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    Experts Ticked Off: What's Best for Lyme Disease?


    And yet a few patients may develop "post-Lyme disease syndrome," which resembles another disease known as fibromyalgia, says rheumatologist Nancy Shadick, MD, MPH, director of the Lyme Disease Center at Boston's Brigham and Women's Hospital and assistant professor of medicine at Harvard Medical School. Symptoms include fatigue, joint pain, and poor concentration and memory, but some doctors don't recognize the symptoms of the chronic syndrome.

    This issue is at the heart of the debate over long-term antibiotic therapy, frequently prescribed for several years. Proponents say that the bacteria that causes Lyme disease can bore deeply into tissue, evading initial treatment and remaining infectious. Skeptics say that the condition isn't fatal, but adverse effects from long-term antibiotics can be. Over the last several months, physicians in both camps have answered to state medical boards on the issue.

    The prevention of Lyme disease is no less controversial. Eighteen months ago, the FDA approved the first vaccine for those at high risk of tick exposure -- those 15-70 years old. Last month, the federal Occupational Safety and Health Administration (OSHA) issued a warning for outdoor workers to ask their doctors about vaccination.

    Since the vaccine was launched, there have been numerous reports of severe arthritic reactions.

    Many believe that the vaccine's genetic engineering produces arthritis in certain people. Thirty percent of the population is thought to be capable of having a reaction to the vaccine because of their specific genetic makeup.

    Citing uneventful human trials with 11,000 participants, drug giant SmithKline Beecham, the maker of the vaccine, denies any association with arthritis. The FDA, which closely monitors adverse events from vaccines in conjunction with the Centers for Disease Control and Prevention (CDC), says the vaccine is not for everybody but sees no red flags for the vaccine, which is known as LYMErix. Officials at both agencies urge those at risk to weigh the risks and benefits with their doctor.

    Because the LYMErix vaccine requires three injections over the course of a year and is only 70-80% effective, the CDC advises other preventive measures when working or playing in wooded areas. These measures include wearing long-sleeved shirts, tucking long pants into socks, and spraying clothing with insect repellant containing the pesticide DEET, such as OFF! and Cutter.

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