Lyme disease primary prevention: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Lyme disease}} | {{Lyme disease}} | ||
{{CMG}} {{AE}} {{IMD}} | {{CMG}}; {{AE}} {{Anmol}}{{IMD}} | ||
==Overview== | ==Overview== | ||
Primary prevention of Lyme disease involves reducing exposure to ticks. | [[Primary prevention]] of [[Lyme disease]] involves [[tick]] control and reducing exposure to [[Tick|ticks]]. The [[tick]] should be removed with proper technique so as to decrease the risk of [[infection]]. A [[Lyme disease]] [[vaccine]] used in the past is no longer available. | ||
==Primary Prevention== | ==Primary Prevention== | ||
=== Tick control === | |||
*[[Tick]] control can help prevent many [[tick-borne diseases]] including [[Lyme disease]], [[Human Granulocytic Anaplasmosis|human granulomatous anaplasmosis]] (HGA), [[babesiosis]], and others. | |||
*Use of acaricidal sprays on vegetation where [[ticks]] live is consistently most effective method. | |||
*Acaricides are [[Pesticide|pesticides]] that kill members of the arachnid subclass Acari, which includes ticks and mites. | |||
*Examples of acaricides include:<ref name="pmid8433317">{{cite journal| author=Curran KL, Fish D, Piesman J| title=Reduction of nymphal Ixodes dammini (Acari: Ixodidae) in a residential suburban landscape by area application of insecticides. | journal=J Med Entomol | year= 1993 | volume= 30 | issue= 1 | pages= 107-13 | pmid=8433317 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8433317 }} </ref><ref name="pmid1903451">{{cite journal| author=Stafford KC| title=Effectiveness of carbaryl applications for the control of Ixodes dammini (Acari: Ixodidae) nymphs in an endemic residential area. | journal=J Med Entomol | year= 1991 | volume= 28 | issue= 1 | pages= 32-6 | pmid=1903451 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1903451 }} </ref><ref name="pmid11296847">{{cite journal| author=Schulze TL, Jordan RA, Hung RW, Taylor RC, Markowski D, Chomsky MS| title=Efficacy of granular deltamethrin against Ixodes scapularis and Amblyomma americanum (Acari: Ixodidade) nymphs. | journal=J Med Entomol | year= 2001 | volume= 38 | issue= 2 | pages= 344-6 | pmid=11296847 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11296847 }} </ref> | |||
**[[Carbaryl]] | |||
**[[Chlorpyrifos]] | |||
**[[Cyfluthrin]] | |||
**[[Deltamethrin]] | |||
*A single spray during the spring has shown to reduce the density of the nymphal stage of ''[[Ixodes scapularis|I. scapularis]]'' significantly, ranging from 67.9% for [[carbaryl]] to 97.4% for [[chlorpyrifos]].<ref name="pmid8433317" /> | |||
*Evidence suggests that removal and controlled burning of vegetation (foilage and leaf litter) results in reduction in the density of the nymph stage of ''[[Ixodes scapularis|I. scapularis]]'' ranging from 72.7 to 100%.<ref name="pmid9701937">{{cite journal| author=Stafford KC, Ward JS, Magnarelli LA| title=Impact of controlled burns on the abundance of Ixodes scapularis (Acari: Ixodidae). | journal=J Med Entomol | year= 1998 | volume= 35 | issue= 4 | pages= 510-3 | pmid=9701937 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9701937 }} </ref><ref name="pmid7473629">{{cite journal| author=Schulze TL, Jordan RA, Hung RW| title=Suppression of subadult Ixodes scapularis (Acari: Ixodidae) following removal of leaf litter. | journal=J Med Entomol | year= 1995 | volume= 32 | issue= 5 | pages= 730-3 | pmid=7473629 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7473629 }} </ref> | |||
*[[Permethrin]]-impregnated cotton balls:<ref name="pmid1941940">{{cite journal| author=Deblinger RD, Rimmer DW| title=Efficacy of a permethrin-based acaricide to reduce the abundance of Ixodes dammini (Acari: Ixodidae). | journal=J Med Entomol | year= 1991 | volume= 28 | issue= 5 | pages= 708-11 | pmid=1941940 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1941940 }} </ref> | |||
**[[Permethrin]]-impregnated cotton balls in an applicator tube are placed outdoors. | |||
**Fibers from the tube are carried to nests by white-footed mice, which are the principle reservoir [[Host (biology)|host]] of ''[[Borrelia burgdorferi|B. burgdorferi]]''. | |||
**Exposure to [[permethrin]] kills all [[Tick|ticks]] infesting these mice. | |||
**This method was a success in the coastal New England area. | |||
**These [[permethrin]]-impregnated cotton balls are available commercially as 'Damminix tick tubes'. | |||
**However, this method was found ineffective in New York and Connecticut.<ref name="pmid1941916">{{cite journal| author=Daniels TJ, Fish D, Falco RC| title=Evaluation of host-targeted acaricide for reducing risk of Lyme disease in southern New York state. | journal=J Med Entomol | year= 1991 | volume= 28 | issue= 4 | pages= 537-43 | pmid=1941916 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1941916 }} </ref><ref name="pmid1495085">{{cite journal| author=Stafford KC| title=Third-year evaluation of host-targeted permethrin for the control of Ixodes dammini (Acari: Ixodidae) in southeastern Connecticut. | journal=J Med Entomol | year= 1992 | volume= 29 | issue= 4 | pages= 717-20 | pmid=1495085 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1495085 }} </ref> | |||
===Minimizing tick exposure=== | ===Minimizing tick exposure=== | ||
[[ | The best way to prevent [[Lyme disease]] is to avoid [[tick]] infested areas, but it is unreasonable to assume that a person can completely eliminate activities that may result in [[tick]] exposure. Therefore, preventive measures should emphasize personal protection when exposed to natural areas where [[Tick|ticks]] are present:<ref name="pmid17029130">{{cite journal|year=2006|title=The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America.|url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17029130|journal=Clin Infect Dis|volume=43|issue=9|pages=1089-134|doi=10.1086/508667|pmc=|pmid=17029130|author=Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS et al.}}</ref> | ||
*Frequently check skin and clothes to identify [[Tick|ticks]] and remove before [[infection]] can be [[Transmission (medicine)|transmitted]]. | |||
*Wear light-colored clothing that allows you to see [[Tick|ticks]] that are crawling on clothing. | |||
*Wear light-colored clothing | *Use long sleeved shirts tucked into pants and tuck pant legs into socks so that ticks cannot crawl up the inside the pant legs. | ||
* | *Apply repellents to discourage tick attachment.<ref name="pmid9634433">{{cite journal| author=Fradin MS| title=Mosquitoes and mosquito repellents: a clinician's guide. | journal=Ann Intern Med | year= 1998 | volume= 128 | issue= 11 | pages= 931-40 | pmid=9634433 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9634433 }}</ref> | ||
*Apply repellents to discourage tick attachment. Repellents containing [[permethrin]] can be sprayed on boots and clothing, and will last for several days. Repellents containing [[DEET]] | **[[Permethrin]] | ||
*Conduct a body check upon return from potentially tick-infested areas by searching | ***Repellents containing [[permethrin]] can be sprayed on boots and clothing, and will last for several days. | ||
*Parents should check their children for ticks, especially in the [[hair]], when returning from potentially tick-infested areas. | **N,N-diethyl-3-methylbenzamide ([[DEET]]) | ||
*Ticks may also be carried into the household on clothing and pets and only attach later, so both should be examined carefully to exclude ticks.<ref name="GenTickDis CDC”">General Tick Disease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/ticks/symptoms.html Accessed on December 30, 2015</ref | ***Repellents containing [[DEET]] can be applied to the skin, but will last only a few hours before reapplication is necessary. | ||
***Use [[DEET]] with caution on children. [[DEET]] is appears to be safe when used as directed.<ref name="pmid157521843">{{cite journal| author=Carroll JF, Klun JA, Debboun M| title=Repellency of deet and SS220 applied to skin involves olfactory sensing by two species of ticks. | journal=Med Vet Entomol | year= 2005 | volume= 19 | issue= 1 | pages= 101-6 | pmid=15752184 | doi=10.1111/j.0269-283X.2005.00559.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15752184 }}</ref> | |||
***Application of large amounts of [[DEET]] on children has been associated with adverse reactions.<ref name="pmid2506420">{{cite journal| author=Centers for Disease Control (CDC)| title=Seizures temporally associated with use of DEET insect repellent--New York and Connecticut. | journal=MMWR Morb Mortal Wkly Rep | year= 1989 | volume= 38 | issue= 39 | pages= 678-80 | pmid=2506420 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2506420 }}</ref> | |||
***[[DEET]] should be avoided on face, hands, and irritated or abraded skin. | |||
***[[DEET]] should be washed off with soap and water upon returning indoors. | |||
*Conduct a body check upon return from potentially [[tick]]-infested areas by searching the entire body for ticks. Use a hand-held or full-length mirror to view all parts of the body. Remove any tick found on the body. | |||
*Parents should check their children for ticks, especially in the [[hair]], when returning from potentially [[tick]]-infested areas. | |||
*[[Tick|Ticks]] may also be carried into the household on clothing and pets and only attach later, so both should be examined carefully to exclude ticks.<ref name="GenTickDis CDC”">General Tick Disease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/ticks/symptoms.html Accessed on December 30, 2015</ref> | |||
===The best way to remove a tick=== | ===The best way to remove a tick=== | ||
{| | |||
#Use fine-tipped tweezers or notched tick extractor, and protect | | | ||
#Grasp the tick as close to the skin surface as possible and pull upward with steady, even pressure. Do not twist or jerk the tick; this may cause the mouth-parts to break off and remain in the skin | #Use fine-tipped tweezers or notched [[tick]] extractor, and protect fingers with a tissue, paper towel, or latex gloves. Persons should avoid removing [[Tick|ticks]] with bare hands. | ||
#After removing the tick, thoroughly disinfect the bite site and wash your hands with soap and water. | #Grasp the [[tick]] as close to the skin surface as possible and pull upward with steady, even pressure. Do not twist or jerk the [[tick]]; this may cause the mouth-parts to break off and remain in the skin (If this happens, remove mouth-parts with tweezers. Consult your health care provider if illness occurs). | ||
#After removing the [[tick]], thoroughly disinfect the bite site and wash your hands with soap and water. | |||
*Do not squeeze, crush, or puncture the body of the tick because its fluids may contain infectious organisms. Skin accidentally exposed to tick fluids can be disinfected with iodine scrub, rubbing alcohol, or water containing detergents. | '''Note:''' | ||
[[ | *Do not squeeze, crush, or puncture the body of the [[tick]] because its fluids may contain infectious organisms. [[Skin]] accidentally exposed to [[tick]] [[Fluid|fluids]] can be [[disinfected]] with [[iodine]] scrub, [[rubbing alcohol]], or water containing detergents. | ||
*Save the [[tick]] for identification in case you become ill. This may help your doctor to make an accurate diagnosis. Place the tick in a sealable plastic bag and put it in your freezer. Write the date of the bite on a piece of paper with a pencil and place it in the bag.<ref name="Tick Removal CDC”">Tick Removal. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/ticks/removing_a_tick.html Accessed on December 30, 2015</ref> | |||
| | |||
[[Image:Tick removal.jpg|500px|center|thumb|Tick removal process - [https://www.cdc.gov/lyme/removal/index.html Source:CDC.gov]]] | |||
|} | |||
===Vaccination=== | ===Vaccination=== | ||
* A [[vaccine]] | * A [[vaccine]] called Lymerix against a North American strain of the [[spirochetal]] [[bacteria]] was available from 1998 to 2002. | ||
* It was produced by | * It was produced by GlaxoSmithKline (GSK) and was based on the outer surface protein A (Osp-A) of ''[[Borrelia]]''. Osp-A causes the human [[immune system]] to create [[antibody|antibodies]] that attack that [[protein]]. | ||
* A group of patients who | * A group of patients who were administered Lymerix developed [[arthritis]], [[muscle pain]], and other troubling symptoms post-vaccination.<ref name="LymeInfo-Vaccine">Safety/Efficacy concerns re: Lyme vaccine: LYMErix [http://www.lymeinfo.net/vaccine2.html Controversy] ''LymeInfo.net''</ref> | ||
** It was later learned that patients with the genetic [[allele]] HLA-DR4 were susceptible to [[T-cell]] cross-reactivity between [[epitope]]s of OspA and [[lymphocyte]] function-associated [[antigen]] in these patients, causing an [[autoimmune]] reaction.<ref>{{cite journal |author=Willett TA, Meyer AL, Brown EL, Huber BT |title=An effective second-generation outer surface protein A-derived Lyme vaccine that eliminates a potentially autoreactive T cell epitope |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=101 |issue=5 |pages=1303-8 |year=2004 |pmid=14742868 |doi=10.1073/pnas.0305680101 | url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=14742868}}</ref> | |||
* It was later learned that patients with the genetic [[allele]] HLA-DR4 were susceptible to T-cell cross-reactivity between [[epitope]]s of OspA and lymphocyte function-associated antigen in these patients causing an autoimmune reaction.<ref>{{cite journal |author=Willett TA, Meyer AL, Brown EL, Huber BT |title=An effective second-generation outer surface protein A-derived Lyme vaccine that eliminates a potentially autoreactive T cell epitope |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=101 |issue=5 |pages=1303-8 |year=2004 |pmid=14742868 |doi=10.1073/pnas.0305680101 | url = http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=14742868}}</ref> | * New [[vaccines]] are being researched using outer surface protein C (Osp-C) and [[Glycolipid|glycolipoprotein]] as methods of immunization.<ref>{{cite journal |author=Earnhart CG, Marconi RT |title=OspC phylogenetic analyses support the feasibility of a broadly protective polyvalent chimeric Lyme disease vaccine |journal=Clin. Vaccine Immunol. |volume=14 |issue=5 |pages=628-34 |year=2007 |pmid=17360854 |doi=10.1128/CVI.00409-06}}</ref><ref>{{cite journal |author=Pozsgay V, Kubler-Kielb J |title=Synthesis of an experimental glycolipoprotein vaccine against Lyme disease |journal=Carbohydr. Res. |volume=342 |issue=3-4 |pages=621-6 |year=2007 |pmid=17182019 |doi=10.1016/j.carres.2006.11.014 | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17182019&query_hl=35&itool=pubmed_docsum}}</ref> | ||
* New vaccines are being researched using outer surface protein C (Osp-C) and [[Glycolipid|glycolipoprotein]] as methods of immunization.<ref>{{cite journal |author=Earnhart CG, Marconi RT |title=OspC phylogenetic analyses support the feasibility of a broadly protective polyvalent chimeric Lyme disease vaccine |journal=Clin. Vaccine Immunol. |volume=14 |issue=5 |pages=628-34 |year=2007 |pmid=17360854 |doi=10.1128/CVI.00409-06}}</ref><ref>{{cite journal |author=Pozsgay V, Kubler-Kielb J |title=Synthesis of an experimental glycolipoprotein vaccine against Lyme disease |journal=Carbohydr. Res. |volume=342 |issue=3-4 |pages=621-6 |year=2007 |pmid=17182019 |doi=10.1016/j.carres.2006.11.014 | url = http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17182019&query_hl=35&itool=pubmed_docsum}}</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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[[Category:Spirochaetes]] | [[Category:Spirochaetes]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
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Latest revision as of 22:35, 29 July 2020
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Risk calculators and risk factors for Lyme disease primary prevention |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]Ilan Dock, B.S.
Overview
Primary prevention of Lyme disease involves tick control and reducing exposure to ticks. The tick should be removed with proper technique so as to decrease the risk of infection. A Lyme disease vaccine used in the past is no longer available.
Primary Prevention
Tick control
- Tick control can help prevent many tick-borne diseases including Lyme disease, human granulomatous anaplasmosis (HGA), babesiosis, and others.
- Use of acaricidal sprays on vegetation where ticks live is consistently most effective method.
- Acaricides are pesticides that kill members of the arachnid subclass Acari, which includes ticks and mites.
- Examples of acaricides include:[1][2][3]
- A single spray during the spring has shown to reduce the density of the nymphal stage of I. scapularis significantly, ranging from 67.9% for carbaryl to 97.4% for chlorpyrifos.[1]
- Evidence suggests that removal and controlled burning of vegetation (foilage and leaf litter) results in reduction in the density of the nymph stage of I. scapularis ranging from 72.7 to 100%.[4][5]
- Permethrin-impregnated cotton balls:[6]
- Permethrin-impregnated cotton balls in an applicator tube are placed outdoors.
- Fibers from the tube are carried to nests by white-footed mice, which are the principle reservoir host of B. burgdorferi.
- Exposure to permethrin kills all ticks infesting these mice.
- This method was a success in the coastal New England area.
- These permethrin-impregnated cotton balls are available commercially as 'Damminix tick tubes'.
- However, this method was found ineffective in New York and Connecticut.[7][8]
Minimizing tick exposure
The best way to prevent Lyme disease is to avoid tick infested areas, but it is unreasonable to assume that a person can completely eliminate activities that may result in tick exposure. Therefore, preventive measures should emphasize personal protection when exposed to natural areas where ticks are present:[9]
- Frequently check skin and clothes to identify ticks and remove before infection can be transmitted.
- Wear light-colored clothing that allows you to see ticks that are crawling on clothing.
- Use long sleeved shirts tucked into pants and tuck pant legs into socks so that ticks cannot crawl up the inside the pant legs.
- Apply repellents to discourage tick attachment.[10]
- Permethrin
- Repellents containing permethrin can be sprayed on boots and clothing, and will last for several days.
- N,N-diethyl-3-methylbenzamide (DEET)
- Repellents containing DEET can be applied to the skin, but will last only a few hours before reapplication is necessary.
- Use DEET with caution on children. DEET is appears to be safe when used as directed.[11]
- Application of large amounts of DEET on children has been associated with adverse reactions.[12]
- DEET should be avoided on face, hands, and irritated or abraded skin.
- DEET should be washed off with soap and water upon returning indoors.
- Permethrin
- Conduct a body check upon return from potentially tick-infested areas by searching the entire body for ticks. Use a hand-held or full-length mirror to view all parts of the body. Remove any tick found on the body.
- Parents should check their children for ticks, especially in the hair, when returning from potentially tick-infested areas.
- Ticks may also be carried into the household on clothing and pets and only attach later, so both should be examined carefully to exclude ticks.[13]
The best way to remove a tick
Note:
|
 |
Vaccination
- A vaccine called Lymerix against a North American strain of the spirochetal bacteria was available from 1998 to 2002.
- It was produced by GlaxoSmithKline (GSK) and was based on the outer surface protein A (Osp-A) of Borrelia. Osp-A causes the human immune system to create antibodies that attack that protein.
- A group of patients who were administered Lymerix developed arthritis, muscle pain, and other troubling symptoms post-vaccination.[15]
- It was later learned that patients with the genetic allele HLA-DR4 were susceptible to T-cell cross-reactivity between epitopes of OspA and lymphocyte function-associated antigen in these patients, causing an autoimmune reaction.[16]
- New vaccines are being researched using outer surface protein C (Osp-C) and glycolipoprotein as methods of immunization.[17][18]
References
- ↑ 1.0 1.1 Curran KL, Fish D, Piesman J (1993). "Reduction of nymphal Ixodes dammini (Acari: Ixodidae) in a residential suburban landscape by area application of insecticides". J Med Entomol. 30 (1): 107–13. PMID 8433317.
- ↑ Stafford KC (1991). "Effectiveness of carbaryl applications for the control of Ixodes dammini (Acari: Ixodidae) nymphs in an endemic residential area". J Med Entomol. 28 (1): 32–6. PMID 1903451.
- ↑ Schulze TL, Jordan RA, Hung RW, Taylor RC, Markowski D, Chomsky MS (2001). "Efficacy of granular deltamethrin against Ixodes scapularis and Amblyomma americanum (Acari: Ixodidade) nymphs". J Med Entomol. 38 (2): 344–6. PMID 11296847.
- ↑ Stafford KC, Ward JS, Magnarelli LA (1998). "Impact of controlled burns on the abundance of Ixodes scapularis (Acari: Ixodidae)". J Med Entomol. 35 (4): 510–3. PMID 9701937.
- ↑ Schulze TL, Jordan RA, Hung RW (1995). "Suppression of subadult Ixodes scapularis (Acari: Ixodidae) following removal of leaf litter". J Med Entomol. 32 (5): 730–3. PMID 7473629.
- ↑ Deblinger RD, Rimmer DW (1991). "Efficacy of a permethrin-based acaricide to reduce the abundance of Ixodes dammini (Acari: Ixodidae)". J Med Entomol. 28 (5): 708–11. PMID 1941940.
- ↑ Daniels TJ, Fish D, Falco RC (1991). "Evaluation of host-targeted acaricide for reducing risk of Lyme disease in southern New York state". J Med Entomol. 28 (4): 537–43. PMID 1941916.
- ↑ Stafford KC (1992). "Third-year evaluation of host-targeted permethrin for the control of Ixodes dammini (Acari: Ixodidae) in southeastern Connecticut". J Med Entomol. 29 (4): 717–20. PMID 1495085.
- ↑ Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS; et al. (2006). "The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America". Clin Infect Dis. 43 (9): 1089–134. doi:10.1086/508667. PMID 17029130.
- ↑ Fradin MS (1998). "Mosquitoes and mosquito repellents: a clinician's guide". Ann Intern Med. 128 (11): 931–40. PMID 9634433.
- ↑ Carroll JF, Klun JA, Debboun M (2005). "Repellency of deet and SS220 applied to skin involves olfactory sensing by two species of ticks". Med Vet Entomol. 19 (1): 101–6. doi:10.1111/j.0269-283X.2005.00559.x. PMID 15752184.
- ↑ Centers for Disease Control (CDC) (1989). "Seizures temporally associated with use of DEET insect repellent--New York and Connecticut". MMWR Morb Mortal Wkly Rep. 38 (39): 678–80. PMID 2506420.
- ↑ General Tick Disease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/ticks/symptoms.html Accessed on December 30, 2015
- ↑ Tick Removal. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/ticks/removing_a_tick.html Accessed on December 30, 2015
- ↑ Safety/Efficacy concerns re: Lyme vaccine: LYMErix Controversy LymeInfo.net
- ↑ Willett TA, Meyer AL, Brown EL, Huber BT (2004). "An effective second-generation outer surface protein A-derived Lyme vaccine that eliminates a potentially autoreactive T cell epitope". Proc. Natl. Acad. Sci. U.S.A. 101 (5): 1303–8. doi:10.1073/pnas.0305680101. PMID 14742868.
- ↑ Earnhart CG, Marconi RT (2007). "OspC phylogenetic analyses support the feasibility of a broadly protective polyvalent chimeric Lyme disease vaccine". Clin. Vaccine Immunol. 14 (5): 628–34. doi:10.1128/CVI.00409-06. PMID 17360854.
- ↑ Pozsgay V, Kubler-Kielb J (2007). "Synthesis of an experimental glycolipoprotein vaccine against Lyme disease". Carbohydr. Res. 342 (3–4): 621–6. doi:10.1016/j.carres.2006.11.014. PMID 17182019.