

Why Your Dog Can Get Vaccinated Against Lyme Disease and You Can’t (2012) - omnibrain
http://www.wbur.org/2012/06/27/lyme-vaccine

======
tokenadult
tl;dr: People who had irrational fears of vaccines claimed harms from the Lyme
vaccine that probably were not caused by the vaccine. Sales dropped so much
that vaccine manufacturers became reluctant to market the vaccine to humans.

Similar irrational fears prompted the development of the "acellular" version
of the pertussis (whooping cough) vaccine, which is less effective than the
previously used version of the vaccine. Pertussis is a serious illness, and
now that many people refuse to use the vaccine, and even the people who use it
can only get a type of vaccine that is less effective than the first
vaccine,[1] the whole population is needlessly at risk for pertussis
outbreaks.

[1]
[http://pediatrics.aappublications.org/content/early/2013/05/...](http://pediatrics.aappublications.org/content/early/2013/05/15/peds.2012-3836.abstract)

[http://www.ncbi.nlm.nih.gov/pubmed/22423127](http://www.ncbi.nlm.nih.gov/pubmed/22423127)

~~~
phkahler
>> People who had irrational fears of vaccines claimed harms from the Lyme
vaccine that probably were not caused by the vaccine.

No, people who actually got the vaccine claimed they got arthritis from it.
Weather those claims are true or not remains unverified. Of course the
clinical trials showed no such side effects, but I doubt they were even
looking for that (if I'm really cynical, do you even trust them not to hide
that?). So when mass-marketed, alleged issues showed up and they pulled it.
This is not different from other drugs that were pulled - and turned out to
have actual problems. The fact that vaccine makers are legally protected and
they still pulled it says a lot here.

That said, TFA says the anti-vaxers are ready to attack any new lyme vaccine
that may come along, and that's unfortunate.

~~~
maxerickson
So if the trial was not corrupt then it must have been incompetent? The FDA
and CDC investigated and did not find reason to believe that the vaccine
caused arthritis, but the unnamed people who reported the arthritis are more
believable than all those public servants?

Come on.

~~~
phkahler
>> So if the trial was not corrupt then it must have been incompetent?

In a sense yes. Clinical trials are not great at finding things like that.
Phase 1 is all about determining toxicity - in other words, how much of a
substance can people tolerate. Later phases are for determining dosage and
effectiveness - how well does it treat a condition, or in this case how well
does it immunize a person against infection. If side effects are not reported
during the trials or are of low frequency, they may not get noticed at all. In
fact, the FDA is starting to look at all-cause mortality for some drugs. For
example, does taking something to lower cholesterol actually increase life
expectancy (vs does it lower cholesterol which theoretically increases life
expectancy). Do you really think they've been looking at all age-related
effects (arthritis is one) of taking a vaccine?

I'm not saying the claims against it here are real, but that it is unfair to
lump those people into the general category of anti-vaxxers. Especially since
they were supposedly vaccinated.

Also, companies don't generally pull something from the market unless there is
a serious reason to do so. Vioxx is thought to have killed 500k people before
it was pulled from the market: [http://www.theweek.co.uk/us/46535/when-half-
million-american...](http://www.theweek.co.uk/us/46535/when-half-million-
americans-died-and-nobody-noticed)

~~~
maxerickson
Be sure to read the after report on the vaccine, linked in a cousin comment:

[https://news.ycombinator.com/item?id=9613520](https://news.ycombinator.com/item?id=9613520)

Especially the stuff about the VAERS database, which tracks/looks for patterns
in reported side effects over time...

------
simoneau
Lyme disease can usually be treated by antibiotics, especially in the early
stages:

[http://www.cdc.gov/lyme/treatment/](http://www.cdc.gov/lyme/treatment/)

This isn't mentioned by the article anywhere and must be part of the cost-
benefit analysis for deploying a vaccine, especially one which is to be only
80% effective and requires booster shots.

~~~
vanderZwan
My younger sister had lyme and was nearly paralyzed before it was discovered.
_Both of my parents are GPs_.

My aunt caught Lyme when visiting us in Europe (note that the European and
American versions are different), and had to visit 5 different doctors before
she got her treatment. The first two thought she was just overworked. By the
third time my uncle (neurosurgeon, living in Europe) suggested she had Lyme.
The third and fourth (Canadian) doctors _refused to check it_. The last one
finally was willing to send a blood sample to the lab.

Lyme is very easily missed. It can manifest itself in a way that has nearly no
visible symptoms, with only the patient claiming to be in enormous pain.

~~~
JoeAltmaier
My son was on an island at a retreat, and his neck and head started hurting
like crazy. He was instantly diagnosed by his peers, the counselors and the
resident nurse. He was ferried/driven 200 miles to a hospital the same day for
antibiotics! So it varies to be sure.

~~~
__z
Your son, like most people who get Lyme, probably had a bulls-eye rash and/or
recalled being bitten by a tick. A bulls-eye rash is enough to diagnose Lyme
disease.

Not only that if you start coming down with symptoms of Lyme right after
getting bitten by a tick then diagnosis is very trivial. Those who don't have
a bulls-eye rash or recollection of tick bites and don't spend a lot of time
in the woods have non-specific symptoms such as fatigue and joint pain. Those
are the cases that the diagnosis can very easily be missed.

Nowadays Lyme is so common around here that anyone complaining of any non-
specific symptoms gets a Lyme blood test. 10 years ago that was probably not
the case. A friend of mine went to the doctor with non-specific symptoms and
tested positive for Lyme. If her doctors didn't run the Lyme test they would
have missed it. They ran the Lyme test even though she didn't spend any time
in the woods or remembered any tick bites because they now know to.

If Lyme isn't on the radar of doctors that is a huge problem for diagnosis of
some cases. It probably would especially suck for someone who lives in, say,
Utah who went to vacation in Maine and didn't recall a tick bite. Your average
Utah doctor has probably never even seen a patient with Lyme disease and
probably won't think to check for it or ask if you've traveled somewhere where
Lyme is common.

Source:
[http://www.cdc.gov/lyme/stats/chartstables/reportedcases_sta...](http://www.cdc.gov/lyme/stats/chartstables/reportedcases_statelocality.html)

~~~
thomnottom
Unfortunately, that's not the case in all areas where Lyme is prevalent. On
top of that, the standard Lyme test is not very reliable. Living in New Jersey
(filled with deer, mice, and ticks) you would think that doctors would be more
aware. But it took several different doctors, emergency visits,
hospitalizations, and, yes, a negative Lyme test before my wife was finally
diagnosed.

The standard reply in the hospital was that even though they had no clue what
was wrong with my wife, they were certain that it wasn't Lyme. And since
insurance doesn't cover the Igenix tests, we had to pay the $300+ out of
pocket.

~~~
tomkinstinch
Like you said, the standard Lyme test is not very reliable. Even if laboratory
tests _are_ ordered, labs are still using immunoassays for confirmation of
Lyme (ELISA, then a Western Blot), which have relatively poor sensitivity
(~70% or lower[1]) due to low serum concentration of _Borrelia_ or possible
absence of antibodies—so they can miss one in four true-positive cases. The
newer PCR-based assays have much better sensitivity (>70%, maybe closer to
90%[2]), but the assays are not yet in widespread use, are still being proven,
and thus are seen only as adjuncts to immunoassays that can provide further
evidence of Lyme. It can also take a couple weeks from when the bullseye rash
appears (or when the tick bite occurs) for serology to test positive, again
due to the _Borrelia_ /antibody concentration being below the limit of
detection. Samples tested are also usually blood, which may not be as good as
CSF. It's a tricky bug to diagnose in the laboratory, which is why it comes
down to the discretion of the clinician and the doctor's knowledge of the
patient and his or her history.

1\.
[http://www.igenex.com/files/should_know.pdf](http://www.igenex.com/files/should_know.pdf)

2\. Laboratory Diagnostic Testing for Borrelia burgdorferi Infection, _Lyme
Disease: An Evidence-based Approach:_
[http://www.cdc.gov/lyme/resources/Halperin_2012_Chap4_Johnso...](http://www.cdc.gov/lyme/resources/Halperin_2012_Chap4_JohnsonB.pdf)

------
cbr
The patent for LYMErix has expired [1] and the vaccine is still considered to
be safe and effective by the FDA [2]. Someone want to start producing it
again?

[1] [http://patft1.uspto.gov/netacgi/nph-
Parser?Sect1=PTO1&Sect2=...](http://patft1.uspto.gov/netacgi/nph-
Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=5747294.PN.&OS=PN/5747294&RS=PN/5747294)

[2] [http://www.jefftk.com/fda-lymerix.pdf](http://www.jefftk.com/fda-
lymerix.pdf)

~~~
pgrote
What about the prior lawsuits? Wouldn't it be inviting a fiasco?

I wonder if a Federal law in the USA could prevent lawsuits for specific
vaccines.

~~~
ghaff
Already exists:
[http://www.supremecourt.gov/opinions/10pdf/09-152.pdf](http://www.supremecourt.gov/opinions/10pdf/09-152.pdf)

[EDIT: Actually this may not be correct (in this case) because LymeRix was a
voluntary vaccination.]

~~~
fecak
The tl;dr is that in the US, vaccine manufacturers have no liability for the
vaccines they produce and sell. Vaccine injury claims are heard without a
jury, and paid out by a special fund which exists due to a per-dose tax on
vaccines.

Vaccinations like the one for Lyme being made unavailable isn't a decision
based on liability or risk so much as low demand.

~~~
ghaff
Only some vaccines are covered however:
[http://www.hrsa.gov/vaccinecompensation/84521booklet.pdf](http://www.hrsa.gov/vaccinecompensation/84521booklet.pdf)

The focus is on compulsory childhood vaccines although the government can add
others at its discretion.

------
abakker
FWIW, having been exposed/infected with Lyme disease 3 times, any vaccine
would be welcome. Really. I can't stress that enough.

Due to a variety of factors, including deer overpopulation(1), the Lyme
disease infection rate in Deer Ticks in New England is ridiculously high.
While I was undergoing treatment for the 3rd time, my doctor indicated that
probably 25% of ticks in that region carry the disease.

I'd be all for a vaccine. It would be even better if we could vaccinate the
deer agains being hosts somehow...maybe in a salt lick?

(1)
[http://www.ct.gov/caes/lib/caes/documents/publications/fact_...](http://www.ct.gov/caes/lib/caes/documents/publications/fact_sheets/entomology/deer_&_ticks_fact_sheet.pdf)

~~~
ender89
Eh, I feel like its not so bad after the first few times. I did get bell's
palsy last time, and I walked around looking like a stroke victim for a bit,
but not that bad all in all.

~~~
abakker
Didn't get that all the way, but started to. Ah the joys of liking to hike and
work in the woods...

Though it is conceivable that the same behavior will get me infected again now
that I live in SF instead of CT, the much lower deer population has meant that
I've not had a single tick bite in 3 years since living here. The one weekend
I went back to visit my mom, I got one helping her clean up fallen tree
branches in the lawn whilst being observed by a herd of deer.

------
zxyzzxxx
I was disappointed over the lack of links in a web(!) article, so I did some
research over this comment: _Poland notes that since then, Lyme has become
more widespread and is now the most common tick-borne disease in the country._

Dr. Gregory Poland works in Mayo Clinic which is based in Minnesota. Here are
statistics for Lyme disease in that country:

[http://www.health.state.mn.us/divs/idepc/diseases/lyme/stati...](http://www.health.state.mn.us/divs/idepc/diseases/lyme/statistics.html)

[http://www.health.state.mn.us/divs/idepc/diseases/lyme/cases...](http://www.health.state.mn.us/divs/idepc/diseases/lyme/casesyear.pdf)

And for the entire United States:
[http://www.cdc.gov/lyme/stats/chartstables/casesbyyear.html](http://www.cdc.gov/lyme/stats/chartstables/casesbyyear.html)

Looks like the number of cases is slowly growing. Charts don't seem to be
normalized. The increase in cases could be due to increase in population.

~~~
JonathonW
Here are the nationwide statistics for Lyme disease in the US:
[http://www.cdc.gov/lyme/stats/index.html](http://www.cdc.gov/lyme/stats/index.html)

And some links to the CDC sites about other tick-borne diseases prevalent in
the US:
[http://www.cdc.gov/ticks/diseases/](http://www.cdc.gov/ticks/diseases/) (most
of these also include statistics on incidence and geographic distribution)

~~~
Tiksi
I was curious to see the rate of spread so I made this gif from the images in
your first link:

[http://paste.click/DyTMLM](http://paste.click/DyTMLM)

------
ghaff
There have been Phase 1/2 clinical trials of a new Lyme vaccine by Baxter
(which I believe is now owned by Pfizer)
[http://www.bnl.gov/newsroom/news.php?a=11537](http://www.bnl.gov/newsroom/news.php?a=11537).

The trials seemed to go well but I don't know the status of further trials
that could lead to this coming to market. Lyme's a real problem though with
sharp increases in infection rates in New England in particular.

~~~
voidlogic
>New England in particular.

[http://www.health.state.mn.us/divs/idepc/diseases/lyme/cases...](http://www.health.state.mn.us/divs/idepc/diseases/lyme/casesyear.pdf)

------
WillyF
A family friend was one of the people who helped develop the Lyme vaccine. He
invited my Dad to be part of the trial because my Dad spends a lot of time
outdoors. It turned out that my Dad got the placebo during the trial, but they
let him get the vaccine after the trial was completed. That was a long time
ago. The vaccine has certainly worn off at this point.

------
hyperion2010
Really though we should be actively hunting deer. Tick borne illnesses kill
more people every year than wolves ever have.

------
jivardo_nucci
Sounds like the dog vaccine works in humans. How is dose adjusted (by weight,
by surface area, etc.)? Anyone know the cost of the dog vaccine?

~~~
voidlogic
I've considered doing this if they are compatible- Does anyone know for sure
that they are the same?

I assume I just take a dose for a great dane :P

~~~
blisterpeanuts
I've read that it's the exact same formulation, but you should check with a
veterinarian on that.

------
pvaldes
Not natural top predators in the ecosystem: explosion of coyotes, deers and
deer's ticks.

I'll wish to read some research about tick density in yellowstone after the
arrival of the wolf. Is increasing?, decreasing?. Keeping some parts of the
park relatively clean of deer's ticks?.

Mmmh, both seem mutually exclusive species, that's interesting...

[http://www.cdc.gov/lyme/stats/maps/interactiveMaps.html](http://www.cdc.gov/lyme/stats/maps/interactiveMaps.html)

[http://www.biologicaldiversity.org/campaigns/gray_wolves/ima...](http://www.biologicaldiversity.org/campaigns/gray_wolves/images/USGrayWolfHabitat_03-22-2013.jpg)

------
blisterpeanuts
Lyme is a terrible disease. If not diagnosed early on, it will burrow into
neural tissue and becomes very difficult to kill. Symptoms include chronic
arthritis, cognitive disorders, chronic pain, dizziness, etc. It's not a
disease you want to get.

I strongly believe it was a terrible mistake to remove the vaccine from the
market for human use. It seems that it was taken off the market from fear of
lawsuits and not because it was proven harmful.

20 years ago, few physicians knew anything about Lyme disease. Even today,
physicians don't necessarily recognize Lyme symptoms, but they really ought
to; 300,000 people are known to have the disease in the U.S., but it's thought
that many thousands of others suffer from Lyme as well but are not
diagnosed.[1]

If you diagnose it properly within the first two weeks, the chances are very
good that it's completely curable with heavy treatments of antibiotics. If you
don't, it becomes much harder to treat. Some have tried IV infusions of
antibiotics, with varying degrees of success.

There are strategies that could be applied to greatly reduce the incidence of
Lyme disease. For example, reintroduction of the Northeastern timber rattler
would help cut down the mouse population which plays a large role in the deer
tick's life cycle. One snake can kill dozens or hundreds of mice a year,
reducing the tick population by thousands. These snakes were largely
eradicated from the Northeast which has probably contributed to a rodent
population boom.[2]

Culling the deer population would also greatly help. Several years ago,
Monhegan Island in Maine drastically reduced the deer herds with a special
hunt, and since that time there have been almost no new cases of Lyme disease
reported.[3] I heard of a similar experiment in a county in Connecticut, with
similar results. It came up for a vote on Long Island last year to cull the
deer population but it was voted down.

Deer are beautiful animals, but their population has exploded in recent
decades. In the 1940s there were thought to be about 300,000 deer in the U.S.
(I've read actually that there were around 500,000 in the early 20th C., and
unrestricted hunting brought that number down to 30,000 by the 1940s, so it's
unclear, but drastically fewer than today in any case), and now there are
estimated to be over 32 _million_ deer.

Not just Lyme carriers, they are a menace on the roads and an estimated 200
people die every year in car-deer collisions, plus billions of dollars of
damage.[4]

Increased hunting permits to reduce the deer population, reintroduction of
predators such as cougars, bobcats, black bear, and wolves into their
indigenous habitats in the Northeast (coyotes have been thriving and need no
assistance), reintroduction of snakes like the timber rattler, and of course
tremendous precautions and application of DEET when venturing into the
grasslands and woods will all help to reduce Lyme disease.

I would also advocate more research grants to study the spirochete bacteria
and find genetic markers needed to make more effective vaccines and
treatments. This is an epidemic that people are only beginning to recognize
but there are solutions to be found, if we get moving.

1\.
[http://www.cdc.gov/lyme/stats/humancases.html](http://www.cdc.gov/lyme/stats/humancases.html)

2\.
[http://www.sciencedaily.com/releases/2013/08/130806091815.ht...](http://www.sciencedaily.com/releases/2013/08/130806091815.htm)

3\. [http://www.bostonglobe.com/lifestyle/health-
wellness/2013/07...](http://www.bostonglobe.com/lifestyle/health-
wellness/2013/07/13/ticks-stealth-and-human-nature-hamper-lyme-disease-
prevention/05tnWMvLznGYCJXoevvF4I/story.html)

4\.
[http://www.insurancejournal.com/news/national/2012/10/24/267...](http://www.insurancejournal.com/news/national/2012/10/24/267786.htm)

