Lyme disease primary prevention: Difference between revisions
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==Overview== | ==Overview== | ||
[[Primary prevention]] of [[Lyme disease]] involves [[tick]] control and reducing exposure to [[Tick|ticks]]. [[Tick]] should be removed with proper technique so as to decrease risk of [[infection]]. A [[Lyme disease]] [[vaccine]] used earlier is no longer available. | [[Primary prevention]] of [[Lyme disease]] involves [[tick]] control and reducing exposure to [[Tick|ticks]]. [[Chemoprophylaxis]] may be indicated in selected cases of [[tick]] bite to decrease risk of [[infection]]. [[Tick]] should be removed with proper technique so as to decrease risk of [[infection]]. A [[Lyme disease]] [[vaccine]] used earlier is no longer available. | ||
==Primary Prevention== | ==Primary Prevention== |
Revision as of 21:05, 3 August 2017
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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. Chemoprophylaxis may be indicated in selected cases of tick bite to decrease risk of infection. Tick should be removed with proper technique so as to decrease risk of infection. A Lyme disease vaccine used earlier 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 tick lives is consistently most effective method.
- Acaricides are pesticides that kill members of the arachnid subclass Acari, which includes ticks and mites.
- Examples of acaricide includes:[1][2][3]
- Single spray during spring has shown to 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 is reduction in density of nymph stage of I. scapularis ranging from 72.7 to 100%.[4][5]
- Permethrin-impregnated cotton balls:[6]
- Permethrin-impregnated cotton balls in applicator tube are placed outdoors.
- Fibres from the tube are carried to nests by white-footed mice which is the principle reservoir host of B. burgdorferi.
- Exposure to permethrin killed all ticks infesting these mice.
- This method was a success in coastal New England area.
- These permethrin-impregnated cotton balls are available commercially as 'Damminix tick tubes'.
- However, this method was found uneffective in New York and Connecticut.[7][8]
Minimizing tick exposure
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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]
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The best way to remove a tick
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Note:
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Prophylaxis
- After a tick bite, routine use of antibiotic prophylaxis is not recommended.[9]
- A single dose of doxycycline (avoid in pregnancy and children <8 years) may be offered to adults (200mg) and children (4mg/kg, maximum 200mg) if all of the criteria are fulfilled:
- The tick is identified as I. scapularis (adult or nymph)
- The tick is attached for ⩾36 hours. It is estimated by the degree of engorgement of the tick with blood or approximating the time of exposure to the tick.
- Within 72 hours of tick removal
- Local infection rate of tick with B. burgdorferi is ⩾20%
- There is no contraindication to use of doxycycline.
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 have been administered Lymerix developed arthritis, muscle pain and other troubling symptoms post-vaccination. Class-action litigation against GSK followed. Cassidy v. SmithKline Beecham, No. 99-10423 (Ct. Common Pleas, PA state court) (common settlement case).[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.
- ↑ 9.0 9.1 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.