Host-directed therapies for bacterial and viral infections

Lyme Disease Bites As Ticks Gain Ground In US

In November 1975, health officials in Connecticut received a series of strange and troubling reports about a cluster of children in the small town of Lyme who had apparently developed arthritis.

The officials sent experts to investigate, and soon identified more than 50 residents in the area with recurrent pain and swelling in their joints — some of whom had initially reported unusual skin markings and fever-like symptoms.

"The seasonal and geographic distribution of cases and the association with a skin lesion suggest that a virus carried by a biting insect may be responsible for this disease," the officials cautioned in a memo to their peers. "Any meaningful effort to control this problem and prevent new cases must depend on finding new information about its cause."

Nearly half a century later, a lot more is known about the disease to which Lyme gave its name, and which has since spread to other parts of the US and the world. But further research is needed on the detection and treatment of the bacteria Borrelia burgdorferi, which is transmitted to humans by the bite of infected Ixodes ticks after carriage in "reservoirs", such as deer and mice.

Every year, nearly 500,000 people in the US, alone, are estimated to be diagnosed and treated for Lyme disease infection, imposing medical and related costs of nearly $1bn. That trend is rising, with cases reported far beyond the north-east of the US. Climate change is among the reasons.

According to the Fifth National Climate Assessment produced last year by the US Global Change Research Program, "climate change has profound negative effects on human health" — ranging from the harmful impact of greater heat and increased exposure to poor air quality, to higher rates of pulmonary, neurological, and cardiovascular diseases, and worsening mental health.

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Climate is also "a significant contributing factor" to the rise in a range of vector-borne diseases in the country over the past two decades (those transmitted by blood-feeding arthropods, such as ticks). These include not only Lyme disease — which accounts for four-fifths of vector-borne infections reported in the US — but also Rocky Mountain Spotted Fever and the multiple pathogens transmitted by the Lone Star and Gulf Coast ticks. In addition, there is a rising threat linked to mosquitoes — of dengue, Zika, chikungunya, and West Nile virus.

Ben Beard, deputy director of the Division of Vector-Borne Diseases at the US Centers for Disease Control and Prevention (CDC), and a co-author of the assessment, says: "We've seen a huge increase in tick-borne diseases."

He points to factors including milder winters and longer summers that have encouraged the spread of ticks beyond the north-east of the US, compounded by changes in human activity. Longer summers have helped increase contact, while historic shifts from an agricultural to an industrialised economy, and the growth of suburban sprawl, have increased the likelihood of exposure. Reforestation and the resurgence of deer populations in some areas have added to the scope for interactions.

"People in new areas are being exposed to new diseases they were not exposed to before," Beard says.

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A complication is the range of different vectors and hosts across the US. The mosquitoes carrying West Nile virus in the west of the US are different to those in the east, for instance. The former breed in drainage ditches, the latter in small containers — with rain and temperature differently affecting their reproduction.

If human activity is compounding climate change, other factors also help explain the recent rise in cases of Lyme disease. One is purely definitional: CDC changed its system for reporting cases in 2022 with a simpler classification.

However, the recent coronavirus pandemic — despite all the other the harm it caused — has brought two positive developments.

One is the development of an experimental vaccine at the University of Pennsylvania, which draws on the mRNA approach used for certain Covid-19 vaccines. A late-stage clinical trial using a different approach is now under way by Pfizer and Valneva, which is expected to report in 2025.  

A second development is fresh recognition in the wake of "long Covid" of the risks that, in up to 10 per cent of Lyme disease infections, symptoms may persist despite treatment and even when antibodies cannot be detected.

Prof Nicole Baumgarth, director of the Lyme and Tickborne Diseases Research and Education Institute at the Johns Hopkins Bloomberg School of Public Health, says: "The idea of long Covid was embraced in a way the equivalent with Lyme disease was not. Now, even sceptics consider it's perhaps normal for many different infectious diseases to have long term consequences."

Baumgarth stresses that, "in most cases", patients will fully recover if they see their doctor swiftly once symptoms appear — typically within three weeks — and receive the standard treatment of antibiotics. But symptoms may persist in a small proportion of cases.

Prevention efforts, today, focus on educating walkers to exercise caution when straying off trails and into undergrowth; use of insect repellent; inspecting for ticks, showering, and placing clothes into a hot dryer at the end of the day. The problem, she says, is: "We have no elimination strategies for ticks."

While there may be some signs of greater scientific understanding and new tools to respond to Lyme disease, climate change seems likely to contribute to its continued growth — and that of other infections — in the years ahead.

This article has been amended to reflect precisely the climate conditions aiding the spread of ticks and the breeding locations of mosquitoes carrying West Nile virus.

MaineHealth Helping Test New Lyme Vaccine

Lyme vaccine researcher Robert Smith in the lab at MHIR on Monday. Smith is the director of the Vector-Borne Disease Lab and is leading an assessment of a new blood test for early Lyme disease. Shawn Patrick Ouellette/Staff Photographer

MaineHealth is participating in a research trial that is testing the effectiveness of a potential new Lyme vaccine that could prevent thousands of cases of the disease each year in Maine if approved by federal regulators.

Dr. Robert Smith, director of the MaineHealth Institute for Research's Vector-Borne Disease Lab in Scarborough, said the vaccine is showing promise that it will prevent Lyme disease. If proven safe and effective, it could be ready for public rollout in two to three years.

Ticks at MHIR where researchers are studying tick-borne illnesses and how climate change is increasing the number of ticks on Monday. Shawn Patrick Ouellette/Staff Photographer

Maine set a record for Lyme infections in 2023, with 2,943 reported cases of the disease, and the state has seen a steady rise in cases over the past decade. Lyme disease is transmitted to humans by the deer tick, and symptoms include a fever, headache, fatigue, joint pain, muscle aches and pains, and swollen lymph nodes. The symptoms often include a bulls-eye rash at the site of the tick bite but the rash is not always present.

If caught early, Lyme can be treated with a course of antibiotics. But some people experience chronic symptoms long after the infection has run its course.

Scientists have been working for years to prevent the disease through a safe vaccine.

"The early data is encouraging," Smith said. "I'm hopeful that it's going to really help in protecting people from Lyme disease."

At MaineHealth's Pen Bay Medical Center in Rockport, 84 patients were enrolled in Pfizer's clinical research trial in 2023, with half receiving the Lyme vaccine and the other half getting a placebo. The vaccine trial enrolled 9,000 patients in the United States, Europe and Canada.

Those who got the vaccine or a placebo will be monitored for Lyme disease through December 2025, and results from the clinical trial will start becoming available in 2026. Separately, another potential Lyme vaccine being developed by Valneva also is undergoing clinical trials, the U.S. Centers for Disease Control and Prevention said.

If successful, the new drug would be the first Lyme vaccine available for use in humans since a previous Lyme vaccine was pulled off the market in 2002, although a vaccine for dogs remains available.

Staff Scientist Rebecca Robich works on DNA extraction in the lab at MHIR Monday. Robich is working this summer to determine the mammalian blood meal source for ticks infected with Powassan virus, a rare tick-borne virus that can cause encephalitis disease in humans. Shawn Patrick Ouellette/Staff Photographer

"It feels good to be part of helping to bring this to fruition," said Caroline Knight, a registered nurse and research coordinator at Pen Bay. "Hopefully, we can all be vaccinated just like our dogs are."

There were a number of reasons the previous human vaccine was removed from the market, Smith said, including misinformation that the vaccine caused Lyme disease, and that the disease had not reached the high number of cases now being reported, especially in the Northeast.

Knight said the new vaccine will likely be more effective than the previous one, which was only on the market for a few years starting in the late 1990s.

RESEARCH ON OTHER TICK-BORNE DISEASES

The Lyme vaccine would not protect against other common tick-borne diseases, such as anaplasmosis and babesiosis. There were 777 cases of anaplasmosis in Maine in 2023, and 194 cases of babesiosis.

MaineHealth also is participating in research that could see a more accurate blood test that could detect the presence of the Lyme bacteria, Borrelia burgdorferi. And another research study would try to determine the blood meal source of ticks infected with Powassan virus. Only a handful of cases are reported in Maine each year, and scientists are still learning about it and its potential, but Powassan virus can cause severe disease, including infection of the brain (encephalitis) or the membranes around the brain and spinal cord (meningitis), the CDC says.

Rebecca Robich, a research scientist at MaineHealth, said experts at first believed the Powassan virus was transmitted by ticks found on white-footed mice, but the evidence is so far not supporting that theory. So Robich said a team of researchers this summer in Maine will be testing ticks that carry the Powassan virus to see what animal they were previously attached to, including shrews, mice, voles, birds, deer, dogs and cats.

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Tick Bite Awareness, Prevention Important This Spring, Summer

As she was busy studying for final exams, Colorado Mountain College Steamboat Springs nursing student Reece White also was promoting a screening of the medical documentary "The Quiet Epidemic," which exemplifies her own family's struggle.

When Reece was 9, her family finally found out what had been causing them significant medical problems for years. Mom Monica White, a former wildlife biologist and wildland firefighter, was diagnosed with chronic Lyme disease, which was passed to her two children in utero.

"I had no idea, and that is a huge problem because a good portion of women are now recognizing that their children have been sick from birth," Monica said Tuesday at the Steamboat film screening. "Women who are infected with Lyme prior to pregnancy have that risk of transmission to their children, and they have no clue."

Lyme disease is the most common tickborne disease in the U.S., and most Lyme disease infections occur from May to August, according to the Centers for Disease Control and Prevention. Lyme disease is a bacterial infection largely acquired from the bite of an infected black-legged tick, also called deer ticks. The disease commonly is contracted from the blood-feeding parasites in the northeastern, upper Midwest and Pacific northwest states in the U.S., but cases of Lyme have been reported in all states.

Multiple people living in Routt County battle chronic Lyme disease, although several said they prefer to keep their health struggles private. Considering increases in outdoor recreational travel, more people from out of state moving to Steamboat, and the possibility for Lyme to be passed from a pregnant woman to a baby in utero, patients with Lyme disease are becoming more recognized in Colorado.

According to the International Lyme and Associated Diseases Society, Lyme infection can lead to severe illness and disability in some people. Patients with Lyme disease frequently are misdiagnosed with chronic fatigue syndrome, fibromyalgia, rheumatoid arthritis, multiple sclerosis or depression.

The impact of chronic Lyme disease is the reason Reece, 20, is studying nursing in Steamboat and will graduate with an associate's degree in May. Reece may enter the field of infectious diseases, and plans to earn a bachelor's degree in nursing from CMC.

"My childhood with Lyme disease is the reason that I have a passion for health care," said Reece, who watched nurses provide patient-centered care.

"There are over 20 tick-borne diseases or conditions currently known to occur throughout the U.S. And that may impact Colorado residents and their pets at home or through travel," Monica explained.

Specific medical care for Lyme disease is difficult to find in Colorado, but treating Lyme is one of the specialties of Clark resident Elizabeth Kirt, a family nurse practitioner. With a master's degree in nursing, Kirt's practice LifeSync Health can be found online at ElizabethKirt.Com.

Kirt sees hundreds of patients throughout the nation, including from Routt County and Colorado, through tele-health visits. Her Lyme patients are generally suffering from the chronic condition that show up after unusual symptoms, fatigue or mental health issues cannot be explained by other illnesses.

Kirt's strongest recommendation after tick bites is to save the tick for testing and to seek medical treatment from a Lyme literate provider as soon as possible. She said testing a tick for Lyme is easier and more effective than testing the person bitten. People can save the tick in a plastic container to send for testing at companies such as the lab Ticknology in Fort Collins (online at Ticknology.Org.).

Kirt also recommends Lyme disease specialist Dr. Daniel Kinderlehrer in Denver, who wrote the book "Recovery from Lyme Disease."

Reece said her biggest message to Colorado residents is to learn how to prevent Lyme and other tick-borne diseases, whether on outdoor adventures near home or traveling to other states.

"The population of Steamboat and other Colorado towns need the resources to know about prevention techniques," Reece said. "I think that could have helped our situation if it had been known."

"The bite of a single tick is a life changer," said Monica, who has lived in Salida since 2001. "Nobody realizes that until they are impacted. So, prevention is the key to avoiding tick-borne diseases."

In 2013, after years of undiagnosed illness in their family, the Whites were alarmed to learn the degradation of their health was due to multiple tick-borne infections, including Lyme disease.

"As soon as I got my diagnosis, the lightbulb when off because we had been putting out medical spot fires for years with both children without a clue how we were all connected," Monica said.

In 2016, Monica co-founded the nonprofit Colorado Tick-Borne Disease Awareness Association, with information at ColoradoTicks.Org.

"We discovered that the issues surrounding Lyme and other tick-borne diseases affect far too many Coloradans and that risk, prevention and recognition of these diseases is not common knowledge in our region of the country," Monica said. "This lack of knowledge led to years of pain and suffering that changed my life and the lives of my husband and children. We are determined to make a difference for others."

If a tick is found biting a human or pet, prompt and proper removal is important. Use fine point tweezers and grasp the tick by the mouth as close to the skin as possible and pull gently straight out. Clean and wash the bite site and hands. Never put any substance or heat on the tick as that can increase the risk of infection.

"The earlier a tick-borne disease is diagnosed and treatment initiated, typically the better the outcome for the patient," Monica said.

May is National Lyme and Tick-Borne Disease Awareness Month, with more information available at LymeDiseaseAssociation.Org, LymeDisease.Org and ColoradoTicks.Org.

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