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Lyme Disease: Prevention and Treatment

Lyme disease is the most common disease spread by a tick bite. About 7,000 cases are reported each year in the U.S. Complications from this disease, however, are rare.

Lyme disease has been divided into three stages. If treated with antibiotics, it does not progress from one stage to the next.

Stage I occurs 3 to 32 days after the tick bite. A unique rash develops in about 50% of children. The expanding rash (called "erythema migrans") resembles a bull's-eye, with a red edge and a lighter center that usually starts where the person was bitten. However, the rash can appear anywhere on the body. The rash is not painful or itchy. It lasts 2 weeks to 2 months. Some children also develop a flu-like illness including fever, chills, sore throat, and headache that lasts for several days. In some cases, only one of these signs (the rash or flu-like symptoms) appears, and in others there are no signs at all.

Stage 2 occurs 2 to 12 weeks after the tick bite. It develops in only 15% of the people who have not received treatment for the disease. The main symptoms are related to the nervous system; for example, stiff neck (aseptic meningitis), weak facial muscles (Bellís palsy), and weakness or numbness of the extremities (polyneuritis). A few children (4-8%) may develop some heart rhythm abnormalities.

Stage 3 occurs 6 weeks to 2 years after the tick bite. Arthritis, the main symptom, may present without any previous symptoms of Lyme disease. When seen in children, Lyme arthritis usually affects the knee, causing swelling, pain, and redness. The ankle, hip, wrist, and elbow may also be affected.

The Cause of Lyme Disease

Lyme disease is caused by a type of bacteria called spirochetes. The bacteria are transmitted by dark brown deer ticks, the size of a pinhead, making them hard to see with the naked eye. Deer ticks, which do not jump or fly, attach themselves to animals and humans, that brush by their living area, in low-lying woodland vegetation and grass. They crawl around on your childís body before they bite, looking for an out-of-the-way place to attach. Lyme disease is not carried by the more common wood tick which is bigger (1/4 to 1/2 inch in size).

In most states, only 2% of deer ticks carry Lyme disease. In the New England states, Wisconsin, and Minnesota, however, up to 50% of deer ticks are infected with Lyme disease.

If not disturbed, a tick will remain attached to a person's skin and feed there for 3 to 6 days. The longer a tick is attached to a person, the greater the chance a person has of being infected by the tick. For Lyme disease to be transmitted, the tick needs to be attached for at least 24 hours.

Treatment of Lyme Disease

Lyme disease is usually cured by 14-21 days of oral antibiotics when diagnosed during stage 1. Treatment of stage 2 or 3 may require antibiotics for up to a month.

Antibiotics should be given to any youngster who develops a rash characteristic of Lyme disease within one month of having a tick bite or within one month of being in a high-risk area. In a child without a rash, antibiotics may be prescribed if the child is definitely bitten by a deer tick where the tick was known to be attached for more than 24 hours. Remember that most deer tick bites do not pass on Lyme disease.

Lyme Vaccine

The US Food and Drug Administration (FDA) has announced approval of the first vaccine available to protect against Lyme disease. LYMErix, manufactured by SmithKline Beecham, is approved for use in people between the ages of 15 and 70 years, and is administered in 3 doses over a 1-year period. Clinical trials have shown the vaccine to be effective in 78% of cases. Side effects include redness, soreness, and swelling at the site of injection, and mild-to-moderate flulike symptoms.

The FDA says that the time of year the vaccine is administered may be an important factor in efficacy. The vaccine appears to be most effective when the final dose is administered between January and April -- just before the tick population in the northeastern US reaches its peak. Spacing of doses is also an issue. Recent studies have shown that administering doses of the vaccine over a 3-month period may be just as effective as giving them over a 1-year period.

In granting approval of LYMErix, the FDA stressed that other questions remain about the vaccine. For example, it's not known how long protection lasts following vaccination; participants in clinical trials were followed only about 20 months. In addition, some safety data on the vaccine are limited and need further clarification.

Lyme specialists are recommending that people at risk should, besides considering taking the vaccine, continue to protect themselves with traditional methods -- such as wearing protective clothing, using tick repellents, and checking for ticks after venturing into the woods.

A second Lyme vaccine, this one developed by a division of RhŰne-Poulenc, has completed Phase III trials and may be approved by the FDA during the next year or so.

Prevention of Tick Bites

Cover your childís body as much as possible if your child will be playing in wooded areas. Tuck shirts into pants, and long pants into socks or boots.

Dress your child in light-colored, tightly woven fabrics. Ticks are easy to see on white cloth, and they have difficulty latching on to tight weaves.

Apply a tick repellent to clothes (especially cuffs and socks) and shoes rather than to bare skin. It is safer, more effective, and longer-lasting when used that way. Repellents containing permethrin kill ticks on contact. Those with deet (diethyltoluamide) repel, but do not kill ticks.

Check your child's body every day for ticks. Remember, the hard-to-detect deer tick is one-fourth the size of a common dog tick, and can easily pass for a freckle or a speck of dirt. Look through the hair at the scalp (use a flashlight if your child has dark hair) and check warm, out-of-the-way places: behind ears, under arms, and between toes. Check clothes, too.

To prevent the spread of Lyme disease by your dog, wash him with an anti-tick shampoo or treat with some of the new products that can be applied to your dogís skin once a month during the spring, summer, and fall months. Check for ticks on him if he goes with you on a hike. Pull off any ticks that you find.

Tick Removal

The simplest and quickest way to remove a tick is to pull it off. Use tweezers to grasp the tick as close to the skin as possible (try to get a grip on its head). Pull gently and steadily upward until the tick releases its grip. Do not twist the tick or jerk it suddenly. This may break the tickís head off and trap it under the skin. Do not squeeze the tweezers to the point of crushing the tick while it is still attached as this may increase the spread of Lyme disease.

If you don't have tweezers, pull the tick off in the same way using your fingers or a needle. Some tiny ticks need to be scraped off with a knife blade or the edge of a credit card.

Sometimes the tick's body comes off, but the head stays in the skin. You must remove the head also. Use a sterile needle to remove the head just as you would to remove a splinter..

Dispose of the tick by flushing it down the toilet. You do not have to save the tick for positive identification.

Do not crush ticks with your fingers because crushing increases your chance of getting Lymeís disease.

Wash the area of the tick bite and your hands with soap and water after you remove the tick. Apply an antibiotic ointment (Polysporin) to the area.

A recent study showed that attached ticks do not back out when covered with petroleum jelly, fingernail polish, or rubbing alcohol. It was thought that this would block the ticks breathing pores and stop itís eating. Unfortunately, ticks breathe only a few times per hour. The study also found that touching the tick with a hot match did not make the tick detach. In fact, the hot match could make the tick vomit infected secretions into the wound, increasing the chance of spreading Lyme disease.

Call our office if:
  • You canít remove the tick or the tick's head.
  • Fever or a bullís eye rash occurs in the 2 weeks after a tick bite.
  • You think your child has some of the symptoms of Lyme disease as described above.
  • You think your child has been bitten by a deer tick and it was probably attached for more than 24 hours.

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