Red Book 28e
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Lyme Disease

Control Measures


see Prevention of Tickborne Infections .


Many people who seek medical attention for a tick bite have been bitten by a species of tick that does not transmit Lyme disease, or the recovered material is not a tick. The overall risk of infection with B burgdorferi after a recognized deer tick bite is less than 1% and, even in areas with highly endemic rates of infection, is sufficiently low that prophylactic antimicrobial Treatment is not indicated routinely for most people. People bitten by an ixodid tick in areas with low incidence of Lyme disease should not receive chemoprophylaxis. The risk is extremely low after attachment (eg, a flat, nonengorged deer tick is found) and is higher after engorgement, especially if a nymphal deer tick has been attached for at least 72 hours. Analysis of the tick for spirochete infection has a poor predictive value and is not recommended. On the basis of a study of doxycycline for prevention of Lyme disease after a deer tick bite, some experts recommend a single 200-mg dose (4.4 mg/kg for body weight less than 45 kg) of doxycycline for people 8 years of age and older who have been bitten in an area with hyperendemic infection (ie, local rate of infection of these ticks with B burgdorferi is 20% or greater) who have found an engorged deer tick, especially if the suspected duration of attachment is 72 hours or longer and prophylaxis can be started within 72 hours after the tick was removed. Data are insufficient to recommend amoxicillin prophylaxis.

Blood Donation

Patients with active disease should not donate blood, because spirochetemia occurs in early Lyme disease. Patients who have been treated for Lyme disease can be considered for blood donation.


A Lyme disease vaccine was licensed by the US Food and Drug Administration on December 21, 1998, for people 15 to 70 years of age but was withdrawn in early 2002 and no longer is available.

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