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Telebriefing Transcript
MMWR Lyme Disease - 2000
January 17, 2002
CDC MODERATOR: Thanks, John, and on behalf of everyone here in the
Division of Media Relations at CDC, I'd like to welcome those who have
decided to join us for today's media briefing.
We have two individuals from our Division of Vector-Borne Infectious
Diseases in Fort Collins, Colorado, that will be discussing this week's MMWR
article on "Lyme Disease--United States 2000."
Before we get started, I want to bring to everyone's attention that there's
a mistake in the e-mail that you all received in regards to the embargo time
for this article. That time is noontime, and from here on out, MMWRs will be
embargoed on noon on Thursday instead of the previous time of 4 o'clock.
In addition to that, we hope to be doing these media briefings on MMWRs each
and every week. So stay tuned to your e-mail messages for announcements
about further media briefings.
With that, I'd like to turn the call over to Stacie Marshall, who is a CDC
epidemiologist, who will briefly give you an overview of this week's
article, and then we'll turn the Q&A over for Stacie and Ned Hayes, another
CDC medical epidemiologist, to answer your questions.
Stacie, go ahead.
DR. MARSHALL: Can you hear me?
CDC MODERATOR: Yes, everybody can hear you. They're in a listen-only mode,
but go ahead. Just start talking.
DR. MARSHALL: Lyme disease, a tick-borne bacterial illness, continues to be
an important emerging infectious disease in the United States. In 2000,
17,730 cases were reported to CDC from the states, compared to an average of
12,745 cases reported annually since 1991, when Lyme disease became
nationally notifiable.
As expected, most cases of lyme disease were reported from states in the
Northeast, Mid-Atlantic and North-Central region. Most cases of lyme disease
arise from tick exposures in late spring and early summer. Children and
older adults are at highest risk of infection.
Lyme disease can be prevented by reducing tick populations, avoiding
tick-infested areas, using repellents, promptly removing attached ticks, and
vaccination. CDC-sponsored community lyme disease prevention projects are
currently underway in four states with high rates of lyme disease. CDC is
intensifying efforts for prevention of lyme disease in the face of
increasing cases.
CDC MODERATOR: Okay. Thanks, Stacie.
John, I think we're ready for questions.
AT&T MODERATOR: Certainly. And, once again, ladies and gentlemen, if you do
have a question, please press the one at this time.
We do have a question from the line of Emma Hitt [ph] with Reuters Health.
Please go ahead.
QUESTION: Yes. Hi. I was curious, in the MMWR, the CDC talks about
vaccination as preventing lyme disease. Is that something that the CDC is
now recommending?
DR. MARSHALL: The recommendations for lyme disease vaccination haven't
changed since they were originally published in 1999 in a report by the
Advisory Committee on Immunization Practices, and these guidelines are
available in the MMWR, Volume 48, Number RR7.
AT&T MODERATOR: And the next question is from the line of Ridgely Oaks [ph]
with Newsday. Please go ahead.
QUESTION: Is there any indication that the increase is from better reporting
is it from the spread of the tick?
DR. MARSHALL: I think it's a bit of both. It's due to better reporting
methods in endemic states, and it's also due to the fact that humans are
having increased exposure to the ticks. This may be because people are
living in close proximity with the tick, and there has been some increase in
tick density and the distribution of the ticks. So both of these factors, in
addition to better reporting, have probably led to the increased reported
cases.
AT&T MODERATOR: And we have a question from the line of Aaron McClem [ph]
with the Associated Press. Please go ahead.
QUESTION: Actually, my question was just answered, but I'll ask another one.
How do you go about trying to cut the rates for lyme disease, given this
really concentrated area? If we have it narrowed down to these few states,
how can you sort of target your prevention efforts?
DR. MARSHALL: Well, that's a great question, and what CDC is doing is we're
definitely focused on prevention, preventing lyme disease. And what we've
done is four community prevention projects are underway in states in areas
where there's high levels of human lyme disease. So these community
prevention projects focus on reducing tick populations in the areas and also
on education on preventive methods and personal protective measures people
can take to reduce their chance of being exposed to the ticks.
CDC MODERATOR: Stacie, I wonder if you could elaborate a little bit more on
some of the specifics of one of those prevention programs. I mean, what
actually do they entail? Is it something you could elaborate on a little bit
more?
DR. MARSHALL: Well, the prevention projects, it's a community effort. So, in
a community that has a project going, it would involve many different
things. One of the things I mentioned was reducing tick populations. This is
done in some of the projects through using devices such as the bait box for
treating rodents and killing ticks on rodents, and a four-poster device for
feeding deer, which then provides a repellant to the deer.
In addition to this, there's education on surveys, practices, for
personal measures, so there's education and brochures are being produced to
inform people about how to remove ticks, about how to wear proper protective
clothing and apply repellant appropriately in order to reduce their chances
of getting Lyme disease.
There's also [inaudible] of the projects that's landscape modification,
reducing tick and deer areas around the homes, since most cases of Lyme
disease are acquired peri-domestically in areas around the home.
CDC MODERATOR: Next question.
AT&T MODERATOR: And, ladies and gentlemen, just a quick reminder, if you do
have a question, please press the 1.
And Mr.--oh, excuse me. We have a question from the line of Paul Simeo [ph]
with Reuters. Please go ahead.
QUESTION: Yes. I wonder if you'd be more specific about the vaccination
program. Are you recommending it in fact, because there have been reports--I
don't know if you consider them credible--of people saying the got Lyme
disease from vaccinations.
MR. : Ned, do you want to jump in on that one?
DR. HAYES: Sure. We don't have--there's no plausible biological reason why
anybody could get Lyme disease from the vaccine. The vaccine is not an
inactivated live vaccine. It's a subunit recombinant protein vaccine, so
that you can't Lyme disease from the vaccine.
There have been reports, as with any vaccine that CDC has recommendations
for, of adverse events, and we recently reviewed the adverse events for Lyme
disease vaccine, and this should be published shortly in a peer review
medical journal. We found no unexpected pattern of adverse events reported
for the vaccine compared to the results of the clinical trial which was done
before FDA approval. There's no scientific evidence that the vaccine causes
arthritis, and the safety profile of the vaccine, while it continues to be
acceptable, the vaccine is not specifically recommended by the Advisory
Committee on Immunization Practices. The language is that the vaccine should
be considered for persons who reside, work or recreate in areas of high or
moderate risk, ages 15 to 70 years.
CDC MODERATOR: And Stacie, can you repeat the volume number where that can
be found? Maybe that would be helpful to--
DR. MARSHALL: Sure. It was published in June 4th, 1999, Volume 48, No. RR7.
It's called Recommendations for the Use of Lyme Disease Vaccine.
CDC MODERATOR: Okay.
DR. MARSHALL: And there's a summary table at the very end.
CDC MODERATOR: John, next question?
AT&T MODERATOR: And that's from the line of Ted Vigoski [ph] with WABE FM.
Please go ahead.
QUESTION: Yes, good morning. A quick question. If a person does not display
a bulls-eye rash after a tick bite, how does a doctor know what the
diagnosis would be? Has that gotten a little better?
CDC MODERATOR: Ned, you want to take that one?
DR. HAYES: Sure. We believe that up to about 80 to 90 percent of Lyme
disease cases do present with the characteristic rash, erythema migrans, but
that leaves anywhere from 10 to 20 percent that may not, and those
situations certainly are more difficult to diagnose. Some of those patients
will subsequently present with arthritis, and patients with arthritis almost
always have a positive serum antibody test for Lyme disease. So the
diagnosis can be quickly established in people that have known exposure to
Lyme-diseased ticks and present with arthritis in an endemic area.
And so the situation with Lyme disease diagnosis in patients without
erythema migrans is still difficult in the early stages, of course, but is
somewhat better if the patient has a late manifestation of Lyme disease. Of
course, our focus is to try to get these patients diagnosed and treated as
early as possible to avoid the late manifestations, and above all, to try to
prevent Lyme disease in the first place so that we don't have to go to the
step of treatment.
CDC MODERATOR: Next question.
AT&T MODERATOR: And that's a follow up from Ridgely Oakes. Please go ahead.
QUESTION: Yes. I was wondering if you could be more specific on what you
did--what you reviewed to determine that there was no increase in adverse
events and Lyme arthritis or Lyme-like arthritis from the vaccine? Was that
from the VAERS reports or--
DR. HAYES: We reviewed the reports to the Vaccine Adverse Event Reporting
System, which is a passive surveillance system for adverse events following
vaccination that's run by both CDC and FDA. And those are--those are reports
collected from anybody who wishes to file a report to the system. It can
come from individuals who receive the vaccine. It can come from physicians,
and it can come from the vaccine manufacturer.
And we reviewed those reports, and as I said, found no unexpected pattern of
adverse events compared to the clinical trials.
AT&T MODERATOR: And, Mr. Skinner, no further questions in queue.
CDC MODERATOR: Okay. I know we have just a few reporters on, and if there
any more follow ups from them, that's fine. Otherwise we'll conclude, so
maybe give it a few seconds.
AT&T MODERATOR: Certainly. And Ridgely Oakes, please go ahead.
QUESTION: Hi. I'd like to talk some about the vaccine. So is there any--is
there any follow up at this point? When is this peer-reviewed article
expected to be published?
DR. HAYES: I would expect the article should come out in the next couple of
months.
QUESTION: Okay. And does that mean--I know that FDA was concerned that the
Vaccine Advisory Panel was concerned about this vaccine. Does that mean that
nothing further happened? What happens at this point?
DR. HAYES: I can't address how FDA will proceed.
QUESTION: Okay. Could somebody spell the names of the people that have--
CDC MODERATOR: Yeah, I'll do that. It's S-t-a-c-i-e, Marshall,
M-a-r-s-h-a-l-l.
QUESTION: Okay.
CDC MODERATOR: And then Ned, N-e-d, Hayes, H-a-y-e-s.
QUESTION: Okay. Thank you so much.
CDC MODERATOR: I think that's it, John. If there are no more questions,
we'll conclude.
AT&T MODERATOR: No further questions.
CDC MODERATOR: All right, thanks a lot.
Thank you to all who participated, and like I said, stay tuned to your
e-mails in regards to announcements regarding these media briefings.
AT&T MODERATOR: And, ladies and gentlemen, that does conclude your
conference for today. Thank you for your participation, and you may now
disconnect.
