Charles A. Bertrand, M.D., FACP, DIM-CD (Ret.)
Associate Clinical Professor of Medicine at New York Medical College
and at the Medical University of South Carolina


The purpose of these medical articles is to keep the reader current with some of the latest developments in the field of medicine. TO accomplish this, I review over 20 medical journals each month, and when one of the articles is cited, then the exact reference is given so the reader may pursue the subject further, if desired. In addition, three medical letters are reviewed.

The three medical letters are the HArvard Health, Letter, the Johns Hopkins Medical Letter and the Mayo Clinic Health Letter. And all three are recommended highly. Last month was unusual in that both the Hopkins and the Harvard Health Letters headlined the same topic- Lyme Disease- and the necessity for vaccination. (April 2000)

Lyme Disease is caused by bacteria called Borrelia burgdorferi which look like a cork screw under the microscope. The bacteria is carried by an adult tick or a much smaller, younger form called a nymph. When the tick bites a person, it ingests blood - thus causing the disease. About 4 percent of those bitten actually develop the disease, but most do not.

Clinically, the tick bite causes a small rash which looks something like a bullseye. Other manifestations may include chills and fever, headache, lethargy, muscular aches and pains, and stiff neck. About half of those who develop the disease have arthritis, which is characterized by inflammation of large joints, particularly the knees.

If treatment is initiated soon after exposure, about 90 percent of those infected are cured. Treatment consists of a three to four week course of antibiotics - usually amoxicillin or doxycycline.

In December 1998, the FDA approved a vaccine called LYMErix - but the key question is who should be vaccinated? And this question was raised in both publications mentioned above and the conclusions reached were similar.

Geography plays a major role - if one lives in the southern part of New England or New York State, where Lyme Disease is prevalent, vaccinations should be considered. In New York State, the three counties with the most cases are Suffolk, Dutchess and Westchester.

If one is an outdoors individual, especially from May to September (hunting, fishing, gardening, for example), then vaccination should be considered. Clearly, when outdoors, appropriate clothing should be worn, and when ticks are found on the skin, they should be promptly removed.

The vaccination process requires three injections - the second one being a month after the first, and the third being a year later. Short-term studies show the vaccine to be 76 percent effective - there are no long-term studies yet. Soreness at the injection site is the most common side effect. A small number of people experience transitory flu-like symptoms and muscular aches and pains.

About 12,500 cases are reported to health authorities each year, although many more are likely unreported. The decision to vaccinate or not depends primarily on the risk of exposure from ticks. For further information, consult your doctor.

The advice provided on this website is intended to be general in nature and should not be relied upon for specific treatment. If you need personal medical attention please contact your physician.

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