Lyme Disease Vaccine

1. Background
   1. Vaccine no longer available in U.S.
2. Indication: Prevention of Lyme Disease in high risk areas
   1. Ages 15 to 70 years old
   2. Live, work or recreate in high risk areas
   3. Frequent or prolonged Deer Tick exposure
3. Mechanism
   1. Recombinant outer surface protein Borrelia Burgdorferi
   2. Antibodies responding to vaccine form
      1. Destroy Spirochetes in tick gut prior to transmission
4. Efficacy
   1. Studied in 20 month, double blind trial (n=11,000)
      1. After 2 doses: 49% effective
      2. After 3 doses: 76% effective
      3. Prevents 100% of asymptomatic infections
   2. References
      1. Steere (1998) N Engl J Med 339:209
5. Adverse Effects
   1. Soreness at injection site
   2. Flu-like illness with fever and chills
      1. Onset days 1-2 after Immunization
      2. Duration 2-3 days
   3. Risk of autoimmune arthritis
      1. High Antibody levels to OSPa protein
6. Dosing
   1. Three doses: 0, 1, and 12 months Intramuscular
      1. Third dose can be given at 2 or 6 months also
   2. Consider scheduling first dose in March
      1. April starts tick season
   3. Pharmacist cost: $61.25 per dose
7. Reference
   1. Medical Letter (1999) 41(1049): 29-30