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
- Use fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible.
- 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.
- After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol, an iodine scrub, or soap and water.
- 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
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