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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.


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.


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.

[End of conference.]

Listen to the telebriefing

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