Ticks and Lyme Disease

[AJE]

I'm sending out this note to reinforce the information regarding ticks and Lyme disease. There have been reports that folks are encountering a large numbers of ticks while outdoors. News media has also picked up on this, and I've read that the experts attribute the high number of wood ticks and Lyme disease cases reported this year to Wisconsin 's large deer population. Lyme disease is the most frequently reported tick-borne illness in the United States according to CDC.



The best protection from ticks is to avoid areas where there are high numbers of ticks found. But if avoiding these areas is not an option, use clothing, insect repellent, and tick checks to prevent tick bites. :arrow: Take a look at the Centers for Disease Control website below for more information.


Adult Deer Tick

US Department of Health and Human Services,
Centers for Disease Control and Prevention

Use These Simple Measures to Prevent Tick Bites :arrow:
http://www.cdc.gov/ncidod/dvbid/lyme...tion_Avoid.htm

How to remove ticks immediately using fine-tipped tweezers: :arrow:
http://www.cdc.gov/ncidod/dvbid/lyme/ld_tickremoval.htm



State of Wisconsin , Department of Health & Family Services :arrow:
http://dhfs.wisconsin.gov/communicable/LymeDisease/

http://dhfs.wisconsin.gov/news/press...ymedisease.pdf




From left to right: The deer tick (Ixodes scapularis) adult female,
adult male, nymph, and larva on a centimeter scale.

[AJE]

:idea: Incidence of Lyme disease per 100,000 population, by county of residence - United States, 2002.

Travellers acquire Lyme disease when they come into contact with ticks in forested, grassy, or woodland areas of endemic regions. Activities that might put a traveller at risk include camping, walking or working in these areas. Living near or frequenting wooded, grassy areas. Working outdoors such as surveying, landscaping, forestry, gardening, and utility company service work. Lyme disease has a seasonal transmission with highest risk periods during the Spring, Summer and Autumn months.

[AJE]

from Encarta
The bacteria that cause Lyme disease are spread by the deer tick, which has a two-year life cycle. Feeding on infected small animals, the larva of the deer tick becomes infected. The nymph spreads the bacteria by feeding on larger animals including humans. The adult tick breeds and the cycle begins again.







Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans by the bite of infected blacklegged ticks.

Symptoms and signs

Stage 1: Within days to weeks following a tick bite, 80% of patients will have a red, bull’s eye rash (called erythema migrans). The rash can also have areas of necrosis, and there may be multiple rashes. Other lesions may appear on the body. This is often accompanied by a variety of symptoms ranging from fatigue to fever, headache, stiff neck, aches, and pains. Nonetheless, meningitis may be present as well as cranial nerve palsies.



Stage 2: Patients may develop arthritis and periods of swelling, neurological problems, and heart problems (occurs weeks to months after infection).



Stage 3 – Chronic Lyme Disease: This late stage of the disease is characterized by chronic neurological problems and arthritis (occurs months to years after infection). Arthritis is more likely to occur in patients with more extensive problems in stages 1 and 2. Chronic lyme disease is more rare in the young who are treated with antimicrobials in stage 1. People with a particular HLA molecule that matches the OspA outer surface protein are prone to an autoimmune arthritis. This is a serious complication with Lyme disease; the disease may be cured, which is indicated by a lack of bacterial presence in the body, but patients can still be left with a serious arthritis. Early treatment is required to prevent autoimmune responses. Symptoms in this late stage can be variable among patients.

American Lyme Disease Foundation
http://www.aldf.com

[AJE]

FDA APPROVES FIRST LYME DISEASE VACCINE

December 21, 1998

FDA today licensed the first vaccine to aid in the prevention of Lyme disease, which is transmitted to people through the bites of ticks infected with the bacterium Borrelia burgdorferi. The new vaccine (trade-name Lymerix) is approved for use in people 15 to 70 years of age who live or work in grassy or wooded areas where these infected ticks are present.
Although Lymerix may provide protection for a majority of people, it does not prevent all cases of Lyme disease. Therefore, people should continue to take standard preventive measures against infection, including wearing protective clothing, using tick repellent and removing attached ticks.

Lymerix contains a genetically engineered protein from an outer surface protein of B. burgdorferi, the spiral shaped bacterium that is responsible for Lyme disease. The surface protein, called OspA, stimulates antibodies that appear to disable the bacterium's ability to infect the individual.

"For people who spend a lot of time outdoors in areas where Lyme disease is common, this new vaccine may be a good option," said Dr. Jane E. Henney, FDA Commissioner. "However, this vaccine's effectiveness depends on people getting all three doses over the period of a year. We also want to emphasize that the vaccine is not 100% effective, so other precautions should be taken."

Lyme disease, which is rarely fatal, typically (but not always) causes a characteristic "bull's eye" rash and flu-like symptoms in the early stages of infection, and occasionally facial weakness and heart problems. In the later stages of the disease, months or years later, some patients may have chronic arthritis or neurologic problems.

Since the Centers for Disease Control and Prevention (CDC) first began tracking cases for Lyme disease in the U.S. in 1982, over 99,000 cases have been reported. More than 16,000 cases were reported by 45 states to CDC in 1996, the last year for which complete statistics are available. Most cases in the U.S. have been reported in the Northeast, upper Midwest and Pacific coastal states.

The randomized, multi centered, placebo-controlled trial of Lymerix involved almost 11,000 people between 15 and 70 years of age, and was conducted in the northeast U.S. and Wisconsin, where Lyme disease is common. Individuals received three doses of vaccine at 0, 1, and 12 months, and then were followed for 20 months after the first injection or through two tick seasons. After two doses of the vaccine in the first year of the trial, the protection rate against definite Lyme Disease was 50% and in the second year, after three doses, it was 78%.

The time of year when people get vaccinated with Lymerix may be important. In the clinical trial, conducted over two years in the northeast U.S, safety and efficacy were shown when the vaccine doses were given between January and April, shortly before the peak tick season in the northeast U.S. It is not currently known how long protection against Lyme disease lasts after vaccination.

The vaccine was given to healthy individuals, and was generally well tolerated. Local injection site reactions, including redness, soreness, and swelling, were common. Most other adverse events, such as flu-like symptoms and muscle and joint pain, occurred less frequently and were mild to moderate.

People were excluded from the clinical trial if they were pregnant or if they had chronic joint or neurologic illnesses related to Lyme disease, diseases such as rheumatoid arthritis associated with joint swelling, or certain heart conditions. Therefore, limited safety data are available for these individuals.

No data are available for people under 15 or over 70 years of age. The vaccine is not currently approved for use in children less than 15 years of age.

Lymerix will be marketed by SmithKline Beecham Pharmaceuticals, Philadelphia, PA.

:arrow: To all the bubbler folks and visitors who read this: I would consider the 11-month course of doctor visits to get vaccinated. Don't worry its only a few times! My family was vaccinated the moment this was available back in 1998 and it has been a Godsend; since we are very active in outdoor activates.

This is a vaccine used to provide protection against Lyme disease. This vaccine is not a treatment for Lyme disease.:

:arrow: HOW TO USE: This medication is given into a muscle (IM) at 0, 1, and 12 months as directed for a total of 3 doses. The second and third doses should be given several weeks before exposure to areas with infected ticks that cause Lyme disease. All three doses are needed to provide maximum protection.

[AJE]

LYME DISEASE AND BABESIOSIS (TAKEN FROM A MEDICAL LIBRARY)


:cry: :cry: :cry: :cry: :cry: Lyme disease vaccine is no longer available. :cry: :cry: :cry: :cry: :cry:

The manufacturer of LYMErix™ discontinued the manufacture and sale of this vaccine in March 2002 and requested immediate cessation of its administration and return of existing stock.

INTRODUCTION:
Lyme disease and babesiosis are both tick-borne diseases that occur most commonly in areas of the United States and Europe. The etiologic agent of Lyme disease in the United States is Borrelia burgdorferi sensu stricto, while B. afzelii and B. garinii are responsible for cases in Europe. Babesiosis is a zoonosis caused by intraerythrocytic protozoan parasites belonging to the genus Babesia, notably B. microti in the United States, and B. divergens and B. bovis in Europe. The incidence of Lyme disease in the United States has been increasing steadily since surveillance began in 1982, and it has now become the most common vector-borne disease in the country. There were 17,730 cases reported in 2000.

MODE OF TRANSMISSION:
Both Lyme disease and babesiosis are transmitted chiefly by the bite of hard ticks of the Ixodes ricinus complex. These ticks undergo several molts before reaching the adult stage, and they need a blood meal to complete each of the developmental steps. However, because the transmission efficiency increases with duration of attachment to the human host, the nymphal stages, which are much smaller and therefore more difficult to spot than adult ticks, are more likely to transmit infectious agents to humans. Babesiosis can also be transmitted by transfusion of blood products from infected donors, but the risk, even in endemic areas such as Connecticut, has been estimated to be only around 0.17 percent.Erythema migrans, the most common initial manifestation of Lyme disease, characteristically appears 7 to 10 days after the initial infection. Symptoms of babesiosis typically appear 1 to 4 weeks after the infecting bite, but transfusion-acquired cases can have incubation periods of up to 9 weeks.

EPIDEMIOLOGY:
In the United States, there are 3 regions of high Lyme disease activity: the area from Maine to Maryland in the Northeast, Wisconsin and Minnesota in the Midwest, and northern California and Oregon on the West Coast, with the center of the country exhibiting little or no risk of transmission. Although cases of Lyme disease have been reported from 48 states, over 90% of them are acquired in Connecticut, Rhode Island, New York, New Jersey (especially Hunterdon County), Delaware, New Hampshire, Vermont, Pennsylvania, Wisconsin, Maryland, or Massachusetts. Lyme disease is also present in several Canadian provinces, most notably southeastern Ontario and the southern coast and islands of British Columbia.In Europe including Russia to its far eastern regions, Lyme disease occurs in most countries and is distributed throughout forested areas. Most cases are concentrated in Germany, Austria, Switzerland, the Netherlands, the Czech Republic, Slovenia, and Sweden. (See individual country entries in Travax/Encompass.) Small numbers of cases have been documented in China and Japan. Countries where lyme borreliosis may occur but its presence has not been confirmed by isolation of the spirochete include Brazil, Bolivia, Colombia, Venezuela, Mexico, Australia, Egypt, Korea, Taiwan, Israel, Algeria, and Tunisia and Turkey.Most cases of human babesiosis in the United States occur in the Northeast, particularly the offshore islands of Massachusetts (Nantucket and Martha's Vineyard) and New York (Long Island, Center Island and Fire Island), as well as Rhode Island, Connecticut, Maryland, New York State, and Virginia. The prevalence in Europe is much lower than in the United States, and most cases have occurred in France, the former Yugoslavia, Ireland, the Commonwealth of Independent States, and the United Kingdom. Additionally, human babesiosis is present in areas of China, Egypt, Mexico, South Africa, and Taiwan.Both Lyme disease and babesiosis are typically acquired during the summer months, when both ticks and human outdoor presence are most active.

RISK FACTORS:
Travelers at high risk for acquiring tick-borne diseases are those who engage in outdoor activities such as hiking and camping in forested or brushy areas where deer and rodents abound. Splenectomized and other immunosuppressed persons are at risk for severe forms of babesiosis and should avoid exposure to ticks whenever possible.

CLINICAL PRESENTATION:
Lyme disease can involve the skin, musculoskeletal, neurological, and cardiovascular systems. In more than 80% of cases in the United States, the initial clinical manifestation of Lyme disease is erythema migrans, a localized, well defined circular erythematous rash that develops around the site of the infecting tick bite and expands slowly over the course of days, eventually developing a central clearing that produces the characteristic "bullseye" or target appearance. Influenza-like symptoms commonly accompany the skin lesion. Patients with spirochetemia during this phase can develop multiple erythema migrans lesions, a condition that should be differentiated from the very similar lesions of erythema multiforme. Early disseminated disease occurs a few weeks after the beginning of symptoms and presents with neurological involvement in up to 15% or with cardiac involvement in up to 5% of untreated patients. Most often, early neuroborreliosis manifests with a lymphocytic meningitis and diverse forms of peripheral neuropathy, including facial palsy. Other patients may develop subtle encephalitis with mental status changes, cerebellar ataxia, myelitis, or optic neuritis. Cardiac involvement is usually in the form of atrioventricular or bundle branch blocks, or rare cases of myopericarditis that can be severe or even fatal. In Europe and Asia, erythema migrans tends to be a more indolent, localized lesion, but neurologic involvement seems to occur more often than in the United States.Although self-limited arthralgia and arthritis can occur early in the course of Lyme disease, a chronic, recurrent arthropathy that resembles juvenile rheumatoid arthritis occurs in up to 60% of untreated patients in the U.S. after months of illness onset. After a few attacks of arthritis, some patients develop a treatment-resistant inflammatory process of the joints. Up to 5% of untreated patients can develop chronic neuroborreliosis, which in the United States presents with mild encephalopathic changes and ill-defined cognitive and mood disorders. In Europe, B. garinii causes a more severe form of chronic involvement, with encephalomyelitis, spastic paraparesis, and cranial neuropathy in addition to the cognitive disturbances. Also in Europe and Asia, patients infected with B. afzelii can develop a chronic rash called acrodermatitis chronica atrophicans, the first manifestation of Lyme disease ever described. Both in Europe and in the United States, asymptomatic seroconversion and an acute constitutional illness without focal manifestations are also part of the disease spectrum.The clinical presentation of babesiosis is markedly different between the United States and Europe. In the U.S., almost half of the patients have a mild to moderate illness, with a mortality rate of around 6.5%, at least in New York State. In Europe, the vast majority of cases have occurred in asplenic individuals, with a fatality rate in excess of 90%. Presenting symptoms include malaise, anorexia, fatigue, and headaches, followed by high fevers, chills, drenching sweats, and severe myalgias. Severe cases develop signs of a hemolytic syndrome with anemia, jaundice, hypotension, and liver dysfunction. Because of the common mode of transmission, up to 10% of patients with Lyme disease in southern New England have concomitant babesiosis, while serologic or clinical evidence of babesiosis is found in up to 20% of patients presenting with Lyme disease.Persons who had received Lyme disease vaccine (no longer available) will later demonstrate a false-positive test for B. burgdorferi. The Western blot test is not affected by the vaccine and is the preferred laboratory test to establish or exclude a diagnosis of Lyme disease in persons who have received the Lyme disease vaccine.

PREVENTION STRATEGIES:
Strategies to prevent Lyme disease include avoidance of the vector and prophylactic antibiotics. Standard insect precautions include the use of repellent-impregnated clothing, ideally long sleeves and trousers. These precautions reduce but do not eliminate the risk of tick bites. Since the vector needs to remain attached to its host for a relatively prolonged period of time to transmit B. burgdorferi efficiently, the most practical measure is probably mutual daily "tick checks" under a bright light while in the endemic area. If possible, hikers should stay on well-cleared trails when crossing wooded areas. A single dose of doxycycline, 200 mg orally, has been shown to be 87% effective for the prevention of erythema migrans in persons who had had a documented I. scapularis bite within the previous 72 hours. There is no longer a vaccine to protect against Lyme disease.No vaccines or prophylactic antibiotic regimens are available for babesiosis, so the general tick avoidance measures mentioned before for Lyme disease are the main strategy for the prevention of this disease.

NEED FOR MEDICAL ASSISTANCE:
Ticks found attached to a person's body should be promptly removed as described in the infestations article (see "Infestations") and ideally should be saved in a glass container for later identification. A dose of doxycycline seems to confer protection against Lyme disease after a documented I. scapularis bite, and may be considered for self-treatment in this situation if it is anticipated that medical care will not be available within 72 hours of the exposure. Any symptoms of Lyme disease or babesiosis in a returned traveler from an endemic area require medical evaluation, as both diseases are readily treatable in the early stages, and untreated cases may have serious consequences.

[AJE]

VA Offers Tips on Tick Bite Protection
19 Jun 2005

Ticks carry diseases that can be transmitted to humans and animals. In the U.S., there are 82 species of ticks that collectively can cause nine major diseases, according to the American College of Emergency Physicians. The most common diseases caused by ticks are Rocky Mountain Spotted Fever and Lyme Disease. Most tick-related diseases have symptoms similar to the flu, such as high fever, headache, muscle aches, vomiting, and loss of appetite.

Deer ticks can transmit Lyme Disease. Most cases of Lyme Disease occur in the Northeast from Maryland to Maine; in the North-central states, mostly in Wisconsin and Minnesota; and on the West Coast, particularly northern California. The risk of being bitten by an infected tick is greatest in the summer months, especially in May and June. The Department of Veterans Affairs (VA) offers the following tips to protect yourself from tick bites as you step outdoors this summer.

-- Wear light colors so it is easier to see ticks;
-- Use insect repellent containing DEET and follow the label directions;
-- Wear long pants, long-sleeved shirts, shoes and socks;
-- Tuck pant bottoms into sock tops to keep ticks from getting under clothing; and,
-- Conduct a head-to-toe examination of yourself and your children after being outdoors.
If you are bitten by a tick, remove it using fine tweezers to grasp the tick as close to the surface of the skin as possible. Pull firmly but gently and do not jerk or twist. Be careful not to puncture the body of the tick since its fluids may contain infectious agents. Apply alcohol to the wound. Notify your health care provider and preserve the tick in alcohol for identification.

For more information, contact your local VA medical center or visit http://www.nchpdp.med.va.gov.

Veterans Affairs (VA) R&D
103 S. Gay St., Ste 517
Baltimore, MD 21202
United States
http://www.va.gov/resdev