Vaccine

Prevention of Lyme Disease Through Active Immunization:

Recommendations of the Advisory Committee on Immunization Practices (ACIP)

References

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Table 1. Lyme Disease Risk by State*

High Risk States: Connecticut, Delaware, Maryland, New Jersey, New York, Pennsylvania, Rhode Island, Wisconsin.

Moderate Risk States: Maine, Massachusetts, Minnesota, New Hampshire, Vermont

Low Risk States: Alabama, Arizona, Arkansas, California, District of Columbia, Florida, Georgia, Illinois Indiana, Iowa, Kansas, Kentucky, , Michigan, Mississippi, Missouri, Nevada, North Carolina, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennesse, Texas, Utah, Virginia, Washington, West Virginia.

No Risk States: Alaska, Colorado, Hawaii, Idaho, Montana, Nebraska, New Mexico, North Dakota, Wyoming.

*States designated as high risk had, in the period 1993-1997, annual incidences of reported cases of Lyme disease at the level of the national average rate (4.7 per 100,000 population) or greater; those designated as moderate risk had an incidence of reported cases less than the national average rate for the period but greater than half the national rate, and ranged from 2.43-4.61 per 100,000 population; those designated as low risk are states with reported populations of vector ticks (I. scapularis or I. pacificus) but incidence rates of reported cases less than half the national rate; and, states designated as no risk states have no known populations of vector ticks.

Figure 1. National Lyme disease risk map with 4 categories of risk: Class 1 (high risk) identifies counties in the to 10th percentile by numbers of cases of Lyme disease reported to CDC from 1994-1995, and where I. scapularis or I. pacificus populations have been established* and have a high prevalence of infection** with Borrelia burgdorferi. Class 2 (medium risk) identifies all other counties where I. scapularis or I. pacificus populations have been established with a high prevalence of infection. Class 3 (low risk) identifies counties where I. scapularis or I. pacificus populations have been established, but infection prevalence is low; or where I. scapularis populations have been reported but not established. Class 4 (no risk) identifies counties where neither I. scapularis or I. pacificus have been established or reported. Note: This map demonstrates an approximate distribution of relative Lyme disease risk in the United States. The true relative risk in any given county compared to other counties may differ from that shown here and may change from year to year. Information on risk distribution within states and counties is best obtained from state and local public health authorities.

Figure 2. Cost effectiveness of Lyme disease vaccination. This graph shows the effect of variations in cost of vaccination, vaccine effectiveness, and the probability of contracting Lyme disease on cost effectiveness of vaccination. The left hand y-axis measures cost per case of Lyme disease averted. The right hand y-axis measures the cost per long-term sequelae (cardiac, neuralgic, and musculoskeletal) averted. Underlying assumptions are as follows: probability of identifying and treating early Lyme disease, 0.85; cost of treating cardiac sequelae, $6,845; cost of treating neurological sequelae, $61,193; cost of arthritis $34,304; cost of treating early Lyme disease without sequelae $161).

*data derived from I. scapularis and I. pacificus distributions in Dennis DT, Nekemoto TS, Victor JC, et al. Reported distribution of Ixodes scapularis or Ixodes pacificus (Acari:Ixodidae) in the United States. J Med Entomol 1998;35:629-38, and modified by a GIS-based smoothing technique to minimize the effect of missing data.

**Data on infection prevalence in ticks is based upon a combination of published and unpublished reports, and the ratio of competent ot non-competent reservoir hosts present in each county as determined from range distribution maps for vector host species.

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