Copyright 2007, The Johns Hopkins University and Diane Griffin. All rights reserved. Use of these materials permitted only in accordance with license rights granted. Materials provided “AS IS”; no representations or warranties provided. User assumes all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy and efficacy. May contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed. This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike License . Your use of this material constitutes acceptance of that license and the conditions of use of materials on this site.
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Lecture 15: Lyme Disease and Its Epidemiology - JHSPH …ocw.jhsph.edu/courses/EpiInfectiousDisease/PDFs/EID_lec15_Griffin.pdf · Lyme Disease and Its Epidemiology. Diane E. Griffin,
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Copyright 2007, The Johns Hopkins University and Diane Griffin. All rights reserved. Use of these materials permitted only in accordance with license rights granted. Materials provided “AS IS”; no representations or warranties provided. User assumes all responsibility for use, and all liability related thereto, and must independently review all materials for accuracy and efficacy. May contain materials owned by others. User is responsible for obtaining permissions for use from third parties as needed.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike
License. Your use of this material constitutes acceptance of that license and the conditions of use of materials on this site.
Professor and Chair, Department of Molecular Microbiology and ImmunologyResearch interests fall in the area of pathogenesis of viral diseases, with a particular focus on measles and alphavirus encephalitisEditor for Field’s VirologyPresident-elect, American Society for Microbiology
Section A
Background/History
5
First Recognition of Lyme Arthritis in Connecticut, 1976
6
Characteristics of the First 52 Cases Identified
7
Site Affected/total Prevalence per 100 children
Old LymeRoad ARoad B
4/51
4/65
7.8
7.7
East HaddamRoad CRoad D
4/265/33
15.412.1
Total 17/175 9.7
Prevalence of Lyme Arthritis on Four Roads in Connecticut
8
Lyme Arthritis: Associated Symptoms (12 Patients)
MalaiseChills and feverHeadacheStiff neckBackacheMyalgiasNausea and vomitingSore throat
75%75%50%50%33%25%25%8%
Source: Steere, A. C., et al. (1977, June). Ann Intern Med, 86(6), 685–698.
9
Typical Lyme Arthritis
Photo by Dr. Alan Steere, Massachusetts General Hospital, Boston.
Efficacy of OspA Lyme Disease Vaccine in Two Trials
45
Osp
A Osp
C
Borrelia Osp
Expression of outer surface proteins (Osp) on Borrelia in the midgut of unfed ticks
Figure Source: Schwan
TG, et al. Induction of an outer surface protein on Borrelia
burgdorferi
during tick feeding. PNAS 1995;92:2909-13. Copyright (1995) National Academy of Sciences, U.S.A
46
How the Osp A Lyme Disease Vaccine Protects
47
Lyme Disease Prevention
Distribution of pyrethrin-impregnated cotton balls in habitat of white-footed mice−
Kills ticks overwintering
with mice
48Source: Shapiro et al. (1992). N Engl J Med, 327, 1769.
Lyme Disease Prevention
Treatment Ticks infected Persons with LD
Placebo 23/159 (14%) 2/173 (1.2%)
Amoxicillin 30/185 (16%) 0/192 (0%)
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Conclusions
Lyme disease is caused by a spirochetal bacteria, Borrelia burgdorferiThe reservoir host in the eastern U.S. is the white-footed mouseBorrelia is maintained in a geographically restricted natural cycle between ticks and mammalsHuman disease is determined by−