Vaccines for Special Circumstances: Lyme Disease

Two mothers contacted their state health department in 1975 about the high number of children in their Lyme, Connecticut, neighborhood who were developing joint inflammation. Many had been diagnosed with juvenile rheumatoid arthritis, but this uncommon disease was not known to occur in clusters. The report led to an investigation and, ultimately, to the first identification of Lyme disease. Between 1993 and 1997, approximately 12,500 cases of Lyme disease were reported annually in the United States.

What is Lyme disease, and how is it spread?

A corkscrew-shaped microbe, Borrelia burgdorferi, causes Lyme disease. Deer ticks-small ticks that usually feed on deer, mice, and birds-carry the bacterium and spread it to humans they bite. In the U.S., most cases of Lyme disease are restricted to the northeast, the mid-Atlantic, the upper north-central states, and northwestern California.

Ticks tend to live near the ground in moist, shaded areas, particularly in tall grasses, leaf litter, overgrown brush, and woody environments. So people who frequent these areas are at risk, especially from June to August when young ticks are feeding. Children less than 10 years of age and middle-aged adults (possibly because so many work outside or garden) are most likely to contract Lyme disease.

The most consistent finding is the initial skin lesion. It is a red patch or pimple that expands around a tick bite-though only a few patients recall experiencing a tick bite. Often, the center of the patch returns almost to its normal color, so the patch looks like a bull’s eye (pale in the middle, ringed in red). The sore may become quite large, exceeding five centimeters across. Sixty to 80 percent of persons with Lyme disease develop this skin lesion.

Patients may develop a host of flu-like symptoms, including swollen or painful joints and muscle aches. Some patients go on to develop a strange rash three to five weeks later, along with inflammation of the brain or its outer cover (meningitis), paralysis of the facial muscles, or conduction defects in the heart.

What is the treatment for Lyme disease?

Many oral antibiotics are available to treat Lyme disease. Specific regimens are prescribed depending on the symptoms, and 75 to 80 percent of persons treated will recover from the disease. Unfortunately, before treatment some patients will develop a severe case of the disease, with tissue damage and disability.

To avoid being bitten by the deer tick you should use outdoor insecticides and keep deer away from areas where children play (use an eight-foot-high or electrified fence). However, personal protection measures are often more realistic. These include the following:

  • Wear light-colored clothing to make ticks more visible.

  • Tuck pant legs into socks to keep ticks off your legs.

  • Use tick or insect repellents (e.g., DEET on skin or clothes, permethrin on clothes only).

  • Conduct daily inspections of children and pets for attached ticks. (Ticks on a person for less than 48 hours probably won’t transmit the disease.)

  • If a tick bite sore begins to widen, seek medical advice.

What is the Lyme disease vaccine, and how effective is it?

The Lyme disease vaccine is inactivated, being a protein piece of the microbe’s cell wall. The vaccine was licensed in the U.S. in 1998 for persons age 15 to 70 years of age. Testing in children younger than 15 is not yet complete, so to prevent tick bites, parents should make sure their children follow the precautions listed above.

Three doses of Lyme disease vaccine are needed. The first two doses are given one month apart; the third dose follows the first by 12 months. The second and third doses should be timed to be given before April, the beginning of the tick season. After three doses, the vaccine is effective for more than 75 percent of the people who received it.

Who should get the vaccine?

ACIP recommends that you consider getting the vaccine if you are 15 to 70 years old and

  • Live, work, or play in an area of high or medium risk for Lyme disease;

  • Are in tick-infested areas often or for long periods.

    You may consider getting the vaccine if you spend less time in tick areas.

Who should not get the vaccine?

Lyme disease vaccine should not be given to anyone who

  • Is less than 15 or more than 70 years old.

  • Had a serious allergic reaction to a prior dose of Lyme disease vaccine.

  • Has a moderate to severe illness. If this is the case, the person may receive the vaccine when feeling better.

What are the vaccine risks and side effects?

Allergic reactions could occur after any vaccine. Pain or tenderness, swelling, or warmth at the injection site may occur in about 25 percent of people who receive the vaccine and last one to two days. About 3 percent of people will have muscle or joint aches, flu-like symptoms, fever, or chills.

Frequently Asked Questions

Q: We are going on vacation to an area that is known for Lyme disease and we are camping out. Everyone in our family has gotten the vaccine except the person who rolls around in the bushes the most: my 8-year-old son. Why shouldn’t he get the vaccine?

Tests of vaccine safety and effectiveness are not complete for children younger than 15, so preventing tick bites is the recommended alternative until a vaccine becomes available.

This information is excerpted from the book Vaccinating Your Child: Questions and Answers for the Concerned Parent (Peachtree Publishers, Ltd., 2000). The book’s authors are Dr. Sharon G. Humiston, a pediatrician and clinical researcher at the CDC and the University of Rochester, and Cynthia Good, an award-winning journalist and host of the television show “Good for Parents”.