Prevention Of Lyme Disease Research Articles

Contrasting Perceptions, Knowledge, and Actions around Lyme Disease in an Urban Area of Emerging Lyme Disease and an Area of Endemic Lyme Disease in the Northeastern United States.

Lyme disease transmission dynamics in the northeastern United States vary by context. Periurban regions, including Block Island, RI, have experienced decades of endemic transmission. In urban areas, including Staten Island, a borough in New York City, NY, Lyme disease is an emerging issue. Knowledge, attitudes, and practices around Lyme disease evolve as an area progresses from emergent to endemic. We conducted focus group discussions and household surveys within Staten Island, NY and Block Island, RI to compare knowledge, attitudes, and practices surrounding Lyme disease and other tick-borne diseases. Qualitative data were coded into themes, and survey data were used to provide more general context of the focus group discussions. Using item response theory, we developed an index of knowledge from relevant factors within the household survey. We identified a significant difference in knowledge scores between the two study areas. Additionally, we identified key differences across multiple domains. Participants from Block Island were more likely to report prior tick exposure and Lyme disease in themselves or household members and were more likely to express concerns about the environmental impact of mitigation strategies. Individuals on Staten Island were more likely to assign responsibility of prevention and control to local, state, and federal government than to take personal prevention measures. Prevention of Lyme disease and other tick-borne diseases must be tailored to the community context and monitored over time as perceptions and priorities may evolve as transmission dynamics transition from emergent to endemic.

Age- and Sex-Specific Differences in Lyme Disease Health-Related Behaviors, Ontario, Canada, 2015-2022.

We investigated differences in risk factors and preventive behaviors by age and sex among persons with reported Lyme disease in Ontario, Canada, during 2015-2022. Incidence rates peaked among children 5-9 and adults 50-79 years of age. Median age was higher for female than male case-patients (54 vs. 51 years). Male case-patients reported more activity in wooded and tall grass areas than did female case-patients; fewer male case-patients reported sharing living space with outdoor-exposed companion animals. As age increased, more case-patients reported activity in blacklegged tick habitats, exposure to ticks, and wearing adequate clothing, but fewer reported sharing living space with outdoor-exposed companion animals. Adoption of preventive behaviors was relatively low and did not differ by sex. Male case-patients, children 5-9 years of age and their parents or caregivers, and adults >59 years of age represent populations that would benefit from tailored public health messaging on Lyme disease prevention.

Lyme Disease Prophylaxis by Single-Dose Doxycycline in the United States, 2010-2020.

Single-dose doxycycline after high-risk tick bites can prevent Lyme disease, which disproportionately affects children. We described single-dose doxycycline dispensings in an outpatient cohort in the United States. During 2010-2020, a total of 427 105 patients received ≥1 dispensing(s); most were aged ≥65 years. Lyme disease postexposure prophylaxis may be underprescribed for some groups, including children.

Psychosocial Determinants of Lyme Disease Preventive Behavior Among Outdoor Recreationists

The incidence of Lyme disease (LD) has grown over time despite extensive awareness campaigns of disease risk. While previous research has explored public knowledge, perceptions, and attitudes toward tick-borne diseases, there is minimal research in understanding preventive behavior among individuals frequently engaging in outdoor recreation. This study addresses this gap by investigating the perceptions of LD preventive behavior, focusing on psychosocial factors influencing behavior. Utilizing an integrative framework incorporating the Health Belief Model and Social Cognitive Theory, we examined outdoor recreationist performance of three key preventive behaviors: tick checks, tick repellent use, and protective clothing. Data were collected through intercept surveys at Bradbury Mountain State Park (Maine, US). Findings indicate that tick-related knowledge and experience have a limited impact on preventive behavior, while efficacy beliefs and perceived benefits significantly influence behavior. In this paper we discuss the implications of these factors to both theory and practice in LD prevention studies.

Vaccination to Prevent Lyme Disease: A Movement Towards Anti-Tick Approaches.

Lyme disease is caused by the spirochete, Borrelia burgdorferi, which is transmitted by Ixodes spp ticks. The rise in Lyme disease cases since its discovery in the 1970s has reinforced the need for a vaccine. A vaccine based on B burgdorferi outer surface protein A (OspA) was approved by the Food and Drug Administration (FDA) several decades ago, but was pulled from the market a few years later, reportedly due to poor sales, despite multiple organizations concluding that it was safe and effective. Newer OspA-based vaccines are being developed and are likely to be available in the coming years. More recently, there has been a push to develop vaccines that target the tick vector instead of the pathogen to inhibit tick feeding and thus prevent transmission of tick-borne pathogens to humans and wildlife reservoirs. This review outlines the history of Lyme disease vaccines and this movement to anti-tick vaccine approaches.

Antibody-mediated immunological memory correlates with long-term Lyme veterinary vaccine protection in mice

Lyme disease, caused by the bacterium Borrelia burgdorferi, is the most common tick-borne illness in the United States. Despite the rise in Lyme disease incidence, there is no vaccine against B. burgdorferi approved for human use. Little is known about the immune correlates of protection needed to prevent Lyme disease. In this work, a mouse model was used to characterize the immune response and compare the protection provided by two USDA-approved vaccines for use in canines: Duramune (bacterin vaccine) and Vanguard crLyme (subunit vaccine composed of two outer surface proteins, OspA and OspC). C3H/HeNCrl mice were immunized with two doses of either Duramune or Vanguard, and immune responses and protection against B. burgdorferi were assessed in short (35 days) and long-term (120 days) studies. Flow cytometry, ELISPOT detection of antibody-producing cells, and antibody affinity studies were performed to identify correlates of vaccine-mediated protection. Both vaccines induced humoral responses, with high IgG titers against B. burgdorferi. However, the levels of anti-B. burgdorferi antibodies decayed over time in Vanguard-vaccinated mice. While both vaccines triggered the production of antibodies against both OspA and OspC, antibody levels against these proteins were also lower in Vanguard-vaccinated mice 120 days post-vaccination. Both vaccines only provided partial protection against B. burgdorferi at the dose used in this model. The protection provided by Duramune was superior to Vanguard 120 days post-vaccination, and was characterized by higher antibody titers, higher abundance of long-lived plasma cells, and higher avidity antibodies than Vanguard. Overall, these studies provide insights into the importance of the humoral memory response to veterinary vaccines against Lyme disease and will help inform the development of future human vaccines.

By-degree Health and Economic Impacts of Lyme Disease, Eastern and Midwestern United States

Lyme disease (LD) is the most common vector-borne disease in the United States (U.S.). This paper assesses how climate change may influence LD incidence in the eastern and upper Midwestern U.S. and the associated economic burden. We estimated future Ixodes scapularis habitat suitability and LD incidence with a by-degree approach using variables from an ensemble of multiple climate models. We then applied estimates for present-day and projected habitat suitability for I. scapularis, present-day presence of Borrelia burgdorferi, and projected climatological variables to model reported LD incidence at the county level among adults, children, and the total population. Finally, we applied an estimate of healthcare expenses to project economic impacts. We show an overall increase in LD cases with regional variation. We estimate an increase in incidence in New England and the upper Midwestern U.S. and a concurrent decrease in incidence in Virginia and North Carolina. At 3°C of national warming from the 1986–2015 baseline climate, we project approximately 55,000 LD cases, a 38-percent increase from present-day estimates. At 6°C of warming, our most extreme scenario, we project approximately 92,000 LD cases in the region, an increase of 145 percent relative to current levels. Annual LD-related healthcare expenses at 3°C of warming are estimated to be $236 million (2021 dollars), approximately 38 percent greater than present-day. These results may inform decision-makers tasked with addressing climate risks, the public, and healthcare professionals preparing for treatment and prevention of LD.

A systemic approach to identify non-abundant immunogenic proteins in Lyme disease pathogens.

Borrelia burgdorferi, the pathogen of Lyme disease, differentially produces many outer surface proteins (Osp), some of which represent the most abundant membrane proteins, such as OspA, OspB, and OspC. In cultured bacteria, these proteins can account for a substantial fraction of the total cellular or membrane proteins, posing challenges to the identification and analysis of non-abundant proteins, which could serve as novel pathogen detection markers or as vaccine candidates. Herein, we introduced serial mutations to remove these abundant Osps and generated a B. burgdorferi mutant deficient in OspA, OspB, and OspC in an infectious 297-isolate background, designated as OspABC- mutant. Compared to parental isolate, the mutant did not reflect growth defects in the cultured medium but showed differential mRNA expression of representative tested genes, in addition to gross changes in cellular and membrane protein profiles. The analysis of differentially detectable protein contents of the OspABC- mutant, as compared to the wild type, by two-dimensional gel electrophoresis followed by liquid chromatography-mass spectrometry, identified several spirochete proteins that are dominated by proteins of unknown functions, as well as membrane transporters, chaperons, and metabolic enzymes. We produced recombinant forms of two of these represented proteins, BBA34 and BB0238, and showed that these proteins are detectable during spirochete infection in the tick-borne murine model of Lyme borreliosis and thus serve as potential antigenic markers of the infection.IMPORTANCEThe present manuscript employed a systemic approach to identify non-abundant proteins in cultured Borrelia burgdorferi that are otherwise masked or hidden due to the overwhelming presence of abundant Osps like OspA, OspB, and OspC. As these Osps are either absent or transiently expressed in mammals, we performed a proof-of-concept study in which their removal allowed the analysis of otherwise less abundant antigens in OspABC-deficient mutants and identified several immunogenic proteins, including BBA34 and BB0238. These antigens could serve as novel vaccine candidates and/or genetic markers of Lyme borreliosis, promoting new research in the clinical diagnosis and prevention of Lyme disease.

Preventing Lyme disease through identification of key beliefs

Lyme disease and other vector-borne diseases are on the rise because of climate change. In the province of Quebec, Canada, Lyme disease has become a public health problem deserving the attention of health authorities. Despite their recognized effectiveness at preventing tick-to-human transmission, rates of adoption of Lyme disease adaptive behaviours (LDAB) remain relatively low in the population. Using the Theory of Planned Behaviour (TPB), the aim of this study is to identify specific and actionable beliefs associated with the adoption of Lyme disease adaptive behaviours. Specifically, 2,011 people were surveyed to determine the decision-making process behind specific beliefs, which could be targeted for raising awareness. Statistically significant associations were found between the three determinants of the TPB (i.e., attitudes, perceived social pressure and perceived behavioral control) and the intention to adapt. In addition, the intention itself was significantly associated with adopting LDAB. Belief-based analyses indicated that 8 primary beliefs (4 behavioral beliefs, 2 normative beliefs, and 2 control beliefs) were associated with LDAB. Among these, control beliefs (barriers and facilitating factors) appeared to have the greatest impact on adaptation. These findings can be used to guide educational and awareness-raising campaigns to promote LDAB by changing or reinforcing these primary beliefs.

Diagnosis, Treatment and Prevention of Pediatric Lyme disease

Lyme disease remains a significant public health challenge in the United States, particularly in the Northeast and Midwest regions, and is likely to increase in the coming years with population growth to suburban areas and warmer weather. Lyme disease is a bacterial infection caused by the spirochete, Borrelia burgdorferi, that is transmitted to humans through deer ticks. The presentation of Lyme disease can involve multiple systems with dermatologic, neurologic, rheumatologic, and cardiac symptoms commonly described. However, there is substantial variation in the presentation of Lyme disease, creating a challenge to diagnosis and treatment. The standard treatment for Lyme disease is administration of antibacterial agents. Although the majority of pediatric patients achieve symptom resolution with treatment, a subset continues to experience fatigue, pain, and psychological disturbances known as post-treatment Lyme disease syndrome. Prevention of Lyme disease largely relies on behavioral measures such as wearing long sleeves and pants and checking for ticks given the absence of an effective vaccine. Prophylactic antibiotic treatment is also highly effective for children who have experienced a Ixodes tick bite, occurring in an endemic region with tick attachment for at least 36 hours. Although Lyme disease disproportionately impacts children, the existing literature primarily focuses on its presentation in adults. In this review, we summarize the latest literature surrounding the diagnosis, treatment, and prevention of Lyme disease with a specific emphasis on pediatric populations and the recent advancements in vaccine development.

Lyme Disease Knowledge, Practices, and Vaccine Acceptability Among Nurse Practitioners in Pediatric Practice

Lyme disease (LD) is a major public health problem in the United States. Given its incidence and geographic expansion, nurse practitioners (NPs) will likely encounter patients with this condition. NPs were invited to participate in an electronic survey via email, newsletter, and social media posts. The 31-question survey collected information on provider characteristics, clinical scenario decisions, resources used, and vaccine sentiment for LD. Survey participants (n=606) were primarily cisgender female (75%) and aged 30-49 years (62%). Responding to six hypothetical clinical scenarios, only 31% of participants answered most questions correctly. If an LD vaccine becomes available, 39% said they would incorporate it into practice; 48% would seek further information before deciding. Additional education on LD prevention, diagnosis, and treatment is needed for NPs. Increasing provider awareness of current guidelines and developing tailored resources for NPs may improve patient care.

Identifying Trusted Sources of Lyme Disease Prevention Information Among Internet Users Connected to Academic Public Health Resources: Internet-Based Survey Study.

Misinformation about Lyme disease and other tick-transmitted pathogens circulates frequently on the internet and can compete with, or even overshadow, science-based guidance on tick-borne disease (TBD) prevention. We surveyed internet users connected to academic tick-related resources to identify trusted sources of Lyme disease prevention information, explore confidence in tick bite prevention information, and examine associations of these responses with answers to commonly disputed issues. The survey was conducted through social media and website pages for Western Connecticut State University Tickborne Disease Prevention Laboratory and the University of Rhode Island TickEncounter Resource Center. Respondents (N=1190) were predominantly female (903/1190, 76.3%), middle-aged (574/1182, 48.6%), and resided in New England states (663/1190, 55.7%). In total 984 of 1186 (83%) respondents identified conventional experts (eg, the Centers for Disease Control [CDC] or other government health agencies, physicians who follow Infectious Diseases Society of America guidelines for Lyme disease treatment guidelines, and academics) as trustworthy TBD prevention resources. However, nearly one-fourth of respondents would first consult personal contacts and web-based communities regarding prevention information before consulting conventional expert sources. The opinions of public health experts and physicians were rated among the top motivators underlying personal prevention decisions; yet, more than 50% of participants revealed distrustful attitudes toward, or were uncertain about, CDC-supported statements related to time to transmission of Lyme disease (708/1190, 59.5%), the safety of diethyltoluamide-based repellents for children (604/1183, 51.1%), and recommended use of antibiotic prophylaxis (773/1181, 65.4%). Multimodal regression models revealed that participants from high-Lyme-disease-incidence states were more likely to first seek TBD prevention information from personal networks and nontraditional sources before approaching conventional sources of TBD prevention information. We found that those reporting high rates of social media usage were more than twice as likely to first seek traditional expert sources of prevention information but were overall more likely to reject CDC-promoted Lyme disease information, in particular the established time to transmission of Lyme disease bacteria. Models also predicted that those participants who disagreed with the conventional scientific view on the antibiotic prophylaxis prevention statement were less likely to be confident in their ability to protect themselves from a tick bite. Overall, uncertainty in one's ability to protect oneself against tick bites was strongly associated with uncertainty about beliefs in CDC-promoted TBD prevention information. Self-reported trust in experts and frequency of social media use suggest that these platforms may provide opportunities to engage directly with the public about TBD prevention practices. Using strategies to improve public trust and provide information where the public engages on social media may improve prevention communication and adoption of best practices.

Which trial do we need? Treatment of multiple erythema migrans with doxycycline for 7 days versus 14 days

Which trial do we need? Treatment of multiple erythema migrans with doxycycline for 7 days versus 14 days

DNA lipid nanoparticle vaccine targeting outer surface protein C affords protection against homologous Borrelia burgdorferi needle challenge in mice.

The incidence of Lyme disease (LD) in Canada and the United States has risen over the last decade, nearing 480,000 cases each year. Borrelia burgdorferi sensu lato, the causative agent of LD, is transmitted to humans through the bite of an infected tick, resulting in flu-like symptoms and often a characteristic bull's-eye rash. In more severe cases, disseminated bacterial infection can cause arthritis, carditis and neurological impairments. Currently, no vaccine is available for the prevention of LD in humans. In this study, we developed a lipid nanoparticle (LNP)-encapsulated DNA vaccine encoding outer surface protein C type A (OspC-type A) of B. burgdorferi. Vaccination of C3H/HeN mice with two doses of the candidate vaccine induced significant OspC-type A-specific antibody titres and borreliacidal activity. Analysis of the bacterial burden following needle challenge with B. burgdorferi (OspC-type A) revealed that the candidate vaccine afforded effective protection against homologous infection across a range of susceptible tissues. Notably, vaccinated mice were protected against carditis and lymphadenopathy associated with Lyme borreliosis. Overall, the results of this study provide support for the use of a DNA-LNP platform for the development of LD vaccines.

Evaluation of a community-based One Health intervention to reduce the risk of Lyme disease in a high-incidence municipality

Abstract Integrated interventions coherent with the One Health approach are required to maximize the effectiveness of tick-borne disease prevention. The objective of this study was to evaluate the feasibility of a community-based One Health preventive intervention in a municipality reporting a high incidence of Lyme disease (LD) in the province of Quebec, Canada. The intervention integrated several activities to promote the adoption of preventive behaviours in the community (community component), with the reduction of infected ticks in the environment (environmental component). To evaluate short-term effects of the community component, quantitative data on knowledge, attitudes, and practices (KAP) of citizens were collected using online questionnaires at the beginning of the intervention and 1 year later. To evaluate the implementation of the intervention, a qualitative approach was principally used, and individual interviews (n=37) were conducted with key informants. Results showed that having a high level of participation in the community activities included in the intervention was associated with a higher adoption of preventive measures at the end of the intervention, although participation was not significantly associated with changes in KAP over the intervention period. Interviews revealed that the community mobilization approach was perceived as an effective and sustainable way to empower citizens and researchers with regard to LD prevention. This study suggests that community-based interventions of this type offer a promising approach to the prevention of tick-borne diseases.

Femoral Nerve Injury during Neuroborreliosis — Nursing Care. Case Report

Introduction. Neuroborreliosis is an insidious disease. It is often confused with other neurological diseases. Diagnosis is possible when the following are present: neurological symptoms indicative of neuroborreliosis, pleocytosis in CSF, and production of antibodies to Borrelia burgdorferi in CSF.
 Aim. To assess the health situation and determine the nursing needs of a patient with femoral nerve damage during neuroborreliosis.
 Case Report. A 31-year-old woman was admitted to the Department of Neurology as an elective patient. On the basis of the clinical picture, elevated levels of protein and lymphocytic cells in the examination of cerebrospinal fluid and the demonstrated intrathecal synthesis of antibodies against Borrelia diagnosed neuroborreliosis with damage to the left femoral nerve. Observation, interview, and analysis of medical records were used to identify nursing problems correctly. The scales used were: the NRS Rating Scale (pain intensity), Lovett Scale (muscle strength assessment), Hospital Anxiety and Depression Scale Questionnaire (a modified version of the HADS scale to assess anxiety and depression), AIS Scale (to assess insomnia), Baxter Scale (to monitor and assess the risk of complications associated with venous cannulation).
 Conclusions. Dorothea Orem’s nursing theory is appropriate for a patient with neuroborreliosis. The patient’s main problems are: experiencing pain, difficulty in movement, and mental deterioration. The disease and related treatment and hospitalization influence bio-psycho-social deterioration. Holistic nursing management should be adapted to the patient’s changing condition. Care includes activities aimed at nullifying the effects of the disease, providing emotional support, and education regarding proper rehabilitation management and prevention of Lyme disease. (JNNN 2022;11(4):174–179)

Consultation in out-of-hours practice: a clinical review of Lyme disease

In this article Sharon Brydon and Dr Sonya MacVicar highlight the importance of reaching a shared decision with the patient understanding the perceived risk and benefits of treatment In recent times, telephone triage and virtual consultation have been expedited in the out-of-hours urgent primary care setting. This brings challenges concerning gaining a comprehensive history and building a therapeutic relationship between nurse prescriber and patient. This article presents a clinical review of Lyme disease to explore consultation models and how implementing a hybrid consultation approach may support the practitioner to develop safe prescribing practices and optimise patient expectations. This review of Lyme disease management highlights the sparse, low-quality evidence available, with national guidance indicating antimicrobial treatment for those who present with an erythema migrans rash prior to laboratory testing confirmation. This reinforces the importance of reaching a shared decision with the patient understanding the perceived risk and benefits of treatment. The factors discussed include Lyme disease prevention and how the practitioner ensures safety netting in the out-of-hours setting.

Use of the Western blot technique to identify the immunogenic proteins of Borrelia burgdorferi for developing a Lyme disease vaccine

BackgroundLyme disease is a serious infectious disease having a restricted worldwide distribution for which there is no vaccine available for human use. ObjectiveThis study was designed to determine common reactive antigens involved in Borrelia burgdorferi (Bb) infection that are recognized in mammalian sera that may be useful for vaccine development. MethodsBlood samples were collected from patients with documented Lyme disease, and from rabbits and mice experimentally infected with either tick-transmitted or culture-grown Borrelia burgdorferi. All samples were then processed for sera. For performing the Western blots, sonicated Bb organisms (whole cell lysates) and protein ladders were separated by protein gel electrophoresis. Immune reactivities of the electrophoresed proteins with the serum samples were then probed with anti-HRP IgG reagent. ResultsRabbit, mouse and human sera consistently reacted with the 41 kDa band of Bb which corresponded to the flagellin protein – the major protein component of this organism’s periplasmic flagella, also known as axial filaments or fibrils. Various other Bb antigens of wide molecular weight ranges were also recognized by rabbit and human sera, and less frequently with mouse sera. ConclusionThe strong immune response to the 41 kDa flagellin protein by the different mammalian species suggests the utility of a possible vaccine targeting this protein, although other proteins may also be appropriate, for preventing Lyme disease following a bite from an infected tick.

BABESIA MICROTI INFECTION WITH LOW-GRADE PARASITEMIA CAUSING ARDS IN AN IMMUNOCOMPETENT PATIENT

BABESIA MICROTI INFECTION WITH LOW-GRADE PARASITEMIA CAUSING ARDS IN AN IMMUNOCOMPETENT PATIENT

Consultation in out-of-hours practice: a clinical review of Lyme disease

In recent times, telephone triage and virtual consultation have been expedited in the out-of-hours urgent primary care setting. This brings challenges concerning gaining a comprehensive history and building a therapeutic relationship between nurse prescriber and patient. This article presents a clinical review of Lyme disease to explore consultation models and how implementing a hybrid consultation approach may support the practitioner to develop safe prescribing practices and optimise patient expectations. This review of Lyme disease management highlights the sparse, low-quality evidence available, with national guidance indicating antimicrobial treatment for those who present with an erythema migrans rash prior to laboratory testing confirmation. This reinforces the importance of reaching a shared decision with the patient understanding of the perceived risk and benefits of treatment. The factors discussed include Lyme disease prevention and how the practitioner ensures safety netting in the out-of-hours setting.