Prevention of Tick-Borne Diseases

By Piesman, Joseph; Beard, C. Ben | Journal of Environmental Health, June 2012 | Go to article overview

Prevention of Tick-Borne Diseases


Piesman, Joseph, Beard, C. Ben, Journal of Environmental Health


Lyme disease ranks among the top 10 notifiable infectious diseases in the U.S.; in 2009, state health departments reported 29,959 confirmed and 8,509 probable cases to the Centers for Disease Control and Prevention (CDC, 2010). The first line of defense in the effort to prevent Lyme disease is personal protection (Piesman & Eisen, 2008). Educational efforts, however, such as promoting tick checks, avoiding tick infested habitat, and using repellents, have had only modest success in changing behavior or actually preventing Lyme disease (Connally et al., 2009; Gould et al., 2008). The nymphal stage of the blacklegged tick, Ixodes scapularis, is the principal vector of the Lyme disease spirochete (Borrelia burgdorferi sensu stricto); it has been a focus of research on methods for tick control for prevention of Lyme disease. Some of the methods developed include the application of area-wide acaricides; applying acaricides to rodent hosts of immature ticks; and applying acaricides directly to deer, the principal hosts for the adult ticks. The least toxic agents for killing ticks include soaps and desiccants, fungi, and botanical extracts (reviewed in Piesman & Eisen, 2008). Vegetation management strategies can potentially reduce tick exposure (Schulze, Jordan, & Hung, 1995) as can eradication of deer (Rand, Lubelczyk, Holman, Lacombe, & Smith, 2004).

Despite a plethora of excellent academic research on tick control, however, the public has been slow to adopt any of these methods on a wide scale. One potential hurdle to tick control at a community level is the fact that unlike mosquito control, where mosquito abatement districts receive public funding, tick control is basically an individual homeowner or homeowner association responsibility. The amount of money individual homeowners are willing to spend on tick control, even in highly endemic Lyme disease regions, is extremely limited (Gould et al., 2008).

Targeting the pathogen within the natural reservoir or vector holds promise. Vaccines directed against the outer surface protein A (OspA) of B. burgdorferi have been applied to rodents either via direct inoculation (Tsao et al., 2004) or as baits containing spirochetal OspA (Meirelles Richer, Aroso, Contente-Cuomo, Ivanova, & Gomes-Solecki, 2011). Moreover, rodent-targeted baits containing antibiotics that clear rodents and ticks of spirochetes have also been tested in the lab and the field (Dolan et al., 2011). None of these pathogen-targeted ecological approaches is to the stage yet where commercial products are available for testing.

Human-targeted approaches to blocking transmission of the Lyme disease spirochete include vaccines and antibiotic prophylaxis. An effort toward developing an OspA recombinant protein for deployment as a human vaccine was successful. Two vaccine candidates were tested in clinical trials in both North America (Sigal et al., 1998; Steere et al., 1998) and Europe (Beran, De Clercq, Dieussaert, & Van Hoecke, 2000), and a commercial vaccine became available in 1999. Although this vaccine was effective (Steere et al., 1998) and surveillance did not demonstrate adverse events tied to the vaccine (Lathrop et al., 2002), the vaccine was withdrawn from the market in 2002. The principal reason for withdrawal of the vaccine was lack of market success; however, public perceptions about the safety of the vaccine may have contributed to its withdrawal (Shen, Mead, & Beard, 2011). Antibiotic prophylactic treatment of tick bite can potentially play an important role as a method to prevent B. burgdorferi transmission. A large clinical trial in Westchester County, New York, an area highly endemic for Lyme disease, examined patients that had an I. scapularis tick removed within 72 hours of entering the trial (Nadelman et al., 2001). The efficacy of doxycycline prophylaxis was judged to be 87%, but how widely physicians practice this method is presently unknown. …

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