Lyme Disease Prevention and Vaccine Prophylaxis
Abstract
Abstract
OBJECTIVE:
To provide a comprehensive review of the epidemiology, diagnosis, and prevention of Lyme disease with a focus on the Lyme disease vaccine.
DATA SOURCE:
A computerized search of MEDLINE (January 1996–December 1998) was used to identify articles regarding Lyme disease, Borrelia burgdorferi, epidemiology, prevention, and vaccine.
DATA SYNTHESIS:
Lyme disease is a condition caused by infection with B. burgdorferi. The organism is carried by certain species of Ixodes ticks and is the most common tick-borne disease in the US. In patients with clinical manifestations of Lyme disease, various pharmacotherapeutic approaches have proven effective in treatment of the clinical features. Prevention strategies exist; however, their application is sometimes difficult. A vaccine for the prevention of Lyme disease is available, and another is being considered for approval. The recombinant outer surface protein A (OspA) vaccines to prevent Lyme disease are immunogenic and have an acceptable adverse effect profile. These vaccines are highly efficacious for the prevention of Lyme disease.
CONCLUSIONS:
Lyme disease is the most common tick-borne disease in the US. The infection, caused by B. burgdorferi, results in dermatologic, neurologic, cardiovascular, and musculoskeletal manifestations. Until recently, tick bite prevention strategies were the only means of decreasing the risk of acquiring the infection. The OspA vaccines are efficacious for the prevention of infection. Although universal immunization with these vaccines is unlikely, the availability of effective vaccines represents an important tool for the prevention of Lyme disease in endemic regions of the US.
Resumen
OBJETIVO:
Proveer un repaso comprensivo sobre la epidemiología, diagnosis, y prevención de la enfermedad de Lyme enfocando en el uso de la vacuna contra esta enfermedad infecciosa.
FUENTES DE INFORMACIÓN:
Se llevó a cabo una búsqueda en el banco de datos de MEDLINE para identificar artículos usando términos relacionados a la enfermedad de Lyme, Borrelia burgdorferi, epidemiología, prevención, y vacuna.
SÍNTESIS:
La enfermedad de Lyme es una condición causada por la infección con el organísmo llamado B. burgdorferi. Este organísmo es transmitido por medio de ciertas especies de garrapatas llamadas Ixodes, y constituyen una de las enfermedades de garrapatas más comunes en los Estados Unidos. Existen varios tratamientos farmacoterapéuticos que han sido provado efectivos en el tratamiento de pacientes con manifestaciones clínicas de la enfermedad de Lyme. Existen también otras estrategias preventivas, pero sus applicaciones han sido difíciles de implementar. Vacunas capaces de prevenir el desarrollo de la enfermedad de Lyme están sido investigadas. Las vacunas recombinantes derivadas de la proteína superficial externa A (OspA) que previenen la enfermedad de Lyme son inmunogénicos y tienen un perfil de efectos adversos aceptables. Estas vacunas son altamente eficaces en prevenir la enfermedad de Lyme.
CONCLUSIONES:
La enfermedad de Lyme es una de las enfermedades de garrapatas más comunes que ocurren en los Estados Unidos. La infección causada por el organísmo B. burgdorferi puede resultar en manifestaciones dermatológicas, cardiovasculares, y musculoesqueléticas. Hasta reciente, la única manera de disminuir el riesgo de adquirir esta infección era promedio del uso de estrategias que prevenien la mordida del garrapato. Las vacunas OspA son eficaces en prevenir esta infección. Aunque la inmunización universal es improbable, la disponibilidad de estas vacunas efectivas representan un instrumento importante en la prevención de la enfermedad de Lyme en regiones endémicas de los Estados Unidos.
Résumé
OBJECTIF:
Réviser de façon exhaustive l'épidémiologie, le diagnostic, et la prévention de la maladie de Lyme à l'aide d'un vaccin.
REVUE DE LITTÉRATURE:
Une recherche informatisée (MEDLINE) a permis l'identification d'articles concernant la maladie de Lyme, le Borrelia burgdorferi, son épidémiologie, sa prévention et son vaccin.
RÉSUMÉ:
La maladie de Lyme est une maladie causée par une infection à B. burgdorferi. Cet organisme est transporté par certaines espèces de tiques Ixodes et l'infection résultante constitue la maladie causée par des tiques la plus fréquente des étas-Unis. Chez les patients avec des symptômes cliniques de la maladie, plusieurs approches thérapeutiques sont efficaces. Des stratégies de prévention existent, bien que leurs applications soient difficiles. Des vaccins permettant la prévention de la maladie sont présentement en étude clinique. Le vaccin d'origine génétique impliquant la protéine A de surface (OspA) est immunogénique et présente des effets secondaires tolérables. Ces vaccins sont très efficaces dans la prévention de la maladie de Lyme.
CONCLUSIONS:
La maladie de Lyme est la plus fréquente maladie causée par des tiques aux États-Unis. L'infection causée par B. burgdorferi cause des malaises dermatologiques, neurologiques, cardiovasculaires, et musculosquelettiques. La stratégie de prévention des piqûres des tiques était jusqu'à récemment la seule mesure efficace. Le développement du vaccin a l'OspA efficace représente un outil important dans la prévention de la maladie de Lyme dans les régions endémiques.
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References
1. Centers for Disease Control and Prevention. Lyme disease cases reported to CDC by state health departments, 1982–1997. Available at: http://www.cdc.gov/ncidod/dvbid/ld82_97.pdf. Accessed May 24, 1999.
2. Sigal LH. Myths and facts about Lyme disease. Cleve Clin J Med 1997;64: 203–9.
3. Meek JI, Roberts CL, Smith EV Jr, Cartter ML. Underreporting of Lyme disease by Connecticut physicians, 1992. J Public Health Manag Pract 1996;2: 61–5.
4. Coyle BS, Strickland GT, Liang YY, Pena C, McCarter R, Israel E. The public health impact of Lyme disease in Maryland. J Infect Dis 1996;173: 1260–2.
5. Steere AC, Grodzicki RL, Kornblatt AN, Craft JE, Barbour AG, Burgdorfer W, et al. The spirochetal etiology of Lyme disease. N Engl J Med 1983;308:733–40.
6. Benach JL, Bosler EM, Hanrahan JP, Coleman JL, Habicht GS, Bast TF, et al. Spirochetes isolated from the blood of two patients with Lyme disease. N Engl J Med 1983;308:740–2.
7. Steere AC. Lyme disease. N Engl J Med 1989;321: 586–96.
8. Evans J. Lyme disease. Curr Opin Rheumatol 1997;9: 328–36.
9. Sood SK, Salzman MB, Johnson BJ, Happ CM, Feig K, Carmody L, et al. Duration of tick attachment as a predictor of the risk of Lyme disease in an area in which Lyme disease is endemic. J Infect Dis 1997;175:996–9.
10. Piesman J, Mather TN, Sinsky RJ, Spielman A. Duration of tick attachment and Borrelia burgdorferi transmission. J Clin Microbiol 1987;25: 557–8.
11. Fish D. Environmental risk and prevention of Lyme disease. Am J Med 1995;98 (suppl):2S–8S.; discussion 8S–9S.
12. Verdon ME, Sigal LH. Recognition and management of Lyme disease. Am Fam Physician 1997;56:427–36, 439–40.
13. Gerber MA, Shapiro ED, Burke GS, Parcells VJ, Bell GL. Lyme disease in children in southeastern Connecticut. Pediatric Lyme Disease Study Group. N Engl J Med 1996;335: 1270–4.
14. Sigal LH. The Lyme disease controversy. Social and financial costs of misdiagnosis and mismanagement. Arch Intern Med 1996;156: 1493–500.
15. Centers for Disease Control and Prevention. Recommendations for test performance and interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease. MMWR Morb Mortal Wkly Rep 1995;44:590–1.
16. Tugwell P, Dennis DT, Weinstein A, Wells G, Shea B, Nichol G, et al. Laboratory evaluation in the diagnosis of Lyme disease. Ann Intern Med 1997;127:1109–23.
17. Guidelines for laboratory evaluation in the diagnosis of Lyme disease. American College of Physicians. Ann Intern Med 1997;127: 1106–8.
18. Johnson BJ, Robbins KE, Bailey RE, Cao BL, Sviat SL, Craven RB, et al. Serodiagnosis of Lyme disease: Accuracy of a two-step approach using a flagella-based ELISA and immunoblotting. J Infect Dis 1996;174:346–53.
19. Nocton JJ, Dressler F, Rutledge BJ, Rys PN, Persing DH, Steere AC. Detection of Borrelia burgdorferi DNA by polymerase chain reaction in synovial fluid from patients with Lyme arthritis [see comments]. N Engl J Med 1994;330: 229–34.
20. Malawista SE, Barthold SW, Persing DH. Fate of Borrelia burgdorferi DNA in tissues of infected mice after antibiotic treatment. J Infect Dis 1994;170: 1312–6.
21. Schutzer SE, Brown T Jr, Holland BK. Reduction of Lyme disease exposure by recognition and avoidance of high-risk areas (letter). Lancet 1997;349:1668.
22. Fradin MS. Mosquitoes and mosquito repellents: A clinician's guide. Ann Intern Med 1998;128: 931–40.
23. Piesman J, Maupin GO, Campos EG, Happ CM. Duration of adult female Ixodes dammini attachment and transmission of Borrelia burgdorferi, with description of a needle aspiration isolation method. J Infect Dis 1991;163: 895–7.
24. Needham GR. Evaluation of five popular methods for tick removal. Pediatrics 1985;75: 997–1002.
25. Genter J, Berman NG, Madison RE. Antimicrobial prophylaxis after tick bites (letter). N Engl J Med 1993;328:1418; discussion 1420.
26. Warshafsky S, Nowakowski J, Nadelman RB, Kamer RS, Peterson SJ, Wormser GP. Efficacy of antibiotic prophylaxis for prevention of Lyme disease. J Gen Intern Med 1996;11: 329–33.
27. Magid D, Schwartz B, Craft J, Schwartz JS. Prevention of Lyme disease after tick bites. A cost-effectiveness analysis. N Engl J Med 1992;327: 534–41.
28. Johnson RC, Kodner C, Russell M. Passive immunization of hamsters against experimental infection with the Lyme disease spirochete. Infect Immun 1986;53: 713–4.
29. Schmitz JL, Schell RF, Hejka AG, England DM. Passive immunization prevents induction of Lyme arthritis in LSH hamsters [published erratum appears in Infect Immun 1993;61:791]. Infect Immun 1990;58: 144–8.
30. Kazmierczak JJ, Sorhage FE. Current understanding of Borrelia burgdorferi infection, with emphasis on its prevention in dogs. J Am Vet Med Assoc 1993;203: 1524–8.
31. Sigal LH. Cross-reactivity between Borrelia burgdorferi flagellin and a human axonal 64,000 molecular weight protein. J Infect Dis 1993;167: 1372–8.
32. Aberer E, Brunner C, Suchanek G, Klade H, Barbour A, Stanek G, et al. Molecular mimicry and Lyme borreliosis: A shared antigenic determinant between Borrelia burgdorferi and human tissue. Ann Neurol 1989;26:732–7.
33. Gross DM, Forsthuber T, Tarylehmann M, Etling C, Ito K, Nagy ZA, et al. Identification of Lfa-1 as a candidate autoantigen in treatment-resistant Lyme arthritis. Science 1998;281:703–6.
34. Wormser GP. Prospects for a vaccine to prevent Lyme disease in humans. Clin Infect Dis 1995;21: 1267–74.
35. Fikrig E, Telford SR 3rd, Barthold SW, Kantor FS, Spielman A, Flavell RA. Elimination of Borrelia burgdorferi from vector ticks feeding on OspA-immunized mice. Proc Natl Acad Sci 1992;89: 5418–21.
36. Telford SR 3rd, Kantor FS, Lobet Y, Barthold SW, Spielman A, Flavell RA, et al. Efficacy of human Lyme disease vaccine formulations in a mouse model. J Infect Dis 1995;171:1368–70.
37. Foley DM, Wang YP, Wu XY, Blanco DR, Lovett MA, Miller JN. Acquired resistance to Borrelia burgdorferi infection in the rabbit. Comparison between outer surface protein A vaccine- and infection-derived immunity. J Clin Invest 1997;99: 2030–5.
38. Callister SM, Schell RF, Case KL, Lovrich SD, Day SP. Characterization of the borreliacidal antibody response to Borrelia burgdorferi in humans: A serodiagnostic test. J Infect Dis 1993;167: 158–64.
39. Fikrig E, Bockenstedt LK, Barthold SW, Chen M, Tao H, Ali-Salaam P, et al. Sera from patients with chronic Lyme disease protect mice from Lyme borreliosis [see comments]. J Infect Dis 1994;169:568–74.
40. Lovrich SD, Callister SM, DuChateau BK, Lim LC, Winfrey J, Day SP, et al. Abilities of OspA proteins from different seroprotective groups of Borrelia burgdorferi to protect hamsters from infection. Infect Immun 1995;63:2113–9.
41. Johnson BJ, Sviat SL, Happ CM, Dunn JJ, Frantz JC, Mayer LW, et al. Incomplete protection of hamsters vaccinated with unlipidated OspA from Borrelia burgdorferi infection is associated with low levels of antibody to an epitope defined by mAb LA-2. Vaccine 1995;13:1086–94.
42. Straubinger RK, Chang YF, Jacobson RH, Appel MJ. Sera from OspAvaccinated dogs, but not those from tick-infected dogs, inhibit in vitro growth of Borrelia burgdorferi. J Clin Microbiol 1995;33: 2745–51.
43. Padilla ML, Callister SM, Schell RF, Bryant GL, Jobe DA, Lovrich SD, et al. Characterization of the protective borreliacidal antibody response in humans and hamsters after vaccination with a Borrelia burgdorferi outer surface protein A vaccine. J Infect Dis 1996;174:739–46.
44. West DJ, Calandra GB. Vaccine induced immunologic memory for hepatitis B surface antigen: Implications for policy on booster vaccination. Vaccine 1996;14: 1019–27.
45. Schoen RT, Meurice F, Brunet CM, Cretella S, Krause DS, Craft JE, et al. Safety and immunogenicity of an outer surface protein A vaccine in subjects with previous Lyme disease. J Infect Dis 1995;172:1324–9.
46. Keller D, Koster FT, Marks DH, Hosbach P, Erdile LF, Mays JP. Safety and immunogenicity of a recombinant outer surface protein A Lyme vaccine. JAMA 1994;271: 1764–8.
47. Lebacq E, Parenti DL, Ofori-Anyinam O, Buscarino C, Van Hoecke C, Krause DS. A study to evaluate the reactogenicity and the immunogenicity of SmithKline Beecham Biologicals' vaccine against Lyme disease when administered on two different schedules (abstract). 38th Interscience Conference on Antimicrobial Agents and Chemotherapy, September 24–27, 1998:12.
48. Steere AC, Sikand V, Meurice F, Parenti DL, Fikrig E, Schoen RT, et al. Vaccination against Lyme disease using recombinant Borrelia burgdorferi outer-surface lipoprotein A with adjuvant. N Engl J Med 1998;339:209–15.
49. Steere AC, Schoen RT, Taylor E. The clinical evolution of Lyme arthritis. Ann Intern Med 1987;107: 725–31.
50. Reik L, Steere AC, Bartenhagen NH, Shope RE, Malawista SE. Neurologic abnormalities of Lyme disease. Medicine 1979;58: 281–94.
51. Sigal LH, Zahradnik JM, Lavin P, Patella SJ, Bryant G, Haselby R, et al. A vaccine consisting of recombinant Borrelia burgdorferi outer-surface protein A to prevent Lyme disease. N Engl J Med 1998;339:216–22.
52. Steere AC, Malawista SE, Snydman DR, Shope RE, Andiman WA, Ross MR, et al. Lyme arthritis: An epidemic of oligoarticular arthritis in children and adults in three Connecticut communities. Arthritis Rheum 1977;20:7–17.
53. Centers for Disease Control and Prevention. Lyme disease — United States, 1995. MMWR Morb Mortal Wkly Rep 1996;45:481–4.
54. Bertino JS Jr, Tirrell P, Greenberg RN, Keyserling HL, Poland GA, Gump D, et al. A comparative trial of standard or high-dose S subunit recombinant hepatitis B vaccine versus a vaccine containing S subunit, pre-S1, and pre-S2 particles for revaccination of healthy adult nonresponders. J Infect Dis 1997;175:678–81.
55. Steere AC. Borrelia burgdorferi (Lyme disease, Lyme borreliosis). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell and Bennett's principles and practice of infectious diseases. New York: Churchill Livingston, 1995: 2150–4.
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Article first published: June 1999
Issue published: June 1999
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PubMed: 10410187
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