Despite heavy publicity, Lyme vaccine not for all; Doctors say series of shots right for those at high risk


Amid an advertising blitz for the world's first vaccine against Lyme disease, doctors caution that the product is probably best reserved for people who live, work or play in the region's tick-infested woods and grasslands.

The vaccine's cost -- a total of $150 for three shots that must be given over 12 months -- is just one reason why doctors say the vaccine is not for everyone. And while a clinical trial showed the vaccine is 78 percent effective, researchers are not sure whether boosters will be needed to maintain a high level of protection.

"I try to find out what people do for a living, where they live and whether their hobby puts them at high risk for the disease," said Dr. Brian Schwartz, an occupational health specialist at the Johns Hopkins University School of Public Health. "If they say they are at high risk and would get peace of mind from the vaccine, that's OK with me."

The vaccine has been approved for people ages 15 to 70. Further studies will be needed to determine whether it is safe for children and the elderly.

On Maryland's Eastern Shore, where fear of Lyme disease runs high, doctors are fielding questions about the new vaccine.

"A lot of people are coming in and asking for it," said Dr. Helen Noble of Chestertown. "We only got it in from the manufacturer last week, and I'm probably giving it to three or four people a day."

Even so, Noble says she first asks people whether their lifestyle puts them at high risk for the disease: if they work outdoors, see deer roaming through their back yards or hunt in the woods. "There are a lot of people who spend their lives indoors," she said. "They have no significant exposure."

The vaccine, produced by SmithKline Beecham, was approved last month by the U.S. Food and Drug Administration and is being advertised heavily on prime-time television and in the nation's print media. It comes 21 years after the first documented cases of Lyme disease, a bacterial illness that is spread to humans by tiny deer ticks that feast on infected field mice and deer.

Nationally, diagnosed cases have risen to about 15,000 a year. States with the highest rates are Connecticut, Rhode Island, New York and New Jersey, though Maryland is also considered a high-risk state, with 400 to 500 cases yearly.

Lyme disease causes a circular red rash, followed by fever, painful joints and -- in severe cases -- chronic heart and neurological problems. When caught in its early stages, however, it is easily and cheaply cured with antibiotics.

A commercial vaccine was made available for dogs in the early 1990s. The original product was made from whole bacteria, but later versions consisted of a single protein from the microbe's outer surface. That vaccine is similar to the one being offered to humans.

The SmithKline vaccine was approved after a clinical trial in which it was given to almost 11,000 people who received a placebo or three vaccine injections. Those getting the vaccine received their first two doses a month apart, and then a third injection in the 12th month.

Insurance coverage is spotty, though many carriers have not decided whether they will cover the new vaccine.

Even with the vaccine, people are advised to continue common-sense precautions: Wear long sleeves and long pants, use bug spray and check routinely for ticks.

Greg Schenck, a biologist who works on the 485-acre LeCompte Wildlife Management Area in Dorchester County, said he doesn't plan to let down his guard but sees the vaccine as an extra weapon. Last summer, he counted 30 to 40 ticks that had burrowed into his skin.

"This would definitely offer a lot of reassurance," said Schenck.

Pub Date: 1/27/99

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