Those seeking a vaccine for Lyme disease, the tick-born disease that afflicts as many as 300,000 Americans annually, were dealt a severe blow last week when the Minnesota Board of Medical Practice (MBMP) ruled against the use of a controversial antibiotic that its supporters say is the best-known method for treating the disease.
Lyme disease originates with deer ticks that pass on the bacteria Borrelia burgdorferi when they attach themselves to humans. The tick’s bite typically produces a red bulls-eye-like rash on the victim’s skin followed by a severe headache or neck stiffness, arthritis with severe joint pain and swelling, partial facial paralysis and heart palpitations.
There is no known cure for Lyme disease but effective short-term antibiotic treatments, are available.
Defenders of the newly proscribed drug say it works as a long-term antibiotic “cure.” But critics, citing a number of studies, including one conducted in the Netherlands in 2016, say the evidence of such a long-term effect is weak at best.
Moreover, overuse use of the drug could give rise to drug-resistant bacteria strains, they claim.
The decision of the Minnesota Board carries unusual weight because the Gopher State is considered ground zero for Lyme disease. Lyme disease cases are concentrated in the Northeast and upper Midwest, with 14 states accounting for over 96% of cases reported to CDC.
But Minnesota’s incidence rate is 25.2, nearly three times the national average. Two large pharmaceutical companies — GlaxoSmithKline (GSK, formerly SmithKline Beecham) and Pasteur Merieux Connaught — have devoted considerable effort to developing a vaccine for Lyme disease, with major clinical trials involving 10,000 or more volunteers.
But neither has received FDA approval so far.
Currently, prevention of Lyme disease relies on guidance to hikers and campers to avoid bushy wooded areas and to check regularly for ticks and to remove them quickly. In addition, there a number of special tick repellants available on the market.
Lyme disease also afflicts animals, including dogs. But an effective vaccine for canines has been available for years, while development of a vaccine for humans continues to lag behind.
The CDC has also come out against use of the controversial long-term antibiotic citing the same evidence cited by the MBMP.
Technically, the MBMP’s decision is not a formal ban, only an advisory that the drug no longer carries official approval and its use should be discouraged.
That doesn’t necessarily mean that doctors that continue to treat patients with the drug would suffer real penalties.
Some doctors that treat Lyme disease patients feel that the MBMP’s decision – like the guidance issued by the CDC – is misguided.
Dr. Elizabeth Maloney of Wyoming, Minn., who offers an online training for physicians regarding Lyme disease and serves on the treatment subcommittee of the federal Tick-Borne Disease Working Group, says a separate study shows that long-term antibiotics offer real benefits to a subgroup of Lyme patients with persistent fatigue.
She says the new MBMP guidance will likely discourage doctors from using the long-term anti-biotic even when other treatments aren’t working.
“It becomes an access-to-care issue for these very sick patients,” she said in an interview with the Minnesota Star-Tribune.
New surveillance monitoring techniques developed by the CDC have led to a radical re-estimation of the number of new Lyme cases annually. According to previous estimates, based on reporting to hospitals and clinics, there were just 30,000 cases annually. Now federal health authorities believe the number could be 10-12 times higher.
The growing number of cases – and the evident need for vastly expanded treatment — is one reason advocates of long-term antibiotics are especially disappointed with the recent MBMP decision.
Other states with a high number of Lyme disease cases include Virginia, New York Maryland and West Virginia in the mid-Atlantic region, Rhode Island and Connecticut in New England, and Wisconsin in the Midwest.
Many observers believe that the rising incidence of Lyme disease is due to the overpopulation of deer in these three regions. Reducing deer populations could be an important part of Lyme disease management, some researchers argue.
But other studies show that Lyme disease is growing fastest in areas where the deer population has declined.
The increased incidence of the disease is due to a growing number of ticks but not an increase in the deer population itself, these studies suggest.
Predictably, some environmentalists want to blame climate change, but, in fact, no one has a compelling explanation for why there are more disease-carrying ticks than ever.