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Should Children Be Vaccinated Against Lyme Disease?

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WebMD Health News

Jan. 18, 2000 (Boston) -- A vaccine designed to protect people against the tick-borne illness Lyme disease may be as effective and well-tolerated in children as it is in teen-agers and adults. But even if the vaccine is eventually approved by the FDA for the under-15 set, should every child get it? Probably not, say leading pediatricians interviewed by WebMD.

"I think it's up to individual patients and physicians to decide, but this is not a huge scourge of humanity -- we're not preventing a fatal illness like polio," says Eugene D. Shapiro, MD, professor of pediatrics and epidemiology at Yale University School of Medicine in New Haven, Conn., in an interview with WebMD.

The old chestnut about an ounce of prevention being worth a pound of cure certainly holds true for Lyme disease, which, according to the CDC, accounts for more than the 95% of all insect- or animal-borne illness in the U.S. But although a recently approved vaccine (LYMErix) offers reasonably good protection against infection with the organism that causes Lyme disease, the best defense is to avoid getting bitten in the first place, say members of an American Academy of Pediatrics (AAP) advisory panel in the January issue of Pediatrics.

Lyme disease -- so named because some of the earliest identified cases occurred in the area around Old Lyme, Conn. -- can occur when a person is bitten by a common deer tick that is infected with a corkscrew-shaped bacterium called Borrelia burgdorferi. Infection usually begins with a red rash that spreads like a bulls-eye around the bite site. When caught early, the infection readily responds to treatment with antibiotics, but if it is left untreated or is misdiagnosed, it can cause muscle pain and headaches, fever, and painful swelling and inflammation of the large joints (Lyme arthritis). In advanced cases, infections can cause disabling symptoms in the heart and brain.

Most cases of Lyme disease in the U.S. are clustered in New England and the mid-Atlantic states and in the upper reaches of the Mississippi River. Deer ticks tend to favor wooded areas, high grasses, marshes, and beaches. But even in areas where the disease is common, the overall risk of infection following a deer tick bite is still 1 in 50, researchers estimate.

The AAP panel recommends that people take commonsense measures against infection, such as avoiding tick-infested areas, using protective clothing (pants tucked into socks, long-sleeved shirts), and using an insect repellent containing the chemical DEET (n,n-diethyl-m-toluamide) on the skin. A different type of repellent designed for application on clothing only and containing the chemical permethrin has also been shown to be highly effective.

The panel opposes routine use of antibiotics in people who have been bitten by a tick but have not been positively diagnosed with Lyme disease, saying that the practice "is of unproven value and is associated with potential risks and costs."

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