Lyme disease primary prevention

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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:
  • Carbaryl
  • Chlorpyrifos
  • Cyfluthrin
  • Deltamethrin
• Single spray during spring has shown to nymphal stage of I. scapularis significantly ranging from 67.9% for carbaryl to 97.4% for chlorpyrifos.
• 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%.
• Permethrin-impregnated cotton balls:
  • 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.

Minimizing tick exposure

Tuck pants into socks

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: Frequently checking skin and clothes to identify ticks and remove before infection can be transmitted. Wear light-colored clothing which allows you to see ticks that are crawling on your clothing. Use long sleeve shirts tucked into pants and tuck your pants' legs into your socks so that ticks cannot crawl up the inside of your pants' legs. Apply repellents to discourage tick attachment. 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. Application of large amounts of DEET on children has been associated with adverse reactions. DEET should be avoided on face, hands and irritated or abraded skin. DEET should be washed off with soap and water once returning indoor. Conduct a body check upon return from potentially tick-infested areas by searching your entire body for ticks. Use a hand-held or full-length mirror to view all parts of your body. Remove any tick you find on your 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.

The best way to remove a tick

Use fine-tipped tweezers or notched tick extractor, and protect your fingers with a tissue, paper towel, or latex gloves. Persons should avoid removing ticks with bare hands. 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.

Tick removal process

Note: 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. 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.

Removal of an embedded tick using fine-tipped tweezers

Prophylaxis

• After a tick bite, routine use of antibiotic prophylaxis is not recommended.
• 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).
  • 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.

• New vaccines are being researched using outer surface protein C (Osp-C) and glycolipoprotein as methods of immunization.

References

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