Interventions to prevent Lyme disease in humans: A systematic review.

Lyme disease (LD) is an infection transferred to humans through bites from infected ticks. Surveillance indicates that the number of LD cases is increasing in the UK, therefore, improved knowledge about reducing transmission from ticks to humans is needed. Eighteen electronic databases were searched and additional web-based searching was conducted, to locate empirical research, published from 2002 onwards. Sixteen studies that evaluated five types of prevention intervention were included: personal protection (n = 4), domestic strategies (landscape modification and chemical pest control) (n = 3), education (n = 6), vaccination (n = 3), and deer-reduction programmes (n = 2). In general the quality of evidence was low. Results suggest that personal protection strategies, including the use of tick repellents and wearing of protective clothes, can prevent tick bites and reduce the incidence of LD among adults. Educational interventions were generally successful for improving adults' knowledge, behavioural beliefs (e.g., self-efficacy for performing tick checks) and preventative behaviour, but for children, the findings were mixed. For adults and children, knowledge changes did not typically translate into a lower incidence of LD. Whilst evidence on vaccination against LD is promising, too few studies were available to reach robust conclusions. There was no evidence of effectiveness for deer culling, and the evidence was inconclusive for applying acaricide (tick poison) to deer's ears and heads. Low-quality evidence suggests 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, vaccination and deer programmes is needed.