Abstract
BackgroundLyme disease, caused by Borrelia burgdorferi, is the most common tick-borne infection in the United States. Although humans can be infected by at least 16 different strains of B. burgdorferi, the overwhelming majority of infections are due to only four strains. It was recently demonstrated that patients who are treated for early Lyme disease develop immunity to the specific strain of B. burgdorferi that caused their infection. The aim of this study is to estimate the reduction in cases of Lyme disease in the United States that may occur as a result of type specific immunity.MethodsThe analysis was performed based on three analytical models that assessed the effects of type specific immunity. Observational data on the frequency with which different B. burgdorferi strains cause human infection in culture-confirmed patients with an initial episode of erythema migrans diagnosed between 1991 and 2005 in the Northeastern United States were used in the analyses.ResultsAssuming a reinfection rate of 3 % and a total incidence of Lyme disease per year of 300,000, the estimated number of averted cases of Lyme disease per year ranges from 319 to 2378 depending on the duration of type specific immunity and the model used.ConclusionGiven the assumptions of the analyses, this analysis suggests that type specific immunity is likely to have public health significance in the United States.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1190-7) contains supplementary material, which is available to authorized users.
Highlights
Lyme disease, caused by Borrelia burgdorferi, is the most common tick-borne infection in the United States
The probability of exposure to various strains of B. burgdorferi due to a bite from an infected tick was estimated based on the frequency with which different strains of B. burgdorferi were recovered from skin biopsy samples of patients with early Lyme disease associated with erythema migrans in the Lower Hudson Valley region of New York State (Table 1) [17, 18]
Assuming that a patient was initially infected by one of these four strains and that patients are exposed to B. burgdorferi strains at rates consistent with published data on initial human infections (Table 1, Additional file 2: Table S1), the results of the deterministic model suggest that the probability of a positive blood culture in patients with a recurrence of erythema migrans would be reduced by approximately 25 % due to strain-specific immunity
Summary
It was recently demonstrated that patients who are treated for early Lyme disease develop immunity to the specific strain of B. burgdorferi that caused their infection. Lyme disease, caused by Borrelia burgdorferi, is the most common tick-borne infection in the United States. The majority of reported Lyme disease cases originate in the Northeastern (82 %) and Midwest (9 %) United States [2], the geographic range is currently expanding [3,4,5]. Despite the fact that more than 16 B. burgdorferi lineages exist in these areas, the majority of disseminated human infections are caused by just four. The variability at the ospC locus, along with the high linkage among all genetic loci [12,13,14,15], makes ospC a good marker to delineate different B. burgdorferi lineages
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