Ortega-Hernandez, O.-D. and Y. Shoenfeld. “Infection, vaccination, and autoantibodies in chronic fatigue syndrome, cause or coincidence?” Ann. N. Y. Acad. Sci., 2009, 1173(Contemporary Challenges in Autoimmunity): 600-609.

Nau, R., et al. “Lyme disease–current state of knowledge.” Dtsch Arztebl Int, 2009, 106(5): 72-81.

Wormser, G. P. and E. D. Shapiro. “Implications of gender in chronic Lyme disease.” J Womens Health (Larchmt), 2009, 18(6): 831-834.

Wahlberg, P. and D. Nyman. “Chronic Lyme borreliosis–fact or fiction?” Duodecim, 2009, 125(12): 1269-1276.

Qureshi, M., et al. “Lyme disease serology in amyotrophic lateral sclerosis.” Muscle Nerve, 2009, 40(4): 626-628.

ALSUntangled update 1: investigating a bug (Lyme Disease) and a drug (Iplex) on behalf of people with ALS.” Amyotrophic Lateral Sclerosis, 2009, 10: 248-250.

Allan, E. J., et al. “Bacterial L-forms.” Adv. Appl. Microbiol., 2009, 68: 1-39.

Wormser, G. P. and I. Schwartz. “Antibiotic treatment of animals infected with Borrelia burgdorferi.” Clin. Microbiol. Rev., 2009, 22(3): 387-395.

Wormser, G. P., et al. “Impact of clinical variables on Borrelia burgdorferi-specific antibody seropositivity in acute-phase sera from patients in North America with culture-confirmed early lyme disease.” Clin. Vaccine Immunol., 2008, 15(10): 1519-1522.

Marques, A. “Chronic Lyme disease: a review.” Infect Dis Clin North Am, 2008, 22(2): 341-360, vii-viii.

Dandache, P. and R. B. Nadelman. “Erythema migrans.” Infect Dis Clin North Am, 2008, 22(2): 235-260, vi.

Steere, A. C., et al. “Prospective study of serologic tests for lyme disease.” Clin Infect Dis, 2008, 47(2): 188-195.

Fallon, B. A., et al. “A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy.” Neurology, 2008, 70(13, Pt. 1): 992-1003.

Hodzic, E., et al. “Persistence of Borrelia burgdorferi following antibiotic treatment in mice.” Antimicrob. Agents Chemother., 2008, 52(5): 1728-1736.

Appel, S., et al. “Infection and vaccination in chronic fatigue syndrome: myth or reality?” Autoimmunity, 2007, 40(1): 48-53.

Wilske, B., et al. “Microbiological and serological diagnosis of Lyme borreliosis.” FEMS Immunol. Med. Microbiol., 2007, 49(1): 13-21.

Feder, H. M., Jr., et al. “A critical appraisal of “chronic Lyme disease”.” N. Engl. J. Med., 2007, 357(14): 1422-1430.

Auwaerter, P. G. “Point: antibiotic therapy is not the answer for patients with persisting symptoms attributable to lyme disease.” Clin. Infect. Dis., 2007, 45(2): 143-148.

Stricker, R. B. “Counterpoint: long-term antibiotic therapy improves persistent symptoms associated with lyme disease.” Clin. Infect. Dis., 2007, 45(2): 149-157.

Wormser, G. P. “Clinical practice. Early Lyme disease.” N Engl J Med, 2006, 354(26): 2794-2801.

Wormser, G. P., et al. “The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America.” Clin Infect Dis, 2006, 43(9): 1089-1134.

Steere, A. C. and S. M. Angelis. “Therapy for Lyme arthritis.” Arthritis Rheum., 2006, 54(10): 3079-3086.

Ivetic Tkalcevic, V., et al. “Anti-inflammatory activity of azithromycin attenuates the effects of lipopolysaccharide administration in mice.” Eur. J. Pharmacol., 2006, 539(1-2): 131-138.

Aguero-Rosenfeld, M. E., et al. “Diagnosis of Lyme borreliosis.” Clin. Microbiol. Rev., 2005, 18(3): 484-509.

Bratton, R. L. and R. Corey. “Tick-borne disease.” Am Fam Physician, 2005, 71(12): 2323-2330.

Rothstein, J. D., et al. “β-Lactam antibiotics offer neuroprotection by increasing glutamate transporter expression.” Nature, 2005, 433(7021): 73-77.

Sanz, M.-J., et al. “Erythromycin exerts in vivo anti-inflammatory activity downregulating cell adhesion molecule expression.” Br J Pharmacol, 2005, 144(2): 190-201.

Cameron, D., et al. “Evidence-based guidelines for the management of Lyme disease.” Expert Rev Anti Infect Ther, 2004, 2(1 Suppl): S1-13.

Steere, A. C., et al. “The emergence of Lyme disease.” J. Clin. Invest., 2004, 113(8): 1093-1101.

Auwaerter, P. G., et al. “Lyme borreliosis (Lyme disease): molecular and cellular pathobiology and prospects for prevention, diagnosis and treatment.” Expert Rev Mol Med, 2004, 6(2): 1-22.

Domercq, M. and C. Matute. “Neuroprotection by tetracyclines.” Trends Pharmacol. Sci., 2004, 25(12): 609-612.

Tamaoki, J., et al. “Clinical implications of the immunomodulatory effects of macrolides.” Am. J. Med., 2004, 117(Suppl. 9A): 5S-11S.

Brownstein, J. S., et al. “A climate-based model predicts the spatial distribution of the Lyme disease vector Ixodes scapularis in the United States.” Environ Health Perspect, 2003, 111(9): 1152-1157

Krupp, L. B., et al. “Study and treatment of post Lyme disease (STOP-LD): a randomized double masked clinical trial.” Neurology, 2003, 60(12): 1923-1930.

Kaplan, R. F., et al. “Cognitive function in post-treatment Lyme disease. Do additional antibiotics help?” Neurology, 2003, 60(12): 1916-1922.

Lathrop, S. L., et al. “Adverse event reports following vaccination for Lyme disease: December 1998-July 2000.” Vaccine, 2002, 20(11-12): 1603-1608.

Sood, S. K. “Effective retrieval of Lyme disease information on the Web.” Clin Infect Dis, 2002, 35(4): 451-464.

Donta, S. T. “Late and chronic Lyme disease.” Med Clin North Am, 2002, 86(2): 341-349, vii.

Collignon, P. J. “11 Antibiotic resistance.” Med J Aust, 2002, 177(6): 325-329.

Alexopoulou, L., et al. “Hyporesponsiveness to vaccination with Borrelia burgdorferi OspA in humans and in TLR1- and TLR2-deficient mice.” Nat. Med., 2002, 8(8): 878-884.

Bockenstedt, L. K., et al. “Detection of attenuated, noninfectious spirochetes in Borrelia burgdorferi-infected mice after antibiotic treatment.” J Infect Dis, 2002, 186(10): 1430-1437.

Schmutzhard, E. “Multiple sclerosis and Lyme borreliosis.” Wien. Klin. Wochenschr., 2002, 114(13-14): 539-543.

Klempner, M. S., et al. “Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease.” N. Engl. J. Med., 2001, 345(2): 85-92.

Wooten, R. M. and J. J. Weis. “Host-pathogen interactions promoting inflammatory Lyme arthritis: Use of mouse models for dissection of disease processes.” Curr. Opin. Microbiol., 2001, 4(3): 274-279.

Steere, A. C. “Lyme disease.” N Engl J Med, 2001, 345(2): 115-125.

Lindgren, E. and R. Gustafson. “Tick-borne encephalitis in Sweden and climate change.” The Lancet, 2001, 358(9275): 16-18.

Gayle, A. and E. Ringdahl. “Tick-borne diseases.” Am Fam Physician, 2001, 64(3): 461-466.

Patel, R., et al. “Death from Inappropriate Therapy for Lyme Disease.” Clin. Infect. Dis., 2000, 31(4): 1107-1109.

Ozinsky, A., et al. “The repertoire for pattern recognition of pathogens by the innate immune system is defined by cooperation between toll-like receptors.” Proc Natl Acad Sci U S A, 2000, 97(25): 13766-13771.

Marques, A. R., et al. “Lack of evidence of Borrelia involvement in Alzheimer’s disease.” J Infect Dis, 2000, 182(3): 1006-1007.

Hirschfeld, M., et al. “Cutting edge: Inflammatory signaling by Borrelia burgdorferi lipoproteins is mediated by toll-like receptor 2.” J. Immunol., 1999, 163(5): 2382-2386.

Lien, E., et al. “Toll-like receptor 2 functions as a pattern recognition receptor for diverse bacterial products.” J. Biol. Chem., 1999, 274(47): 33419-33425.

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Woodrum, J. E. and J. H. Oliver, Jr. “Investigation of venereal, transplacental, and contact transmission of the Lyme disease spirochete, Borrelia burgdorferi, in Syrian hamsters.” J Parasitol, 1999, 85(3): 426-430.

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