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How does the Lyme disease (LD) vaccine work? After a person is vaccinated, the vaccine stimulates the individual’s immune system to produce antibodies against a specific protein found on the LD bacteria called "Outer surface protein A," or OspA. When a vaccinated individual is bitten, the tick ingests blood containing the anti-OspA antibodies, which then bind and inactivate the LD bacteria, effectively preventing transmission of the bacteria to the vaccinated individual. The LD vaccine is administered as a series of three injections into the muscle; the second dose is given one month later, and the third dose 12 months after the first dose. The LD vaccine was tested among approximately 11,000 individuals residing in areas of the Northeastern and Upper Midwestern United States where the risk of LD is much higher than in California. The vaccine was shown to be 50 percent effective after two doses, and 76 percent effective after the third dose in preventing LD during the one-year follow up period. The effectiveness was lower among persons aged 60 and older. After I get the first series of three shots, how often do I need to receive a booster? There are preliminary data that the antibodies from vaccination decline rather rapidly, therefore booster doses of vaccine may be needed (perhaps yearly) to maintain adequate protection. However, there is no recommendation for booster at this time. Are there any side effects to the LD vaccine? In the vaccine testing phase, 25-30 percent of vaccine recipients experienced a local reaction--pain, swelling, tenderness at the injection site--within the first 30 days following vaccination. Approximately 20 percent experienced mild headache, fever, or muscle and joint ache during this same time period. Since this is a new vaccine, the potential for late, long-term complications of vaccination is unknown. Once I have been vaccinated, is it then safe to engage in activities in areas where there are ticks? It is important to remember that maximum LD protection is not conferred until after the third vaccine dose, given one year after the first. Even then, the expected protection is less than 100 percent. Also, the LD vaccine provides no protection against other diseases that ticks can transmit. Therefore, even vaccinated persons should continue to use personal protective measures, including wearing proper clothing, applying insect repellants, performing whole-body tick checks, and promptly removing attached ticks. These measures should be practiced daily when in tick-infested areas. When should LD vaccine be considered in California? LD vaccine is not recommended for routine vaccination anywhere in California because the risk for LD is much lower in this state compared to the upper Midwestern and Northeastern states. However, within California, there are areas of moderate risk for LD, particularly the northern coastal range, and areas of some risk such as the western Sierra foothills and the San Francisco Bay area (see map). In the areas of moderate risk, LD vaccine should be considered in individuals who have frequent or prolonged contact with natural vegetation (including leaf litter). Examples of individuals with prolonged and frequent contact are park rangers and persons working daily in such environments. For individuals with exposure in those areas but whose exposures are neither frequent nor prolonged (such as regular weekend hikers who usually go off the trails into brushy vegetation), and for individuals with frequent and prolonged exposure but in areas with some risk, LD vaccine may be considered; but there is no data to support that the vaccine is more beneficial than personal protective measures in those situations. In areas of low or no risk and in situations where minimal or no exposure occurs, LD vaccine is not recommended. My family is planning a vacation to an area where ticks are prevalent. Should we be vaccinated for Lyme disease? Vaccination is not generally recommended for persons who occasionally travel to areas where LD is prevalent. Maximum protection from the LD vaccine is conferred only after completion of the third dose, which is administered one year after the initial two doses. In this situation, there are no data to prove that the vaccine is more beneficial than personal protective measures described above. Contact the local health department in the areas you plan to visit to determine if Lyme disease is a serious risk in these areas. I believe my family may be at risk of getting Lyme disease. What’s the age at which a person may be vaccinated? Persons less than 15 years old or older than 70 were not included in the vaccine field trials, thus comprehensive information on the safety and efficacy of the vaccine in these age groups is unavailable. The vaccine is therefore neither licensed nor recommended for use in these persons. For what other persons is the vaccine not recommended for use at this time?
My family enjoys hiking and camping in the mountains and foothills each summer and we frequently pull ticks off our clothing. Should we consider getting vaccinated for Lyme disease? Vaccination is not routinely recommended for persons who occasionally travel for work or recreation to areas where ticks are present. Infected ticks capable of transmitting the Lyme disease organism have been found in moderate numbers in only a few areas of California--notably the northern coastal mountain ranges. In those areas, LD vaccine may be considered for exposure that is neither prolonged nor frequent; however, staying on trails and not brushing against bushes or leaf litter piles would significantly decrease contact with ticks. Personal protective methods such as daily tick checks and prompt removal of attached ticks are still the most effective means of preventing LD and other tick-borne diseases. There are no data that the vaccine is more beneficial than personal protective measures for people who occasionally travel or recreate in areas with LD. Remember that the vaccine is not 100 percent effective and ticks can transmit other diseases for which the LD vaccine provides no protection. Should I receive the LD vaccine or not? Because of the small proportion of infected ticks in California and the low risk of infection to most residents, the California Department of Health Services, in accordance with national guidelines, does not recommend routine use of the LD vaccine in California residents. However, persons who frequently work outdoors in areas with dense vegetation WITHIN geographic areas of moderate risk for LD (notably the northern coastal mountain ranges) should be considered for LD vaccination. These persons should consult with their health care provider about the potential benefits and risks of LD vaccination. Because of limited data on safety and efficacy in some groups, the vaccine is currently not recommended for children (lessthan15 years old), adults over 70 years old, pregnant women, individuals with compromised immune system function, or patients with chronic arthritis. Where can I obtain additional information about LD? Information regarding the prevalence of ticks and risk of LD in your area can be obtained by contacting your local health department or local mosquito/vector control district. (Consult the Government Pages of your local telephone directory.) Information about LD in California is available from the California Department of Health Services, Division of Communicable Disease Control (Tel: 510-540-2566, or http://www.dhs.ca.gov/ps/dcdc/cm/970401CM.htm). Information on LD throughout the United States can be obtained from the Centers for Disease Control and Prevention, Division of Vector-Borne Infectious Diseases (Tel: 970-221-6400, or http://www.cdc.gov/ncidod/dvbid/lymeinfo.htm).
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