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Volume: 2
Issue: 14
Date: 22-Aug-94


Table of Contents:

I.    AP: 93 CDC Case Reports Down: Underreporting Suspected
II.   MMWR: Lyme Disease -- United States, 1993
III.  LYMENET: News from the Fox Chase Lyme Project
IV.   LDANJ: Fundraiser for Fox Chase Lyme Disease Project
V.    LYMENET: Bologna Conference Proceedings Now Available
VI.   How to Subscribe, Contribute, and Get Back Issues


Newsletter:

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IDX#                Volume 2 - Number 14 - 8/22/94
IDX#                            INDEX
IDX#
IDX#  I.    AP: 93 CDC Case Reports Down: Underreporting Suspected
IDX#  II.   MMWR: Lyme Disease -- United States, 1993
IDX#  III.  LYMENET: News from the Fox Chase Lyme Project
IDX#  IV.   LDANJ: Fundraiser for Fox Chase Lyme Disease Project
IDX#  V.    LYMENET: Bologna Conference Proceedings Now Available
IDX#  VI.   How to Subscribe, Contribute, and Get Back Issues
IDX#


QUOTE OF THE WEEK:

     "It is noteworthy that Dr. Bayer has demonstrated that
      a sizable number of chronically ill people diagnosed
      with Lyme disease and treated with antibiotics for
      various times still excrete Borrelia-specific DNA."


      -- Robert C. Young, M.D.
         President, Fox Chase Cancer Center (See Section III).



I.    AP: 93 CDC Case Reports Down: Underreporting Suspected
------------------------------------------------------------
DATE: August 11, 1994
SOURCE: Excerpted from the St. Paul Pioneer Press Friday August 12,
       1994 p 3B


The number of reported cases of Lyme disease dropped about 15 percent
last year, federal health officials said Thursday, in part because of
the continued problems with doctors failing to diagnose and report the
illness.


The Centers for Disease Control and Prevention said 8,185 cases
of Lyme disease were reported in 1993, down from 9,677 the year
before.  Most cases of the tickborne disease were reported in the
Northeast, mid-Atlantic, northcentral and Pacific regions.


Four states - Wisconsin, California, Connecticut and New York-
accounted for 83% of the decrease. New York's 2,761 cases accounted
for 34% of the total and 41 percent of the decrease.  New Jersey had
the largest increase - 786 cases up from 681 the previous year.


The decrease in reported cases masks the persistent spread of the
disease and may be due to problems with doctors not recognizing the
illness, CDC officials said.


"We know there is a very great problem of underreporting and
misdiagnosis " said Dr David Dennis of the CDC's National Center for
Infectious Diseases.


Since its discovery in 1976 Lyme disease has spread to 44 states and
the District of Columbia and is now endemic in 15 states, he said.


But despite great public attention he said, many physicians still do
not recognize and report the telltale signs of Lyme disease - a red
targetlike area surrounding a tick bite and accompanied by fever,
fatigue and joint inflammation.


To combat that obstacle, the CD earlier this year gave a $220,000
grant to the College of Physicians to develop an education program
aimed at doctors, Dennis said.


Strategies to avoid the disease such as wearing insect repellent and
protective clothing, may also not be as effective as previously
thought, Dennis said.  The CDC found that residents in endemic areas
who take precautions against the deer tick carrying the Lyme bacteria
don't lower their risk of disease.


[...]


=====*=====


II.   MMWR: Lyme Disease -- United States, 1993
-----------------------------------------------
SOURCE: MMWR 43(31);564-565,571-572
DATE: Aug 12, 1994


In 1982, CDC initiated surveillance for Lyme disease (LD), and
in 1990, the Council of State and Territorial Epidemiologists
adopted a resolution making LD a nationally notifiable disease.
This report summarizes surveillance data for LD in the United
States during 1993.


LD is defined as the presence of an erythema migrans rash or
at least one objective sign of musculoskeletal, neurologic, or
cardiovascular disease and laboratory confirmation of infection
[1].  In 1993, 8185 cases of LD were reported to CDC by 44 state
health departments, 1492 (15%) fewer cases than were reported in
1992 (9677).  Most cases were reported from the northeastern,
mid-Atlantic, north-central, and Pacific coastal regions (Figure 2).
Six states (Alaska, Arizona, Colorado, Mississippi, Montana, and
South Dakota) reported no LD cases.  The overall incidence rate was
3.3 per 100,000 population.  Eight states in established LD-endemic
northeastern and upper north-central regions reported rates of more
than 3.3 per 100,000 (Connecticut, 41.3; Rhode Island, 27.3;
Delaware, 21.0; New York, 15.5; New Jersey, 10.1; Pennsylvania, 8.9;
Wisconsin, 8.2; and Maryland, 3.8); these states accounted for 6962
(85%) of the cases reported nationally.  Of the total cases, 6132
(75%) were reported from 81 counties that had at least five cases and

had rates of at least 10 per 100,000 population.

Most (83%) of the decrease in 1993 resulted from reductions in the
numbers of case reports from four states in which LD is endemic
(California, Connecticut, New York, and Wisconsin).  New York, which
reported 34% of the U.S. cases in 1993, accounted for 41% of the
decrease (609 cases), and Connecticut accounted for 27% of the
decrease (410 cases).  Thirteen states reported small increases in
the number of cases.  New Jersey had the largest increase (786
cases, compared with 681 in 1992).


The age distribution of persons reported with LD was bimodal, with
peaks occurring for children aged 5-14 years (1098 cases) and adults
aged 30-49 years (2298 cases).  Males (51%) and females were nearly
equally affected.


Reported by: State health departments. Bacterial Zoonoses Br, Div
of Vector-Borne Infectious Diseases, National Center for Infectious
Diseases, CDC.


Editorial Note: LD, the most commonly reported vectorborne infectious
disease in the United States [2], is caused by the spirochete Borrelia
burgdorferi and is transmitted by the bite of an infected Ixodes tick.
In the northeastern and upper north-central regions of the United
States, the principal tick vector is Ixodes scapularis (black-legged
tick), and in Pacific coast states, the principal vector is Ixodes
pacificus (western black-legged tick).


LD risks are geographically limited; rates vary substantially by town
or other geopolitical area within counties [3,4], and the distribution
of vector ticks varies greatly, even within individual residential
properties [5].  LD can be prevented by avoiding contact with the tick
vector or by applying insect repellents and acaricides as directed,
wearing long pants and long-sleeved shirts, tucking pants into socks,
checking regularly for ticks, and promptly removing attached ticks.


The decrease in reported cases in 1993 may reflect a combination of
three factors: decreased reporting by physicians, decreased case
detection [6], and a true decrease in the number of cases.  In
Connecticut and New York, vector surveillance data suggest that I.
scapularis population densities were lower in 1993 than in previous
years.  The decrease in New York also may be attributed to limitations
in staffing and decreased reporting by physicians (D. White, Bureau of
Communicable Diseases, New York State Department of Health, personal
communication, 1994).  The increase in New Jersey was attributed to an
increase in reported cases from Hunterdon County as a result of
improved reporting by physicians and a true increase in disease
incidence (CDC, unpublished data, 1993).  The actual incidence of LD
in the United States is unknown, and estimates are subject to the
influences of underreporting, misclassification, and overdiagnosis.


Accurate surveillance data are needed to target populations for LD
prevention strategies (e.g., vaccination).  In 1993, two U.S.
manufacturers received Food and Drug Administration approval to
conduct field trials of LD vaccines in humans.  One manufacturer is
conducting Phase III efficacy trials involving approximately 10,000
participants from endemic areas of the north central, mid-Atlantic,
and New England states.  The second manufacturer is conducting Phase
II safety and immunogenicity trials involving approximately 400
persons residing in New England.  Results of Phase I trials
conducted in the United States have been published [7], and
preliminary results of Phase II safety and efficacy trials [8,9]
suggest the vaccine is safe and immunogenic. Both candidate
vaccines use a recombinant outer-surface protein as the immunogen.
The candidate vaccines stimulate production of antibodies that
target B. burgdorferi in the midguts of infected ticks while they
extract blood from a vaccinated animal [10].


Reliable identification of risks is required for targeting
individually applied interventions for LD.  LD surveillance data
will be needed to determine the effectiveness of control and
prevention efforts.


References:
-----------
[1] CDC. Case definitions for public health surveillance. MMWR
1990;39 (no. RR-13):19-21.
[2] Dennis DT. Epidemiology. In: Coyle PK, ed. Lyme disease. St.
Louis: Mosby-Year Book, 1993:27-37.
[3] Cartter ML, Mshar P, Hadler JL. The epidemiology of Lyme disease
in Connecticut. Conn Med 1989;53:320-3.
[4] White DJ, Chang H-G, Benach JL, et al. The geographic spread and
temporal increase of the Lyme disease epidemic. JAMA 1991;266:1230-6.
[5] Maupin GO, Fish D, Zultowsky J, Campos EG, Piesman J. Landscape
ecology of Lyme disease in a residential area of Westchester
County, New York. Am J Epidemiol 1991;133:1105-13.
[6] CDC. Lyme disease -- United States, 1991-1992. MMWR 1993;42:345-8.
[7] Keller D, Koster FT, Marks DH, Hosbach P, Erdile LF, Mays JP.
Safety and immunogenicity of a recombinant outer surface protein A
Lyme vaccine. JAMA 1994;271:1764-8.
[8] Hoecke CV, De Grave D, Hauser P, Lebacq E. Evaluation of three
formulations of a candidate vaccine against Lyme disease in healthy
adult volunteers. In: Proceedings of the VI International Congress

on Lyme Borreliosis. Bologna, Italy: International Congress on Lyme
Borreliosis, 1994:123-6.
[9] Hosbach P, Koster F, Wormser G, et al. Clinical studies in
humans of outer surface protein A (Osp A) vaccine for Lyme disease
{Abstract}. In: Proceedings of the VI International Congress on
Lyme Borreliosis. Bologna, Italy: International Congress on Lyme
Borreliosis, 1994.
[10] Fikrig E, Telford SR, Barthold SW, Kantor FS, Spielman A,
Flavell RA. Elimination of Borrelia burgdorferi from vector ticks
feeding on Osp A-immunized mice. Proc Natl Acad Sci 1992;89:5418-21.


Data contained in Fig 2:

AK    0       HI    1       MS    0       NV    5       UT    2
AL    4       IA    8       MI   23       NY 2761       VA   95
AR    8       ID    2       MN  141       OH   30       VT   12
AZ    0       IL   19       MO  148       OK   19       WA    9
CA  134       IN   32       MT    0       OR    2       WI  401
CO    0       KS   54       NB    6       PA 1069       WV   50
CT 1350       KY   18       NC   86       RI  272       WY    9
DC    2       LA    3       ND    2       SC    9
DE  143       MA  148       NH   15       SD    0
FL   37       MD  180       NJ  786       TN   20
GA   44       ME   18       NM    2       TX   48



=====*=====


III.  LYMENET: News from the Fox Chase Lyme Project
---------------------------------------------------
From: Robert C. Young, M.D.
     President, Fox Chase Cancer Center
     Philadelphia, PA


                                                     Summer, 1994
Dear Friends,


Most people are aware of the emotional and physical toll taken by
cancer and our mission at Fox Chase is to reduce the burden of human
cancer.  However, many Fox Chase scientists also work diligently to
solve some of the riddles of other, equally devastating diseases.


The Fox Chase Lyme disease project, under the direction of Dr. Manfred
Bayer, is one example of these efforts.  Dr Bayer's research is
providing important insights into ways of improving the diagnosis and
treatment of Lyme disease.  I am pleased to provide you with an
update on this program.


During the past two years, more than 400 samples from people with
suspected disease have been examined.  The results of these assays
have provided valuable assistance to physicians in diagnosing and
treating these people.  It is noteworthy that Dr. Bayer has
demonstrated that a sizable number of chronically ill people diagnosed
with Lyme disease and treated with antibiotics for various times still
excrete Borrelia-specific DNA.


Dr. Bayer and his colleagues continue to refine the polymerase chain
reaction (PCR) assay for detecting Borrelia burgdorferi to make it
more efficient, faster and less sensitive to errors.  Ultimately,
these efforts would provide the means for physicians to monitor the
effectiveness of a treatment protocol for Lyme disease.  In addition,
Dr. Bayer is exploring new methods for detecting the Lyme disease
spirochete based on a relatively fast fluorescence-microscopy
procedure.


A second goal of the Fox Chase Lyme disease project is discovering
ways to inactivate the spirochete in its antibiotic-insensitive
state.  Dr. Bayer plans to use tissue culture systems to examine the
spirochete after it invades a human host cell.  Using novel methods
of cell biology and electron microscopy, Dr. Bayer hopes to discover
approaches to therapies which will overcome the intracellular
spirochete's  insensitivity to antibiotics.


The progress made by Dr. Bayer and his colleagues on this important
project is most gratifying.  The generosity and dedication of the
Lyme Disease Association of New Jersey have been pivotal to the
success of this project.  We are very grateful for your sustained
support.


                                                Sincerely,

                                                Robert C. Young, M.D.
                                                President



=====*=====


IV.   LDANJ: Fundraiser for Fox Chase Lyme Disease Project
----------------------------------------------------------
Source: The Lyme Disease Association of New Jersey


The LDANJ, a non-profit corporation staffed entirely by volunteers,
is inviting family and friends to a fundraising event at Jenkinson's
Pavilion in Point Pleasant Beach, NJ, on Sunday, October 23, 1994.
Our fourth annual "Great Imitator" Family Masquerade Party will
feature great food, prizes, costume judging and music.


Lyme disease research has been hindered by a lack of funding, and
the LDANJ wants to do something about that.  The proceeds from the
fundraiser will be directed to the Lyme Disease Research Project
at Fox Chase Cancer Center.


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=====*=====



V.    LYMENET: Bologna Conference Proceedings Now Available
-----------------------------------------------------------
Byline: By Marc Gabriel
Date: August 20, 1994


Copies of "Advances in Lyme Borreliosis Research: Proceedings of the
VI International Conference on Lyme Borreliosis" are now available.
The 239 page volume contains summaries of over 50 research projects
on topics ranging from biology to pathogenicity, clinical
manifestations to diagnostic tests.


The publication costs 60,000 Italian Lira (postage and handling
included) and may be ordered from:


Societa Editrice Esculapio s.r.l.
Via U. Terracini, 30
40131 Bologna, Italy
Phone: 39-51-634-0343
FAX:   39-51-634-1136



=====*=====


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