Life After Lyme Disease

Image of adult blacklegged tick

Lyme disease is a tick-borne infection, and is primarily spread to humans through bites from deer ticks, Western blacklegged ticks and possibly lone star ticks.  These tick species carry the Borrelia burgdorferi bacterium which causes Lyme disease, and feed on a number of small to medium size mammals and birds including small rodents, deer and household pets.

Birds

Birds play a major role in the spread of Lyme disease as they can pick up a tick carrying the Borrelia burgdorferi bacterium in one location, and because it takes a long time for ticks to feed they could be hundreds or even thousands of miles away before the tick finally drops off.  The seasonal migration of birds in Northern America is key to the spread of Lyme disease and over 650 species of bird migrate to different parts of the world annually, either taking part in long distance migration to places such as Africa, Eastern Europe and South America, or short distance migration of just a few hundred miles.  Many birds such as White-throated Sparrows and robins spend the winter in Northern America before moving on to summer feeding grounds in Canada, and there are also a number of transitory birds that pass through Canada as a stop over on the way to other feeding grounds, and many of these could potentially be carrying infected ticks or the Borrelia burgdorferi bacterium itself, which they could pass on to uninfected ticks in the areas they feed in.

The spread of ticks carrying Borrelia burgdorferi bacterium into Southern Canada

Reforestation

A number of factors can influence the spread of any insect species, but the main culprit for the spread of ticks is thought to be reforestation.  Ticks are hardy creatures, but they do require the right habitats to live in. For example the blacklegged tick thrives in cool, moist conditions and the majority can be found in forested areas with dense shrub layers to provide shade and moisture, and tend to condense along the forest and woodland edges, where food is most abundant.  They can also survive in denser underground planting in some landscaped residential areas.

In recent years many areas that were previous cleared for farmland in northern America have been reverted back to small patches of woodland and forest, creating ideal environments not just for ticks, but for the animals they feed on such as deer and small rodents.  This increase in wild tick populations would not normally be a major problem but as urbanization is also increasing, with residential developments encroaching on wild areas, more and more infected ticks are coming into contact with humans, and these woodland border areas in which ticks are prevalent are now coexisting alongside residential areas, creating high risk zones for Lyme disease crossing to humans.

Reforestation is thought to be having a significant impact on the increasing spread of Lyme disease from North America into Canada, and studies by the Public Health Agency of Canada have so far tracked new infected tick emergence in Ontario, Nova Scotia, New Brunswick, Quebec and Manitoba. 

Steps to Prevent the Spread

The Public Health Agency of Canada and other organizations are calling for national surveillance to be put in place to monitor the changing patterns of tick behavior, to identify new endemic areas quickly and effectively in order to notify the public and local health authorities and ensure education is put in place to minimize the impact of Lyme disease.  Doctors are now required to report any suspected and confirmed cases of Lyme disease to the Public Health Agency, and this enhanced surveillance combined with greater physician and public awareness are crucial steps to help mimize the impact of the disease as it spreads into Canada.

New studies published in the November 2009 issue of Cell Host & Microbe (a leading scientific journal published by Cell Press) have shown some possible ways forward for scientists who are working hard to develop an effective vaccine for Lyme disease, which is caused by the bacterium Borrelia burgdorferi and transmitted through tick bites.  Researchers at the Yale School of Medicine and the Howard Hughes Medical Institute have discovered evidence that suggests a vaccine could be developed from a protein in the tick’s salvia (the pathogen’s transmitting agent), which could confer immunity to those people living in areas affected by this disease.

Developing the Vaccine

The interaction between the Borrelia burgdorferi bacterium and ticks is highly complex, and lead author Erol Fikrig, M.D. of Yale University stated that the recent studies have shown that the bacterium actually uses a protein in the tick’s saliva to ‘facilitate infection of the mammalian host’.  This means that the bacteria effectively ‘wraps’ itself in a coating of these proteins (which it stimulates the tick into producing in excess quantities), which masks its presence from the host’s immune system and allows it to pass into the system unnoticed.  Researcher believe that this interaction between the protein in the tick’s salvia and the bacterium is absolutely key to the infection process, and by interfering with this process an effective protective vaccine could be developed against Lyme disease.

Previous vaccines have been developed against Lyme disease but these have subsequently been removed from the market following unsuccessful field trials, and as yet no other antigens have been released for testing in phase III clinical trials.  These previous vaccinations targeted just the outer surface proteins of the pathogen itself, but the new research suggests that by adopting a different strategy and targeting the transmitting agent (in this case the tick’s salvia) instead of the pathogen a much more effective form of defense could be developed, which could have far reaching effects in the fight against not just Lyme disease, but other harmful insect-borne pathogens that as yet we are unable to vaccinate against such as dengue fever, West Nile virus and even one of the most deadly killers in the world, malaria.

As yet the research on tick’s saliva is still only in the laboratory stages, but the initial studies on animals at the Howard Hughes Medical Institute have shown that mice test subjects responded well to a basic antiserum produced to interfere with the protein in the tick saliva identified as being essential to the Borrelia burgdorferi bacterium infection of the host, which significantly reduced the risks of the mice becoming infected with Lyme disease after being exposed to this tick-borne pathogen.

Hope for the Future

These results are encouraging for the future of vaccination against not just Lyme disease but other insect-borne diseases, and can certainly bring a measure of hope for all those living in areas affected by the Borrelia burgdorferi bacterium.  Ticks produce anesthetics in their salvia that stop the bite from stinging, so in many cases the host does not even realize they have been attacked by the insect, and Lyme disease is an insidious condition and can be difficult to diagnose in the early stages as symptoms are wide ranging and include rashes (that can go unnoticed), fever and chills, tiredness, weakness and joint pain, and if left untreated can result in serious conditions such as heart problems and chronic fatigue.

If you know anything about Lyme disease, it is that there are conflicting opinions on how to treat the problem. In fact, this has been a sticking point for many years and it does not seem that things are going to calm down anytime in the near future. Many doctors, scientists and Lyme disease sufferers feel that long term antibiotics are the best way currently available to treat Lyme disease.

On Wednesday, February 17, 2010, New Hampshire House lawmakers approved a bill that would make it easier for doctors in the state to treat Lyme disease through the use of long term, prescribed antibiotics.

Why is this such a big deal, you may ask? In the past, doctors have been reluctant to prescribe long term antibiotics because many were skeptical of the existence of a chronic form of Lyme disease, primarily because of the flawed guidelines issued by the Infectious Disease Society of America (IDSA) who has consistently ignored scientific evidence that does not agree with their position. In addition many doctors are afraid that the IDSA will go after them and try to revoke their license to practice medicine, as has happened in several cases. With the passage of this bill, New Hampshire doctors will be able to treat their patients as they and their patients feel is best, without any intrusion by the IDSA.

Rep. Jen Coffee (R) of Andover had this to say about passing the bill: “Any medication has the potential to have a problem, but we allow long-term antibiotic use for treatment of acne — acne of all things.” She added, “Why wouldn’t we allow it for Lyme disease?”

Many people don’t think Lyme disease is a big problem, but once they take a closer look at the statistics they find out differently. Believe it or not, more than 25,000 new cases of Lyme disease are diagnosed across the country every year, and since Lyme disease is so frequently misdiagnosed, the true number of cases is most likely much higher. This has led to New Hampshire, as well as several other states, passing legislation to protect doctors who actually try to treat this debilitating disease. The states that have yet to have done so are holding back because they feel that long term treatments need to be studied in more depth, no doubt the result of the confusion caused by the controversy with the IDSA guidelines.

Lawmakers and doctors are not the only ones supporting the bill. Many Lyme disease sufferers have been actively lobbying for such bills to be passed in their state. They are tiered of being told by doctors who follow the IDSA guidelines that it’s all in their heads and they should just go home and suffer. Furthermore, because of these guidelines many insurance companies have began to refuse to pay for antibiotic treatments for chronic Lyme disease, adding more problems to the lives of those who suffer from this disease.

Kathy Kettmann a Lyme disease sufferer and supporter of the New Hampshire bill said: “I couldn’t walk. I couldn’t talk,”… “I was very sick, and to be put in a car for five hours to go to the doctor because we couldn’t get treated in New Hampshire was hard.”

It yet remains to see if the New Hampshire State Senate will pass the bill. It will also be interesting to see if more states follow suit with similar legislation.

Parker Posey is questioning conventional medicine after the pills she was prescribed failed to cure her of Lyme disease.

The Best In Show star was forced to pull out of an off-Broadway play earlier this year (2009) to focus on battling her tick-borne illness.

Doctors had put Posey on a course of antibiotics but after that treatment failed to restore her health, she decided to try a holistic approach and treat her Lyme disease with supplements and a complete change in her diet. She felt so much better after her holistic treatment that she decided to lend her backing to a new documentary, Rethinking Cancer, about patients who seek out alternative methods of treatment.

She says, “As someone who dealt with Lyme disease recently, I had the opportunity to approach it both with conventional medicine (antibiotics) and homoeopathic remedies and supplements. The first round of antibiotics did not destroy all the bacteria and I made a decision not to take them anymore and instead approach it purely holistically – through the help of my homoeopathic doctor, who guided me with my diet and gave me the natural supplements to bring my body back to its vitality.
“It raises the questions: How can a natural approach to healing oneself be considered so unconventional? Why do we think we can’t play an active role in getting healthy? Why do we give ourselves away so easily to pharmaceuticals that deplete our system and confuse the natural healing process?”

New Haven, Conn. — Yale researchers have discovered that a protein found in the saliva of ticks helps protect mice from developing Lyme disease. The findings, published in the November 19th issue of Cell Host & Microbe, may spur the development of a new vaccine against infection from Lyme disease, which is spread through tick bites .

Traditionally, vaccines have directly targeted specific pathogens. This is the first time that antibodies against a protein in the saliva of a pathogen’s transmitting agent (in this case, the tick) have been shown to confer immunity when administered protectively as a vaccine.

The Lyme bacterium known as Borrelia burgdorferi is transmitted by ticks. When it moves through the tick, it is coated with a tick salivary protein known as Salp15. The Yale research team injected Salp15 into healthy mice and found that it significantly protected them from getting Lyme disease. When combined with outer surface proteins of B. burgdorferi , the protection was even greater.

Lead author Erol Fikrig, M.D. of Yale School of Medicine and Howard Hughes Medical Institute said, “The interaction between the Lyme disease agent and ticks is very complex, and the bacteria uses a tick salivary protein to facilitate infection of the mammalian host. By interfering with this important interaction, we can influence infection by the Lyme disease agent.”

Several years ago there was a Lyme vaccine on the market that utilized just the outer surface proteins of the bacteria. It was taken off the market in 2002, and to date no other antigen has been tested in phase III clinical trials.

The authors believe this new strategy of targeting the saliva – the “vector molecule” that a microbe requires to infect a host – may be applicable not just to Lyme disease but to other insect-borne pathogens that cause other human illnesses.

“We believe that it is likely that many arthropod-borne infection agents of medical importance use vector proteins as they move to the mammalian host,” Fikrig explained. “If so, then this paradigm, described with the Lyme disease agent, is likely to be applicable to these illnesses. Currently, we are working to determine if this strategy is likely to be important for West Nile virus infection, dengue fever, and malaria, among other diseases.”

Other researchers were Jianfeng Dai, Penghua Wang, Sarojini Adusumilli, Carmen J. Booth and Sukanya Narasimhan of Yale School of Medicine, and Juan Anguita of the University of Massachusetts. This work was support by grants from the National Institutes of Health.

Contact: Helen Dodson , 203-436-3984

Source: Yale University

Using a powerful microscopic live imaging technique, a research team led by Dr. Justin Radolf, professor in the Departments of Medicine and Genetics and Developmental Biology at the University of Connecticut Health Center, has discovered that how ticks transmit Lyme disease to humans is different than was previously thought. His research is published online in the Journal of Clinical Investigation .

It has been known for some time now that Lyme disease is caused by the transmission of the spirochete bacterium Borrelia burgdorferi from ticks to humans, but the transmission process has been difficult to study for a number of technical reasons.

Dr. Radolf and researchers Star Dunham-Ems and Melissa Caimano tried a novel approach at solving this mystery. They genetically modified a virulent strain of B. burgdorferi with a green fluorescent protein (GFP). “This bacterium glows and can be followed in the living state as it migrates through the tick to the mouse during feeding,” explains Radolf. “Then using a powerful microscopic technique called confocal microscopy, we discovered that the transmission process unfolds quite differently than previously believed.”

Spirochetes in culture are highly motile, and it is widely believed that during feeding, the spirochetes in the mid-gut rapidly move through the wall of the mid-gut. But Radolf and his team discovered that during much of the feeding period, the spirochetes do not move. They actually divide and surround the cells of the mid-gut lining or epithelium, forming tight networks. “We also found that the reason they don’t move is that the tick mid-gut secretes molecules that actually inhibit the motility of the spirochetes,” explains Radolf.

Eventually, spirochetes in the networks reach the base of the epithelium by completely surrounding the epithelial cells. At this point, they become motile, detach, and completely penetrate the mid-gut, although in very small numbers. These bacteria then swim to the salivary glands, which they penetrate en route to the mouse. “So rather than being entirely motility-driven, dissemination of spirochetes within ticks actually happens in two phases,” says Radolf, “which is something we didn’t know before.”

Lyme disease is the most prevalent vector-borne infection in the United States with more than 25,000 new cases reported annually. “The improved understanding of the transmission process revealed by our study could lead to novel strategies for controlling the spread of Lyme disease,” says Radolf.

FOR IMMEDIATE RELEASE
October 20, 2009
WASHINGTON – The U.S. Environmental Protection Agency (EPA) has launched a new Web page containing product information on certain skin-applied insect repellents. EPA’s goal is to provide the public with information on registered insect repellents and their effectiveness claims in a clear, consistent, and user-friendly format.

“EPA’s release of information on the effectiveness of insect repellents will help American consumers select the right product for their needs and protect themselves and their children from potentially devastating diseases spread by mosquitoes and ticks, such as West Nile virus and Lyme disease,” said Steve Owens, assistant administrator for EPA’s Office of Prevention, Pesticides and Toxic Substances. “ This Web-based dissemination of information supports Administrator Jackson’s goals of transparency and public access and protecting children’s health.”

The new Web page contains two tables listing insect repellent products that are registered by the agency: those that control mosquitoes and ticks, and those that only control mosquitoes. This Web page compiles publicly available information on protection times based on product effectiveness data reviewed by the EPA, and presents it in a format that makes it easy for consumers to make informed risk management decisions to protect their health and that of their families and children. The Web page also contains information on vector-borne diseases such as Lyme disease and the West Nile virus , and the importance of personal protection measures.

The Web page can be accessed at http://www.epa.gov/pesticides/health/mosquitoes/insectrp.htm

Researchers from Michigan State University and five other schools want to determine why Lyme disease is more common in some areas invaded by ticks than others.

The four-year, $2.5 million study funded by The National Science Foundation is being led by fisheries and wildlife assistant professor Jean Tsao (SOW),  at the East Lansing school.

Tsao says she will analyze factors making Lyme disease more likely to be carried by ticks in northern states than those in the south. She says one goal of the study is to help health professionals manage the disease better.

Also participating are researchers from the universities of Tennessee , Rhode Island and Montreal; as well as Hofstra and Georgia Southern universities.

Canadian Lyme disease sufferers and their families are ticked off at how the federal government is dealing with the disease and are rallying across the country to bring attention to their plight.

They say the disease, transmitted through the bite of infected ticks, is not being properly diagnosed by Canadian doctors.

Lyme Action Group will present a petition to the province calling for better physician training, availability of treatment options, improved testing, mandatory screening of the blood supply and protection for Lyme-treating physicians against harassment from the College of Physicians Surgeons of Ontario.

The group states doctors are not being educated on the increasing prevalence of the disease in Canada.

Dr. Jozef Krop, a practitioner of environmental medicine, and Helke Ferrie, a medical/science author, will speak at the event.

Organizers hope to make a formal presentation of the petition to MPPs, to be subsequently read in the Legislature.

The Wall of Hope event begins Thursday at 10 a.m. on the south lawn of the Ontario Legislature at Queen’s Park.

For more information, contact LymeActionGroup@gmail.com or visit LymeActionGroup.blogspot.com

Received from the TickedOff group for distribution:

Here is the information for the upcoming hearing for HB 1148, filed by Representative Robert Hargraves, which will allow all Massachusetts physicians the ability to treat Lyme disease based on their own clinical judgment.

HB 1148 (pdf)

This post serves as an initial announcement, but will be updated during the coming week as we receive more information.

What: Public hearing on HB 1148 (Joint Committee on Public Health) Date: Tuesday, September 22, 2009
Place: Boston State House Room A1
24 Beacon Street Boston, MA, 02108
Directions
Time: 10:00 a.m. (If you plan to attend, please try to arrive by 9:00 a.m.)

Note: We will be sharing the hearing day with other bills and our time will be limited. We must plan carefully in order to utilize the time that we are allowed to full advantage.

Members of the Lyme community are encouraged to participate in each of three ways:

1. Written Testimony NEED YOUR HELP WITH THIS ASAP – Details to follow
2. Attendance at the hearing
3. Participation at the rally on the State House steps on the day of the hearingWe will describe each of these opportunities in subsequent emails. We are trying to keep this information as simple and “user friendly” as possible. Please bear with us, as we strive to clarify and convey the relevant information.

We look forward to working together with you!