1. Preventive practices for Lyme disease
Lyme disease is the most frequently reported vector-borne disease in the U.S and Europe yet it is highly preventable by simple, safe and cost effective strategies. The most effective method of preventing the disease is avoiding tick-infested places. Never the less, since this may not be possible other preventive practices for lime disease include using insect repellant chemicals, using personal protective clothes (this could include light-colored clothes to enhance detection of ticks and clothes that cover as much skin as possible), regularly checking the body and clothing for ticks and quickly removing them, applying acaricides on animals and property, landscape management and managing the population of deer (American Academy of Pediatrics:Committee on Infectious Diseases, 2000; Poland, 2011; Shen, Mead, & Beard, 2011; CDC, 2013).
2. Lime Disease vaccine, costs, risks and benefits
Only one vaccine (LYMErix) for Lyme disease was registered in the U.S in 1998 but was voluntarily withdrawn by the manufacturer in 2002 due to public concerns on the safety of the vaccine and the cost. The vaccine is based on the outer surface protein (OSPA) of the causative agent (Borellia burgdorferi). The vaccine renders protection by immunizing the human body against OSPA subsequently leading to the development of antibodies in the blood that are bactericidal. The tick then ingests the antibodies during a blood meal and consequently the antibodies bind to the bacterial and neutralize its virulence. The main benefit of the vaccine is that it offers protection at the infection stage (thus prevents infection) whereas most vaccines offer protection after infection so that they only reduce severity of the disease.
Several risks were linked to the Lyme disease vaccine leading to its withdrawal due to bad publicity. First, due to the existence of several subspecies of the B.burgdirferi FDA review panel concluded that an immunized person was not protected against Lyme disease caused by subspecies outside the U.S. Secondly, the vaccine is administered in 3 doses over a period of over 12 months and the efficacy of the vaccine during the first two doses is below 80%. As such, the immunized are not fully protected until after 12 months. Thirdly, after vaccination the vaccinated person tests positive for the disease by the conventional ELISA test and thus creating a false positive result that confuses clinicians. By the time of the vaccine’s withdrawal the cost of a single dose was approximately $50.
3. Treatment
Several treatment options, mainly antibiotics, are available for Lyme disease. The early stages of the disease can be treated using oral antibiotics; doxycycline for children older than 8 years and adults and cefuroxime and amoxicillin for younger children, adults and even pregnant women. Intravenous antibiotics are recommended for severe cases particularly where the CNS is involved. Other antibiotics commonly used are penicillin, erythromycin, rocephin and claforan. While antibiotics are effective in treating the disease, intravenous antibiotics eliminate the bacteria but take longer to cure the symptoms.
4. Leadership strategies
Suffice to say that an effective and safe vaccine remains the best option and the only efficacious method in preventing the Lyme water in a large community. As such, a good leadership strategy for increasing health status for the disease could involve enhancing the acceptance of the vaccine. The withdrawal of the vaccine was not due to empirical data on safety but bad publicity, because the review by FDA gave the vaccine a clean bill of health. The success of the future prospects of a new vaccine depends on a leadership strategy that addresses the intersection between science, public perception and policy. The public leadership must support the private sector in educating the public and coordinating the vaccination by including the vaccine in the national vaccine program especially in high-risk areas. The leadership should also spearhead research and development activities so as to build empirical data on the vaccine’s safety as well as come up with more vaccine candidates to that meet the threshold of safety, efficacy and public acceptance. In conclusion, the leadership should establish effective surveillance to enhance evaluation and monitoring.
References
American Academy of Pediatrics:Committee on Infectious Diseases. (2000). Prevention of Lyme Disease. Pediatrics , 105 (1), 142-147.
CDC. (2013, June 14). Lyme Disease. Retrieved August 18, 2013, from http://www.cdc.gov/lyme/
Mayo clinic . (2012, October 3). Treatments and drugs. Retrieved August 18, 2013, from http://www.mayoclinic.com/health/lyme-disease/DS00116/DSECTION=treatments-and-drugs
Poland, G. A. (2011). Vaccines against Lyme Disease: What Happened and What Lessons Can We Learn? Clinical Infectious Diseases , 52 (3), 253-258.
Shen, A. K., Mead, P. S., & Beard, C. B. (2011). The Lyme Disease Vaccine—A Public Health Perspective. Clinical Infectious Diseases , 52 (3), 247-252.
