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Lyme disease is a tick-borne illness caused by spiral-shaped bacteria belonging to the genus Borrelia. The disease occurs in the temperate regions of North America, Europe and Asia. Far more cases are reported from central and northern Europe, especially Austria and Slovenia, than the southern countries. In the United States, the illness is reported in the Northeast, Midwest, and Pacific coastal regions. Lyme disease is transmitted by small hard ticks of the Ixodes complex. The nymphal stage is responsible for most infections. Disease activity peaks in the late spring and summer. The incubation period usually ranges from one to two weeks, but is variable. An expanding red rash, often pale in the center (known as a bull's eye rash), is the most common initial manifestation but, in many cases, the rash is not present or is not observed because of its location. Flu-like symptoms are common, including fever, headache, joint pains, body aches, and malaise. Complications may include (1) arthritis, resulting in painful swelling of one or more joints, especially large joints such as the knee; (2) infection of the nervous system, leading to meningitis, encephalitis, or Bells palsy; (3) cardiac involvement, usually manifesting as heart block (slow heart rate). Early treatment of Lyme disease with an appropriate oral antibiotic, generally doxycycline or amoxicillin, usually but not always prevents these complications from occurring. Treatment of complications may require an intravenous antibiotic, usually ceftriaxone. A Lyme vaccine (LYMErix; GlaxoSmithKline) has been approved by the U.S. Food and Drug Administration, but is no longer being manufactured or sold. Even when available, Lymerix is not generally recommended for travelers because full immunization requires three doses over a one-year period, which is not practical for most trips, and because the vaccine may not be effective against the strains present in Europe and Asia. Tick precautions are strongly advised for travel to rural and forested areas in regions where Lyme disease is known to occur.
From the World Health Organization (WHO)
From the Centers for Disease Control (CDC)
Recommendations for the Use of Lyme Disease Vaccine Recommendations of the Advisory Committee on Immunization Practices (ACIP) (comprehensive summary; chiefly for physicians)
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