The cost-effectiveness of vaccinating against Lyme disease.

Letters 6. Graczyk TK, Cranfield MR, Fayer R. Recovery of waterborne oocysts of Cryptosporidium parvum from water samples by the membrane-filter dissolution method. Parasitol Res 1997;83:121-5. 7. Graczyk TK, Cranfield MR, Fayer R. Evaluation of commercial enzyme immunoassay (EIA) and immunofluorescent antibody (IFA) test kits for detection of Cryptosporidium oocysts of species other than Cryptosporidium parvum. Cryptosporidium parvum oocysts recovered from water by the membrane filter dissolution method retain their infectivity. To the Editor: The recent article by Meltzer and colleagues (1) is an important contribution to a pertinent public health issue: who should receive the newly licensed Lyme disease vaccine. Answering this question is a daunting task, given the scarcity of valid data. Estimates of the spectrum and prevalence of the long-term sequelae of Lyme disease remain controversial (2-4). In generating their cost-effectiveness model, Meltzer et al. examined the cost savings involved in preventing three categories of classic organ-specific Lyme disease sequelae (cardiovas-cular, neurologic, and arthritic); however, they did not take into account the potential cost savings from preventing cases of a generalized symptom complex known as post-Lyme syndrome , which includes persisting myalgia, arthralgia, headache, fatigue, and neurocognitive deficits. These generalized sequelae, which are recognized by the National Institutes of Health as late sequelae of Lyme disease, have been found to persist for years after antibiotic therapy (5,6). Two population-based retrospective cohort studies (7,8) among Lyme disease patients whose illness was diagnosed in the mid-1980s determined that one third to half had clinically corroborated post-Lyme syndrome symptoms years after the initial onset of disease. Although these studies were conducted 15 years ago, when optimal antibiotic regimen guidelines were still evolving, the estimated cost of averting these often-disabling nonorgan-specific symptoms should also be taken into account in estimated detected in digestive tracts of flies exposed to feces with oocysts. C. parvum oocysts were also numerous on maggot and pupa surfaces; approximately 150 and 320 oocysts were recovered per maggot and pupa, respectively. Wild-caught flies belonged to the families Calliphoridae (96% of total flies), Sarcophagidae (2%), and Muscidae (2%). An average of eight flies was caught per trap, and more than 90% of flies harbored C. parvum oocysts. The number of trap-recovered C. parvum oocysts per fly was 2 to 246 (mean 73 oocysts per fly). Synanthropic flies that breed in or come in contact with a fecal substrate contaminated with C. parvum oocysts can harbor these oocysts both externally …