February 2000
CHICAGO - The American Academy of Pediatrics (AAP) recently released its first statement on the prevention of Lyme disease. The AAP recommends vaccination against Lyme disease for people older than 15 who live in, work or visit areas of high to moderate risk or people with a history of Lyme disease who are at continued high risk.
LYMErix (SmithKline Beecham) is the only Lyme disease vaccine available in the United States and is licensed for use in individuals ages 15 to 70.
All ages are equally susceptible to the disease, but the highest rates of Lyme disease occur in children ages 2 to 15 and in people ages 30 to 55 and older.
Use of the vaccine, causes false-positive enzyme immunoassay results for the disease. Disease can be diagnosed in vaccinated individuals by immunoblot testing. The vaccine, however, should be considered an adjunct, not a replacement for, personal protective measures.
LYMErix contains recombinant OspA (OspA) and uses the OspA gene from Borrelia burgdorferi and contains 30 mg of purified OspA lipidated protein combined with 0.5mg of aluminum adjuvant. Dosage is 0.5 mL (30 mg) of OspA vaccine administered by intra-muscular injection for optimal protection; with a second dose given one month later and a third dose given 12 months after the initial dose. Doses should be timed with the start of disease transmission season, usually in April.
Other data suggest immunization at zero, one and six months is safe, but the vaccine is not licensed for that schedule. The safety and efficacy of simultaneous administration with other vaccines has not been established, but OspA should not interfere with other routine vaccines, according to the AAP statement. Data is insufficient on vaccine administration to those with immunodeficiencies and is not recommended for pregnant women.
Soreness at the injection site is the most common adverse event, followed by redness and swelling. According to the AAP, there is no evidence that the OspA vaccine exacerbated prior Lyme arthritis, caused arthritis in subjects with or without a history of Lyme disease or caused neurological disease. The possibility exists, however, that a OspA vaccine could predispose to arthritis in selected people with the genetic disposition to the disorder. Approximately 10% of adults and 5% of children develop inflammatory joint disease that doesn't respond to antimicrobial agents.
The AAP recommends against routine use of antimicrobial agents to prevent Lyme disease in people who have received a tick bite because of its unproven value, cost, adverse events and potential infection with an antibiotic-resistant bacteria. The AAP also recommends against serologic testing at the time of a recognized bite because there is little or no chance a patient would have detectable antibodies to the spirochete B. burgdorferi from a new infection at the time of the bite. Early serologic testing has a high probability of false-positive test results in Lyme disease.
Reported cases of Lyme disease have increased 25-fold since 1982, with approximately 12,500 cases reported annually between 1993 and 1997. More than 90% of Lyme disease cases have occurred in approximately 150 counties in 13 states, including states along the Northeast, mid-Atlantic seaboard and upper Midwest areas. Lyme disease is the most frequently reported vector-borne illness in the United States, accounting for more than 95% of cases.
For more information:
- AAP Committee on Infectious Diseases. Prevention of Lyme disease. Pediatrics. 2000;105(1):142-147.
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