LymeNet Newsletter Volume 2 Issue 14

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:

*********************************************************************** * The National Lyme Disease Network * * LymeNet Newsletter * ***********************************************************************

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.

[...]

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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

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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

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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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