INTRODUCTION

Since the discovery of the Lyme disease spirochete, Borrelia burgdorferi, in 1982, and the establishment of Lyme disease as a reportable disease in the United States in 1991, reported Lyme disease cases have increased so dramatically that it is now the most commonly reported vector-borne disease in the United States; over 20,000 cases are reported annually. Efforts to prevent Lyme disease have focused in four principal areas: personal protection, environmental intervention, prophylactic treatment, and vaccination.

The effectiveness of any given preventive intervention is dependent on both the efficacy of the intervention and the level of engagement in the intervention by the target population [1]. Thus, effective Lyme disease prevention depends on selection of strategies that are both efficacious and acceptable to people in endemic regions.

Personal protection and environmental interventions for the prevention of Lyme disease and other tick-borne diseases will be reviewed here. The microbiology, epidemiology, clinical manifestations, diagnosis, and treatment of Lyme disease are discussed separately; the evaluation of a tick bite for possible Lyme disease, which includes a discussion of antibiotic prophylaxis, is also covered elsewhere. (See "Microbiology of Lyme disease" and "Epidemiology of Lyme disease" and "Clinical manifestations of Lyme disease in adults" and "Lyme disease: Clinical manifestations in children" and "Diagnosis of Lyme disease" and "Treatment of Lyme disease" and "Evaluation of a tick bite for possible Lyme disease".)

PERSONAL PROTECTION

Several strategies for personal protection against Lyme disease have been advocated (figure 1) [2,3]. These include:

• Checking for and removing ticks after outdoor activities
• Bathing after outdoor activities where ticks are abundant
• Wearing protective clothing
• Using tick repellent on skin and clothing
• Avoiding areas where ticks are abundant