Prevention of Lyme disease
- Rebecca Eisen, PhD
Rebecca Eisen, PhD
- Research Biologist
- Division of Vector-Borne Diseases, CDC
- Paul Mead, MD, MPH
Paul Mead, MD, MPH
- Chief, Epidemiology and Surveillance Activity
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; 25,000 confirmed 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 acceptance by the target population . 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".)
Several strategies for personal protection against Lyme disease have been advocated [2,3]. These include:
●Checking for and removing ticks after outdoor activities
- Hayes EB, Maupin GO, Mount GA, Piesman J. Assessing the prevention effectiveness of local Lyme disease control. J Public Health Manag Pract 1999; 5:84.
- Hayes EB, Piesman J. How can we prevent Lyme disease? N Engl J Med 2003; 348:2424.
- Connally NP, Durante AJ, Yousey-Hindes KM, et al. Peridomestic Lyme disease prevention: results of a population-based case-control study. Am J Prev Med 2009; 37:201.
- Gould LH, Nelson RS, Griffith KS, et al. Knowledge, attitudes, and behaviors regarding Lyme disease prevention among Connecticut residents, 1999-2004. Vector Borne Zoonotic Dis 2008; 8:769.
- Vázquez M, Muehlenbein C, Cartter M, et al. Effectiveness of personal protective measures to prevent Lyme disease. Emerg Infect Dis 2008; 14:210.
- Orloski KA, Campbell GL, Genese CA, et al. Emergence of Lyme disease in Hunterdon County, New Jersey, 1993: a case-control study of risk factors and evaluation of reporting patterns. Am J Epidemiol 1998; 147:391.
- Ley C, Olshen EM, Reingold AL. Case-control study of risk factors for incident Lyme disease in California. Am J Epidemiol 1995; 142:S39.
- Nelson CA, Hayes CM, Markowitz MA, et al. The heat is on: Killing blacklegged ticks in residential washers and dryers to prevent tickborne diseases. Ticks Tick Borne Dis 2016; 7:958.
- Carroll JF. A cautionary note: survival of nymphs of two species of ticks (Acari: Ixodidae) among clothes laundered in an automatic washer. J Med Entomol 2003; 40:732.
- Stjernberg L, Berglund J. Detecting ticks on light versus dark clothing. Scand J Infect Dis 2005; 37:361.
- Wallace JW, Nicholson WL, Perniciaro JL, et al. Incident Tick-Borne Infections in a Cohort of North Carolina Outdoor Workers. Vector Borne Zoonotic Dis 2016; 16:302.
- Miller NJ, Rainone EE, Dyer MC, et al. Tick bite protection with permethrin-treated summer-weight clothing. J Med Entomol 2011; 48:327.
- Vaughn MF, Meshnick SR. Pilot study assessing the effectiveness of long-lasting permethrin-impregnated clothing for the prevention of tick bites. Vector Borne Zoonotic Dis 2011; 11:869.
- Jordan RA, Schulze TL, Dolan MC. Efficacy of plant-derived and synthetic compounds on clothing as repellents against Ixodes scapularis and Amblyomma americanum (Acari: Ixodidae). J Med Entomol 2012; 49:101.
- Insect Repellents. In: The Medical Letter on drugs and therapeutics, 58, New Rochelle, NY 2016. p.83.
- Katz TM, Miller JH, Hebert AA. Insect repellents: historical perspectives and new developments. J Am Acad Dermatol 2008; 58:865.
- Fradin MS, Day JF. Comparative efficacy of insect repellents against mosquito bites. N Engl J Med 2002; 347:13.
- Piesman J, Eisen L. Prevention of tick-borne diseases. Annu Rev Entomol 2008; 53:323.
- Lane RS, Steinlein DB, Mun J. Human behaviors elevating exposure to Ixodes pacificus (Acari: Ixodidae) nymphs and their associated bacterial zoonotic agents in a hardwood forest. J Med Entomol 2004; 41:239.
- Daltroy LH, Phillips C, Lew R, et al. A controlled trial of a novel primary prevention program for Lyme disease and other tick-borne illnesses. Health Educ Behav 2007; 34:531.
- Malouin R, Winch P, Leontsini E, et al. Longitudinal evaluation of an educational intervention for preventing tick bites in an area with endemic lyme disease in Baltimore County, Maryland. Am J Epidemiol 2003; 157:1039.
- Heller JE, Benito-Garcia E, Maher NE, et al. Behavioral and attitudes survey about Lyme disease among a Brazilian population in the endemic area of Martha's Vineyard, Massachusetts. J Immigr Minor Health 2010; 12:377.
- Jenks NP, Trapasso J. Lyme risk for immigrants to the United States: the role of an educational tool. J Travel Med 2005; 12:157.
- Shadick NA, Zibit MJ, Nardone E, et al. A School-Based Intervention to Increase Lyme Disease Preventive Measures Among Elementary School-Aged Children. Vector Borne Zoonotic Dis 2016; 16:507.
- Eisen L, Dolan MC. Evidence for Personal Protective Measures to Reduce Human Contact With Blacklegged Ticks and for Environmentally Based Control Methods to Suppress Host-Seeking Blacklegged Ticks and Reduce Infection with Lyme Disease Spirochetes in Tick Vectors and Rodent Reservoirs. J Med Entomol 2016.
- Panella NA, Dolan MC, Karchesy JJ, et al. Use of novel compounds for pest control: insecticidal and acaricidal activity of essential oil components from heartwood of Alaska yellow cedar. J Med Entomol 2005; 42:352.
- Dietrich G, Dolan MC, Peralta-Cruz J, et al. Repellent activity of fractioned compounds from Chamaecyparis nootkatensis essential oil against nymphal Ixodes scapularis (Acari: Ixodidae). J Med Entomol 2006; 43:957.
- Benjamin MA, Zhioua E, Ostfeld RS. Laboratory and field evaluation of the entomopathogenic fungus Metarhizium anisopliae (Deuteromycetes) for controlling questing adult Ixodes scapularis (Acari: Ixodidae). J Med Entomol 2002; 39:723.
- Hinckley AF, Meek JI, Ray JA, et al. Effectiveness of Residential Acaricides to Prevent Lyme and Other Tick-borne Diseases in Humans. J Infect Dis 2016; 214:182.
- Mather TN, Ribeiro JM, Spielman A. Lyme disease and babesiosis: acaricide focused on potentially infected ticks. Am J Trop Med Hyg 1987; 36:609.
- Deblinger RD, Rimmer DW. Efficacy of a permethrin-based acaricide to reduce the abundance of Ixodes dammini (Acari: Ixodidae). J Med Entomol 1991; 28:708.
- Daniels TJ, Fish D, Falco RC. Evaluation of host-targeted acaricide for reducing risk of Lyme disease in southern New York state. J Med Entomol 1991; 28:537.
- Dolan MC, Maupin GO, Schneider BS, et al. Control of immature Ixodes scapularis (Acari: Ixodidae) on rodent reservoirs of Borrelia burgdorferi in a residential community of southeastern Connecticut. J Med Entomol 2004; 41:1043.
- Gomes-Solecki MJ, Brisson DR, Dattwyler RJ. Oral vaccine that breaks the transmission cycle of the Lyme disease spirochete can be delivered via bait. Vaccine 2006; 24:4440.
- Dolan MC, Schulze TL, Jordan RA, et al. Elimination of Borrelia burgdorferi and Anaplasma phagocytophilum in rodent reservoirs and Ixodes scapularis ticks using a doxycycline hyclate-laden bait. Am J Trop Med Hyg 2011; 85:1114.
- Pound JM, Miller JA, George JE, Lemeilleur CA. The '4-poster' passive topical treatment device to apply acaricide for controlling ticks (Acari: Ixodidae) feeding on white-tailed deer. J Med Entomol 2000; 37:588.
- Carroll JF, Allen PC, Hill DE, et al. Control of Ixodes scapularis and Amblyomma americanum through use of the '4-poster' treatment device on deer in Maryland. Exp Appl Acarol 2002; 28:289.
- Garnett JM, Connally NP, Stafford KC 3rd, Cartter ML. Evaluation of deer-targeted interventions on Lyme disease incidence in Connecticut. Public Health Rep 2011; 126:446.
- Rand PW, Lubelczyk C, Holman MS, et al. Abundance of Ixodes scapularis (Acari: Ixodidae) after the complete removal of deer from an isolated offshore island, endemic for Lyme Disease. J Med Entomol 2004; 41:779.
- Schulze TL, Jordan RA, Schulze CJ, et al. Integrated use of 4-Poster passive topical treatment devices for deer, targeted acaricide applications, and Maxforce TMS bait boxes to rapidly suppress populations of Ixodes scapularis (Acari: Ixodidae) in a residential landscape. J Med Entomol 2007; 44:830.
- Maupin GO, Fish D, Zultowsky J, et al. Landscape ecology of Lyme disease in a residential area of Westchester County, New York. Am J Epidemiol 1991; 133:1105.
- Schulze TL, Jordan RA, Hung RW. Suppression of subadult Ixodes scapularis (Acari: Ixodidae) following removal of leaf litter. J Med Entomol 1995; 32:730.
- Mather TN, Duffy DC, Campbell SR. An unexpected result from burning vegetation to reduce Lyme disease transmission risks. J Med Entomol 1993; 30:642.
- Steere AC, Sikand VK, Meurice F, et al. Vaccination against Lyme disease with recombinant Borrelia burgdorferi outer-surface lipoprotein A with adjuvant. Lyme Disease Vaccine Study Group. N Engl J Med 1998; 339:209.
- Lathrop SL, Ball R, Haber P, et al. Adverse event reports following vaccination for Lyme disease: December 1998-July 2000. Vaccine 2002; 20:1603.
- Poland GA. Vaccines against Lyme disease: What happened and what lessons can we learn? Clin Infect Dis 2011; 52 Suppl 3:s253.
- Shen AK, Mead PS, Beard CB. The Lyme disease vaccine--a public health perspective. Clin Infect Dis 2011; 52 Suppl 3:s247.
- Steere AC, Drouin EE, Glickstein LJ. Relationship between immunity to Borrelia burgdorferi outer-surface protein A (OspA) and Lyme arthritis. Clin Infect Dis 2011; 52 Suppl 3:s259.
- Livey I, O'Rourke M, Traweger A, et al. A new approach to a Lyme disease vaccine. Clin Infect Dis 2011; 52 Suppl 3:s266.
- PERSONAL PROTECTION
- Checking for and removing ticks
- Bathing after exposure to tick-infested habitat
- Placing clothes in a dryer
- Protective clothing
- Tick repellents
- Avoiding tick habitat
- Educational interventions
- ENVIRONMENTAL INTERVENTIONS
- Targeting the tick
- Targeting reservoir hosts
- - Rodents
- - Deer
- - Integrated pest management
- Landscape management
- PROPHYLAXIS FOR TICK BITE
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS