Tick Talk

Tick Talk Time
Spring is here. Flowers are blooming. Grass is growing. And disease-carrying ticks are
beginning to stir after a brief, mild winter. Time to start thinking about how to recognize and
prevent Lyme disease, that backyard nuisance spread by the bite of the impossibly small deer
tick.
So far this year, Maryland has reported 97 cases to the Centers for Disease Control and
Prevention (CDC). Last year there were 1,211 cases in Maryland, and a total of 21,304 cases
throughout the U.S.
Lyme disease is a multistage, inflammatory infection caused by the bacterium Borrelia
burgdorferi. Most of the time the infection presents as a “bull’s-eye” skin rash with various
arthritic, neurologic or cardiac symptoms. Fortunately, these infections respond well to
antibiotics when caught early.
In 2000, the Infectious Disease Society of America (IDSA) published clinical guidelines
to aid physicians in recognizing and treating Lyme disease. After six more years of clinical
experience and research, those guidelines have been updated. The new guidelines will be
published in the journal, Clinical Infectious Diseases, and will be available on the IDSA web site
(www.idsociety.org). In addition, the CDC recently published physician guidance for
diagnosing and treating other tick-borne infections, including Rocky Mountain spotted fever,
ehrlichiosis, and anaplasmosis.
Lyme disease remains the most common insect-borne infection in the U.S. Ninety-five
percent of cases come from Maryland and eleven other states. In order to get an idea of the cost
of preventing and treating Lyme infections, researchers from the CDC and the University of
1
Maryland studied five Lyme endemic counties on the Eastern Shore during 1997-2000. Looking
at all dollar costs and all types of cases, they found the median—or typical—cost of Lyme
disease per person was $281.00. They also found the average cost per case decreased over the
course of the study period. That may mean more people are taking better precautions against
ticks and visiting their doctors more frequently. Physicians also may be ordering more blood
tests and providing faster antibiotic treatments.
The study was limited in scope, and the researchers noted that “more research on the
social behavior of…patients and economic evaluation of…prevention interventions is needed.”
Perhaps they could start by looking at the demise and possible rebirth of the Lyme disease
vaccine.
In the 1990’s Lyme disease activists were pushing federal agencies and researchers for a
vaccine. In 1997, activists persuaded a number of U.S. Senators (including Barbara Mikulski) to
write to the Food and Drug Administration urging a speedy review of new Lyme vaccine
applications. One of the vaccines, Lymerix, was approved for general use in December 1998.
By February 2002, it was off the market.
Sales were poor. Large numbers of people were unwilling to pay $100 for a vaccine that
required three shots and an annual booster to protect them from a non-fatal, non-communicable
infection that was confined to a handful of states.
In the interval between vaccine approval and withdrawal, some vaccine recipients and
activists complained that the vaccine induced an autoimmune arthritis. The FDA and CDC
investigated 905 adverse reaction reports but found no correlation between Lymerix and arthritis.
Still, the absence of harm or causality never got in the way of expensive litigation. A lawsuit
was filed in Philadelphia and the vaccine maker eventually settled with $1,064,247 in fees and
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costs to the lawyers. (As far as I know, no patient received any money from the settlement.) So
ended the ten-year quest for a Lyme vaccine in the U.S.
Surprisingly, the Lyme vaccine has been resurrected in Europe. Baxter Vaccines in
Vienna, Austria has developed a second-generation vaccine based on the work of American
scientists at Brookhaven Labs on Long Island. The new vaccine has been designed to protect
against the three species of Borrelia bacteria that cause Lyme disease in Europe. (There’s only
one in the U.S.) In addition, part of the vaccine’s structure allegedly associated with
autoimmune arthritis complaints has been removed—making this the first vaccine specifically
designed to protect against both an infection and litigation.
Based on preliminary trials, the new Lyme vaccine appears to be safe and effective.
Perhaps this new vaccine will find a more favorable market in Europe. Europeans tend to have
more serious, neurologic forms of Lyme disease so they may be more inclined to pay for a
vaccine. They also tend to be less litigious, and many Europeans have prior experience with
another vaccine against a dangerous viral infection called tick-borne encephalitis.
In the absence of a U.S. vaccine for Lyme disease, we’ll just have to continue relying on
personal preventive measures, experienced physicians, and luck. Readers can find out more
about preventive measures from the CDC (www.cdc.gov) and the American Lyme Disease
Foundation (www.lyme.com).

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Tick Talk Time

throughout the U.S.

Lyme disease is a multistage, inflammatory infection caused by the bacterium Borrelia

arthritic, neurologic or cardiac symptoms. Fortunately, these infections respond well to

antibiotics when caught early.

(www.idsociety.org). In addition, the CDC recently published physician guidance for

ehrlichiosis, and anaplasmosis.

tests and providing faster antibiotic treatments.

social behavior of…patients and economic evaluation of…prevention interventions is needed.”

By February 2002, it was off the market.

infection that was confined to a handful of states.

ended the ten-year quest for a Lyme vaccine in the U.S.

designed to protect against both an infection and litigation.

another vaccine against a dangerous viral infection called tick-borne encephalitis.

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