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A Vaccine against Lyme Disease?
- Gary P. Wormser, MD
- Westchester County Medical Center Valhalla, NY 10595 Acknowledgments: The author thanks Drs. Ira Schwartz, Harold Horowitz, Donald Marks, David Krause, and Durland Fish for their helpful comments and Eleanor Bramesco for her assistance. Grant Support: In part by cooperative agreement U50/CCU 210280 from the Centers for Disease Control and Prevention and by grants 41508 and 43135 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Wormser's laboratory also receives support from Connaught Laboratories, Inc., and SmithKline Beecham Biologicals, which are currently testing Lyme disease vaccine preparations for efficacy. Requests for Reprints: Gary P. Wormser, MD, Division of Infectious Diseases, Westchester County Medical Center, Room 209SE, Macy Pavilion, Valhalla, NY 10595.
The approximately 8000 to 10 000 cases of Lyme disease reported annually in the United States makes this tickborne spirochetal infection by far the most common vector-borne disease in this country. The etiologic agent of Lyme disease, Borrelia burgdorferi sensu lato, was recovered from the tick vector in 1981 and from infected humans in 1982 [1]. Successful cultivation of the organism in an enriched artificial medium (Barbour-Stoenner-Kelly medium) has permitted the rapid accumulation of information on structural features, genetic composition, and useful animal models of infection. Knowledge in these areas has greatly facilitated vaccine development.
In the United States and other countries, leptospiral vaccines are tested in hamsters before being used in domesticated species. Drawing on this experience, Johnson and coworkers [2] did seminal studies in 1986 showing that Syrian hamsters could be successfully immunized against B. burgdorferi using an inactivated whole-cell vaccine without adjuvant. In 1990, a whole-cell, chemically inactivated B. burgdorferi vaccine formulation with a proprietary polymer-based adjuvant (Fort Dodge Laboratories, Fort Dodge, Iowa) was conditionally licensed by the U.S. Department of Agriculture for use in dogs. This vaccine was fully licensed in 1992, but little information on its effectiveness and safety has been published [3].
There has been little enthusiasm for developing an inactivated whole-cell vaccine for humans, primarily because of theoretical concerns that such a vaccine may be too “reactogenic,” that is, potentially inducing immunologic responses to cross-reactive human antigens [4]. Subunit vaccines consisting of single recombinant proteins are considered to have …
