Prevention interventions for Lyme disease: A systematic review

Michelle Richardson, Claire Louise Khouja, Ruth Alice Elizabeth Walker, Katy Sutcliffe, Claire Stansfield, Melissa Harden, Amanda Jayne Sowden, James Thomas

Research output: Book/ReportCommissioned report


Lyme disease is the result of an infection, caused by the Borrelia burgdorferi bacterium, which is common in ticks; people can develop Lyme disease after being bitten by an infected tick. This report is one of a series of evidence reviews on Lyme disease, commissioned by the Department of Health (England) Policy Research Programme, and undertaken by the Department of Health Reviews Facility. This evidence review focuses on interventions for preventing Lyme disease. The aim is to determine the types of evaluated interventions, their effectiveness and their applicability to the UK.
Review questions and methods
The review aimed to address the following questions:
 What types of interventions have been developed to prevent Lyme disease in
humans and are they effective?
 To what extent are the findings generalisable to the UK context?
We searched seventeen electronic databases and conducted additional web-based searching for unpublished and grey literature. Empirical research published in or since 2002, on Lyme disease, in humans, was included and synthesised to produce a systematic evidence map that spanned a wide range of topic areas (Stokes et al. 2017). The in-depth review reported herein focuses on evaluations of prevention interventions identified in the map. To be included, studies had to evaluate the effectiveness of an intervention that aimed to reduce the incidence of Lyme disease, in humans, using a control group or comparator research design. Due to the heterogeneity in interventions and outcomes, the
data were synthesised narratively and cross-referenced with current prevention
guidelines. To see how review findings resonated with UK patient experiences we sought feedback from eight UK patient advocacy groups.
Eighteen studies were included that evaluated five types of intervention: personal
protection (n=4), domestic strategies (encompassing landscape modification and chemical control) (n=3), education (n=6), vaccination (n=5), and deer-targeted programmes (n=2). There were no UK-based studies; 12 were conducted in the USA and six were conducted in Europe. In general, the studies were low in quality and, therefore, had a high potential for bias making it difficult to ascertain reliable information about intervention effects. Low-quality evidence suggests that personal protection strategies, including the use of tick
repellents and wearing of protective clothes, may prevent tick bites among adults. Low-quality evidence suggests that education interventions may be successful for improving knowledge, behavioural beliefs (e.g., self-efficacy for performing tick checks) and preventative behaviours among adults. The few studies (n=2) that targeted children produced low quality mixed findings for the same outcomes. For both adults and children, changes in beliefs and behaviour did not generally translate into a reduction of tick bites or incidence of Lyme disease.
Whilst the evidence on vaccination of Lyme disease is promising, too few studies were available to reach robust conclusions about effectiveness, and safety.
There was no evidence to support the use of domestic strategies and the culling of deer, and the evidence on the effectiveness of acaricide applied to deer’s ears and heads was inconclusive.
Current UK prevention guidance for Lyme disease relates mostly to personal behaviour that aims to prevent tick bites occurring (such as the use of tick repellents and wearing of protective clothes) and is, therefore, consistent with the findings of this review.
Six patient advocacy groups provided feedback on these findings. Three groups felt that a national Lyme disease awareness strategy is needed; two of these groups and one other group suggested that, currently, most awareness raising is undertaken by patient advocacy groups. Two groups expressed concern about the lack of evidence from the UK.
The conclusions must be considered in light of the low quality studies on which they are based. The findings suggest that personal protective strategies that limit exposure to ticks should continue to be recommended, as should education to encourage the adoption of personal protective strategies; further investigation of education interventions for children is particularly needed. Other research needs include:-
 UK-based studies examining the effectiveness of personal protection and education to verify their applicability for this country.
 Evaluations that use objective outcome measures to assess the incidence of Lyme disease (e.g., GP records of diagnoses).
 Empirical work to evaluate the generalisability of these findings to different social and ethnic groups.
 Robust evaluations of antibiotic prophylaxis and checking pets for ticks.
 More research on the effectiveness and safety of vaccination and deer-targeted programmes.
 Collaborative research between key stakeholders to optimise the relevance and
utility of Lyme prevention research.
Original languageEnglish
Place of PublicationLondon
PublisherEPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.
Commissioning bodyDepartment of Health and Social Care
Number of pages71
ISBN (Electronic)978-1-911605-02-7
Publication statusPublished - Dec 2017

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