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Book Review
Lyme Borreliosis–Biology,
Epidemiology and Control
J.S. Gray, O. Kahl, R.S. Lane, and G. Stanek, authors
CABI Publishing, Wallingford, Oxfordshire, UK, ISBN: 0851996329, 347 pages,
including index
Suggested citation
for this article:
Schwartz I. Lyme borreliosis–biology, epidemiology and control. Emerg
Infect Dis [serial online] 2004 Mar [date cited]. Available from:
http://www.cdc.gov/ncidod/EID/vol10no3/03-0686.htm
Lyme borreliosis is the most common arthropod-borne disease in the United
States and Europe, and cases are reported from nearly all regions of the
Northern Hemisphere. As such, it is a particularly useful example of a
zoonotic disease that should be considered not only from the perspective
of the human patient but also from that of the vectors and reservoir hosts.
This approach is the one adopted by the editors of Lyme BorreliosisBiology,
Epidemiology and Control. The first five chapters constitute a general
review covering characteristics of the disease, molecular biology of the
etiologic agent Borrelia burgdorferi sensu lato, and vector and
host biology. Some of these chapters are not reviews in the truest sense.
For example, chapter 2 is a primer on ecologic research; it provides important
definitions and categorization of hosts and vectors. Likewise, a substantial
portion of the chapter on B. burgdorferi in the vertebrate host
is devoted to the role of complement in host specificity. Still, these
chapters provide a good general description of the topics covered.
Chapters 6–9 provide more specific detail on the unique aspects of ecology
in Europe, Russia, Japan, and North America, respectively. Although these
chapters do not follow the same format, all cover essentially identical
topics, including description of the diversity of spirochete species,
vectors, hosts, landscape ecology, and risk factors. The chapter on the
ecology of B. burgdorferi in Russia is particularly worthwhile
because many of the studies described have only been published to date
in Russian-language journals. This information is now available to a broader
audience.
The final three chapters deal with epidemiology, prevention, and control.
The chapter by Dennis and Hayes on epidemiology is outstanding and provides
an excellent consideration of several controversial topics, including
seronegative Lyme disease, persistent infection, chronic refractory Lyme
disease, and problems of both underdiagnosis (in Lyme disease–endemic
areas) and overdiagnosis. Hayes and Schriefer provide a comprehensive
description of vaccine development. Unfortunately, the only commercially
available vaccine, Lymerix, has been discontinued by the manufacturer,
and little progress is reported on development of alternative vaccines.
This leaves personal protective measures (e.g., avoiding tick-infested
terrain, using appropriate clothing, checking for attached ticks), single-dose
antimicrobial prophylaxis following selected tick bites, and tick control
as the primary means of prevention. The last topic is covered in the book’s
final chapter.
The reader interested in details of the clinical aspects of Lyme disease
will not find them here. Rather, the book focuses on vector and host wildlife
ecology and epidemiology, as the title implies. There is an obvious effort
to cover Lyme borreliosis from a global perspective rather than from a
distinctly American one. This approach is one of the book’s strengths,
although it does lead to some bias in the selected references in certain
chapters. A comprehensive index is provided, and topics covered in multiple
chapters are cross-referenced well, providing an integrated feel. The
book will be quite useful for ecologists, epidemiologists, and public
health workers, especially those interested in vector-borne infectious
diseases. The book will be less informative for those interested in detailed
descriptions of the molecular pathogenesis and clinical aspects of Lyme
borreliosis.
Ira Schwartz*
*New York Medical College, Valhalla, New York, USA
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