Month: June 2024

Nova Scotia Pharmacists Can Now Diagnose/Treat Early/Acute Lyme

As of May 1, 2024, Nova Scotia Pharmacists have been able to diagnose and treat Early/Acute Lyme disease. The following is from the Nova Scotia College of Pharmacists website under “Notices”:

“Effective May 1, 2024, pharmacists will be authorized to assess and prescribe for the treatment of early Lyme disease. For clarity, this is in addition to the existing authority to prescribe chemoprophylaxis for the prevention of Lyme disease. Of note:

  • The standards set out:
  • PANS will host an education session on assessing and prescribing for early Lyme disease with Drs. Tasha Ramsey and Emily Black at 7:00 PM on May 7, 2024. For more information and to register, please click on the appropriate link below:
  • PANS has been working with the Department of Health and Wellness on funding for this prescribing, with an expected announcement in May.”

As it is now June 24th and I have yet to see an announcement, I believe it is due to the fact that funding has not yet been finalized for all pharmacies. I have heard via two pharmacists now that some pharmacies are free for this service and some charge. The fee is fairly nominal but is apparently resulting in an announcement not yet being made.

I am given to understand that a person needs to have an erythema migrans (EM) rash for diagnosis so this will continue to eliminate a certain percentage of the population that do not get, or see, a rash, from receiving a prompt diagnosis. As well, I hope that pharmacists have been adequately trained on what constitutes an EM Lyme rash. Some helpful information – https://www.aad.org/public/diseases/a-z/lyme-disease-signs; https://www.cdc.gov/lyme/signs-symptoms/lyme-disease-rashes.html; and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9687974/.

Pharmacists are also required to utilize the NS Lyme Guidelines as prepared by the NS Infectious Disease Expert Group – https://novascotia.ca/dhw/cdpc/documents/statement-management-ld-hga-b-pvi.pdf. Unfortunately, these guidelines recommend following the IDSA Lyme Guidelines – https://www.idsociety.org/practice-guideline/lyme-disease/ – even though the IDSA Lyme Guidelines include a disclaimer under the Notes section that they are guidelines only, are voluntary, and do not supplant physician judgement. The fact that there are at least three other Lyme guidelines available for use is not mentioned.

The three other Lyme guidelines are:

The other issue, of significant note, is that ticks can transmit other things along with, or instead of, Lyme. Hopefully people receiving a diagnosis and treatment of Lyme will be adequately educated on the fact that they should keep note of any new symptoms that might occur and to ensure follow-up if they do have some.

What I Know, And Don’t Know, About Lyme Vaccines

First of all, yes there was once a Lyme vaccine – https://www.aamc.org/news/lyme-disease-rise-why-there-still-no-vaccine#:~:text=LYMErix%2C%20manufactured%20by%20what%20was,FDA%20approved%20it%20in%201998 and a bit more – https://thewalrus.ca/lyme-disease-vaccine/. At present, however, your dog can be vaccinated, but you cannot. It’s interesting that a Lyme vaccine is required if it’s rare, hard to get, and easy to treat, as some doctors will still say. Fortunately, many doctors are now acknowledging that it is a bigger problem then we were once told.

There are a variety of vaccines presently being developed. Some are for humans and some are for mice.

The chatter around Lyme disease vaccines is becoming greater lately. I’m sure it has nothing to do with the fact that Valneva/Pfizer are in Phase 3 of a Lyme vaccine – https://valneva.com/research-development/lyme-disease/; https://valneva.com/press-release/pfizer-and-valneva-complete-recruitment-for-phase-3-valor-trial-for-lyme-disease-vaccine-candidate-vla15/. It looks like it will be the first to market.

From what I have read, including this – https://valneva.com/press-release/valneva-announces-publication-of-lyme-disease-phase-2-trials-in-the-lancet-infectious-diseases/, this vaccine is only for Lyme disease. If that is the case, I do have some worries. What if you are bitten by a tick carrying something instead of, or along with, Lyme? Will the vaccine help, or hinder, diagnosis and treatment of any other potential tick-borne disease? Will it be 100% effective for Lyme? If not, will doctors say you don’t have Lyme because you were vaccinated? They frequently say you don’t have Lyme because the test was negative, even though there are several reasons for a false negative test.

There are actually a number of other human vaccines also in the development stage that I think might have value – https://igenex.com/tick-talk/recent-developments-in-lyme-disease-vaccinations-what-you-need-to-know/. However, these have the same questions as the one above as they are all Lyme related, as far as I can tell.

There is also work underway to vaccinate white-footed mice, a carrier of the Lyme bacteria – https://www.sciencenews.org/article/new-lyme-vaccine-mice-protect-humans & https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3610442/#:~:text=Oral%20vaccination%20of%20white%2Dfooted,burgdorferi%20infection (this is from 2013 and begs the question as to why something hadn’t been developed before now).

This is a bit more on another? vaccine – https://news.uthsc.edu/uthsc-researchers-lyme-disease-intervention-headed-to-market/, https://www.nature.com/articles/s41541-023-00802-y, and https://pubmed.ncbi.nlm.nih.gov/38360853/. This may be one already mentioned as some are quite similar.

This vaccine is confusing me a bit as most research starts with mice – https://www.the-scientist.com/newly-developed-mrna-vaccine-protects-against-lyme-disease-71477. I think it is eventually meant for humans – https://www.cell.com/molecular-therapy-family/molecular-therapy/fulltext/S1525-0016(23)00428-8?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1525001623004288%3Fshowall%3Dtrue.

When I first read about this – https://www.wired.com/story/pill-kills-ticks-lyme-disease-babesiosis-anaplasmosis/ – I immediately thought that I wouldn’t take anything that would kill ticks upon feeding. It would be similar to what dogs can be given apparently. They want the treatment to kill an attached tick within 24 hours of attaching and starting to feed as that is “generally” how long it takes a tick to transmit the Lyme bacteria. Unfortunately, things like Powassan virus can transmit in 15 minutes and less is known about how long it takes other things to be transmitted. So ick re putting something into you that can kill ticks upon a bite and what about the things that can be transmitted more quickly? Lyme can also occasionally be transmitted more quickly. What then?

I’m not a doctor, researcher, etc., yet I have many, many questions. I’m sure I’m not the only one. Perhaps someone more knowledgeable than I can provide input regarding the vaccines under development.

If I read everything correctly, none of the above will have a 100% guarantee that a tick bite will not result in the transmission of tick-borne diseases. Therefore, as always, prevention will be key. We need to learn to live with ticks by undertaking daily preventative measures. It’s a year-round issue in many parts of the world now, including in Nova Scotia. We can’t continue to put our head in the sand and say that it’s no big deal. It can be. It has been for many.

PLEASE take the issue seriously. Learn about the different tick-borne diseases. Educate yourself regarding signs and symptoms. Prevention is key!