Prevention

There is no vaccine for Lyme disease. In 1998 LYMErix, the FDA approved vaccine against Lyme disease, was introduced to the market. It was proven to be 80% effective in prevention of the disease. Nonetheless, it was withdrawn within a matter of 3 years because of poor public demand and concerns regarding safety which were never scientifically proven.

Therefore, raising tick awareness is the only pragmatic way to reduce the incidence of Lyme disease. It is necessary to engage in public awareness programs such as campaigns and signposting.

Essentially Lyme disease can be prevented at three stages:

• Before the tick bite
• During the event of tick bite
• After the tick bite

The definitive way to prevent Lyme disease is to promote tick awareness, early tick bite identification and appropriate tick removal.

Removal of a tick:

A tick should be removed as soon as possible after it has been identified. To remove a tick in the ED, use fine-tipped tweezers or a tick removal tool. Grasp the tick as close to the skin as possible and pull upwards slowly and firmly as tick mouthparts left in the skin can cause a local infection.

After this, apply antiseptic to the bite area and wash with soap and water.  Advise the patient to keep an eye on the bite area for several weeks to identify any changes and to contact their GP if they feel unwell (remembering to tell them that they have previously been bitten by a tick).

Key learning points:

1. Lyme disease can occur anywhere in the UK so consider it in your differential diagnosis for a range of presentations so as not to miss it
2. Ensure that you adequately expose the patient in whom Lyme disease could be a possibility to look for a rash and/or the presence of a tick
3. Erythema migrans is diagnostic of Lyme disease. There is no gold standard investigation for the diagnosis of Lyme disease where this characteristic rash is not present.  Understand the limitations of the available serological tests and be able to explain the implications of these to patients
4. Follow the recommended treatment algorithms and seek specialist input where there are focal signs or symptoms, negative serological testing despite high clinical suspicion, in children under 18 (unless they have a single erythema migrans lesion and no other symptoms), and where symptoms persist despite two courses of appropriate antibiotics