Asian Longhorned Tick Continues to Multiply, Can transmit to Animals in the Lab
These pictures of the Haemaphysalis longicornis (Asian longhorned) were taken recently by LDA’s Scientific & Professional Advisory Board member James L. Occi, Rutgers, in Bergen County NJ. The invasive tick was first discovered on a NJ farm on a sheep in 2017. The tick probably came from Asia, where it is able to transmit diseases to cattle, other animals, and to humans and is now found in 12 states. One of the greatest concerns is about its parthenogenetic ability, the female reproduces without the male. This enables the tick to quickly become an established species in an area. It has already killed cattle in a couple states where more than a thousand ticks were found on each of the deceased animals.
To date, the Asian longhorned tick has been found in the laboratory to be able to acquire and transmit Rickettsia rickettsii, the agent of Rocky Mountain spotted fever (RMSF) and was also found to be able to transmit R. rickettsii through the ova (Stanley et al, 2020).* The Asian longhorned tick has not been found to transmit to humans outside the lab at this time in North America.
However, we need to be cautious, since until several years ago, the government indicated that brown dog ticks only fed upon dogs, not people. Therefore humans did not have to worry about getting RMSF from a brown dog tick. Now we know that human transmission is happening from the brown dog tick, since we know they are biting humans, especially in the Southwest.
chest pain or rib soreness, shortness of breath, heart palpitations, pulse skips, heart block, heart murmur
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Only about 9% get the classic bull’s eye rash. Others may get another type of Erythema Migrans (EM) rash or may get no rash at all. Rash at other than bite site may be disseminated disease. Symptoms may occur days or months after a tick bite.
According to the Centers for Disease Control & Prevention (CDC) surveillance criteria, an erythema migrans (EM) rash in an endemic area, means Lyme disease. In a non-endemic area, a rash requires a positive test. The CDC criteria are for surveillance purposes, not diagnosis.
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nausea or vomiting, GERD, change in bowel function (constipation, diarrhea), gastritis, abdominal cramping, cystitis, irritable bladder or bladder dysfunction, newly diagnosed irritable bowel syndrome (IBS)
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joint/muscle pain in feet, ankle pain, shin splints, joint pain or swelling, stiffness of the joints, neck or back, muscle pain or cramps that migrate, Temporomandibular joint dysfunction (TMJ/TMJD jaw pain), neck creaks & cracks, neck stiffness.
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muscle twitching, headache, tingling, numbness, burning or stabbing sensations, facial paralysis (Bell’s palsy), dizziness, poor balance, increased motion sickness, light-headedness, wooziness, difficulty walking, tremor, confusion, difficulty thinking/concentrating/ reading, forgetfulness, poor short-term memory, disorientation (getting lost, going to wrong place), difficulty with speech, double or blurry vision, eye pain, blindness, increased floaters, increased sensitivity to light or sound, buzzing or ringing in ears, ear pain, decreased hearing, seizure activity, white matter lesions, low blood pressure.
testicular pain/pelvic pain, menstrual irregularity, milk production (lactation), sexual dysfunction or loss of libido.
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fever, sweats, or chills, weight change (loss or gain), fatigue, tiredness, hair loss, swollen glands, sore throat, difficulty swallowing, swelling around the eyes, burning in feet, swelling
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Not all patients recall a tick bite. Studies vary as to how long the tick must be attached in order to transmit Lyme disease. The longer an infected tick is attached, the greater the chance of contracting Lyme disease. Lyme can be transmitted through the placenta.
Lyme from Borrelia mayonii Another strain of Borrelia that causes Lyme
Early symptoms: fever, headaches, rash, neck pain Later: arthritis. Difference from Borrelia burgdorferi may include nausea & vomiting, diffuse rashes, higher concentration of bacteria in blood
Symptoms reviewed by Elizabeth Maloney, MD; President, Partnership for Tick-Borne Diseases Education
Other Tick-Borne Diseases & Conditions:
Patients may also contract other tick-borne diseases (co-infections) from a tick bite along with Lyme disease.
Clinical practice treatment guidelines are often used as reference by physicians for Lyme disease treatment and treatment of other tick-borne diseases. The LDA provides some links here for informational purposes only, as LDA does not make specific treatment recommendations.
The only Lyme disease treatment guidelines that that were posted on the National Guidelines Clearinghouse (NGC), under the auspices of the US Department of Health & Human Services, are those adhering to newly revised National Academy of Medicine (NAM), formerly the Institute of Medicine (IOM), standards for guidelines: the International Lyme & Associated Diseases Society (ILADS) Lyme Guidelines, which address usefulness of antibiotic prophylaxis for tick bite, effectiveness of EM treatment, and antibiotics’ role in treatment of persistent Lyme disease symptoms. Note: Funding to support AHRQ’s NGC contract ended on July 16, 2018. View update here.
Primary care physicians and other healthcare providers seeking continuing medical education (CME) credits for Lyme disease diagnosis and treatment can now approach the non-profit Partnership for Tick-Borne Diseases Education (PTDE) led by Elizabeth Maloney, MD, a physician with longstanding experience in speaking about tick-borne diseases, organizing Lyme disease conferences, and co-authoring treatment guidelines on Lyme and other tick-borne diseases.
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How CDC Surveillance Criteria Impact Lyme Treatment
The Centers for Disease Control & Prevention (CDC) has a case definition for Lyme disease which is developed by the Council of State & Territorial Epidemiologists (CSTE). This definition is meant to be used for surveillance purposes only, not for diagnosis. Surveillance is the collection, analysis and interpretation of data for public health, e.g., comparing case numbers in different states: In 2015, PA is number one in Lyme case numbers, NJ is number two, etc. Below, is the current case definition used for surveillance.
Depending upon what state you live in, surveillance reporting of cases might be mandatory. Some states require doctors to report cases that meet this surveillance criteria to the State, and some also require laboratories to report these Lyme cases or maybe only labs who do electronic reporting.
Doctors are not supposed to use the surveillance criteria to diagnose so Lyme treatment should not be based on surveillance criteria. Insurance companies should not base their payment on surveillance criteria.
DISCLAIMER: The LDA is not a medical organization. The LDA does not make specific recommendations for treatment. Whenever medical advice is needed, the services of a qualified medical provider should be sought. The guidelines on the web sites above are the products of the guidelines’ authors who are solely responsible for their content.
GAO Investigation of Ticks/Vector-Borne Agents’ Biowarfare Experiments Passes House
Update July 29, 2020: The Bill and passed amendments such as this one (below) has now moved to the conference committee where the House and Senate will work to decide what language goes into the final product. The LDA provided input into the amendment language and has been working to get Senators to champion the inclusion of this GAO Investigation Amendment into the final bill.
Said LDA president Pat Smith: “We thank Congressmen Smith & Peterson for championing this investigation. Lyme and tick-borne diseases (TBD) patients and the public are entitled to know the truth about what past government research may reveal not only about the documented tick releases along the Atlantic bird flyway but also about research on the mysterious ‘Swiss agent’ which Dr. Willy Burgdorfer identified as a new Rickettsia strain in his work for the US Government– at Rocky Mountain Labs and in Switzerland. Perhaps it may uncover clues to help stop this epidemic of tick-borne diseases.”
July 23, 2020: The House voted this week to pass a number of amendments to the NDAA, National Defense Authorization Act, including a Chris Smith/Collin Peterson amendment, # 587 —The Comptroller General of the United States shall conduct a review of whether the Department of Defense experimented with ticks, other insects, airborne releases of tick-borne bacteria, viruses, pathogens, or any other tick-borne agents regarding use as a biological weapon between the years of 1950 and 1977. (https://rules.house.gov/bill/116/hr-6395).
There is information in various publications that such activities did occur, especially in the book “Bitten” by Kris Newby– a science writer at Stanford University—a book, which explores the evidence through actual government documents and interviews with some researchers who were involved that document such experiments.
Said LDA president Pat Smith: “Lyme and tick-borne diseases (TBD) patients and the public are entitled to know the truth about what past government research may reveal not only about the documented tick releases along the Atlantic bird flyway but also about research on the mysterious ‘Swiss agent’ which Dr. Willy Burgdorfer identified as a new Rickettsia strain in his work for the US Government– at Rocky Mountain Labs and in Switzerland. The book indicates there is speculation that this pathogen, if crossed with Borrelia, might well complicate treatment and thus be a candidate for biowarfare.” She added, “There is the possibility that any uncovered information could lead to facts which could shed light on the current epidemic of Lyme and other TBD and help develop solutions. We thank Congressmen Smith and Peterson for their continued push to make the truth known and the US House of Representatives for their vote to approve the amendment. ”
Some things author Newby revealed for the first time were: that ticks were developed and deployed as stealth biological weapons during the Cold War, and that Willy Burgdorfer, the scientist the Lyme bacteria, Borrelia burgdorferi, was named after, was at the center of this program. According to Newby, specific revelations she makes in book include:
A 1962 pilot study where infected ticks were dropped on Cuba sugar workers.
Releases of hundreds of thousands of radioactive, aggressive Lone Star ticks on the Atlantic coastal bird flyway.
Omissions of other microbes transmitted with Lyme-carrying ticks during the original outbreak (“Swiss Agent´).
Documentation of military studies where live disease-causing bacteria, some which can be spread by ticks, were sprayed from planes, boats and vehicles on the unsuspecting American public.
In 2019, a similar amendment was introduced and passed the House unanimously but there was no senate support for it.
The Lyme Disease Association (LDA) has been encouraging Lyme advocates across the country to contact both of their US Senators to champion and support this amendment. It is being heard in the Senate this week. LDA thanks those leaders who have made calls and sent emails to garner support.
Lyme Vaccine Candidate: Valneva Announces Phase 2 Study Results
Valneva announced that the vaccine candidate against Lyme disease, VLA15-201, showed positive initial results meeting its endpoints in the Phase 2 study. They stated in the July 22, 2020 press release that “compared to Phase 1, the higher doses used in this trial elicited higher antibody responses across all serotypes.” Of particular note was the the immunological response found in older adults (50-65 years), one of the main target groups for a Lyme vaccine. The vaccine candidate is described as “generally safe across all dose and age groups tested”, finding no Serious Adverse Events (SAEs) associated with VLA15. This is an important finding given the history of vaccines and serious concerns that have been generated regarding patient safety and vaccines in the Lyme community.
VLA15 is the only active Lyme disease vaccine candidate in clinical development today, covering six serotypes of Lyme disease prevalent in North America and Europe. It was granted Fast Track designation by the U.S. Food and Drug Administration (FDA) in July 2017. In a few months, Valneva expects to report top-line results for the second Phase 2 study, VLA15-202. Valneva and Pfizer are collaborating for development and commercialization of VLA15.
The picture in New Jersey of spotted fever group rickettsiosis (SFGR), which includes Rocky Mountain Spotted fever (RMSF), is complex. In this latest study from the Am. Journal of Tropical Medicine and Hygiene (James Occi, Rutgers University, et al, ), the researchers tested American dog ticks and lone star ticks in NJ to determine which Rickettsia are found in these two NJ ticks. They did not find the Rickettsia for RMSF in either of those ticks; however, they did find other Rickettsia in those ticks.
James Occi is a member of the Lyme Disease Association’s Scientific and Professional Advisory Board. Thanks to him for below picture of Dermacentor variabilis, American dog ticks: female, male, and engorged female laying eggs.
Elizabeth L. Maloney, MD Publishes on Reducing the Burden of Lyme Disease
Elizabeth L. Maloney, MD, President of the Partnership for Tick-Borne Diseases Education and Family Medicine Physician in Wyoming, MN published a paper titled “Reducing the Burden of Lyme Disease” in Minnesota Family Physician. It includes discussion of tick bite management, early treatment, and shared decision-making.
In the article, Dr. Maloney highlights the expensive cost of Lyme disease, stating that, “Nationwide, the annual direct medical costs could reach 1.3 billion dollars” and calls attention to the disadvantages in research the illness has suffered, as well as clinical trial evidence that is “generally scant and/or of low quality”.
The author advises that, “Blacklegged tick bites acquired in Minnesota carry a significant risk of Lyme disease,” and offers guidance for making decisions regarding antibiotic prophylaxis of asymptomatic bites.
Maloney stresses the importance of early treatment and writes, “Early Lyme disease, when promptly diagnosed and appropriately treated with antibiotics, is curable.” Above all, she states, “the risks and benefits of all options should be discussed with patients in the setting of shared decision-making in order to arrive at a therapeutic plan that fits both the clinical circumstances and the patient’s goals and values.”
Johns Hopkins’ Aucott Makes Case for Chronic Lyme Disease
John Aucott, Director, Johns Hopkins Lyme Disease Research Center and Associate Professor of Medicine, Johns Hopkins University, published a piece in The Conversation providing his insight on the highly controversial topic of chronic Lyme disease.
In the article, Aucott outlines the existence of a population of patients – an estimated 10-20% – with persistent, lingering symptoms months to years after treatment. He details some of his experience treating these patients and provides an explanation of the various challenges that impair the diagnostic and treatment process. Aucott states, “My chronic Lyme patients were sicker and had less hope than the AIDS patients I worked with, but the underlying mechanism of illness remained elusive.”
Aucott emphasizes that while the mechanism of chronic Lyme disease remains unknown, and molecular markers are needed to provide further insights, it is “no longer accurate to simply argue that chronic Lyme disease doesn’t exist.”
Examining Adult Tick Behavior
Daniel Cameron, MD, reported in his Lyme Science blog on a study that uncovers new information about deer tick questing. The study, from the SUNY Broome Community College’s Tracy R. Curtis, et al., was published in Medical and Veterinary Entomology and looked at how adult blacklegged ticks (Ixodes scapularis) move on public trails with “increasing levels of terrain complexity with a potential host nearby.”
The study examined the extent to which adult ticks may actively search (vs. sit-and-wait) for a nearby host. The researchers aimed to determine whether or not ticks could locate the position of the host in natural conditions, as well as to better understand the role of terrain complexity on the distance ticks traveled in a brief period of time (30 min).
What did they find?
According to Curtis “Overall, ticks were more often observed moving (72% of observations) than stationary (28% of observations).” This observation, along with other indicative deer tick questing behaviors captured in the study, led the authors to conclude that adult deer ticks will actively search for their next meal, rather than taking a stationary “sit-and-wait” tactic.
Curtis continued, “Although ticks may indeed utilize a sit-and-wait strategy when no host is detected, this study suggests that adult I. scapularis ticks utilize an active-search strategy when a potential host is detected nearby.”
The Importance of Understanding Deer Tick Questing
Dr. Cameron notes that understanding how ticks move is important in developing ways to minimize our risk of tick bites and infection. The researchers caution readers to be particularly wary of adult ticks – since the study showed their ability to actively seek a host – and because they are found to be nearly twice as infected with TBD as nymphal ticks. Adult ticks will be out questing for their next blood meal in spring and fall while nymphal ticks seek a host in summer.
LDA has received permission from Dr. Daniel Cameron to share this blog information on the LDA website.
Lyme Disease Vaccine Collaboration Announced
Press Release Summary
Specialty vaccine company Valneva SE and Pfizer Inc. announced a collaboration to develop VLA15, Valneva’s Lyme disease vaccine candidate, which is currently in Phase 2 clinical studies.
According to a Pfizer press release, VLA15 is the only active Lyme disease vaccine program in clinical development today. The program covers six serotypes of Lyme disease that are prevalent in North America and Europe. The vaccine’s mechanism targets the outer surface protein A (OspA) of Borrelia burgdorferi (Bb), the bacteria that causes Lyme disease. OspA is one of the most dominant surface proteins expressed by Bb when present in a tick.
Pfizer states that VLA15 has demonstrated strong immunogenicity and safety data in pre-clinical and Phase 1 studies. In July 2017, the program was granted Fast Track designation by the U.S. Food and Drug Administration (FDA). Valneva expects to report on results from the first Phase 2 studies by mid-2020.
“We look forward to working closely with Valneva to continue advancing the VLA15 program and potentially bring a new solution to patients for this significant unmet need,” said Nanette Cocero, Global President, Pfizer Vaccines.
Comments From the Lyme Disease Association
The Lyme Disease Association President, Pat Smith, had this to say about the announcement: “A safe and effective vaccine for Lyme disease has been a goal for many decades. Unfortunately, many stakeholders, especially some vaccine recipients and providers who were then giving the vaccine, felt there were problems associated with the past Lyme vaccine, perhaps connected to its Osp A base. There are still many unanswered questions about what really happened, and like much that happens with Lyme disease, decades later, we still do not have those answers. The prudent thing for the government and/or vaccine developers to have done would have been to hold public meetings regarding a new Lyme vaccine with all interested stakeholders to hear concerns and answer questions about the development of a new Osp A-based vaccine and what research was done to address the previous concerns and any newly arisen concerns.
In general, much research on Lyme disease has still not been done. In fact, ~46 years into Lyme disease, it ranks below leprosy in the number of clinical trials done in infectious diseases (Goswami et al., 2013). Those who have questioned the safety and efficacy and approval process of the past vaccine have been publicly accused of bringing that vaccine down. When the opportunity for dialogue which engages the Lyme community and all stakeholders has not been offered as part of the approval process, it creates an atmosphere of distrust among those whose trust is necessary to accept a new Lyme disease vaccine.”