LymeNet Newsletter Volume 1 Issue 06

Volume: 1
Issue: 06
Date: 23-Mar-93

Table of Contents:

NEWS: Lyme-related Legislation from Around the Country DISCUSSION: Lyme Disease for Dogs ANSWER: What is the Prognosis for Chronic LD? QUESTION: Lyme AB Screen BIBLIOGRAPHY: Veterinary Lyme Disease -- Selected References

Newsletter:

***************************************************************************** * Lyme Disease Electronic Mail Network * * LymeNet Newsletter * ***************************************************************************** Volume 1 - Number 06 - 3/23/93

I. Introduction II. News from the wires III. Questions 'n' Answers IV. Op-Ed Section V. Partial Bibliography for Further Reading VI. Jargon Index VII. How to Subscribe, Contribute and Get Back Issues

I. ***** INTRODUCTION *****

I would like to begin by thanking Dr. David Dorward for the paper he wrote on Lyme testing for electronic publication, which we featured in LymeNet vol #1 issue #05. Several physicians have already praised the article and commented that it will help in interpreting the lab results. New subscribers may obtain the article by requesting issue #05 (instructions below).

We begin this newsletter with something that caught me completely by surprise: a flurry of legislative activity on LD issues. In the past 2 months more LD legislation has been proposed on the state and federal level than in the past 10 years combined. In the "News from the Wires," you will find summaries of all the bills pending before state legislatures and the Congress. If you feel strongly about a certain bill, please write to your representative and express your opinion.

Why did this happen? I'm not sure, but I'd be interested to hear your ideas. In any case, this trend is very encouraging!

We also have several questions and answers in this issue. Finally, Dr. Lloyd Miller provides us with some selected references on veterinary LD issues.

-Marc.

II. ***** NEWS FROM THE WIRES ******

New York State ==============

1993 NY A.B. 1212 DATE-INTRO: JANUARY 14, 1993 LAST-ACTION: JANUARY 14, 1993

SYNOPSIS: Includes within category of occupational disease Lyme Disease (Lyme Borroliosis).

STATUS: 01/14/93 INTRODUCED. To ASSEMBLY Committee on LABOR. SPONSOR: Brodsky et al

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1993 NY A.B. 2510 DATE-INTRO: FEBRUARY 1, 1993 LAST-ACTION: FEBRUARY 1, 1993

SYNOPSIS: Requires every health and accident insurance policy, group or blanket health insurance policy, and medical expense indemnity corporation, hospital service corporation or health service corporation to provide coverage for treatment of Lyme disease; requires workers' compensation coverage for treatment of Lyme disease.

STATUS: 02/01/93 INTRODUCED. To ASSEMBLY Committee on INSURANCE. SPONSOR: Warren

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1993 NY A.B. 2545 DATE-INTRO: FEBRUARY 2, 1993 LAST-ACTION: FEBRUARY 2, 1993

SYNOPSIS: Provides for establishment of statewide toll-free telephone hotline service for the purpose of responding to inquiries for information and counseling referral relating to Lyme Disease; appropriates $100,000 therefor.

STATUS: 02/02/93 INTRODUCED. To ASSEMBLY Committee on HEALTH. SPONSOR: Conte et al

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1993 NY A.B. 2799 DATE-INTRO: FEBRUARY 4, 1993 LAST-ACTION: FEBRUARY 4, 1993

SYNOPSIS: Appropriates funds to reimburse county agricultural fairs and county youth fairs which conduct Lyme disease awareness programs.

STATUS: 02/04/93 INTRODUCED. To ASSEMBLY Committee on AGRICULTURE. SPONSOR: D'Andrea et al

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1993 NY A.B. 2958 DATE-INTRO: FEBRUARY 8, 1993 LAST-ACTION: FEBRUARY 8, 1993

SYNOPSIS: Authorizes the Commissioner of Education, in cooperation with the Department of Health, to create and maintain an instructional program for students and teachers on the incidence, prevention and recognition of Lyme disease.

STATUS: 02/08/93 INTRODUCED. To ASSEMBLY Committee on EDUCATION. SPONSOR: Wertz et al

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1993 NY A.B. 3642 DATE-INTRO: FEBRUARY 16, 1993 LAST-ACTION: FEBRUARY 16, 1993

SYNOPSIS: Requires the Department of Health through the Tick-Borne Disease Institute to conduct a mass media public education and awareness campaign on the cause, prevention, detection and treatment of Lyme disease and other tick-borne diseases; specifies that such campaign shall be concentrated in the counties of Westchester, Nassau and Suffolk during the months of April, May, June and August.

STATUS: 02/16/93 INTRODUCED. To ASSEMBLY Committee on HEALTH. SPONSOR: Wertz et al

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1993 NY A.B. 3700 DATE-INTRO: FEBRUARY 16, 1993 LAST-ACTION: FEBRUARY 16, 1993

SYNOPSIS: Provides that the Department of Public Health shall provide facilities and personnel for and shall conduct free blood tests for Lyme Disease in the Counties of Westchester, Suffolk and Nassau to any person for whom such a blood test has been recommended in writing by a physician and who is not covered by any policy of insurance which will pay for such testing.

STATUS: 02/16/93 INTRODUCED. To ASSEMBLY Committee on HEALTH. SPONSOR: Muscarella et al

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1993 NY S.B. 634 DATE-INTRO: JANUARY 14, 1993 LAST-ACTION: JANUARY 14, 1993

SYNOPSIS: Includes within category of occupational disease Lyme Disease (Lyme Borroliosis).

STATUS: 01/14/93 INTRODUCED. To ASSEMBLY Committee on LABOR. SPONSOR: La Valle et al

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1993 NY S.B. 2237 DATE-INTRO: FEBRUARY 22, 1993 LAST-ACTION: FEBRUARY 22, 1993

SYNOPSIS: Requires the Department of Health through the Tick Borne Disease Institute to conduct a mass media Public Education and Awareness Campaign on the cause, prevention, detection and treatment of Lyme Disease and other tick-borne diseases; states such campaign shall be concentrated in the counties of Westchester, Nassau and Suffolk during the months of April, May, June and August.

STATUS: 02/22/93 INTRODUCED. To SENATE Committee on HEALTH. SPONSOR: Hannon

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MINNESOTA =========

1993 MN H.B. 595 DATE-INTRO: FEBRUARY 25, 1993 LAST-ACTION: FEBRUARY 25, 1993

SYNOPSIS: Directs the Metropolitan Mosquito Control Commission and the Commissioner of Health to provide an annual Lyme disease prevention education program in public schools, and an information brochure for public distribution; requires signs to be posted by the DNR at state parks; requires funding from Mosquito Control Commission; requires statistical data on all cases to be kept by the Department of Health, which will distribute reporting forms to physicians.

STATUS: 02/25/93 INTRODUCED. To HOUSE Committee on HEALTH AND HUMAN SERVICES. SPONSOR: Murphy et al

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1993 MN S.B. 549 DATE-INTRO: FEBRUARY 25, 1993 LAST-ACTION: FEBRUARY 25, 1993

SYNOPSIS: Directs the Metropolitan Mosquito Control Commission and the Commissioner of Health to provide an annual Lyme disease prevention education program in public schools, and an information brochure for public distribution; requires signs to be posted by the DNR at state parks; requires funding from Mosquito Control Commission; requires statistical data on all cases to be kept by the Department of Health, which will distribute reporting forms to physicians.

STATUS: 02/25/93 INTRODUCED. To SENATE Committee on HEALTH CARE. SPONSOR: Johnston et al

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PENNSYLVANIA ============

1993 PA S.B. 464 DATE-INTRO: FEBRUARY 9, 1993 LAST-ACTION: FEBRUARY 9, 1993

SYNOPSIS: Provides for control and treatment of Lyme disease. Makes an appropriation.

STATUS: 02/09/93 INTRODUCED. To SENATE Committee on PUBLIC HEALTH AND WELFARE. SPONSOR: Greenleaf et al

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NEW JERSEY ==========

1993 NJ A.R. 119 DATE-INTRO: MARCH 1, 1993 LAST-ACTION: MARCH 1, 1993

SYNOPSIS: Designates May 1993 as "Lyme Disease Awareness Month".

STATUS: 03/01/93 INTRODUCED. To ASSEMBLY Committee on HEALTH AND HUMAN SERVICES.

SPONSOR: Farragher et al

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OREGON ======

1993 OR H.B. 2555 DATE-INTRO: JANUARY 26, 1993 LAST-ACTION: JANUARY 26, 1993

SYNOPSIS: Requires reporting of Lyme disease to the Health Division.

STATUS: 01/26/93 INTRODUCED. 01/26/93 To HOUSE Committee on HUMAN DEVELOPMENT SERVICES.

SPONSOR: Local Sponsor

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FEDERAL LEGISLATION ===================

1993 H.J. Res. 92 (House of Representatives) DATE-INTRO: February 3, 1993 LAST-ACTION-DATE: March 4, 1993 SPONSOR: Representative George J. Hochbrueckner D-NY TOTAL-COSPONSORS: 61 Cosponsors: 42 Democrats / 19 Republicans

SYNOPSIS: Joint resolution designating the weeks beginning June 6, 1993, and June 5, 1994, as "Lyme Disease Awareness Week".

ACTIONS: Committee Referrals: 02/03/93 House Post Office and Civil Service Committee Legislative Chronology: 1st Session Activity: 02/03/93 139 Cong Rec H 483 Referred to the House Post Office and Civil Service Committee 02/23/93 139 Cong Rec H 795 Cosponsors added 03/04/93 139 Cong Rec H 1047 Cosponsors added

CO-SPONSORS: Added 02/23/93: Shays R-CT Morella R-MD Clement D-TN Gallo R-NJ Saxton R-NJ Smith R-NJ de Lugo D-VI Norton D-DC Quillen R-TN LaFalce D-NY Walsh R-NY Rangel D-NY Lowey D-NY Rose D-NC Roukema R-NJ Schumer D-NY Kasich R-OH Pallone D-NJ Horn R-CA Hyde R-IL Bevill D-AL de la Garza D-TX Vento D-MN Pelosi D-CA Gejdenson D-CT Andrews D-ME Clinger R-PA Gilman R-NY Hughes D-NJ Pickett D-VA

Added 03/04/93: King R-NY Frost D-TX McNulty D-NY Andrews D-NJ Murtha D-PA Ravenel Jr. R-SC Slattery D-KS McDermott D-WA McCloskey D-IN Matsui D-CA Montgomery D-MS Doolittle R-CA Dellums D-CA Manton D-NY Gonzalez D-TX Faleomavaega D-AS DeLauro D-CT Parker D-MS Coble R-NC Traficant, Jr. D-OH McCollum R-FL Levy R-NY Unsoeld D-WA Waxman D-CA Evans D-IL Scott D-VA Boucher D-VA Spratt, Jr. D-SC Ackerman D-NY Jacobs, Jr. D-IN Martinez D-CA

DATE OF VERSION: FEBRUARY 5, 1993 -- VERSION: 1

SPONSOR(S): Mr. HOCHBRUECKNER introduced the following joint resolution; which was referred to the Committee on Post Office and Civil Service TEXT: Whereas Lyme disease (borreliosis) is spread primarily by the bite of four types of ticks infected with the bacteria Borrelia burgdorferi; Whereas Lyme disease -carrying ticks can be found across the country - in woods, mountains, beaches, even in our yards, and no effective tick control measures currently exist; Whereas infected ticks can be carried by animals such as cats, dogs, horses, cows, goats, birds, and transferred to humans; Whereas our pets and livestock can be infected with Lyme disease by ticks; Whereas Lyme disease was first discovered in Europe in 1883 and scientists have recently proven its presence on Long Island as early as the 1940's; Whereas Lyme disease was first found in Wisconsin in 1969, and derives its name from the diagnosis of a cluster of cases in the mid-1970's in Lyme, Connecticut; Whereas forty-nine States reported more than 40,000 cases of Lyme disease
from 1982 through 1991; Whereas Lyme disease knows no season - the peak west coast and southern season is November to June, the peak east coast and northern season is April to October, and victims suffer all year round; Whereas Lyme disease, easily treated soon after the bite with oral antibiotics, can be difficult to treat (by painful intravenous injections) if not discovered in time, and for some may be incurable; Whereas Lyme disease is difficult to diagnose because there is no reliable test that can directly detect when the infection is present; Whereas the early symptoms of Lyme disease may include rashes, severe headaches, fever, fatigue, and swollen glands; Whereas if left untreated Lyme disease can affect every body system causing severe damage to the heart, brain, eyes, joints, lungs, liver, spleen, blood vessels, and kidneys; Whereas the bacteria can cross the placenta and affect fetal development; Whereas our children are the most vulnerable and most widely affected group; Whereas the best cure for Lyme disease is prevention;
Whereas prevention of Lyme disease depends upon public awareness; and Whereas education is essential to making the general public, health care professionals, employers, and insurers more knowledgeable about Lyme disease and its debilitating side effects: Now, therefore, be it

* Resolved by the Senate and House of Representatives of the United * * States of America in Congress assembled, * * That the weeks beginning June 6, 1993, and June 5, 1994, are * * designated as "Lyme Disease Awareness Week", and the President is * * authorized and requested to issue a proclamation calling upon the * * people of the United States to observe such weeks with appropriate * * programs, ceremonies, and activities.

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1993 S.J. Res. 43 (Senate) DATE-INTRO: February 4, 1993 LAST-ACTION-DATE: February 18, 1993 SPONSOR: Senator Joseph Lieberman D-CT TOTAL-COSPONSORS: 56 Cosponsors: 35 Democrats / 21 Republicans

SYNOPSIS: A joint resolution designating the week beginning June 6, 1993, and June 5, 1994, as "Lyme Disese Awareness Week."

ACTIONS: Committee Referrals: 02/04/93 Senate Judiciary Committee Legislative Chronology: 1st Session Activity: 02/04/93 139 Cong Rec S 1385 Referred to the Senate Judiciary Committee 02/04/93 139 Cong Rec S 1491 Remarks by Sen. Lieberman, CT 02/18/93 139 Cong Rec S 1922 Cosponsors added

Original Cosponsors: Dodd D-CT Moynihan D-NY D'Amato R-NY Lautenberg D-NJ

Added 02/18/93: Bradley D-NJ Reid D-NV Bumpers D-AR Sarbanes D-MD Chafee R-RI Hollings D-SC Kennedy D-MA Levin D-MI Warner R-VA Johnston D-LA Akaka D-HI Breaux D-LA Wellstone D-MN Cohen R-ME McCain R-AZ Cochran R-MS DeConcini D-AZ Glenn D-OH Pell D-RI Craig R-ID Murkowski R-AK Stevens R-AK Durenberger R-MN Inouye D-HI Metzenbaum D-OH Burns R-MT Nunn D-GA Riegle D-MI Thurmond R-SC Coats R-IN Graham D-FL Bond R-MO Danforth R-MO Wofford D-PA Rockefeller D-WV Domenici R-NM Kerry D-MA Braun D-IL Simon D-IL Packwood R-OR Grassley R-IA Mikulski D-MD Feingold D-WI Specter R-PA Sasser D-TN Pressler R-SD Conrad D-ND Roth R-DE Feinstein D-CA Daschle D-SD Kohl D-WI
Dorgan D-ND

DATE OF VERSION: FEBRUARY 8, 1993 -- VERSION: 1

SPONSOR(S): Mr. LIEBERMAN (for himself, Mr. DODD, Mr. MOYNIHAN, Mr. D'AMATO, and Mr. LAUTENBERG) introduced the following bill; which was read twice and referred to the Committee on the Judiciary

TEXT:

[ Text same as in House version ]

III. ***** QUESTIONS 'N' ANSWERS *****

Sender: Ralph E. Yozzo <[email protected]> Subject: LymeNet Newsletter vol#1 #04

>LYME COMMENT: [Exercise done under controlled conditions is recommended for >patients with chronic Lyme disease. This article would indicate that the >exercise may not have much effect on the pain symptoms. Maybe more important, >it indicates that exercise was tolerated without exacerbating symptoms. >Therefore, exercising and physical therapy to help maintain body condition in >chronic Lyme patients would seem like a good idea. It would be interesting to >know if Lyme patients are finding this to be the case.]

In my case, I was a runner and biker before I got Lyme Disease (LD) and I continued to run and bike after (and during) LD symptoms. I've had no recurrence of the LD symptoms. In fact, I feel healthier now then before getting LD. (Please do not interpret this as a recommendation to run out and get LD. ;-) )

Take care of yourself.

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Sender: "Lloyd E. Miller,DVM" <[email protected]> Subject: Veterinarians and Lyme vaccine

I must take exception to a comment in LymeNet -4 pertaining veterinarians and the Lyme vaccine for dogs:< ..... the vets push it, (the vaccine) because it makes them lots of money, but all that says is that veterinarians are no more ethical than a lot of physicians in trying to make a fast profit over the suffering of dogs or people who have Lyme Disease.>

In any profession there are bad apples but to paint us all with the same brush is grossly inaccurate.

NOT ALL VETERINARIANS are pushing the vaccine. In fact a considerable number are NOT administering it at the present time. Many veterinarians I have contact with do in fact have the vaccine in their refrigerators but have used very little of it, only administering it to patients at the owner's request or to patients going into high risk areas. The figure the company reports as doses sold does not necessarily equate with the number of doses administered. Even if we estimate that 1.5 million dogs have been vaccinated this is a very small proportion of the national dog population.

Controversies about how serious Lyme disease it is in animals, clinical presentation, modes of transmission, laboratory diagnosis, and proper treatment are all also present in the veterinary field. Vaccination controversies continue regarding the need to vaccinate - especially in non-endemic areas, safety (short and long term), efficacy, length of protection, and the epidemiological implications of administering a vaccine that renders the recipient serologically positive on all tests.

A second statement <...as far as I know, there is NO evidence that it is at all effective.> made in the same issue also requires comment.

Scientific evidence of probable efficacy has been published [see reference 2]. Keep in mind that this information was developed by the manufacturer. To date I am unaware of any published independent data to confirm or deny their findings. I do know independent studies are in progress.

An independent *opinion* was expressed in reference 3. It states that there are two ways to prevent Lyme disease in dogs. One is to prevent tick engorgement. The other is vaccination. About vaccination it states that "The Borrelia burgdorferi bacterin from Fort Dodge Laboratories is currently the only licensed Lyme disease vaccine for dogs. More than two million doses have been sold, and there appear to have been no immediate adverse reactions to its use in dogs. Field observations would suggest that the vaccine may induce protective immunity to acute Lyme disease in dogs. However, the vaccine does not protect from actual infection. It is too early to know whether B. burgdorferi persisting in dogs vaccinated after tick exposure might cause later disease."

"Vaccination of dogs, therefore, can be recommended only in known endemic areas and in dogs that are continually exposed to ticks." Note the vaccine is a bacterin (i.e. killed organisms) and therefore can NOT cause infection.

In my own practice (in a non-endemic area) we follow this recommendation. We do not recommend vaccination of all dogs in our area. However, if a client is concerned about his/her dog contracting the disease or is traveling to highly endemic areas and requests vaccination we will vaccinate after explaining what we currently know about safety and efficacy. It is unclear at present how serious a disease this is in dogs or what the long term effects of persistent infection may be. Therefore, if I were practicing in a highly endemic area and the vaccine had a reasonable expectation of safely preventing the disease I would recommend vaccination.

SUGGESTED READING:

1. Green RT: Questions "push" for vaccination against Borrelia burgdorferi. Journal of the America Veterinary Medical Association 1992;201(10): 1491-93. [letter]

2. Chu H, Chavez LG et al: Immunogenicity and efficacy study of a commercial Borrelia burgdorferi bacterin. Journal of the America Veterinary Medical Association 1992;201(3):403-18.

3. Lyme disease in Dogs. Institute News and Views 1992; (Spring-Summer). [James A. Baker Institute for animal health Cornell University - College of Veterinary Medicine]

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Sender: [email protected] (Patricia Emily) Subject: Lyme Vaccine Available?

Hello, I understand that a lyme vaccine exists for dogs, and other 4-footed critters.

Is there a lyme vaccine available for humans? In research stage? If yes, how effective is the vaccine? Any other related information would be greatly appreciated!

Thanks!

=====*=====

Sender: [email protected] (Joe Wells) Subject: Which test is "LYME DISEASE AB SCREEN"?

Hi, folks,

I had a test for Lyme last August. On the bills I got, it said "LYME DISEASE AB SCREEN". The charge was $34 (not including the blood drawing). Which test was this? The result was negative. What is the probability the result was false?

-- Thanks

IV. ***** OP-ED SECTION *****

This section is open to all subscribers who would like to express an opinion. Send your masterpieces to [email protected] or FAX them to 215-974-6410.

V. ***** PARTIAL BIBLIOGRAPHY FOR FURTHER READING *****

Sender: "Lloyd E. Miller, DVM" <[email protected]> Subject: VETERINARY LYME DISEASE -- SELECTED REFERENCES

1. Appel MJG: Lyme disease in dogs and cats. The Compendium 1990;12(5):617-626.

2. Burgess EC: Borrelia Burgdorferi infection in Wisconsin horses and cows. Annals of the New York Academy of Sciences 1988;539:235-242.

3. Burgess EC: Experimentally induced infection of cats with Borrelia burgdorferi. American Journal of Veterinary Research 1992;53(9):1507-1511.

4. Cohen ND, Cohen Daniel: Borreliosis in horses: A comparative review. The Compendium 1990;12(10):1449-1458.

5. Grauer GF, Burgess EC et al: Renal lesions associated with Borrelia Burgdorferi infection in a dog. JAVMA 1988;193(2):237-239.

6. Greene RT: An update on the serodiagnosis of Canine Lyme Borreliosis. Jour Vet Int Med 1990;4:167-171.

7. Fridriksdottir V, Overnes G, Stuen S: Suspected Lyme borreliosis in sheep. Vet Rec 1992;130(15):323-4.

8. Fridriksdottir V, Nesse LL, Gudding R: Seroepidemiological studies of Borrelia burgdorferi infection in sheep in Norway. J Clin Microbiol 1992;30(5):1271-7.

9. Levy SA: Lyme borreliosis in dogs. Canine Practice 1992;17(2):5-14.

10. Levy SA, Magnarelli LA: Relationship between development of antibodies to Borrelia Burgdorferi in dogs and subsequent development of limb/joint borreliosis. Journal of the American Veterinary Medical Association 1992; 200(3):344-347.

11. Lindenmayer J, Weber M et al: Comparison of indirect immunofluorescent-antibody assay, enzyme-linked immunosorbent assay, and western immunoblot for the diagnosis of Lyme disease in dogs. Journal of Clinical Microbiology 1990;28(1):92-96.

12. Magnarelli LA et al: Clinical and serologic studies of canine borreliosis. JAVMA November 1, 1987;191(9):1089-1093.

13. Magnarelli LA, Andersen JF et al: Persistence of antibodies to Borrelia burgdorferi in dogs of New York and Connecticut. Journal of the America Veterinary Medical Association 1990;196(7):1064-1068.

14. Magnarelli LA, Andersen JF et al: Tick parasitism and antibodies to Borrelia burgdorferi in cats. Journal of the America Veterinary Medical Association 1990;197(1):63-66.

15. Parker JL, White KK: Lyme borreliosis in cattle and horses: a review of the literature. Cornell Vet 1992; 82(3):253-74.

16. Post JE, Shaw EE: Suspected borreliosis in cattle. Annals of the New York Academy of Sciences 1988;539:488.

17 Shepard RM, Falkner FC: Pharmacokinetics of azithromycin in rats and dogs. Journal Antimicrobial Chemotherapy 1990;25(Suppl A):49-60.

18. Wasmoen TL, Sebring RW, Blumer BM et al: Examination of Koch's postulates for Borrelia burgdorferi as the causative agent of limb/joint dysfunction in dogs with borreliosis. J Am Vet Med Assoc 1992;201(3):412-8.

19. Wells SJ, Trent AM et al: Association between clinical lameness and Borrelia burgdorferi antibody in dairy cows. American Journal of Veterinary Research 1993;54(3):398-405.

VI. ***** JARGON INDEX *****

Bb - Borrelia burgdorferi - The scientific name for the LD bacterium. CDC - Centers for Disease Control - Federal agency in charge of tracking diseases and programs to prevent them. CNS - Central Nervous System. ELISA - Enzyme-linked Immunosorbent Assays - Common antibody test EM - Erythema Migrans - The name of the "bull's eye" rash that appears in ~60% of the patients early in the infection. IFA - Indirect Fluorescent Antibody - Common antibody test. LD - Common abbreviation for Lyme Disease. NIH - National Institutes of Health - Federal agency that conducts medical research and issues grants to research interests. PCR - Polymerase Chain Reaction - A new test that detects the DNA sequence of the microbe in question. Currently being tested for use in detecting LD, TB, and AIDS. Spirochete - The LD bacterium. It's given this name due to it's spiral shape. Western Blot - A more precise antibody test.

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