Allen Steere
Encyclopedia
Allen C. Steere is a professor of rheumatology
at Harvard University
and previously at Yale University
. Steere is credited with discovering and naming Lyme disease
, and he published almost 200 scholarly articles on Lyme disease between 1977 and 2007. At a ceremony in Hartford, Connecticut
in 1998, Governor John G. Rowland
declared September 24 to be "Allen C. Steere Day."
State Health Department received complaints from Polly Murray, a mother living in the small town of Lyme, Connecticut
. Two of her children had been diagnosed with juvenile rheumatoid arthritis, but she knew of others in the area with similar symptoms.
An epidemic intelligence officer assigned to the Connecticut state health department, David R. Snydman, MD contacted Allen Steere, MD who was studying rheumatology at Yale University, after he had performed a preliminary investigation and thought that there was some symptom complex worth investigating. He knew Allen Steere since they were together in Atlanta the year before at the Centers for Disease Control, when both were in the Epidemic Intelligence Service, a CDC program set up in the 1950s to track epidemics worldwide.
Steere met with Ms. Murray, who gave him a list of children who shared a set of symptoms. Steere called each affected family, representing 39 children in all, and he found an additional twelve adults suffering from what was thought to be juvenile rheumatoid arthritis.
A quarter of the people Steere interviewed remembered getting a strange, spreading skin rash (erythema migrans
) before experiencing any other symptoms. A European doctor happened to be visiting Yale at the time, and he pointed out that the rash was similar to one frequently encountered in northern Europe and known to be associated with tick
bites. Most of the rashes were found somewhere on the torso, suggesting a crawling vector rather than a flying one or a spider, but most patients did not remember being bitten.
In 1976, Steere began testing blood from disease victims for specific antibodies against 38-known tick-transmitted diseases and 178 other arthropod
-transmitted viruses. Not one came out positive. When the broader definition of the disease was applied, more cases were discovered, in Connecticut, adjoining states, and the upper Midwest.
Steere then learned about the work of the Swedish dermatologist Arvid Afzelius
, who in 1909 had described an expanding, ring-like lesion and speculated that it was caused by the bite of an Ixodes
tick. The rash described by Afzelius was later named erythema migrans. Research in Europe had found that erythema migrans and acrodermatitis chronica atrophicans
, another rash caused by tics in Europe, responded to penicillin
, suggesting that the cause was bacterial, not viral
. Yet no microorganisms could be found in fluid from the joints of Lyme disease patients.
The recognition that the patients in the United States had erythema migrans led to the recognition that "Lyme arthritis" was one manifestation of the same tick-borne disease
known in Europe. The syndrome first found in and around Lyme
and Old Lyme, Connecticut came to be called "Lyme Arthritis" and later "Lyme Disease".
In 1980, Steere and colleagues began to test antibiotic regimens in adult patients with Lyme disease.
Steere first published about neurological and cardiac symptoms involved in his early studies of Lyme disease in 1977. Steere first published work about chronic manifestations of the disease in 1979.
Steere later worked with Frank Dressler; the CDC later adopted their work for its Lyme Disease surveillance case definition. Using primarily sera from early, acute Lyme patients, Steere formulated serodiagnostic criteria for Western blotting, a technique which identifies antibodies in the serum directed against foreign antigen, in this case, B. burdorferi, the causative agent of Lyme disease.
", covering maladies ranging from chronic fatigue syndrome
(CFS), fibromyalgia
to hypochondria
. Steere was concerned that many people with no evidence of past or present Lyme disease receiving antibiotic treatments, especially treatments beyond the recommended four week treatment guideline protocol, "were being done more harm than good".
Writing in the Journal of the American Medical Association
(JAMA) in 1993, Steere and colleagues stated that Lyme disease had become "overdiagnosed" and overtreated. This statement became a rallying point for what advocacy groups call the Lyme disease controversy. In the face of some elements of mainstream medical opinion, some doctors and patient advocacy groups claim that Lyme disease can develop into a chronic disease requiring high doses of antibiotics over long periods of time. However aside from the issue of terminology, some mainstream medical opinion goes as far as to assert that some Lyme disease cases can become "difficult to treat" if not quickly diagnosed.
Although the term "chronic Lyme" was once used by Steere and others to define persistent complications following acute Lyme disease, various Lyme advocacy organizations and a dissident group of doctors called the International Lyme and Associated Diseases Society (ILADS) have redefined the term to describe a wide range of symptoms, mostly in patients who have no evidence of Lyme disease. Steere and his colleagues averred that even patients with a positive serology
for Borrelia infection and with symptoms resembling those of CFS or fibromyalgia, would not be helped by further antibiotics.
Steere's prominence, and his support of the medical view that patients with "chronic Lyme disease" often have no actual evidence of Lyme disease and are not helped by long courses of antibiotics, led to him being targeted, harassed, and threatened with death by patients and advocacy groups angered by his refusal to validate their belief that they suffer from chronic Lyme disease.
, Steere led the research effort on Lymerix, the preventive Lyme vaccine
by SmithKline Beecham, now GlaxoSmithKline
(GSK), which first appeared on the market in January 1999. The research took four years, spanned ten states, and involved 11,000 patients and 31 scientists.
Lymerix works on the outer surface protein A (Osp-A) of Borrelia burgdorferi
, the causative agent of Lyme Disease. Osp-A causes creation of antibodies from the body's immune system
to attack that protein
. Tests preceding the vaccine were done primarily on Lyme arthritis, and patients with neurological or cardiac manifestations were excluded.
The vaccine was shown to be 78 percent effective. The drug was taken in three shots administered over the course of a year. Some uncertainty remained about the vaccine's ultimate safety before it was released to the public, especially for people with certain conditions. When the National Vaccine Advisory Committee of the Food and Drug Administration
(FDA) certified the drug in December 1998, members appended a list of concerns about the long-term effect of the vaccine. The FDA released the vaccine on public health
grounds, recommending that it be considered by people at the highest risk. GSK took the drug off the market in 2002 for commercial reasons, citing poor sales (with predictions of less than 10,000 people to be vaccinated in 2002), the high price of the vaccine, the need to exclude children under 15, and the need for frequent boosters. Vaccine expert Stanley Plotkin predicted that the withdrawal meant there will never be another Lyme disease vaccine available.
inflammation may persist in genetically susceptible individuals with antibiotic-resistant Lyme arthritis because of infection-induced autoimmunity via a pro-inflammatory mechanism within the joint. This outcome has been associated with an immunodominant T cell
epitope
of outer-surface protein A (OspA) of the spirochete.
Rheumatology
Rheumatology is a sub-specialty in internal medicine and pediatrics, devoted to diagnosis and therapy of rheumatic diseases. Clinicians who specialize in rheumatology are called rheumatologists...
at Harvard University
Harvard University
Harvard University is a private Ivy League university located in Cambridge, Massachusetts, United States, established in 1636 by the Massachusetts legislature. Harvard is the oldest institution of higher learning in the United States and the first corporation chartered in the country...
and previously at Yale University
Yale University
Yale University is a private, Ivy League university located in New Haven, Connecticut, United States. Founded in 1701 in the Colony of Connecticut, the university is the third-oldest institution of higher education in the United States...
. Steere is credited with discovering and naming Lyme disease
Lyme disease
Lyme disease, or Lyme borreliosis, is an emerging infectious disease caused by at least three species of bacteria belonging to the genus Borrelia. Borrelia burgdorferi sensu stricto is the main cause of Lyme disease in the United States, whereas Borrelia afzelii and Borrelia garinii cause most...
, and he published almost 200 scholarly articles on Lyme disease between 1977 and 2007. At a ceremony in Hartford, Connecticut
Hartford, Connecticut
Hartford is the capital of the U.S. state of Connecticut. The seat of Hartford County until Connecticut disbanded county government in 1960, it is the second most populous city on New England's largest river, the Connecticut River. As of the 2010 Census, Hartford's population was 124,775, making...
in 1998, Governor John G. Rowland
John G. Rowland
John Grosvenor Rowland was the 86th Governor of Connecticut from 1995 to 2004; he is a member of the Republican Party. He is married to Patty Rowland, his second wife, and the couple have five children between them...
declared September 24 to be "Allen C. Steere Day."
Lyme disease research
In 1975, the ConnecticutConnecticut
Connecticut is a state in the New England region of the northeastern United States. It is bordered by Rhode Island to the east, Massachusetts to the north, and the state of New York to the west and the south .Connecticut is named for the Connecticut River, the major U.S. river that approximately...
State Health Department received complaints from Polly Murray, a mother living in the small town of Lyme, Connecticut
Lyme, Connecticut
Lyme is a town in New London County, Connecticut, United States. The population was 2,016 at the 2000 census. Lyme and its neighboring town Old Lyme are the namesake for Lyme disease.-Geography:...
. Two of her children had been diagnosed with juvenile rheumatoid arthritis, but she knew of others in the area with similar symptoms.
An epidemic intelligence officer assigned to the Connecticut state health department, David R. Snydman, MD contacted Allen Steere, MD who was studying rheumatology at Yale University, after he had performed a preliminary investigation and thought that there was some symptom complex worth investigating. He knew Allen Steere since they were together in Atlanta the year before at the Centers for Disease Control, when both were in the Epidemic Intelligence Service, a CDC program set up in the 1950s to track epidemics worldwide.
Steere met with Ms. Murray, who gave him a list of children who shared a set of symptoms. Steere called each affected family, representing 39 children in all, and he found an additional twelve adults suffering from what was thought to be juvenile rheumatoid arthritis.
A quarter of the people Steere interviewed remembered getting a strange, spreading skin rash (erythema migrans
Erythema migrans
Erythema chronicum migrans refers to the rash often seen in the early stage of Lyme disease. It can appear anywhere from one day to one month after a tick bite. This rash does not represent an allergic reaction to the bite, but rather an actual skin infection with the Lyme bacteria, Borrelia...
) before experiencing any other symptoms. A European doctor happened to be visiting Yale at the time, and he pointed out that the rash was similar to one frequently encountered in northern Europe and known to be associated with tick
Tick
Ticks are small arachnids in the order Ixodida, along with mites, constitute the subclass Acarina. Ticks are ectoparasites , living by hematophagy on the blood of mammals, birds, and sometimes reptiles and amphibians...
bites. Most of the rashes were found somewhere on the torso, suggesting a crawling vector rather than a flying one or a spider, but most patients did not remember being bitten.
In 1976, Steere began testing blood from disease victims for specific antibodies against 38-known tick-transmitted diseases and 178 other arthropod
Arthropod
An arthropod is an invertebrate animal having an exoskeleton , a segmented body, and jointed appendages. Arthropods are members of the phylum Arthropoda , and include the insects, arachnids, crustaceans, and others...
-transmitted viruses. Not one came out positive. When the broader definition of the disease was applied, more cases were discovered, in Connecticut, adjoining states, and the upper Midwest.
Steere then learned about the work of the Swedish dermatologist Arvid Afzelius
Arvid Afzelius
Arvid Afzelius was a Swedish dermatologist.As a student at the Karolinska institutet, Afzelius studied under the prominent dermatologist Moritz Kaposi in Vienna...
, who in 1909 had described an expanding, ring-like lesion and speculated that it was caused by the bite of an Ixodes
Ixodes
Ixodes is a genus of hard-bodied ticks . It includes important disease vectors of animals and humans . Some ticks in this genus may transmit the pathogenic bacterium Borrelia burgdorferi responsible for causing Lyme disease...
tick. The rash described by Afzelius was later named erythema migrans. Research in Europe had found that erythema migrans and acrodermatitis chronica atrophicans
Acrodermatitis chronica atrophicans
Acrodermatitis chronica atrophicans is a skin rash indicative of the third or late stage of European Lyme borreliosis....
, another rash caused by tics in Europe, responded to penicillin
Penicillin
Penicillin is a group of antibiotics derived from Penicillium fungi. They include penicillin G, procaine penicillin, benzathine penicillin, and penicillin V....
, suggesting that the cause was bacterial, not viral
Virus
A virus is a small infectious agent that can replicate only inside the living cells of organisms. Viruses infect all types of organisms, from animals and plants to bacteria and archaea...
. Yet no microorganisms could be found in fluid from the joints of Lyme disease patients.
The recognition that the patients in the United States had erythema migrans led to the recognition that "Lyme arthritis" was one manifestation of the same tick-borne disease
Tick-borne disease
Tick-borne diseases are diseases or illnesses transmitted by ticks. As the incidence of tick-borne illnesses increases and the geographic areas in which they are found expand, it becomes increasingly important that health professionals be able to distinguish the diverse, and often overlapping,...
known in Europe. The syndrome first found in and around Lyme
Lyme, Connecticut
Lyme is a town in New London County, Connecticut, United States. The population was 2,016 at the 2000 census. Lyme and its neighboring town Old Lyme are the namesake for Lyme disease.-Geography:...
and Old Lyme, Connecticut came to be called "Lyme Arthritis" and later "Lyme Disease".
In 1980, Steere and colleagues began to test antibiotic regimens in adult patients with Lyme disease.
Steere first published about neurological and cardiac symptoms involved in his early studies of Lyme disease in 1977. Steere first published work about chronic manifestations of the disease in 1979.
Steere later worked with Frank Dressler; the CDC later adopted their work for its Lyme Disease surveillance case definition. Using primarily sera from early, acute Lyme patients, Steere formulated serodiagnostic criteria for Western blotting, a technique which identifies antibodies in the serum directed against foreign antigen, in this case, B. burdorferi, the causative agent of Lyme disease.
Lyme disease controversy
By the mid-1990s, Steere had watched Lyme disease gain acceptance, but he worried that Lyme disease had become a "junk-drawer diagnosisWastebasket diagnosis
A trashcan diagnosis or wastebasket diagnosis is a vague or fake medical or psychiatric diagnosis given to a patient or to medical records department for essentially non-medical reasons...
", covering maladies ranging from chronic fatigue syndrome
Chronic fatigue syndrome
Chronic fatigue syndrome is the most common name used to designate a significantly debilitating medical disorder or group of disorders generally defined by persistent fatigue accompanied by other specific symptoms for a minimum of six months, not due to ongoing exertion, not substantially...
(CFS), fibromyalgia
Fibromyalgia
Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure. It is an example of a diagnosis of exclusion...
to hypochondria
Hypochondria
Hypochondriasis or hypochondria refers to excessive preoccupation or worry about having a serious illness. This debilitating condition is the result of an inaccurate perception of the body’s condition despite the absence of an actual medication condition...
. Steere was concerned that many people with no evidence of past or present Lyme disease receiving antibiotic treatments, especially treatments beyond the recommended four week treatment guideline protocol, "were being done more harm than good".
Writing in the Journal of the American Medical Association
Journal of the American Medical Association
The Journal of the American Medical Association is a weekly, peer-reviewed, medical journal, published by the American Medical Association. Beginning in July 2011, the editor in chief will be Howard C. Bauchner, vice chairman of pediatrics at Boston University’s School of Medicine, replacing ...
(JAMA) in 1993, Steere and colleagues stated that Lyme disease had become "overdiagnosed" and overtreated. This statement became a rallying point for what advocacy groups call the Lyme disease controversy. In the face of some elements of mainstream medical opinion, some doctors and patient advocacy groups claim that Lyme disease can develop into a chronic disease requiring high doses of antibiotics over long periods of time. However aside from the issue of terminology, some mainstream medical opinion goes as far as to assert that some Lyme disease cases can become "difficult to treat" if not quickly diagnosed.
Although the term "chronic Lyme" was once used by Steere and others to define persistent complications following acute Lyme disease, various Lyme advocacy organizations and a dissident group of doctors called the International Lyme and Associated Diseases Society (ILADS) have redefined the term to describe a wide range of symptoms, mostly in patients who have no evidence of Lyme disease. Steere and his colleagues averred that even patients with a positive serology
Serology
Serology is the scientific study of blood serum and other bodily fluids. In practice, the term usually refers to the diagnostic identification of antibodies in the serum...
for Borrelia infection and with symptoms resembling those of CFS or fibromyalgia, would not be helped by further antibiotics.
Steere's prominence, and his support of the medical view that patients with "chronic Lyme disease" often have no actual evidence of Lyme disease and are not helped by long courses of antibiotics, led to him being targeted, harassed, and threatened with death by patients and advocacy groups angered by his refusal to validate their belief that they suffer from chronic Lyme disease.
Lyme vaccine
As chief of the rheumatology and immunology department at Tufts School of MedicineTufts University
Tufts University is a private research university located in Medford/Somerville, near Boston, Massachusetts. It is organized into ten schools, including two undergraduate programs and eight graduate divisions, on four campuses in Massachusetts and on the eastern border of France...
, Steere led the research effort on Lymerix, the preventive Lyme vaccine
Vaccine
A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe or its toxins...
by SmithKline Beecham, now GlaxoSmithKline
GlaxoSmithKline
GlaxoSmithKline plc is a global pharmaceutical, biologics, vaccines and consumer healthcare company headquartered in London, United Kingdom...
(GSK), which first appeared on the market in January 1999. The research took four years, spanned ten states, and involved 11,000 patients and 31 scientists.
Lymerix works on the outer surface protein A (Osp-A) of Borrelia burgdorferi
Borrelia burgdorferi
Borrelia burgdorferi is a species of Gram negative bacteria of the spirochete class of the genus Borrelia. B. burgdorferi is predominant in North America, but also exists in Europe, and is the agent of Lyme disease....
, the causative agent of Lyme Disease. Osp-A causes creation of antibodies from the body's immune system
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
to attack that protein
Protein
Proteins are biochemical compounds consisting of one or more polypeptides typically folded into a globular or fibrous form, facilitating a biological function. A polypeptide is a single linear polymer chain of amino acids bonded together by peptide bonds between the carboxyl and amino groups of...
. Tests preceding the vaccine were done primarily on Lyme arthritis, and patients with neurological or cardiac manifestations were excluded.
The vaccine was shown to be 78 percent effective. The drug was taken in three shots administered over the course of a year. Some uncertainty remained about the vaccine's ultimate safety before it was released to the public, especially for people with certain conditions. When the National Vaccine Advisory Committee of the Food and Drug Administration
Food and Drug Administration
The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
(FDA) certified the drug in December 1998, members appended a list of concerns about the long-term effect of the vaccine. The FDA released the vaccine on public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
grounds, recommending that it be considered by people at the highest risk. GSK took the drug off the market in 2002 for commercial reasons, citing poor sales (with predictions of less than 10,000 people to be vaccinated in 2002), the high price of the vaccine, the need to exclude children under 15, and the need for frequent boosters. Vaccine expert Stanley Plotkin predicted that the withdrawal meant there will never be another Lyme disease vaccine available.
Current work
In his current work Steere is testing the hypothesis that synovialSynovial
Synovial may refer to:* Synovial fluid* Synovial joint* Synovial membrane...
inflammation may persist in genetically susceptible individuals with antibiotic-resistant Lyme arthritis because of infection-induced autoimmunity via a pro-inflammatory mechanism within the joint. This outcome has been associated with an immunodominant T cell
T cell
T cells or T lymphocytes belong to a group of white blood cells known as lymphocytes, and play a central role in cell-mediated immunity. They can be distinguished from other lymphocytes, such as B cells and natural killer cells , by the presence of a T cell receptor on the cell surface. They are...
epitope
Epitope
An epitope, also known as antigenic determinant, is the part of an antigen that is recognized by the immune system, specifically by antibodies, B cells, or T cells. The part of an antibody that recognizes the epitope is called a paratope...
of outer-surface protein A (OspA) of the spirochete.
See also
- Lyme diseaseLyme diseaseLyme disease, or Lyme borreliosis, is an emerging infectious disease caused by at least three species of bacteria belonging to the genus Borrelia. Borrelia burgdorferi sensu stricto is the main cause of Lyme disease in the United States, whereas Borrelia afzelii and Borrelia garinii cause most...
- Lyme disease controversy
- Jorge BenachJorge BenachJorge Benach is a medical researcher at the State University of New York at Stony Brook in New York state. Benach is the chair of the Department of Molecular Genetics and Microbiology...
- Willy BurgdorferWilly BurgdorferWilly Burgdorfer, an American scientist born and educated in Basel, Switzerland, is an international leader in the field of medical entomology. He is famous for his discovery of the bacterial pathogen that causes Lyme disease, a spirochete named Borrelia burgdorferi in his honor.-Background:Dr....
- Spirochete