Lyme Disease: Questions and Answers - CDC Division of Vector-Borne Infectious Diseases (DVBID) +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | Lyme Disease Contents | | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | Introduction | | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | Questions and | | | | | | Answers | | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | The Bacterium | | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | Vector Ecology | | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | Diagnosis | | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | Epidemiology | | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | Prevention and | | | | | | Control | | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | Scientific | | | | | | Literature | | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | PBS Documentary | | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | CDC World | | | | | | Health | | | | | | Organization | | | | | | Collaborating | | | | | | Center for | | | | | | Lyme | | | | | | Borreliosis | | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | Other Tick-Borne Diseases | | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | Southern | | | | | | Tick-Associated | | | | | | Rash Illness | | | | | | (STARI) NEW! | | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | Babesiosis | | | | | | (DPD site) | | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | Ehrlichiosis | | | | | | (DVRD site) | | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | Rocky Mountain | | | | | | Spotted Fever | | | | | | (DVRD site) | | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | Questions and Answers About Lyme Disease | | | | | | | | | | | | Q. How do people get Lyme disease? | | | | | | A. By the bite of ticks infected with Lyme disease | | | | | | bacteria. (Deer tick) | | | | | | | | | | | | Q. What is the basic transmission cycle? | | | | | | A. Immature ticks become infected by feeding on small | | | | | | rodents, such as the white-footed mouse, and other | | | | | | mammals that are infected with the bacterium Borrelia | | | | | | burgdorferi. In later stages, these ticks then transmit | | | | | | the Lyme disease bacterium to humans and other mammals | | | | | | during the feeding process. Lyme disease bacteria are | | | | | | maintained in the blood systems and tissues of small | | | | | | rodents. | | | | | | | | | | | | Q. Could you get Lyme disease from another person? | | | | | | A. No, Lyme disease bacteria are NOT transmitted from | | | | | | person-to-person. For example, you cannot get infected | | | | | | from touching or kissing a person who has Lyme disease, | | | | | | or from a health care worker who has treated someone | | | | | | with the disease, or by sexual contact. | | | | | | | | | | | | Q. What are the signs and symptoms of Lyme disease? | | | | | | A. Within days to weeks following a tick bite, 80% of | | | | | | patients will have a red, slowly expanding "bull's-eye" | | | | | | rash (called erythema migrans), accompanied by general | | | | | | tiredness, fever, headache, stiff neck, muscle aches, | | | | | | and joint pain. If untreated, weeks to months later | | | | | | some patients may develop arthritis, including | | | | | | intermittent episodes of swelling and pain in the large | | | | | | joints; neurologic abnormalities, such as aseptic | | | | | | meningitis, facial palsy, motor and sensory nerve | | | | | | inflammation (radiculoneuritis) and inflammation of the | | | | | | brain (encephalitis); and, rarely, cardiac problems, | | | | | | such as atrioventricular block, acute inflammation of | | | | | | the tissues surrounding the heart (myopericarditis) or | | | | | | enlarged heart (cardiomegaly). | | | | | | | | | | | | Q. What is the incubation period for Lyme disease? | | | | | | A. For the red "bull's-eye" rash (erythema migrans), | | | | | | usually 7 to 14 days following tick exposure. Some | | | | | | patients present with later manifestations without | | | | | | having had early signs of disease. | | | | | | | | | | | | Q. What is the mortality rate of Lyme disease? | | | | | | A. Lyme disease is rarely, if ever, fatal. | | | | | | | | | | | | Q. Can a person be reinfected with Lyme disease? | | | | | | A. Yes. Having had Lyme disease doesn't protect against | | | | | | reinfection. Some persons have had Lyme disease more | | | | | | than once after re-exposure to infective tick bites. | | | | | | This stresses the need for continued tick bite | | | | | | prevention activities such as wearing appropriate | | | | | | clothing when in tick-infested areas, daily tick | | | | | | checks, and quick removal of attached ticks. | | | | | | | | | | | | Q. How many cases of Lyme disease occur in the U.S.? | | | | | | A. Lyme disease is the leading cause of vector-borne | | | | | | infectious illness in the U.S. with about 15,000 cases | | | | | | reported annually, though the disease is greatly under | | | | | | reported. Based on reported cases, during the past ten | | | | | | years 90% of cases of Lyme disease occurred in ten | | | | | | states: More information can be found in the MMWR, | | | | | | March 16, 2001 / 50(10);181-5 | | | | | | (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5010a1.htm). | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | State | Total | Annual | | | | | Number | Incidence | | | | | Cases | per | | | | | Reported | 100,000 | | | | | 1989-1998 | persons | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | New York | 39,370 | 21.6 | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | Connecticut | 17,728 | 54.2 | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | Pennsylvania | 14,870 | 12.3 | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | New Jersey | 13,428 | 16.9 | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | Wisconsin | 4,760 | 9.3 | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | Rhode Island | 3,717 | 37.5 | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | Maryland | 3,410 | 6.8 | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | Massachusetts | 2,712 | 4.5 | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | Minnesota | 1,745 | 3.8 | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | Delaware | 1,003 | 14.0 | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | Q. How is Lyme disease treated? | | | | | | A. According to treatment experts, antibiotic treatment | | | | | | for 3-4 weeks with doxycycline or amoxicillin is | | | | | | generally effective in early disease. Cefuroxime axetil | | | | | | or erythromycin can be used for persons allergic to | | | | | | penicillin or who cannot take tetracyclines. Later | | | | | | disease, particularly with objective neurologic | | | | | | manifestations, may require treatment with intravenous | | | | | | ceftriaxone or penicillin for 4 weeks or more, | | | | | | depending on disease severity. In later disease, | | | | | | treatment failures may occur and retreatment may be | | | | | | necessary. (The Medical Letter, Vol. 42(Issue 1077), | | | | | | May 1, 2000) | | | | | | | | | | | | Q. Is the disease seasonal in its occurrence? | | | | | | A. Yes, Lyme disease is most common during the late | | | | | | spring and summer months in the U.S. (May through | | | | | | August) when nymphal ticks are most active and human | | | | | | populations are frequently outdoors and most exposed. | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | Map: Reported cases of Lyme disease in the United | | | | | | States, 1999. | | | | | | (View enlarged image.) | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | Q. Where is Lyme disease most common? | | | | | | A. Click on the map at right that shows reported cases | | | | | | of Lyme disease in 1999 by patient's county of | | | | | | residence. Generally, most Lyme disease is endemic in | | | | | | the northeastern and upper midwest states. (See "Lyme | | | | | | Disease--United States, 1999." MMWR. March 16, | | | | | | 2001;50:181-185.) | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | National Lyme disease risk map. | | | | | | (View enlarged image.) | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | Q.Who is at risk for getting Lyme disease? | | | | | | A. Persons in endemic areas who frequent sites where | | | | | | infected ticks are common, such as grassy or wooded | | | | | | locations favored by white-tailed deer in the | | | | | | northeastern and upper midwest states, and along the | | | | | | northern Pacific coast of California. | | | | | | | | | | | | Q. Is there a vaccine against Lyme disease? | | | | | | A. As of February 25, 2002 the manufacturer announced | | | | | | that the LYMErixTM Lyme disease vaccine will no longer | | | | | | be commercially available. | | | | | | | | | | | | Q. Does the Lyme disease vaccine cause arthritis? Are | | | | | | individuals with certain HLA-DR4 genetic subtypes more | | | | | | susceptible to getting arthritis from the vaccine? | | | | | | A. An association between naturally acquired | | | | | | treatment-resistant Lyme disease arthritis, certain | | | | | | HLA-DR4 genetic subtypes, and high levels of antibody | | | | | | to OspA of naturally acquired Borrelia burgdorferi has | | | | | | been described in the medical literature (1, 2, 3). | | | | | | Because of the relationship between OspA antibodies and | | | | | | treatment-resistant arthritis from naturally acquired | | | | | | infection, CDC's Advisory Committee on Immunization | | | | | | Practices (ACIP) has stated that the vaccine should not | | | | | | be given to persons with treatment-resistant Lyme | | | | | | arthritis (4). However, at this writing there is no | | | | | | scientific evidence that the currently licensed Lyme | | | | | | disease vaccine increases the recipient's risk of | | | | | | arthritis. To the contrary, there is good evidence that | | | | | | the risk of arthritis in vaccine recipients is not | | | | | | significantly different from the risk in individuals | | | | | | who have received placebo without OspA (5). ACIP has | | | | | | not recommended screening of HLA type prior to | | | | | | vaccination. In the absence of evidence that the | | | | | | vaccine causes arthritis, screening for HLA-DR4 | | | | | | subtypes before vaccination would not seem to be a | | | | | | beneficial use of health resources. | | | | | | | | | | | | -------------------------------------------------------- | | | | | | * Kalish RA, Leong JM, Steere AC. Association of | | | | | | treatment-resistant chronic Lyme arthritis with HLA-DR4 | | | | | | and antibody reactivity to OspA and OspB of Borrelia | | | | | | burgdorferi. Infect Immun 1993;61:2774-2779. | | | | | | | | | | | | -------------------------------------------------------- | | | | | | * Akin E, McHugh GL, Flavell RA, et al. The | | | | | | immunoglobulin (IgG) antibody response to OspA and OspB | | | | | | correlates with severe and prolonged Lyme arthritis and | | | | | | the IgG response to p35 correlates with mild and brief | | | | | | arthritis. Infect Immun 1999;173-181. | | | | | | | | | | | | -------------------------------------------------------- | | | | | | * Gross DM, Forsthuber T, Tary-Lehmann M, et al. | | | | | | Identification of LFA-1 as a candidate autoantigen in | | | | | | treatment-resistant Lyme arthritis. Science | | | | | | 1998;281:703-706. | | | | | | | | | | | | -------------------------------------------------------- | | | | | | * Centers for Disease Control and Prevention. | | | | | | Recommendations for the Use of Lyme Disease Vaccine - | | | | | | Recommendations of the Advisory Committee on | | | | | | Immunization Practices. MMWR 1999;48:1-17. | | | | | | (Also available in PDF format [742 KB, 39 pages].) | | | | | | | | | | | | -------------------------------------------------------- | | | | | | * Steere AC, Sikand VK, Meurice F, et al. Vaccination | | | | | | against Lyme disease with recombinant Borrelia | | | | | | burgdorferi outer-surface lipoprotein A with adjuvant. | | | | | | N Engl J Med 1998;339:209-216. | | | | | | | | | | | | Return to top of page | | | +------------+-----------------+----------------------------------------------------------+--------------+-----------+ | | | | Some | | | | | | documents | | | | | | are | | | | | | available | | | | | | here in | | | | | | Adobe | | | | | | Acrobat | | | | | | Reader | | | | | | format | | | | | | (PDF). 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