Can interventions that aim to decreaseLyme disease hazard at non‑domestic sites be effective without negatively affecting ecosystem health? A systematic review protocol

Jo Middleton, Ian Cooper, Anja Rott

Research output: Contribution to journalArticlepeer-review


Background: Lyme disease (LD) is the most commonly reported, broadly distributed vector-borne disease of thenorthern temperate zone. It is transmitted by ticks and, if untreated, can cause skin, cardiac, nervous system and musculoskeletaldisease. The distribution and incidence of LD is increasing across much of North America and WesternEurope. Interventions to decrease exposure to LD hazard by encouraging behavioural change have low acceptancein high risk groups, and a safe, effective human LD vaccine is not presently available. As a result, habitat level interventionsto decrease LD hazard itself (i.e. levels of infected ticks) have been proposed. However, some interventions maypotentially negatively affect ecosystem health, and consequentially be neither desirable, nor politically feasible. Thissystematic review will catalogue interventions that aim to reduce LD hazard at non-domestic sites, and examine theevidence supporting those which are unlikely to negatively affect ecosystem health.Methods: The review will be carried out in two steps. First, a screening and cataloguing stage will be conducted toidentify and characterise interventions to decrease LD hazard at non-domestic sites. Secondly, the subset of interventionsidentified during cataloguing as unlikely to negatively affect ecosystem health will be investigated. In thescreening and cataloguing step literature will be collected through database searching using pre-chosen searchstrings, hand-searching key journals and reviewing the websites of public health bodies. Further references will beidentified by contacting stakeholders and researchers. Article screening and assessment of the likely effects of interventionson ecosystem health will be carried out independently by two reviewers. A third reviewer will be consultedif disagreements arise. The cataloguing step results will be presented in tables. Study quality will then be assessedindependently by two reviewers, using adapted versions of established tools developed in healthcare research. Theseresults will be presented in a narrative synthesis alongside tables. Though a full meta-analysis is not expected to bepossible, if sub-groups of studies are sufficiently similar to compare, a partial meta-analysis will be carried out.
Original languageEnglish
JournalEnvironmental Evidence
Publication statusPublished - 11 Oct 2016

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© 2016 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.


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