LYME DISEASE – WHAT YOU SHOULD KNOW

By Daniel Mussatti, Campers Monthly, May 2000

            Lyme disease has probably been with us for quite some time, but only recently has it been diagnosed as a unique disease. 

            By the beginning of the twentieth century, medical records began to become common, and medical files show reports of a Lyme-like rash in Europe.  Similar diseases have also been reported in Asia and Australia.  Lyme disease probably spread from Europe to America by infected immigrants or on rodents carried to America on ships, but the disease did not reach noticeable proportions until the early 1970’s. 

            Doctors first identified Lyme disease in 1975, when an unusually high number of children in and around Old Lyme, Connecticut, were diagnosed with juvenile rheumatoid arthritis.  Medical investigators noticed most of the children lived in or near heavily wooded areas (areas most likely to have ticks), many began showing arthritis-like symptoms in the summer (the height of the tick season), and a number of the affected children reported a rash and/or tick bite soon before the onset of their symptoms.  Eventually, the disease was traced to a tiny blood sucking arachnid:  the tick. 

            Deer ticks in the East and North-central United States (also known as the black-legged tick in the West) carry the bacteria Borrelia burgdorferi, which causes Lyme disease.  Ticks live for two years and go through three developmental stages.  Between each stage, the tick must have one blood meal to survive, after which they molt and transform into the next stage of development. 

            Adult deer ticks mate in the autumn, then gorge themselves on blood to incubate their eggs, which are deposited on the ground.  These eggs hatch into larvae in early spring.  Consequently, the warmer the winter, the more ticks that survive from the egg to the larval stage.  Laval deer ticks are not born carriers and therefore their bite is harmless.  Instead, they become infected when they feast on an infected host, typically field mice. 

            Most cases of Lyme disease come from nymph tick bites, because nymphs are smaller than a sesame seed.  Easily overlooked, they stab their host with pincers equipped with fishhook-like barbs designed to keep them attached until they are done feasting.  As an added insurance against being brushed off, ticks also secrete an adhesive in their saliva that “glues” their pincers in place.  When an adult or nymph tick attaches itself to its host, it gorges itself on blood, remaining attached for up to two days.  Generally, it takes about 10 to 24 hours for the infected tick to transmit the bacteria of Lyme disease to the host. 

            An adult female deer tick is about half the size of a lowercase “o” in this article.  After feeding, the female swells to about the size of a capital “O” or larger.  While adult ticks are more active, they are easier to find before they have had time to transmit the Lyme disease bacteria. 

            People with pets face the greatest risk of exposure to ticks at the fringe areas between grasslands and woodlands.  Unlike fleas, ticks do not jump or fly.  Instead, they perch on tall grasses and bushes (not trees) and wait for a passing warm-blooded animal to brush against them.  Once on their host, it crawls to a safe and secluded spot to begin feeding.  Ticks prefer hidden and hairy areas such as the crotch, armpits, and scalp, but any area covered by clothing will seem like a good hiding place. 

            Bug sprays offer excellent protection from ticks.  During hunting season, if scent is a factor, hunters can be reasonably safe from tick bites by tucking pant legs into the tops of boots, putting elastic or rubber bands around shirt and jacket cuffs, and by performing a thorough inspection (for ticks and rashes) each night.  Since it takes so long for a tick to transmit Lyme disease, such a daily regimen can significantly reduce the chances of becoming infected. 

            Since Lyme disease can affect animals as well as humans, whitetail deer hunters and pet owners may wonder about other means of transmitting the disease.  However, the CDC has found no evidence of disease transmission from direct contact with an infected animal, nor has there been any proof of transmittal through contact with infected blood or urine. 

            Since its discovery in the late 1970’s, Lyme disease has become the largest bug-borne disease problem in the United States. 

            According to the Center for Disease Control (CDC), the number of reported cases of Lyme disease in the U.S. has risen at an alarming rate of nearly eighty percent per year, with most cases occurring in seven Northeastern seaboard and Midwestern states (Connecticut, Massachusetts, Rhode Island, New Jersey, New York, Wisconsin, and Minnesota). 

            Between 1980 and 1998, these seven states accounted for more than 91 thousand cases of Lyme disease – nearly three quarters of all reported cases.  According to Dr. David Schofield of SmithKline Beecham, studies indicate as few as one case of Lyme disease in ten actually gets reported to the CDC, which may indicate the true level of infection between 1980 and 1998 was about one and a quarter million cases. 

            For about half of the people affected, the first identifiable symptom of Lyme disease is a rash that appears within a few weeks of a bite, starts out small, and grows in a triangular, oval, or circular pattern for a period of days.  Often, the rash looks like a bull’s eye as it expands, leaving the central area normal in coloration.  There is no predictable size to a Lyme disease rash; nor is there a guarantee an infected person will develop a rash at all. 

            In about half of the cases studied by the CDC, the patient showed no outward sign of infection.  When rashes do occur, they can be as small as a dime or cover an entire stomach or back.  As the infection spreads, additional rash spots may appear on other parts of the body.  Flu-like symptoms such as fever, headache, stiffness, body aches, and fatigue often occur in conjunction with the rash. 

            After several months, more than half of those people not treated with antibiotics develop bouts of painful swollen joints that can last from a few days to a few months.  These recurring attacks, if untreated, can develop into chronic arthritis.  Less than one out of ten Lyme disease patients develops heart problems, such as an irregular heartbeat.  These symptoms rarely last more than a few days or weeks and generally surface several weeks after infection. 

            Lyme disease can also affect the nervous system, causing severe headaches, temporary paralysis of facial muscles (Bell’s palsy), numbness, weakness in the limbs, and poor motor coordination.  Memory loss, difficulty with concentration, mood swings and changes in sleeping habits have also been associated with Lyme disease.  Such nervous system disorders may develop several years following an untreated infection.  

            When caught in the early stages, Lyme disease can be readily treated with antibiotics.  If, however, the disease is not caught until its later stages, victims may need to undergo intravenous antibiotic therapy and may never fully recover.  For many people, the long-term risk of heart disease and arthritis far outweighs the cost of preemptive treatment.  Hence, many outdoor enthusiasts visit their doctor and load up on antibiotics the moment they find a tick bite.  But, according to a recent article in the Journal of the American Medical Association, many people are being treated unnecessarily.  Most people who are bitten by ticks will never develop Lyme disease, and the onset of symptoms in those who do is slow enough that there is no discernible risk to waiting for symptoms to develop. 

            Now, after years of research and study, SmithKline Beecham has developed a vaccine — LYMErix™ that may be the key to preventing infection among outdoor workers and recreational enthusiasts. LYMErix™ works by stimulating the production of antibodies that attack Lyme disease bacteria. 

            The vaccine has been approved for use in adults between 15 to 70 years old, and it takes six months to administer, according to FDA guidelines. 

            After the first shot, FDA recommends a second vaccination be given a month later, and the final dose be administered six months after the first.  According to Dr. David Schofield, SmithKline Beecham is studying faster vaccination schedules and, by the end of the year 2000, they will have determined a schedule for periodic booster shots, as well. 

            Lyme disease is not rare, and there is plenty of evidence it is on the increase.  Now, with the new LYMErix™ vaccination available, you can reduce that danger even farther.  For more information, contact your health care provider and check out the Center for Disease Control at www.cdc.aov and the Lyme Disease Foundation at www.cdc.gov or write them at:  

Lyme Disease Foundation
One Financial Plaza, 18^th Floor
Hartford, Connecticut  06103

A NEW VACCINE FOR LYME DISEASE

(SHAPE magazine, May 2000)   

In spring and summer, the woods are thick with a new crop of young ticks itching for a warm body.   And if they're deer ticks or Pacific Coast black-legged ticks, they may well be carrying Lyme disease.  Although it's not fatal, this disease can debilitate:   Symptoms, which vary greatly and may not appear until weeks after the bite, include a long-lasting "bull's-eye" rash (either at the bite site or elsewhere), fever, aches, chills and, in untreated people after about two months, chronic arthritis.   (There is a blood test to detect Lyme, but it's not always reliable.)

The good news for people who live in Lyme-disease regions (the East Coast, Minnesota, Wisconsin and northern coastal California) is the introduction of a vaccine in 1999.  The vaccine isn't effective until you've had three shots - usually over a year, though some doctors give it on a six-month schedule.  In the meantime, wear light-colored clothing and inspect for the tiny, round, black ticks after each outing.  The Centers for Disease Control recommend using an insect repellent containing DEET.  (DEET is the only chemical that effectively keeps ticks away, and the CDC considers it safe at the doses detailed on the repellent's packaging.)

If you do find an imbedded tick, pull it out carefully with tweezers and clean the wound with antiseptic.  If a rash develops, an antibiotic should prevent more serious symptoms from developing.  If caught early, you'll need three to four weeks of an oral antibiotic like amoxicillin.  If caught a few weeks after, you may need penicillin shots for four weeks.  Because antibiotics are less effective once the disease has taken hold, you may require another round of oral or injected antibiotics.

Please note:  While LYMErix™ may work for many people, an issue has arisen in connection with approximately 30% of the population who could run into problems with the vaccine itself.  Below are various published articles on this problem:

Consumer Reports, June 2000:

A tick fix?

In late 1998 the FDA approved LYMErix, a vaccine intended to prevent Lyme disease in people 15 to 70 years old.  The vaccine is given as three shots over a year's time and is about 78 percent effective (22 percent of vaccinated people remain susceptible to Lyme disease).   If a vaccinated person is later infected, a blood test will still indicate the infection.  The cost of LYMErix - $200 to $300 - may be covered by insurance; check your plan.

In the vaccine's first year on the market, the FDA received 385 reports (mine was one) of adverse reactions, 28 of which were serious; they included a type of chronic arthritis, perhaps from an autoimmune response.  In fact, a class-action suit has been filed in Pennsylvania on behalf of people who claim they got arthritis as a result of vaccination.   The vaccine's maker, SmithKline Beecham says safety trials found no link between autoimmune arthritis and LYMErix.  Still, the national Centers for Disease Control and Prevention says LYMErix should be considered for people "whose exposure to tick-infested habitat is frequent or prolonged."  Check with your doctor:   The CDC also posts useful information at www.cdc.gov/epo/mmwr/preview/mmwrhtml/rr4807a1.htm.

Further to the problems with the vaccine itself, below is an article which appeared in the Appalachian Mountain Club April 2000 publication:

LYME VACCINE ALERT

With the arrival of spring comes a new crop of ticks - and new worries about Lyme disease.  If you are considering LYMErix, the vaccine from SmithKline Beecham, there's something you should know.  A national class-action suit claims the vaccine can trigger an incurable arthritis in those with a certain genetic marker - about 30 percent of the population - even if they were never infected by a tick.  The suit also claims the vaccine could awaken dormant cases of Lyme disease.

SmithKline officials declined to comment, but the lawyers who filed the suit suggest that anyone considering the vaccine should first have a blood test for the genetic marker HLA-DR4+.  If you test positive, or if you've already received the vaccine and are suffering symptoms of arthritis such as joint pain, consult your doctor.  For more on the lawsuit, visit www.LymeNet.org.