Lyme Disease: Vaccine Recommendations - CDC Division of Vector-Borne Infectious Diseases (DVBID)

Lyme Disease Contents
	Introduction
	Questions and Answers
	The Bacterium
	Vector Ecology
	Diagnosis
	Epidemiology
	Prevention and Control
	Vaccine Recommendations
	Scientific Literature
	PBS Documentary
	CDC World Health Organization Collaborating Center for Lyme Borreliosis

Other Tick-Borne Diseases
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Vaccine Recommendations

As of February 25, 2002 the manufacturer announced that the LYMErix™ Lyme disease vaccine will no longer be commercially available. The existing recommendations apply to any vaccine currently in use.

Complete Recommendations: Guidelines for use of Lyme disease vaccine (LYMErix™), as recommended by the Advisory Committee on Immunization Practices (ACIP) are published in the Morbidity and Mortality Weekly Report, Recommendations and Reports series, June 4, 1999;48(RR07):1-17 (also available in PDF format [741 KB, 39 pages]).

National Lyme disease risk map with four categories of risk
(View enlarged image.)

National risk map: Methods used for creating a national Lyme disease risk map are published in the Morbidity and Mortality Weekly Report, Recommendations and Reports Appendix, June 4, 1999;48(RR07);21-24 (also available in PDF format [741 KB, 39 pages]).

Summary Table: Below is a summary table of abbreviated recommendations for use of recombinant outer-surface protein A vaccine (LYMErix™) for the prevention of Lyme disease from the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

**Summary of CDC Advisory Committee on Immunization Practices (ACIP) Recommendations Regarding LYMErix™ Vaccine**
Persons who reside, work, or recreate in areas of high or moderate risk
Persons aged 15-70 years whose exposure to tick-infested habitat is frequent or prolonged	Should be considered
Persons aged 15-70 years who have some exposure to tick-infested habitat but whose exposure is neither frequent nor prolonged	May be considered
Persons whose exposure to tick-infested habitat is minimal or none	Not recommended
Persons who reside, work, or recreate in areas of low or no risk	Not recommended
Travelers to areas of high or moderate risk
Travelers aged 15-70 years whose exposure to tick-infested habitat is frequent or prolonged	Should be considered
Children aged <15 years	Not recommended
Pregnant women Health-care providers are encouraged to register vaccinations of pregnant women by calling SmithKline Beecham, toll free, at (800) 366-8900, ext. 5231	Not recommended
Persons with immunodeficiency	No available data
Persons with musculoskeletal disease	Limited data available
Persons with history of Lyme disease
Persons aged 15-70 years with previous uncomplicated Lyme disease who are at continued high risk	Should be considered
Persons with treatment-resistant Lyme arthritis	Not recommended
Persons with chronic joint or neurologic illness related to Lyme disease and persons with second- or third-degree atrioventricular block	No available data
Other Recommendations
Vaccine schedule Three doses administered by intramuscular injection Initial dose, followed by a second dose 1 month later, followed by a third dose 12 months after the first dose Second dose (year 1) and third dose (year 2) administered several weeks before the disease-transmission season (which usually begins in April)
Boosters Existing data suggest boosters might be needed, but additional data is required to make recommendations regarding booster schedules.
Simultaneous administration with other vaccines Additional data needed If simultaneous administration is necessary, use separate syringes and separate injection sites

References:

Akin E, McHugh GL, Flavell RA, et al. The immunoglobulin (IgG) antibody response to OspA and OspB correlates with severe and prolonged Lyme arthritis and the IgG response to p35 correlates with mild and brief arthritis. Infect Immun 1999;173-181.

Alpert B, Esin J, Sivak SL, et al. Incidence and prevalence of Lyme disease in a suburban Westchester County community. New York State Journal of Medicine 1992;92:5-8.

Centers for Disease Control and Prevention. Recommendations for the Use of Lyme Disease Vaccine - Recommendations of the Advisory Committee on Immunization Practices. MMWR 1999;48:1-17.
(Also available in PDF format [742 KB, 39 pages].)

Centers for Disease Control and Prevention. Methods Used for Creating a National Lyme Disease Risk Map. MMWR. 1999;48(RR07);21-24.
(Also available in PDF format [742 KB, 39 pages].)

DeSilva AM, Telford SR, Brunet LR, et al. Borrelia burgdorferi OspA is an arthropod-specific transmission-blocking Lyme disease vaccine. J Exp Med 1996;183:271-275.

Gross DM, Forsthuber T, Tary-Lehmann M, et al. Identification of LFA-1 as a candidate autoantigen in treatment-resistant Lyme arthritis. Science 1998;281:703-706.

Hanrahan JP, Benach JL, Coleman JL, et al. Incidence and cumulative frequency of Lyme disease in a community. J Infect Dis 1984;150:489-496.

Lastavica CC, Wilson M, Berardi VP, et al. Rapid emergence of a focal epidemic of Lyme disease in coastal Massachusetts. N Engl J Med 1989;320:133-137.

Maes E, Lecomte P, Ray N. A cost-of-illness study of Lyme disease in the United States. Clin Ther 1998;20:993-1008.

Mather TN. Dynamics of spirochete transmission between ticks and vertebrates. In: Ecology and Environmental management of Lyme Disease. H Ginsberg, ed. New Brunswick, NJ: Rutgers University Press 1993;43-62.

Meltzer MI, Dennis DT, Orloski KA. 1999 Cost-effectiveness of a vaccine against Lyme disease in humans. Emerging Infect Dis 1999;5:1-8.

Schoen RT, Meurice F, Brunet CM, et al. Safety and immunogenicity of an outer surface protein A vaccine in subjects with previous Lyme disease. J Infect Dis 1995;172:1324-1329.

Schwan TG, Piesman J, Golde WT, et al. Induction of an outer surface protein on Borrelia burgdorferi during tick feeding. Proc Natl Acad Sci USA 1995;92:2909-2913.

Sigal HL, Zahradnik JM, Levin P, et al. A vaccine consisting of recombinant Borrelia burgdorferi outer-surface protein A to prevent Lyme disease. N Engl J Med 1998;339:216-222.

Steere AC, Sikand VK, Meurice F, et al. Vaccination against Lyme disease with recombinant Borrelia burgdorferi outer-surface lipoprotein A with adjuvant. N Engl J Med 1998;339:209-216.

Steere AC, Taylor E, Wilson ML, et al. Longitudinal assessment of the clinical and epidemiologic features of Lyme disease in a defined population. J Infect Dis 1986;154:295-300.

Zhang YQ, Mathiesen D, Kolbert CP, et al. Borrelia burgdorferi enzyme-linked immunosorbent assay for discrimination of OspA vaccination from spirochete infection. J Clin Microbiol 1997;35:233-238.

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This page last reviewed September 19, 2001

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