Lyme Disease: Cascade of Prevention

Lyme Disease: Cascade of Prevention

Preventing Lyme Disease

By: Ariana Nunez and Alex Pugliese

  • Reduce “Deer Tick” Population

  • Avoid Wooded and High Grass Areas
  • Wear Appropriate Clothing in Wooded Area (long sleeves and pants)
  • Use EPA Recommended Insect Repellants (e.g. DEET)
  • Check Yourself for Ticks When Returning from Outdoors

  • Reproduce and Distribute Previously Available Lyme Vaccination to the Public
  • Start Prophylactic Oral Antibiotics (e.g. Doxycycline or Amoxicillin) Upon Exposure

  • Continue Oral Antibiotics for “Early”/Acute Symptoms
  • Start IV Antibiotics for “Late” or Continuing Symptoms; Based on Laboratory (EIA and Western Blot) Confirmation and Clinical Diagnosis
  • Provide Appropriate Supportive Care for Chronic Lyme Disease Symptoms (neuropathy, arthritis, etc.)
  • = Primary Prevention
  • = Secondary Prevention

  • = Tertiary Prevention

Lyme Disease: Surveillance

**Indicates New,
Proposed Strategy

1) **Use “Deer Tick” Reduction Strategies in High Incidence States:

  • Apply area-wide arcaridies (tick poison) in endemic areas during peak seasons.
  • Apply arcaridies to the fur of host wildlife population (deer).
  • Reduce deer population via culling.yellow curved arrow
  • Biological control via toxic fungi, which ticks consume in the wild.

2) Monitor Estimated Tick Population and Distribution via the CDC’s Tick Surveillance System.

3) Provide Necessary Resources to Healthcare Providers in Both High Incidence and Low Incidence States:

yellow curved arrow

  • Prophylactic antibiotic guidelines for suspected cases.
  • Information on how to report probable Lyme Disease cases.

4) Use Two-Tiered Testing for Lyme Disease to Confirm Diagnosis at Onset of Symptoms (Enzyme Immunoassay & Westerblot):

yellow curved arrow

  • Treat patients with oral or IV antibiotics
  • Report confirmed cases to the Local and State Health Departments as well as the National Notifiable Disease Surveillance System (NNDSS).

5) ** Identify “Chronic Lyme Disease” and “Post-Lyme Disease Syndrome” as Notifiable Conditions to State Health Departments and the NNDDSS.

Feedback Loop #1:

  • Record and report changes and trends in tick population estimations and distributions.

  • Analyze the effectiveness of tick reduction strategies.

Feedback Loop #2:

  • Monitor and report number of incidence cases confirmed by lab testing.
  • Analyze prophylactic antibiotic effectiveness; report any observed differences.

Feedback Loop #3:

  • Monitor and record number of Chronic Lyme and Post-Lyme Disease Syndrome cases.
  • Calculate and report odds of developing these conditions in those with confirmed Lyme Disease. Gather additional info on previous treatment regimens.

Despite public health efforts over the past two decades, Lyme disease continues to be a growing public health concern in the United States with a suspected 300,000 people diagnosed each year. Lyme disease is caused by the bacteria Borrelia burgdorferi, which is spread to humans through “Deer Tick” (Ixodes Scapularis) bites. Understanding how to prevent the transmission of this disease and the surveillance systems currently in place to monitor its distribution will be important in controlling this epidemic. The diagrams above provide insight into prevention strategies, as well as, current and new surveillance systems to help reduce future infections.

By | 2019-07-29T17:37:22-04:00 July 26th, 2019|Infectious Disease|

About the Author:

I am a passionate blogger, author, speaker and 3X Board Certified MD in Infectious Disease, Internal & Sleep Medicine. I currently am an infectious disease physician in Atlanta, GA for Infectious Disease Consultants.


  1. Avatar
    Beth Staropoli September 3, 2019 at 8:34 pm - Reply

    Physicians MUST get on board with Lyme and co-infections already! Too many deny patients, with related symptoms, adequate testing. Without proper testing, the treatment is irrelevant. It’s difficult to test for a long term vector infection which plays a critical role in treatment. Our practice has many chronically ill patients who lost years of their lives due to the denials of many physicians.

    • Avatar
      Andrew Pugliese MD September 23, 2019 at 5:20 pm - Reply

      Hey Beth,
      Thank you very much for reading and giving this insight!

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