title: Protestantism

text: They formed, and identified with various religious groups advocating greater purity of worship and doctrine, as well as personal and group piety. Puritans adopted a Reformed theology, but they also took note of radical criticisms of Zwingli in Zurich and Calvin in Geneva. In church polity, some advocated for separation from all other Christians, in favor of autonomous gathered churches. These separatist and independent strands of Puritanism became prominent in the 1640s. Although the English Civil War (which expanded into the Wars of the Three Kingdoms) began over a contest for political power between the King of England and the House of Commons, it divided the country along religious lines as episcopalians within the Church of England sided with the Crown and Presbyterians and Independents supported "Parliament" (after the defeat of the Royalists, the House of Lords as well as the Monarch were removed from the political structure of the state to create the Commonwealth). The supporters of a Presbyterian polity in the Westminster Assembly were unable to forge a new English national church, and the Parliamentary New Model Army, which was made up primarily of Independents, under Oliver Cromwell first purged Parliament, then abolished it and established The Protectorate.


title: Protestantism

text: England's trans-Atlantic colonies in the war followed varying paths depending on their internal demographics. In the older colonies, which included Virginia (1607) and its offshoot Bermuda (1612), as well as Barbados and Antigua in the West Indies (collectively the targets in 1650 of An Act for prohibiting Trade with the Barbadoes, Virginia, Bermuda and Antego), Episcopalians remained the dominant church faction and the colonies remained Royalist 'til conquered or compelled to accept the new political order. In Bermuda, with control of the local government and the "army" (nine infantry companies of Militia plus coastal artillery), the Royalists forced Parliament-backing religious Independents into exile to settle the Bahamas as the Eleutheran Adventurers.


title: Protestantism

text: Episcopalian was re-established following the Restoration. A century later, non-conforming Protestants, along with the Protestant refugees from continental Europe, were to be among the primary instigators of the war of secession that led to the founding of the United States of America.


title: Protestantism

text: A non-fundamentalist rejection of liberal Christianity along the lines of the Christian existentialism of Søren Kierkegaard, who attacked the Hegelian state churches of his day for "dead orthodoxy," neo-orthodoxy is associated primarily with Karl Barth, Jürgen Moltmann, and Dietrich Bonhoeffer. Neo-orthodoxy sought to counter-act the tendency of liberal theology to make theological accommodations to modern scientific perspectives. Sometimes called "crisis theology," in the existentialist sense of the word crisis, also sometimes called "neo-evangelicalism", which uses the sense of "evangelical" pertaining to continental European Protestants rather than American evangelicalism. "Evangelical" was the originally preferred label used by Lutherans and Calvinists, but it was replaced by the names some Catholics used to label a heresy with the name of its founder.


title: Protestantism

text: Paleo-orthodoxy is a movement similar in some respects to neo-evangelicalism but emphasizing the ancient Christian consensus of the undivided church of the first millennium AD, including in particular the early creeds and church councils as a means of properly understanding the scriptures. This movement is cross-denominational. A prominent theologian in this group is Thomas Oden, a Methodist.


title: Protestantism

text: In reaction to liberal Bible critique, fundamentalism arose in the 20th century, primarily in the United States, among those denominations most affected by Evangelicalism.


title: Protestantism

text: Toward the end of the 20th century, some have tended to confuse evangelicalism and fundamentalism; however, the labels represent very distinct differences of approach that both groups are diligent to maintain, although because of fundamentalism's dramatically smaller size it often gets classified simply as an ultra-conservative branch of evangelicalism.


title: Protestantism

text: Modernism and liberalism do not constitute rigorous and well-defined schools of theology, but are rather an inclination by some writers and teachers to integrate Christian thought into the spirit of the Age of Enlightenment. New understandings of history and the natural sciences of the day led directly to new approaches to theology. Its opposition to the fundamentalist teaching resulted in religious debates, such as the Fundamentalist–Modernist Controversy within the Presbyterian Church in the United States of America in the 1920s.


title: Protestantism

text: Although the Reformation was a religious movement, it also had a strong impact on all other aspects of life: marriage and family, education, the humanities and sciences, the political and social order, the economy, and the arts. Protestant churches reject the idea of a celibate priesthood and thus allow their clergy to marry. Many of their families contributed to the development of intellectual elites in their countries. Since about 1950, women have entered the ministry in most Protestant churches, and some have assumed leading positions (e.g. bishops).


title: Protestantism

text: As the Reformers wanted all members of the church to be able to read the Bible, education on all levels got a strong boost. By the middle of the eighteenth century, the literacy rate in England was about 60 percent, in Scotland 65 percent, and in Sweden 80 percent. Colleges and universities were founded. For example, the Puritans who established Massachusetts Bay Colony in 1628 founded Harvard College only eight years later. About a dozen other colleges followed in the 18th century, including Yale (1701). Pennsylvania also became a center of learning.


title: Protestantism

text: Members of mainline Protestant denominations have played leadership roles in many aspects of American life, including politics, business, science, the arts, and education. They founded most of the country's leading institutes of higher education.


title: Protestantism

text: The Protestant concept of God and man allows believers to use all their God-given faculties, including the power of reason. That means that they are allowed to explore God's creation and, according to Genesis 2:15, make use of it in a responsible and sustainable way. Thus a cultural climate was created that greatly enhanced the development of the humanities and the sciences. Another consequence of the Protestant understanding of man is that the believers, in gratitude for their election and redemption in Christ, are to follow God's commandments. Industry, frugality, calling, discipline, and a strong sense of responsibility are at the heart of their moral code. In particular, Calvin rejected luxury. Therefore, craftsmen, industrialists, and other businessmen were able to reinvest the greater part of their profits in the most efficient machinery and the most modern production methods that were based on progress in the sciences and technology. As a result, productivity grew, which led to increased profits and enabled employers to pay higher wages. In this way, the economy, the sciences, and technology reinforced each other. The chance to participate in the economic success of technological inventions was a strong incentive to both inventors and investors. The Protestant work ethic was an important force behind the unplanned and uncoordinated mass action that influenced the development of capitalism and the Industrial Revolution. This idea is also known as the "Protestant ethic thesis."


title: Protestantism

text: However, eminent historian Fernand Braudel (d. 1985), a leader of the important Annales School wrote: "all historians have opposed this tenuous theory [the Protestant Ethic], although they have not managed to be rid of it once and for all. Yet it is clearly false. The northern countries took over the place that earlier had been so long and brilliantly been occupied by the old capitalist centers of the Mediterranean. They invented nothing, either in technology or business management." Social scientist Rodney Stark moreover comments that "during their critical period of economic development, these northern centers of capitalism were Catholic, not Protestant—the Reformation still lay well into the future," while British historian Hugh Trevor-Roper (d. 2003) said, "The idea that large-scale industrial capitalism was ideologically impossible before the Reformation is exploded by the simple fact that it existed."


title: Protestantism

text: In a factor analysis of the latest wave of World Values Survey data, Arno Tausch (Corvinus University of Budapest) found that Protestantism emerges to be very close to combining religion and the traditions of liberalism. The Global Value Development Index, calculated by Tausch, relies on the World Values Survey dimensions such as trust in the state of law, no support for shadow economy, postmaterial activism, support for democracy, a non-acceptance of violence, xenophobia and racism, trust in transnational capital and Universities, confidence in the market economy, supporting gender justice, and engaging in environmental activism, etc.


title: Protestantism

text: Episcopalians and Presbyterians, as well as other WASPs, tend to be considerably wealthier and better educated (having graduate and post-graduate degrees per capita) than most other religious groups in United States, and are disproportionately represented in the upper reaches of American business, law and politics, especially the Republican Party. Numbers of the most wealthy and affluent American families as the Vanderbilts, the Astors, Rockefellers, Du Ponts, Roosevelts, Forbes, Fords, Whitneys, Mellons, the Morgans and Harrimans are Mainline Protestant families.


title: Protestantism

text: Protestantism has had an important influence on science. According to the Merton Thesis, there was a positive correlation between the rise of English Puritanism and German Pietism on the one hand and early experimental science on the other. The Merton Thesis has two separate parts: Firstly, it presents a theory that science changes due to an accumulation of observations and improvement in experimental technique and methodology; secondly, it puts forward the argument that the popularity of science in 17th-century England and the religious demography of the Royal Society (English scientists of that time were predominantly Puritans or other Protestants) can be explained by a correlation between Protestantism and the scientific values. Merton focused on English Puritanism and German Pietism as having been responsible for the development of the scientific revolution of the 17th and 18th centuries. He explained that the connection between religious affiliation and interest in science was the result of a significant synergy between the ascetic Protestant values and those of modern science. Protestant values encouraged scientific research by allowing science to identify God's influence on the world—his creation—and thus providing a religious justification for scientific research.


title: Protestantism

text: According to "Scientific Elite: Nobel Laureates in the United States" by Harriet Zuckerman, a review of American Nobel prizes awarded between 1901 and 1972, 72% of American Nobel Prize laureates identified a Protestant background. Overall, 84% of all the Nobel Prizes awarded to Americans in Chemistry, 60% in Medicine, and 59% in Physics between 1901 and 1972 were won by Protestants.


title: Protestantism

text: According to "100 Years of Nobel Prize (2005)", a review of Nobel prizes awarded between 1901 and 2000, 65% of Nobel Prize Laureates, have identified Christianity in its various forms as their religious preference (423 prizes). While 32% have identified with Protestantism in its various forms (208 prizes), although Protestants are 12% to 13% of the world's population.


title: Protestantism

text: In the Middle Ages, the Church and the worldly authorities were closely related. Martin Luther separated the religious and the worldly realms in principle (doctrine of the two kingdoms). The believers were obliged to use reason to govern the worldly sphere in an orderly and peaceful way. Luther's doctrine of the priesthood of all believers upgraded the role of laymen in the church considerably. The members of a congregation had the right to elect a minister and, if necessary, to vote for his dismissal (Treatise "On the right and authority of a Christian assembly or congregation to judge all doctrines and to call, install and dismiss teachers, as testified in Scripture"; 1523). Calvin strengthened this basically democratic approach by including elected laymen (church elders, presbyters) in his representative church government. The Huguenots added regional synods and a national synod, whose members were elected by the congregations, to Calvin's system of church self-government. This system was taken over by the other reformed churches and was adopted by some Lutherans beginning with those in Jülich-Cleves-Berg during the 17th century.


title: Protestantism

text: Politically, Calvin favored a mixture of aristocracy and democracy. He appreciated the advantages of democracy: "It is an invaluable gift, if God allows a people to freely elect its own authorities and overlords." Calvin also thought that earthly rulers lose their divine right and must be put down when they rise up against God. To further protect the rights of ordinary people, Calvin suggested separating political powers in a system of checks and balances (separation of powers). Thus he and his followers resisted political absolutism and paved the way for the rise of modern democracy. Besides England, the Netherlands were, under Calvinist leadership, the freest country in Europe in the seventeenth and eighteenth centuries. It granted asylum to philosophers like Baruch Spinoza and Pierre Bayle. Hugo Grotius was able to teach his natural-law theory and a relatively liberal interpretation of the Bible.


title: Protestantism

text: Consistent with Calvin's political ideas, Protestants created both the English and the American democracies. In seventeenth-century England, the most important persons and events in this process were the English Civil War, Oliver Cromwell, John Milton, John Locke, the Glorious Revolution, the English Bill of Rights, and the Act of Settlement. Later, the British took their democratic ideals to their colonies, e.g. Australia, New Zealand, and India. In North America, Plymouth Colony (Pilgrim Fathers; 1620) and Massachusetts Bay Colony (1628) practised democratic self-rule and separation of powers. These Congregationalists were convinced that the democratic form of government was the will of God. The Mayflower Compact was a social contract.


title: Protestantism

text: Protestants also took the initiative in advocating for religious freedom. Freedom of conscience had a high priority on the theological, philosophical, and political agendas since Luther refused to recant his beliefs before the Diet of the Holy Roman Empire at Worms (1521). In his view, faith was a free work of the Holy Spirit and could, therefore, not be forced on a person. The persecuted Anabaptists and Huguenots demanded freedom of conscience, and they practiced separation of church and state. In the early seventeenth century, Baptists like John Smyth and Thomas Helwys published tracts in defense of religious freedom. Their thinking influenced John Milton and John Locke's stance on tolerance. Under the leadership of Baptist Roger Williams, Congregationalist Thomas Hooker, and Quaker William Penn, respectively, Rhode Island, Connecticut, and Pennsylvania combined democratic constitutions with freedom of religion. These colonies became safe havens for persecuted religious minorities, including Jews. The United States Declaration of Independence, the United States Constitution, and the American Bill of Rights with its fundamental human rights made this tradition permanent by giving it a legal and political framework. The great majority of American Protestants, both clergy and laity, strongly supported the independence movement. All major Protestant churches were represented in the First and Second Continental Congresses. In the nineteenth and twentieth centuries, the American democracy became a model for numerous other countries and regions throughout the world (e.g., Latin America, Japan, and Germany). The strongest link between the American and French Revolutions was Marquis de Lafayette, an ardent supporter of the American constitutional principles. The French Declaration of the Rights of Man and of the Citizen was mainly based on Lafayette's draft of this document. The Declaration by United Nations and Universal Declaration of Human Rights also echo the American constitutional tradition.


title: Protestantism

text: Democracy, social-contract theory, separation of powers, religious freedom, separation of church and state—these achievements of the Reformation and early Protestantism were elaborated on and popularized by Enlightenment thinkers. Some of the philosophers of the English, Scottish, German, and Swiss Enlightenment—Thomas Hobbes, John Locke, John Toland, David Hume, Gottfried Wilhelm Leibniz, Christian Wolff, Immanuel Kant, and Jean-Jacques Rousseau—had Protestant backgrounds. For example, John Locke, whose political thought was based on "a set of Protestant Christian assumptions", derived the equality of all humans, including the equality of the genders ("Adam and Eve"), from Genesis 1, 26–28. As all persons were created equally free, all governments needed "the consent of the governed."


title: Protestantism

text: Also, other human rights were advocated for by some Protestants. For example, torture was abolished in Prussia in 1740, slavery in Britain in 1834 and in the United States in 1865 (William Wilberforce, Harriet Beecher Stowe, Abraham Lincoln—against Southern Protestants). Hugo Grotius and Samuel Pufendorf were among the first thinkers who made significant contributions to international law. The Geneva Convention, an important part of humanitarian international law, was largely the work of Henry Dunant, a reformed pietist. He also founded the Red Cross.


title: Protestantism

text: Protestants have founded hospitals, homes for disabled or elderly people, educational institutions, organizations that give aid to developing countries, and other social welfare agencies. In the nineteenth century, throughout the Anglo-American world, numerous dedicated members of all Protestant denominations were active in social reform movements such as the abolition of slavery, prison reforms, and woman suffrage. As an answer to the "social question" of the nineteenth century, Germany under Chancellor Otto von Bismarck introduced insurance programs that led the way to the welfare state (health insurance, accident insurance, disability insurance, old-age pensions). To Bismarck this was "practical Christianity". These programs, too, were copied by many other nations, particularly in the Western world.


title: Protestantism

text: The Young Men's Christian Association was founded by Congregationalist George Williams, aimed at empowering young people.


title: Protestantism

text: Protestant liturgy is a pattern for worship used (whether recommended or prescribed) by a Protestant congregation or denomination on a regular basis. The term liturgy comes from Greek and means "public work". Liturgy is mainly important in the Historical Protestant churches (or mainline Protestant churches), while evangelical Protestant churches tend to be very flexible and in some cases have no liturgy at all. It often but not exclusively occurs on Sunday.


title: Protestantism

text: Martin Luther, Paul Gerhardt, George Wither, Isaac Watts, Charles Wesley, William Cowper, and many other authors and composers created well-known church hymns.


title: Protestantism

text: Musicians like Heinrich Schütz, Johann Sebastian Bach, George Frideric Handel, Henry Purcell, Johannes Brahms, Philipp Nicolai and Felix Mendelssohn composed great works of music.


title: Protestantism

text: Prominent painters with Protestant background were, for example, Albrecht Dürer, Hans Holbein the Younger, Lucas Cranach the Elder, Lucas Cranach the Younger, Rembrandt, and Vincent van Gogh.


title: Protestantism

text: World literature was enriched by the works of Edmund Spenser, John Milton, John Bunyan, John Donne, John Dryden, Daniel Defoe, William Wordsworth, Jonathan Swift, Johann Wolfgang Goethe, Friedrich Schiller, Samuel Taylor Coleridge, Edgar Allan Poe, Matthew Arnold, Conrad Ferdinand Meyer, Theodor Fontane, Washington Irving, Robert Browning, Emily Dickinson, Emily Brontë, Charles Dickens, Nathaniel Hawthorne, Thomas Stearns Eliot, John Galsworthy, Thomas Mann, William Faulkner, John Updike, and many others.


title: Protestantism

text: The view of the Catholic Church is that Protestant denominations cannot be considered churches but rather that they are "ecclesial communities" or "specific faith-believing communities" because their ordinances and doctrines are not historically the same as the Catholic sacraments and dogmas, and the Protestant communities have no sacramental ministerial priesthood and therefore lack true apostolic succession. According to Bishop Hilarion (Alfeyev) the Eastern Orthodox Church shares the same view on the subject.


title: Protestantism

text: Contrary to how the Protestant Reformers were often characterized, the concept of a "catholic" or universal Church was not brushed aside during the Protestant Reformation. On the contrary, the visible unity of the "catholic" or "universal church" was seen by the Protestant reformers as an important and essential doctrine of the Reformation. The Magisterial reformers, such as Martin Luther, John Calvin, and Huldrych Zwingli, believed that they were reforming the Catholic Church, which they viewed as having become corrupted. Each of them took very seriously the charges of schism and innovation, denying these charges and maintaining that it was the Catholic Church that had left them. The Protestant Reformers formed a new and radically different theological opinion on ecclesiology, that the visible Church is "catholic" (lower-case "c") rather than "Catholic" (upper-case "C"). Accordingly, there is not an indefinite number of parochial, congregational or national churches, constituting, as it were, so many ecclesiastical individualities, but one great spiritual republic of which these various organizations form a part, although they each have very different opinions. This was markedly far-removed from the traditional and historic Catholic understanding that the Roman Catholic Church was the one true Church of Christ.


title: Protestantism

text: Yet in the Protestant understanding, the "visible church" is not a genus, so to speak, with so many species under it. In order to justify their departure from the Catholic Church, Protestants often posited a new argument, saying that there was no real visible Church with divine authority, only a "spiritual, invisible, and hidden church"—this notion began in the early days of the Protestant Reformation.


title: Protestantism

text: Wherever the Magisterial Reformation, which received support from the ruling authorities, took place, the result was a reformed national Protestant church envisioned to be a part of the whole "invisible church", but disagreeing, in certain important points of doctrine and doctrine-linked practice, with what had until then been considered the normative reference point on such matters, namely the Papacy and central authority of the Catholic Church. The Reformed churches thus believed in some form of Catholicity, founded on their doctrines of the five solas and a visible ecclesiastical organization based on the 14th- and 15th-century Conciliar movement, rejecting the papacy and papal infallibility in favor of ecumenical councils, but rejecting the latest ecumenical council, the Council of Trent. Religious unity therefore became not one of doctrine and identity but one of invisible character, wherein the unity was one of faith in Jesus Christ, not common identity, doctrine, belief, and collaborative action.


title: Protestantism

text: There are Protestants, especially of the Reformed tradition, that either reject or down-play the designation "Protestant" because of the negative idea that the word invokes in addition to its primary meaning, preferring the designation "Reformed", "Evangelical" or even "Reformed Catholic" expressive of what they call a "Reformed Catholicity" and defending their arguments from the traditional Protestant confessions.


title: Protestantism

text: The ecumenical movement has had an influence on mainline churches, beginning at least in 1910 with the Edinburgh Missionary Conference. Its origins lay in the recognition of the need for cooperation on the mission field in Africa, Asia and Oceania. Since 1948, the World Council of Churches has been influential, but ineffective in creating a united church. There are also ecumenical bodies at regional, national and local levels across the globe; but schisms still far outnumber unifications. One, but not the only expression of the ecumenical movement, has been the move to form united churches, such as the Church of South India, the Church of North India, the US-based United Church of Christ, the United Church of Canada, the Uniting Church in Australia and the United Church of Christ in the Philippines which have rapidly declining memberships. There has been a strong engagement of Orthodox churches in the ecumenical movement, though the reaction of individual Orthodox theologians has ranged from tentative approval of the aim of Christian unity to outright condemnation of the perceived effect of watering down Orthodox doctrine.


title: Protestantism

text: A Protestant baptism is held to be valid by the Catholic Church if given with the trinitarian formula and with the intent to baptize. However, as the ordination of Protestant ministers is not recognized due to the lack of apostolic succession and the disunity from Catholic Church, all other sacraments (except marriage) performed by Protestant denominations and ministers are not recognized as valid. Therefore, Protestants desiring full communion with the Catholic Church are not re-baptized (although they are confirmed) and Protestant ministers who become Catholics may be ordained to the priesthood after a period of study.


title: Protestantism

text: In 1999, the representatives of Lutheran World Federation and Catholic Church signed the Joint Declaration on the Doctrine of Justification, apparently resolving the conflict over the nature of justification which was at the root of the Protestant Reformation, although Confessional Lutherans reject this statement. This is understandable, since there is no compelling authority within them. On 18 July 2006, delegates to the World Methodist Conference voted unanimously to adopt the Joint Declaration.


title: Protestantism

text: There are more than 900 million Protestants worldwide, among approximately 2.4 billion Christians. In 2010, a total of more than 800 million included 300 million in Sub-Saharan Africa, 260 million in the Americas, 140 million in Asia-Pacific region, 100 million in Europe and 2 million in Middle East-North Africa. Protestants account for nearly forty percent of Christians worldwide, and are more than one tenth of the total human population. Various estimates put the percentage of Protestants in relation to the total number of world's Christians at 33%, 36%, 36.7%, and 40%, while in relation to the world's population at 11.6% and 13%.


title: Protestantism

text: In European countries which were most profoundly influenced by the Reformation, Protestantism still remains the most practiced religion. These include the Nordic countries and the United Kingdom. In other historical Protestant strongholds such as Germany, the Netherlands, Switzerland, Latvia, and Estonia, it remains one of the most popular religions. Although Czech Republic was the site of one of the most significant pre-reformation movements, there are only few Protestant adherents; mainly due to historical reasons like persecution of Protestants by the Catholic Habsburgs, restrictions during the Communist rule, and also the ongoing secularization. Over the last several decades, religious practice has been declining as secularization has increased. According to a 2019 study about Religiosity in the European Union in 2019 by Eurobarometer, Protestants made up 9% of the EU population. According to Pew Research Center, Protestants constituted nearly one fifth (or 18%) of the continent's Christian population in 2010. Clarke and Beyer estimate that Protestants constituted 15% of all Europeans in 2009, while Noll claims that less than 12% of them lived in Europe in 2010.


title: Protestantism

text: Changes in worldwide Protestantism over the last century have been significant. Since 1900, Protestantism has spread rapidly in Africa, Asia, Oceania and Latin America. That caused Protestantism to be called a primarily non-Western religion. Much of the growth has occurred after World War II, when decolonization of Africa and abolition of various restrictions against Protestants in Latin American countries occurred. According to one source, Protestants constituted respectively 2.5%, 2%, 0.5% of Latin Americans, Africans and Asians. In 2000, percentage of Protestants on mentioned continents was 17%, more than 27% and 6%, respectively. According to Mark A. Noll, 79% of Anglicans lived in the United Kingdom in 1910, while most of the remainder was found in the United States and across the British Commonwealth. By 2010, 59% of Anglicans were found in Africa. In 2010, more Protestants lived in India than in the UK or Germany, while Protestants in Brazil accounted for as many people as Protestants in the UK and Germany combined. Almost as many lived in each of Nigeria and China as in all of Europe. China is home to world's largest Protestant minority.


title: Protestantism

text: Protestantism is growing in Africa, Asia, Latin America, and Oceania, while declining in Anglo America and Europe, with some exceptions such as France, where it was eradicated after the abolition of the Edict of Nantes by the Edict of Fontainebleau and the following persecution of Huguenots, but now is claimed to be stable in number or even growing slightly. According to some, Russia is another country to see a Protestant revival.


title: Protestantism

text: In 2010, the largest Protestant denominational families were historically Pentecostal denominations (11%), Anglican (11%), Lutheran (10%), Baptist (9%), United and uniting churches (unions of different denominations) (7%), Presbyterian or Reformed (7%), Methodist (3%), Adventist (3%), Congregationalist (1%), Brethren (1%), The Salvation Army (<1%) and Moravian (<1%). Other denominations accounted for 38% of Protestants.


title: Protestantism

text: The United States is home to approximately 20% of Protestants. According to a 2012 study, Protestant share of U.S. population dropped to 48%, thus ending its status as religion of the majority for the first time. The decline is attributed mainly to the dropping membership of the Mainline Protestant churches, while Evangelical Protestant and Black churches are stable or continue to grow.


title: Protestantism

text: By 2050, Protestantism is projected to rise to slightly more than half of the world's total Christian population. According to other experts such as Hans J. Hillerbrand, Protestants will be as numerous as Catholics.


title: Protestantism

text: According to Mark Jürgensmeyer of the University of California, popular Protestantism is the most dynamic religious movement in the contemporary world, alongside the resurgent Islam.


title: Unity (game engine)

text: Unity is a cross-platform game engine developed by Unity Technologies, first announced and released in June 2005 at Apple Worldwide Developers Conference as a Mac OS X game engine. The engine has since been gradually extended to support a variety of desktop, mobile, console and virtual reality platforms. It is particularly popular for iOS and Android mobile game development, is considered easy to use for beginner developers, and is popular for indie game development.


title: Unity (game engine)

text: The engine can be used to create three-dimensional (3D) and two-dimensional (2D) games, as well as interactive simulations and other experiences. The engine has been adopted by industries outside video gaming, such as film, automotive, architecture, engineering, construction, and the United States Armed Forces.


title: Unity (game engine)

text: The Unity game engine launched in 2005, aiming to "democratize" game development by making it accessible to more developers. The next year, Unity was named runner-up in the Best Use of Mac OS X Graphics category in Apple Inc.'s Apple Design Awards. Unity was initially released for Mac OS X, later adding support for Microsoft Windows and Web browsers.


title: Unity (game engine)

text: Unity 2.0 launched in 2007 with approximately 50 new features. The release included an optimized terrain engine for detailed 3D environments, real-time dynamic shadows, directional lights and spotlights, video playback, and other features. The release also added features whereby developers could collaborate more easily. It included a Networking Layer for developers to create multiplayer games based on the User Datagram Protocol, offering Network Address Translation, State Synchronization, and Remote Procedure Calls.


title: Unity (game engine)

text: When Apple launched its App Store in 2008, Unity quickly added support for the iPhone. For several years, the engine was uncontested on the iPhone and it became well-known with iOS game developers.


title: Unity (game engine)

text: Unity 3.0 launched in September 2010 with features expanding the engine's graphics features for desktop computers and video game consoles. In addition to Android support, Unity 3 featured integration of Illuminate Labs' Beast Lightmap tool, deferred rendering, a built-in tree editor, native font rendering, automatic UV mapping, and audio filters, among other things.


title: Unity (game engine)

text: In 2012 "VentureBeat" wrote, "Few companies have contributed as much to the flowing of independently produced games as Unity Technologies. [...] More than 1.3 million developers are using its tools to create gee-whiz graphics in their iOS, Android, console, PC, and web-based games. Unity wants to be the engine for multi-platform games, period." A May 2012 survey by "Game Developer" magazine indicated Unity as its top game engine for mobile platforms.


title: Unity (game engine)

text: In November 2012, Unity Technologies delivered Unity 4.0. This version added DirectX 11 and Adobe Flash support, new animation tools called Mecanim, and access to the Linux preview.


title: Unity (game engine)

text: Facebook integrated a software development kit for games using the Unity game engine in 2013. This featured tools that allowed tracking advertising campaigns and deep linking, where users were directly linked from social media posts to specific portions within games, and easy in-game-image sharing. In 2016, Facebook developed a new PC gaming platform with Unity. Unity provided support for Facebook's gaming platforms, and Unity developers could more quickly export and publish games to Facebook.


title: Unity (game engine)

text: "The Verge" said of 2015's Unity 5 release: "Unity started with the goal of making game development universally accessible. [...] Unity 5 is a long-awaited step towards that future." With Unity 5, the engine improved its lighting and audio. Through WebGL, Unity developers could add their games to compatible Web browsers with no plug-ins required for players. Unity 5.0 offered real-time global illumination, light mapping previews, Unity Cloud, a new audio system, and the Nvidia PhysX 3.3 physics engine. The fifth generation of the Unity engine also introduced Cinematic Image Effects to help make Unity games look less generic. Unity 5.6 added new lighting and particle effects, updated the engine's overall performance, and added native support for Nintendo Switch, Facebook Gameroom, Google Daydream, and the Vulkan graphics API. It introduced a 4K video player capable of running 360-degree videos for virtual reality.


title: Unity (game engine)

text: However, some gamers criticized Unity's accessibility due to the high volume of quickly produced games published on the Steam distribution platform by inexperienced developers. CEO John Riccitiello said in an interview that he believes this to be a side-effect of Unity's success in democratizing game development: "If I had my way, I'd like to see 50 million people using Unity – although I don't think we're going to get there any time soon. I'd like to see high school and college kids using it, people outside the core industry. I think it's sad that most people are consumers of technology and not creators. The world's a better place when people know how to create, not just consume, and that's what we're trying to promote."


title: Unity (game engine)

text: In December 2016, Unity Technologies announced that they would change the versioning numbering system for Unity from sequence-based identifiers to year of release to align the versioning with their more frequent release cadence; Unity 5.6 was therefore followed by Unity 2017. Unity 2017 tools featured a real-time graphics rendering engine, color grading and worldbuilding, live operations analytics and performance reporting. Unity 2017.2 underscored Unity Technologies' plans beyond video games. This included new tools such as Timeline, which allowed developers to drag-and-drop animations into games, and Cinemachine, a smart camera system within games. Unity 2017.2 also integrated Autodesk's 3DS Max and Maya tools into the Unity engine for a streamlined asset sharing in-game iteration process.


title: Unity (game engine)

text: Unity 2018 featured the Scriptable Render Pipeline for developers to create high-end graphics. This included the High-Definition Rendering Pipeline for console and PC experiences, and the Lightweight Rendering Pipeline for mobile, virtual reality, and augmented reality. Unity 2018 also included machine learning tools, such as Imitation Learning, whereby games learn from real player habits, support for Magic Leap, and templates for new developers.


title: Unity (game engine)

text: The C# source code of Unity was published under a "reference-only" license in March 2018, which prohibits reuse and modification.


title: Unity (game engine)

text: As of 2020, software built with Unity's game engine was running on more than 1.5 billion devices. According to Unity, apps made with their game engine account for 50 percent of all mobile games, and are downloaded more than 3 billion times per month, and approximately 15,000 new projects are started daily with its software. Financial Times reported that Unity's engine "powers some of the world's most lucrative mobile games", such as Pokémon Go and Activision's Call of Duty Mobile.


title: Unity (game engine)

text: In June 2020, Unity introduced the Mixed and Augmented Reality Studio (MARS), which provides developers with additional functionality for rules-based generation of augmented reality (AR) applications. Unity released Unity Forma, an automotive and retail solution tool, on December 9, 2020.


title: Unity (game engine)

text: Unity acquired Finger Food Advanced Technology Group in 2020, as it aimed to bolster its non-video game uses and offer additional design help to customers. The company went public in September 2020, to further expand use of its game engine into industries outside of gaming.


title: Unity (game engine)

text: Unity 2021 brought multiple new features such as Bolt, Unity's Visual Scripting system, a new multiplayer library to support multiplayer games, improved Il2cpp runtime performance, Volumetric clouds for the High Definition Render pipeline. Shadow caching and Screen Space Global Illumination for HDRP. For the Universal Render Pipeline it added new features such as point light shadows, Deferred renderer and general core engine improvements and fixes.


title: Unity (game engine)

text: For the year 2022, Unity has come up with some upgrades which involves speed integration to enter play mode and import files, visual search queries and multiselection in the package manager. For 2D creators, they've focused on accelerating foundations, import, animation, and physics. They have added Sprite Atlas v2, support for PSD extension files and layer management in the 2D PSD Importer, and Delaunay tessellation for 2D physics.


title: Unity (game engine)

text: Unity gives users the ability to create games and experiences in both 2D and 3D, and the engine offers a primary scripting API in C# using Mono, for both the Unity editor in the form of plugins, and games themselves, as well as drag and drop functionality. Prior to C# being the primary programming language used for the engine, it previously supported Boo, which was removed with the release of Unity 5, and a Boo-based implementation of JavaScript called "UnityScript", which was deprecated in August 2017, after the release of Unity 2017.1, in favor of C#.


title: Unity (game engine)

text: Within 2D games, Unity allows importation of sprites and an advanced 2D world renderer. For 3D games, Unity allows specification of texture compression, mipmaps, and resolution settings for each platform that the game engine supports, and provides support for bump mapping, reflection mapping, parallax mapping, screen space ambient occlusion (SSAO), dynamic shadows using shadow maps, render-to-texture and full-screen post-processing effects.


title: Unity (game engine)

text: Two separate render pipelines are available, "High Definition Render Pipeline" (HDRP) and "Universal Render Pipeline" (URP, previously LWRP), in addition to the legacy built-in pipeline. All three render pipelines are incompatible with each other. Unity offers a tool to upgrade shaders using the legacy renderer to URP or HDRP.


title: Unity (game engine)

text: Unity is a cross-platform engine. The Unity editor is supported on Windows, macOS, and the Linux platform, while the engine itself currently supports building games for more than 19 different platforms, including mobile, desktop, consoles, and virtual reality. "Unity 2020 LTS" officially supports the following platforms:


title: Unity (game engine)

text: Formerly supported platforms are Wii, Wii U, PlayStation 3, Xbox 360, Tizen, PlayStation Vita, 3DS, BlackBerry 10, Windows Phone 8, Samsung Smart TV, Gear VR, Daydream, Vuforia, and Facebook Gameroom. Unity formerly supported other platforms including its own Unity Web Player, a Web browser plugin. However, it was deprecated in favor of WebGL. Since version 5, Unity has been offering its WebGL bundle compiled to JavaScript using a 2-stage language translator (C# to C++ and finally to JavaScript).


title: Unity (game engine)

text: Unity was the default software development kit (SDK) used for Nintendo's Wii U video game console, with a free copy included by Nintendo with each Wii U developer license. Unity Technologies called this bundling of a third-party SDK an "industry first".


title: Unity (game engine)

text: During its first ten years as a product, the paid versions of Unity were sold outright; in 2016, the corporation changed to a subscription model. Unity has free and paid licensing options. The free license is for personal use or smaller companies generating less than $100,000 annually, later raised to $200,000, and the subscriptions are based on revenues generated by the games using Unity. The paid option, Unity Pro, had been required for developers that had over $200,000 in annual revenue, but this also could have been provided for console developers through a Preferred Platform License from the console manufacturer. The Unity Pro keys would have been part of the other SDK from the console manufacturer that the developer paid for. In June 2021, Unity changed this plan slightly to require any developer making games on the closed console systems (PlayStation, Nintendo Switch, and Xbox) regardless of revenue to have a Unity Pro license or a Preferred Platform License Key from the manufacturers. Sony and Nintendo provide this as part of the SDK, but Microsoft had yet to implement this functionality for their SDK. The engine source code is licensed on a "per-case basis via special arrangements".


title: Unity (game engine)

text: Creators can develop and sell user-generated assets to other game makers via the Unity Asset Store. This includes 3D and 2D assets and environments for developers to buy and sell. Unity Asset Store launched in 2010. By 2018, there had been approximately 40 million downloads through the digital store.


title: Unity (game engine)

text: The engine is used in games including "Pokémon Go", "Monument Valley", "", "Beat Saber" and "Cuphead" according to the Financial Times.


title: Unity (game engine)

text: , Unity had been used to create approximately half of the mobile games on the market and 60 percent of augmented reality and virtual reality content, including approximately 90 percent on emerging augmented reality platforms, such as Microsoft HoloLens, and 90 percent of Samsung Gear VR content. Unity technology is the basis for most virtual reality and augmented reality experiences, and "Fortune" said Unity "dominates the virtual reality business". Unity Machine Learning Agents is open-source software whereby the Unity platform connects to machine learning programs, including Google's TensorFlow. Using trial and error in Unity Machine Learning Agents, virtual characters use reinforcement learning to build creative strategies in lifelike virtual landscapes. The software is used to develop robots and self-driving cars.


title: Unity (game engine)

text: In the 2010s, Unity Technologies used its game engine to transition into other industries using the real-time 3D platform, including film and automotive. Unity first experimented in filmmaking with "Adam", a short film about a robot escaping from prison. Later, Unity partnered with filmmaker Neill Blomkamp, whose Oats Studios used the engine's tools, including real-time rendering and Cinemachine, to create two computer-generated short films, "Adam: The Mirror" and "Adam: The Prophet". At the 2017 Unite Europe conference in Amsterdam, Unity focused on filmmaking with Unity 2017.1's new Cinemachine tool. In 2018, Disney Television Animation launched three shorts, called Baymax Dreams, that were created using the Unity engine. The Unity engine was also used by Disney to create backgrounds for the 2019 film "The Lion King".


title: Unity (game engine)

text: Automakers use Unity's technology to create full-scale models of new vehicles in virtual reality, build virtual assembly lines, and train workers. Unity's engine is used by DeepMind, an Alphabet Inc. company, to train artificial intelligence. Other uses being pursued by Unity Technologies include architecture, engineering, and construction.


title: Unity (game engine)

text: On December 16, 2013, Unity Technologies Japan revealed an official mascot character named , real name (voiced by ). The character's associated game data was released in early 2014. The character was designed by Unity Technologies Japan designer "ntny" as an open-source heroine character. The company allows the use of Unity-chan and related characters in secondary projects under certain licenses. For example, Unity-chan appears as a playable character in "Runbow".


title: Lyme disease

text: Lyme disease, also known as Lyme borreliosis, is a vector-borne disease caused by the "Borrelia" bacterium, which is spread by ticks in the genus "Ixodes". The most common sign of infection is an expanding red rash, known as erythema migrans (EM), which appears at the site of the tick bite about a week afterwards. The rash is typically neither itchy nor painful. Approximately 70–80% of infected people develop a rash. Early diagnosis can be difficult. Other early symptoms may include fever, headaches and tiredness. If untreated, symptoms may include loss of the ability to move one or both sides of the face, joint pains, severe headaches with neck stiffness or heart palpitations. Months to years later repeated episodes of joint pain and swelling may occur. Occasionally shooting pains or tingling in the arms and legs may develop. Despite appropriate treatment about 10 to 20% of those affected develop joint pains, memory problems and tiredness for at least six months.


title: Lyme disease

text: Lyme disease is transmitted to humans by the bites of infected ticks of the genus "Ixodes". In the United States ticks of concern are usually of the "Ixodes scapularis" type and must be attached for at least 36 hours before the bacteria can spread. In Europe "Ixodes ricinus" ticks may spread the bacteria more quickly. In North America the bacteria "Borrelia burgdorferi "and "B. mayonii" cause Lyme disease. In Europe and Asia" Borrelia afzelii, Borrelia garinii, B. spielmanii" and four other species also cause the disease. The disease does not appear to be transmissible between people, by other animals nor through food. Diagnosis is based on a combination of symptoms, history of tick exposure and possibly testing for specific antibodies in the blood. Blood tests are often negative in the early stages of the disease. Testing of individual ticks is not typically useful.


title: Lyme disease

text: Prevention includes efforts to prevent tick bites by wearing clothing to cover the arms and legs and using DEET or picaridin-based insect repellents. Using pesticides to reduce tick numbers may also be effective. Ticks can be removed using tweezers. If the removed tick is full of blood a single dose of doxycycline may be used to prevent the development of infection but is not generally recommended since the development of infection is rare. If an infection develops, a number of antibiotics are effective, including doxycycline, amoxicillin and cefuroxime. Standard treatment usually lasts for two or three weeks. Some people develop a fever and muscle and joint pains from treatment, which may last for one or two days. In those who develop persistent symptoms, long-term antibiotic therapy has not been found to be useful.


title: Lyme disease

text: Lyme disease is the most common disease spread by ticks in the Northern Hemisphere. An estimated 476,000 people a year are diagnosed and treated for the disease in the United States, and over 200,000 people a year in Western Europe. Infections are most common in the spring and early summer. Lyme disease was diagnosed as a separate condition for the first time in 1975 in Lyme, Connecticut. It was originally mistaken for juvenile rheumatoid arthritis. The bacterium involved was first described in 1981 by Willy Burgdorfer. Chronic symptoms following treatment are known as "post-treatment Lyme disease syndrome" (PTLDS). PTLDS is different from chronic Lyme disease, a term no longer supported by scientists and used in different ways by different groups. Some healthcare providers claim that PTLDS is caused by persistent infection but this is not believed to be true because no evidence of persistent infection can be found after standard treatment.


title: Lyme disease

text: No human vaccines for Lyme disease are currently available, although research is ongoing. Multiple vaccines are available for the prevention of Lyme disease in dogs.


title: Lyme disease

text: Lyme disease can affect several body systems and produce a broad range of symptoms. Not everyone with Lyme disease has all of the symptoms and many of the symptoms are not specific to Lyme disease but can occur with other diseases as well.


title: Lyme disease

text: The incubation period from infection to the onset of symptoms is usually one to two weeks but can be much shorter (days) or much longer (months to years). Lyme symptoms most often occur from May to September in the northern hemisphere because the nymphal stage of the tick is responsible for most cases. Asymptomatic infection exists but occurs in less than 7% of infected individuals in the United States. Asymptomatic infection may be much more common among those infected in Europe.


title: Lyme disease

text: Early localized infection can occur when the infection has not yet spread throughout the body. Only the site where the infection has first come into contact with the skin is affected. The initial sign of about 80% of Lyme infections is an "erythema migrans" (EM) rash at the site of a tick bite, often near skin folds such as the armpit, groin or back of the knee, on the trunk, under clothing straps, or in children's hair, ears or neck. Most people who get infected do not remember seeing a tick or a bite. The rash appears typically one or two weeks (range 3–32 days) after the bite and expands 2–3 cm per day up to a diameter of 5–70 cm (median 16 cm). The rash is usually circular or oval, red or bluish, and may have an elevated or darker center. In about 79% of cases in Europe but only 19% of cases in endemic areas of the U.S. the rash gradually clears from the center toward the edges, possibly forming a "bull's eye" pattern. The rash may feel warm but usually is not itchy, is rarely tender or painful and takes up to four weeks to resolve if untreated.


title: Lyme disease

text: The EM rash is often accompanied by symptoms of a viral-like illness, including fatigue, headache, body aches, fever and chills but usually not nausea or upper-respiratory problems. These symptoms may also appear without a rash or linger after the rash has disappeared. Lyme can progress to later stages without these symptoms or a rash.


title: Lyme disease

text: People with high fever for more than two days or whose other symptoms of viral-like illness do not improve despite antibiotic treatment for Lyme disease, or who have abnormally low levels of white or red cells or platelets in the blood, should be investigated for possible coinfection with other tick-borne diseases such as ehrlichiosis and babesiosis.


title: Lyme disease

text: Within days to weeks after the onset of local infection the "Borrelia" bacteria may spread through the lymphatic system or bloodstream. In 10–20% of untreated cases EM rashes develop at sites across the body that bear no relation to the original tick bite. Transient muscle pains and joint pains are also common.


title: Lyme disease

text: In about 10–15% of untreated people Lyme causes neurological problems known as neuroborreliosis. Early neuroborreliosis typically appears 4–6 weeks (range 1–12 weeks) after the tick bite and involves some combination of lymphocytic meningitis, cranial neuritis, radiculopathy and/or mononeuritis multiplex. Lymphocytic meningitis causes characteristic changes in the cerebrospinal fluid (CSF) and may be accompanied for several weeks by variable headache and, less commonly, usually mild meningitis signs such as inability to flex the neck fully and intolerance to bright lights but typically no or only very low fever. After several months neuroborreliosis can also present otolaryngological symptoms. Up to 76.5% of these otolaryngological present as tinnitus, the most common symptom. Vertigo and dizziness (53.7%) and hearing loss (16.7%) were the next most common symptoms. In children partial loss of vision may also occur. Cranial neuritis is an inflammation of cranial nerves. When due to Lyme it most typically causes facial palsy, impairing blinking, smiling and chewing on one or both sides of the face. It may also cause intermittent double vision. Lyme radiculopathy is an inflammation of spinal nerve roots that often causes pain and less often weakness, numbness, or altered sensation in the areas of the body served by nerves connected to the affected roots, e.g. limb(s) or part(s) of trunk. The pain is often described as unlike any other previously felt, excruciating, migrating, worse at night, rarely symmetrical, and often accompanied by extreme sleep disturbance. Mononeuritis multiplex is an inflammation causing similar symptoms in one or more unrelated peripheral nerves. Rarely, early neuroborreliosis may involve inflammation of the brain or spinal cord, with symptoms such as confusion, abnormal gait, ocular movements, or speech, impaired movement, impaired motor planning, or shaking.


title: Lyme disease

text: In North America, facial palsy is the typical early neuroborreliosis presentation, occurring in 5–10% of untreated people, in about 75% of cases accompanied by lymphocytic meningitis. Lyme radiculopathy is reported half as frequently, but many cases may be unrecognized. In European adults, the most common presentation is a combination of lymphocytic meningitis and radiculopathy known as Bannwarth syndrome, accompanied in 36-89% of cases by facial palsy. In this syndrome, radicular pain tends to start in the same body region as the initial erythema migrans rash, if there was one, and precedes possible facial palsy and other impaired movement. In extreme cases, permanent impairment of motor or sensory function of the lower limbs may occur. In European children, the most common manifestations are facial palsy (in 55%), other cranial neuritis, and lymphocytic meningitis (in 27%).


title: Lyme disease

text: In about 4–10% of untreated cases in the U.S. and 0.3–4% of untreated cases in Europe, typically between June and December, about one month (range 4 days-7 months) after the tick bite, the infection may cause heart complications known as Lyme carditis. Symptoms may include heart palpitations (in 69% of people), dizziness, fainting, shortness of breath, and chest pain. Other symptoms of Lyme disease may also be present, such as EM rash, joint aches, facial palsy, headaches, or radicular pain. In some people, however, carditis may be the first manifestation of Lyme disease. Lyme carditis in 19–87% of people adversely impacts the heart's electrical conduction system, causing atrioventricular block that often manifests as heart rhythms that alternate within minutes between abnormally slow and abnormally fast. In 10–15% of people, Lyme causes myocardial complications such as cardiomegaly, left ventricular dysfunction, or congestive heart failure.


title: Lyme disease

text: Another skin condition, found in Europe but not in North America, is borrelial lymphocytoma, a purplish lump that develops on the ear lobe, nipple, or scrotum.


title: Lyme disease

text: Lyme arthritis occurs in up to 60% of untreated people, typically starting about six months after infection. It usually affects only one or a few joints, often a knee or possibly the hip, other large joints, or the temporomandibular joint. There is usually large joint effusion and swelling, but only mild or moderate pain. Without treatment, swelling and pain typically resolve over time but periodically return. Baker's cysts may form and rupture.


title: Lyme disease

text: In early US studies of Lyme disease, a rare peripheral neuropathy was described that included numbness, tingling or burning starting at the feet or hands and over time possibly moving up the limbs. In a later analysis that discovered poor documentation of this manifestation, experts wondered if it exists at all in the US or is merely very rare.


title: Lyme disease

text: A neurologic syndrome called Lyme encephalopathy is associated with subtle memory and cognitive difficulties, insomnia, a general sense of feeling unwell, and changes in personality. However, problems such as depression and fibromyalgia are as common in people with Lyme disease as in the general population.


title: Lyme disease

text: "Acrodermatitis chronica atrophicans" (ACA) is a chronic skin disorder observed primarily in Europe among the elderly. ACA begins as a reddish-blue patch of discolored skin, often on the backs of the hands or feet. The lesion slowly atrophies over several weeks or months, with the skin becoming first thin and wrinkled and then, if untreated, completely dry and hairless. ACA is also associated with peripheral neuropathy.


title: Lyme disease

text: Lyme disease is caused by spirochetes, spiral bacteria from the genus "Borrelia". Spirochetes are surrounded by peptidoglycan and flagella, along with an outer membrane similar to Gram-negative bacteria. Because of their double-membrane envelope, "Borrelia" bacteria are often mistakenly described as Gram negative despite the considerable differences in their envelope components from Gram-negative bacteria. The Lyme-related "Borrelia" species are collectively known as "Borrelia burgdorferi sensu lato", and show a great deal of genetic diversity.


title: Lyme disease

text: "B. burgdorferi sensu lato" is a species complex made up of 20 accepted and three proposed genospecies. Eight species are known to cause Lyme disease: "B. mayonii" (found in North America), "B. burgdorferi sensu stricto", (found in North America and Europe), "B. afzelii", "B. garinii, B. spielmanii, and B. lusitaniae" (all found in Eurasia). Some studies have also proposed that "B. valaisiana" may sometimes infect humans, but this species does not seem to be important causes of disease.


title: Lyme disease

text: There are three stages in the life cycle of a tick. Larva, nymph, and adult. During the nymph stage, ticks most frequently transmit Lyme disease and are usually most active in late spring and early summer in regions where the climate is mild. During the adult stage, Lyme disease transmission is less common due to the fact that it is less possible for adult ticks to bite humans and because they tend to be larger in size and therefore can be easily seen and removed.


title: Lyme disease

text: Lyme disease is classified as a zoonosis, as it is transmitted to humans from a natural reservoir among small mammals and birds by ticks that feed on both sets of hosts. Hard-bodied ticks of the genus "Ixodes" are the vectors of Lyme disease (also the vector for "Babesia"). Most infections are caused by ticks in the nymphal stage, because they are very small and thus may feed for long periods of time undetected. Nymphal ticks are generally the size of a poppy seed and sometimes with a dark head and a translucent body. Or, the nymphal ticks can be darker. (The younger larval ticks are very rarely infected.) Although deer are the preferred hosts of adult deer ticks, and tick populations are much lower in the absence of deer, ticks generally do not acquire "Borrelia" from deer, instead they obtain them from infected small mammals such as the white-footed mouse, and occasionally birds. Areas where Lyme is common are expanding.


title: Lyme disease

text: Within the tick midgut, the "Borrelia"s outer surface protein A (OspA) binds to the tick receptor for OspA, known as TROSPA. When the tick feeds, the" Borrelia" downregulates OspA and upregulates OspC, another surface protein. After the bacteria migrate from the midgut to the salivary glands, OspC binds to Salp15, a tick salivary protein that appears to have immunosuppressive effects that enhance infection. Successful infection of the mammalian host depends on bacterial expression of OspC.


title: Lyme disease

text: Tick bites often go unnoticed because of the small size of the tick in its nymphal stage, as well as tick secretions that prevent the host from feeling any itch or pain from the bite. However, transmission is quite rare, with only about 1.2 to 1.4 percent of recognized tick bites resulting in Lyme disease.


title: Lyme disease

text: In Europe, the main vector is "Ixodes ricinus", which is also called the sheep tick or castor bean tick. In China, "Ixodes persulcatus" (the taiga tick) is probably the most important vector. In North America, the black-legged tick or deer tick ("Ixodes scapularis") is the main vector on the East Coast.


title: Lyme disease

text: The lone star tick ("Amblyomma americanum"), which is found throughout the Southeastern United States as far west as Texas, is unlikely to transmit the Lyme disease spirochetes, though it may be implicated in a related syndrome called southern tick-associated rash illness, which resembles a mild form of Lyme disease.


title: Lyme disease

text: On the West Coast of the United States, the main vector is the western black-legged tick ("Ixodes pacificus"). The tendency of this tick species to feed predominantly on host species such as the Western Fence Lizard that are resistant to "Borrelia" infection appears to diminish transmission of Lyme disease in the West.


title: Lyme disease

text: Transmission can occur across the placenta during pregnancy and as with a number of other spirochetal diseases, adverse pregnancy outcomes are possible with untreated infection; prompt treatment with antibiotics reduces or eliminates this risk.


title: Lyme disease

text: There is no scientific evidence to support Lyme disease transmission via blood transfusion, sexual contact, or breast milk.


title: Lyme disease

text: Ticks that transmit "B. burgdorferi" to humans can also carry and transmit several other parasites, such as "Babesia microti" and "Anaplasma phagocytophilum", which cause the diseases babesiosis and human granulocytic anaplasmosis (HGA), respectively. Among people with early Lyme disease, depending on their location, 2–12% will also have HGA and 2–40% will have babesiosis. Ticks in certain regions, including the lands along the eastern Baltic Sea, also transmit viruses that cause tick-borne encephalitis.


title: Lyme disease

text: Coinfections complicate Lyme symptoms, especially diagnosis and treatment. It is possible for a tick to carry and transmit one of the coinfections and not "Borrelia", making diagnosis difficult and often elusive. The Centers for Disease Control and Prevention studied 100 ticks in rural New Jersey and detected two pathogens in 10% of the ticks.


title: Lyme disease

text: "B. burgdorferi" can spread throughout the body during the course of the disease, and has been found in the skin, heart, joints, peripheral nervous system, and central nervous system. "B. Burgdorferi" does not produce toxins. Therefore, many of the signs and symptoms of Lyme disease are a consequence of the immune response to spirochete in those tissues.


title: Lyme disease

text: "B. burgdorferi" is injected into the skin by the bite of an infected "Ixodes" tick. Tick saliva, which accompanies the spirochete into the skin during the feeding process, contains substances that disrupt the immune response at the site of the bite. This provides a protective environment where the spirochete can establish infection. The spirochetes multiply and migrate outward within the dermis. The host inflammatory response to the bacteria in the skin causes the characteristic circular EM lesion. Neutrophils, however, which are necessary to eliminate the spirochetes from the skin, fail to appear in necessary numbers in the developing EM lesion because tick saliva inhibits neutrophil function. This allows the bacteria to survive and eventually spread throughout the body.


title: Lyme disease

text: Days to weeks following the tick bite, the spirochetes spread via the bloodstream to joints, heart, nervous system, and distant skin sites, where their presence gives rise to the variety of symptoms of the disseminated disease. The spread of "B. burgdorferi" is aided by the attachment of the host protease plasmin to the surface of the spirochete.


title: Lyme disease

text: If untreated, the bacteria may persist in the body for months or even years, despite the production of "B. burgdorferi" antibodies by the immune system. The spirochetes may avoid the immune response by decreasing expression of surface proteins that are targeted by antibodies, antigenic variation of the VlsE surface protein, inactivating key immune components such as complement, and hiding in the extracellular matrix, which may interfere with the function of immune factors.


title: Lyme disease

text: In the brain, "B. burgdorferi" may induce astrocytes to undergo astrogliosis (proliferation followed by apoptosis), which may contribute to neurodysfunction. The spirochetes may also induce host cells to secrete quinolinic acid, which stimulates the NMDA receptor on nerve cells, which may account for the fatigue and malaise observed with Lyme encephalopathy. In addition, diffuse white matter pathology during Lyme encephalopathy may disrupt gray matter connections, and could account for deficits in attention, memory, visuospatial ability, complex cognition, and emotional status. White matter disease may have a greater potential for recovery than gray matter disease, perhaps because neuronal loss is less common. Resolution of MRI white matter hyperintensities after antibiotic treatment has been observed.


title: Lyme disease

text: Tryptophan, a precursor to serotonin, appears to be reduced within the central nervous system in a number of infectious diseases that affect the brain, including Lyme. Researchers are investigating if this neurohormone secretion is the cause of neuropsychiatric disorders developing in some people with borreliosis.


title: Lyme disease

text: Exposure to the "Borrelia" bacterium during Lyme disease possibly causes a long-lived and damaging inflammatory response, a form of pathogen-induced autoimmune disease. The production of this reaction might be due to a form of molecular mimicry, where "Borrelia" avoids being killed by the immune system by resembling normal parts of the body's tissues.


title: Lyme disease

text: Chronic symptoms from an autoimmune reaction could explain why some symptoms persist even after the spirochetes have been eliminated from the body. This hypothesis may explain why chronic arthritis persists after antibiotic therapy, similar to rheumatic fever, but its wider application is controversial.


title: Lyme disease

text: Lyme disease is diagnosed based on symptoms, objective physical findings (such as erythema migrans (EM) rash, facial palsy, or arthritis), history of possible exposure to infected ticks, and possibly laboratory tests. People with symptoms of early Lyme disease should have a total body skin examination for EM rashes and asked whether EM-type rashes had manifested within the last 1–2 months. Presence of an EM rash and recent tick exposure (i.e., being outdoors in a likely tick habitat where Lyme is common, within 30 days of the appearance of the rash) are sufficient for Lyme diagnosis; no laboratory confirmation is needed or recommended. Most people who get infected do not remember a tick or a bite, and the EM rash need not look like a bull's eye (most EM rashes in the U.S. do not) or be accompanied by any other symptoms. In the U.S., Lyme is most common in the New England and Mid-Atlantic states and parts of Wisconsin and Minnesota, but it is expanding into other areas. Several bordering areas of Canada also have high Lyme risk.


title: Lyme disease

text: In the absence of an EM rash or history of tick exposure, Lyme diagnosis depends on laboratory confirmation. The bacteria that cause Lyme disease are difficult to observe directly in body tissues and also difficult and too time-consuming to grow in the laboratory. The most widely used tests look instead for presence of antibodies against those bacteria in the blood. A positive antibody test result does not by itself prove active infection but can confirm an infection that is suspected because of symptoms, objective findings, and history of tick exposure in a person. Because as many as 5–20% of the normal population have antibodies against Lyme, people without history and symptoms suggestive of Lyme disease should not be tested for Lyme antibodies: a positive result would likely be false, possibly causing unnecessary treatment.


title: Lyme disease

text: In some cases, when history, signs, and symptoms are strongly suggestive of early disseminated Lyme disease, empiric treatment may be started and reevaluated as laboratory test results become available.


title: Lyme disease

text: Tests for antibodies in the blood by ELISA and Western blot is the most widely used method for Lyme diagnosis. A two-tiered protocol is recommended by the Centers for Disease Control and Prevention (CDC): the sensitive ELISA test is performed first, and if it is positive or equivocal, then the more specific Western blot is run. The immune system takes some time to produce antibodies in quantity. After Lyme infection onset, antibodies of types IgM and IgG usually can first be detected respectively at 2–4 weeks and 4–6 weeks, and peak at 6–8 weeks. When an EM rash first appears, detectable antibodies may not be present. Therefore, it is recommended that testing not be performed and diagnosis be based on the presence of the EM rash. Up to 30 days after suspected Lyme infection onset, infection can be confirmed by detection of IgM or IgG antibodies; after that, it is recommended that only IgG antibodies be considered. A positive IgM and negative IgG test result after the first month of infection is generally indicative of a false-positive result. The number of IgM antibodies usually collapses 4–6 months after infection, while IgG antibodies can remain detectable for years.


title: Lyme disease

text: Other tests may be used in neuroborreliosis cases. In Europe, neuroborreliosis is usually caused by Borrelia garinii and almost always involves lymphocytic pleocytosis, i.e. the densities of lymphocytes (infection-fighting cells) and protein in the cerebrospinal fluid (CSF) typically rise to characteristically abnormal levels, while glucose level remains normal. Additionally, the immune system produces antibodies against Lyme inside the intrathecal space, which contains the CSF. Demonstration by lumbar puncture and CSF analysis of pleocytosis and intrathecal antibody production are required for definite diagnosis of neuroborreliosis in Europe (except in cases of peripheral neuropathy associated with acrodermatitis chronica atrophicans, which usually is caused by Borrelia afzelii and confirmed by blood antibody tests). In North America, neuroborreliosis is caused by Borrelia burgdorferi and may not be accompanied by the same CSF signs; they confirm a diagnosis of central nervous system (CNS) neuroborreliosis if positive, but do not exclude it if negative. American guidelines consider CSF analysis optional when symptoms appear to be confined to the peripheral nervous system (PNS), e.g. facial palsy without overt meningitis symptoms. Unlike blood and intrathecal antibody tests, CSF pleocytosis tests revert to normal after infection ends and therefore can be used as objective markers of treatment success and inform decisions on whether to retreat. In infection involving the PNS, electromyography and nerve conduction studies can be used to monitor objectively the response to treatment.


title: Lyme disease

text: In Lyme carditis, electrocardiograms are used to evidence heart conduction abnormalities, while echocardiography may show myocardial dysfunction. Biopsy and confirmation of Borrelia cells in myocardial tissue may be used in specific cases but are usually not done because of risk of the procedure.


title: Lyme disease

text: Polymerase chain reaction (PCR) tests for Lyme disease have also been developed to detect the genetic material (DNA) of the Lyme disease spirochete. Culture or PCR are the current means for detecting the presence of the organism, as serologic studies only test for antibodies of "Borrelia". PCR has the advantage of being much faster than culture. However, PCR tests are susceptible to false positive results, e.g. by detection of debris of dead Borrelia cells or specimen contamination. Even when properly performed, PCR often shows false-negative results because few Borrelia cells can be found in blood and cerebrospinal fluid (CSF) during infection. Hence, PCR tests are recommended only in special cases, e.g. diagnosis of Lyme arthritis, because it is a highly sensitive way of detecting "ospA" DNA in synovial fluid. Although sensitivity of PCR in CSF is low, its use may be considered when intrathecal antibody production test results are suspected of being falsely negative, e.g. in very early (< 6 weeks) neuroborreliosis or in immunosuppressed people.


title: Lyme disease

text: Several other forms of laboratory testing for Lyme disease are available, some of which have not been adequately validated. OspA antigens, shed by live "Borrelia" bacteria into urine, are a promising technique being studied. The use of nanotrap particles for their detection is being looked at and the OspA has been linked to active symptoms of Lyme. High titers of either immunoglobulin G (IgG) or immunoglobulin M (IgM) antibodies to "Borrelia" antigens indicate disease, but lower titers can be misleading, because the IgM antibodies may remain after the initial infection, and IgG antibodies may remain for years.


title: Lyme disease

text: The CDC does not recommend urine antigen tests, PCR tests on urine, immunofluorescent staining for cell-wall-deficient forms of "B. burgdorferi", and lymphocyte transformation tests.


title: Lyme disease

text: Neuroimaging is controversial in whether it provides specific patterns unique to neuroborreliosis, but may aid in differential diagnosis and in understanding the pathophysiology of the disease. Though controversial, some evidence shows certain neuroimaging tests can provide data that are helpful in the diagnosis of a person. Magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) are two of the tests that can identify abnormalities in the brain of a person affected with this disease. Neuroimaging findings in an MRI include lesions in the periventricular white matter, as well as enlarged ventricles and cortical atrophy. The findings are considered somewhat unexceptional because the lesions have been found to be reversible following antibiotic treatment. Images produced using SPECT show numerous areas where an insufficient amount of blood is being delivered to the cortex and subcortical white matter. However, SPECT images are known to be nonspecific because they show a heterogeneous pattern in the imaging. The abnormalities seen in the SPECT images are very similar to those seen in people with cerebral vacuities and Creutzfeldt–Jakob disease, which makes them questionable.


title: Lyme disease

text: Community clinics have been reported to misdiagnose 23–28% of Erythema migrans (EM) rashes and 83% of other objective manifestations of early Lyme disease. EM rashes are often misdiagnosed as spider bites, cellulitis, or shingles. Many misdiagnoses are credited to the widespread misconception that EM rashes should look like a bull's eye. Actually, the key distinguishing features of the EM rash are the speed and extent to which it expands, respectively up to 2–3 cm/day and a diameter of at least 5 cm, and in 50% of cases more than 16 cm. The rash expands away from its center, which may or may not look different or be separated by ring-like clearing from the rest of the rash. Compared to EM rashes, spider bites are more common in the limbs, tend to be more painful and itchy or become swollen, and some may cause necrosis (sinking dark blue patch of dead skin). Cellulitis most commonly develops around a wound or ulcer, is rarely circular, and is more likely to become swollen and tender. EM rashes often appear at sites that are unusual for cellulitis, such as the armpit, groin, abdomen, or back of knee. Like Lyme, shingles often begins with headache, fever, and fatigue, which are followed by pain or numbness. However, unlike Lyme, in shingles these symptoms are usually followed by appearance of rashes composed of multiple small blisters along with a nerve's dermatome, and shingles can also be confirmed by quick laboratory tests.


title: Lyme disease

text: Facial palsy caused by Lyme disease (LDFP) is often misdiagnosed as Bell's palsy. Although Bell's palsy is the most common type of one-sided facial palsy (about 70% of cases), LDFP can account for about 25% of cases of facial palsy in areas where Lyme disease is common. Compared to LDFP, Bell's palsy much less frequently affects both sides of the face. Even though LDFP and Bell's palsy have similar symptoms and evolve similarly if untreated, corticosteroid treatment is beneficial for Bell's Palsy, while being detrimental for LDFP. Recent history of exposure to a likely tick habitat during warmer months, EM rash, viral-like symptoms such as headache and fever, and/or palsy in both sides of the face should be evaluated for the likelihood of LDFP; if it is more than minimal, empiric therapy with antibiotics should be initiated, without corticosteroids, and reevaluated upon completion of laboratory tests for Lyme disease.


title: Lyme disease

text: Unlike viral meningitis, Lyme lymphocytic meningitis tends to not cause fever, last longer, and recur. Lymphocytic meningitis is also characterized by possibly co-occurring with EM rash, facial palsy, or partial vision obstruction and having much lower percentage of polymorphonuclear leukocytes in CSF.


title: Lyme disease

text: Lyme radiculopathy affecting the limbs is often misdiagnosed as a radiculopathy caused by nerve root compression, such as sciatica. Although most cases of radiculopathy are compressive and resolve with conservative treatment (e.g., rest) within 4–6 weeks, guidelines for managing radiculopathy recommend first evaluating risks of other possible causes that, although less frequent, require immediate diagnosis and treatment, including infections such as Lyme and shingles. A history of outdoor activities in likely tick habitats in the last 3 months possibly followed by a rash or viral-like symptoms, and current headache, other symptoms of lymphocytic meningitis, or facial palsy would lead to suspicion of Lyme disease and recommendation of serological and lumbar puncture tests for confirmation.


title: Lyme disease

text: Lyme radiculopathy affecting the trunk can be misdiagnosed as myriad other conditions, such as diverticulitis and acute coronary syndrome. Diagnosis of late-stage Lyme disease is often complicated by a multifaceted appearance and nonspecific symptoms, prompting one reviewer to call Lyme the new "great imitator". As all people with later-stage infection will have a positive antibody test, simple blood tests can exclude Lyme disease as a possible cause of a person's symptoms.


title: Lyme disease

text: Tick bites may be prevented by avoiding or reducing time in likely tick habitats and taking precautions while in and when getting out of one.


title: Lyme disease

text: Most Lyme human infections are caused by Ixodes nymph bites between April and September. Ticks prefer moist, shaded locations in woodlands, shrubs, tall grasses and leaf litter or wood piles. Tick densities tend to be highest in woodlands, followed by unmaintained edges between woods and lawns (about half as high), ornamental plants and perennial groundcover (about a quarter), and lawns (about 30 times less). Ixodes larvae and nymphs tend to be abundant also where mice nest, such as stone walls and wood logs. Ixodes larvae and nymphs typically wait for potential hosts ("quest") on leaves or grasses close to the ground with forelegs outstretched; when a host brushes against its limbs, the tick rapidly clings and climbs on the host looking for a skin location to bite. In Northeastern United States, 69% of tick bites are estimated to happen in residences, 11% in schools or camps, 9% in parks or recreational areas, 4% at work, 3% while hunting, and 4% in other areas. Activities associated with tick bites around residences include yard work, brush clearing, gardening, playing in the yard, and letting into the house dogs or cats that roam outside in woody or grassy areas. In parks, tick bites often happen while hiking or camping. Walking on a mowed lawn or center of a trail without touching adjacent vegetation is less risky than crawling or sitting on a log or stone wall. Pets should not be allowed to roam freely in likely tick habitats.


title: Lyme disease

text: As a precaution, CDC recommends soaking or spraying clothes, shoes, and camping gear such as tents, backpacks and sleeping bags with 0.5% permethrin solution and hanging them to dry before use. Permethrin is odorless and safe for humans but highly toxic to ticks. After crawling on permethrin-treated fabric for as few as 10–20 seconds, tick nymphs become irritated and fall off or die. Permethrin-treated closed-toed shoes and socks reduce by 74 times the number of bites from nymphs that make first contact with a shoe of a person also wearing treated shorts (because nymphs usually quest near the ground, this is a typical contact scenario). Better protection can be achieved by tucking permethrin-treated trousers (pants) into treated socks and a treated long-sleeve shirt into the trousers so as to minimize gaps through which a tick might reach the wearer's skin. Light-colored clothing may make it easier to see ticks and remove them before they bite. Military and outdoor workers' uniforms treated with permethrin have been found to reduce the number of bite cases by 80–95%. Permethrin protection lasts several weeks of wear and washings in customer-treated items and up to 70 washings for factory-treated items. Permethrin should not be used on human skin, underwear or cats.


title: Lyme disease

text: The EPA recommends several tick repellents for use on exposed skin, including DEET, picaridin, IR3535 (a derivative of amino acid beta-alanine), oil of lemon eucalyptus (OLE, a natural compound) and OLE's active ingredient para-menthane-diol (PMD). Unlike permethrin, repellents repel but do not kill ticks, protect for only several hours after application, and may be washed off by sweat or water. The most popular repellent is DEET in the U.S. and picaridin in Europe. Unlike DEET, picaridin is odorless and is less likely to irritate the skin or harm fabric or plastics. Repellents with higher concentration may last longer but are not more effective; against ticks, 20% picaridin may work for 8 hours vs. 55–98.11% DEET for 5–6 hours or 30–40% OLE for 6 hours. Repellents should not be used under clothes, on eyes, mouth, wounds or cuts, or on babies younger than 2 months (3 years for OLE or PMD). If sunscreen is used, repellent should be applied on top of it. Repellents should not be sprayed directly on a face, but should instead be sprayed on a hand and then rubbed on the face.


title: Lyme disease

text: After coming indoors, clothes, gear and pets should be checked for ticks. Clothes can be put into a hot dryer for 10 minutes to kill ticks (just washing or warm dryer are not enough). Showering as soon as possible, looking for ticks over the entire body, and removing them reduce risk of infection. Unfed tick nymphs are the size of a poppy seed, but a day or two after biting and attaching themselves to a person, they look like a small blood blister. The following areas should be checked especially carefully: armpits, between legs, back of knee, bellybutton, trunk, and in children ears, neck and hair.


title: Lyme disease

text: Attached ticks should be removed promptly. Risk of infection increases with time of attachment, but in North America risk of Lyme disease is small if the tick is removed within 36 hours. CDC recommends inserting a fine-tipped tweezer between the skin and the tick, grasping very firmly, and pulling the closed tweezer straight away from the skin without twisting, jerking, squeezing or crushing the tick. After tick removal, any tick parts remaining in the skin should be removed with a clean tweezer, if possible. The wound and hands should then be cleaned with alcohol or soap and water. The tick may be disposed by placing it in a container with alcohol, sealed bag, tape or flushed down the toilet. The bitten person should write down where and when the bite happened so that this can be informed to a doctor if the person gets a rash or flu-like symptoms in the following several weeks. CDC recommends not using fingers, nail polish, petroleum jelly or heat on the tick to try to remove it.


title: Lyme disease

text: In Australia, where the Australian paralysis tick is prevalent, the Australasian Society of Clinical Immunology and Allergy recommends not using tweezers to remove ticks, because if the person is allergic, anaphylaxis could result. Instead, a product should be sprayed on the tick to cause it to freeze and then drop off. A doctor would use liquid nitrogen, but products available from chemists for freezing warts can be used instead. Another method originating from Australia consists in using about 20 cm of dental floss or fishing line for slowly tying an overhand knot between the skin and the tick and then pulling it away from the skin.


title: Lyme disease

text: The risk of infectious transmission increases with the duration of tick attachment. It requires between 36 and 48 hours of attachment for the bacteria that causes Lyme to travel from within the tick into its saliva. If a deer tick that is sufficiently likely to be carrying "Borrelia" is found attached to a person and removed, and if the tick has been attached for 36 hours or is engorged, a single dose of doxycycline administered within the 72 hours after removal may reduce the risk of Lyme disease. It is not generally recommended for all people bitten, as development of infection is rare: about 50 bitten people would have to be treated this way to prevent one case of erythema migrans (i.e. the typical rash found in about 70–80% of people infected).


title: Lyme disease

text: Several landscaping practices may reduce the risk of tick bites in residential yards. These include keeping lawns mowed, removing leaf litter and weeds, and avoiding the use of ground cover. A 3-ft-wide rock or woodchip barrier is recommended to separate lawns from wood piles, woodlands, stone walls, and shrubs. Without vegetation on the barrier, ticks will tend not to cross it; acaricides may also be sprayed on it to kill ticks. A sun-exposed tick-safe zone at least 9 ft from the barrier should concentrate human activity on the yard, including any patios, playgrounds and gardening. Materials such as wood decking, concrete, bricks, gravel or woodchips used on the ground under patios and playgrounds would discourage ticks there. An 8-ft-high fence may be added to keep deer away from the tick-safe zone.


title: Lyme disease

text: Outdoor workers are at risk of Lyme disease if they work at sites with infected ticks. This includes construction, landscaping, forestry, brush clearing, land surveying, farming, railroad work, oil field work, utility line work, park or wildlife management. U.S. workers in the northeastern and north-central states are at highest risk of exposure to infected ticks. Ticks may also transmit other tick-borne diseases to workers in these and other regions of the country. Worksites with woods, bushes, high grass or leaf litter are likely to have more ticks. Outdoor workers should be most careful to protect themselves in the late spring and summer when young ticks are most active.


title: Lyme disease

text: Ticks can feed upon the blood of a wide array of possible host species, including lizards, birds, mice, cats, dogs, deer, cattle and humans. The extent to which a tick can feed, reproduce, and spread will depend on the type and availability of its hosts. Whether it will spread disease is also affected by its available hosts. Some species, such as lizards, are referred to as "dilution hosts" because they don't tend to support Lyme disease pathogens and so decrease the likelihood that the disease will be passed on by ticks feeding on them. White-tailed deer are both a food source and a "reproductive host", where ticks tend to mate. The white-footed mouse is a reservoir host in which the pathogen for Lyme disease can survive. Availability of hosts can have significant impacts on the transmission of Lyme disease. A greater diversity of hosts, or of those that don't support the pathogen, tends to decrease the likelihood that the disease will be transmitted.


title: Lyme disease

text: In the United States, one approach to reducing the incidence of Lyme and other deer tick-borne diseases has been to greatly reduce the deer population on which the adult ticks depend for feeding and reproduction. Lyme disease cases fell following deer eradication on an island, Monhegan, Maine, and following deer control in Mumford Cove, Connecticut. Advocates have suggested reducing the deer population to levels of 8 to 10 deer per square mile, compared to levels of 60 or more deer per square mile in the areas of the country with the highest Lyme disease rates.


title: Lyme disease

text: Others have noted that while deer are reproductive hosts, they are not "Borrelia burgdorferi" reservoirs. Researchers have suggested that smaller, less obviously visible Lyme reservoirs, like white-footed mice and Eastern chipmunks, may more strongly impact Lyme disease occurrence. Ecosystem studies in New York state suggest that white-footed mice thrive when forests are broken into smaller isolated chunks of woodland with fewer rodent predators. With more rodents harboring the disease, the odds increase that a tick will feed on a disease-harboring rodent and that someone will pick up a disease-carrying tick in their garden or walking in the woods. Data indicates that the smaller the wooded area, the more ticks it will contain and the likely they are to carry Lyme disease, supporting the idea that deforestation and habitat fragmentation affect ticks, hosts and disease transmission.


title: Lyme disease

text: Tick-borne diseases are estimated to affect ~80 % of cattle worldwide. They also affect cats, dogs, and other pets. Routine veterinary control of ticks of domestic animals through the use of acaricides has been suggested as a way to reduce exposure of humans to ticks. However, chemical control with acaricides is now criticized on a number of grounds. Ticks appear to develop resistance to acaricides; acaricides are costly; and there are concerns over their toxicity and the potential for chemical residues to affect food and the environment.


title: Lyme disease

text: In Europe, known reservoirs of "Borrelia burgdorferi" were 9 small mammals, 7 medium-sized mammals and 16 species of birds (including passerines, sea-birds and pheasants). These animals seem to transmit spirochetes to ticks and thus participate in the natural circulation of B. burgdorferi in Europe. The house mouse is also suspected as well as other species of small rodents, particularly in Eastern Europe and Russia. "The reservoir species that contain the most pathogens are the European roe deer "Capreolus capreolus"; ""it does not appear to serve as a major reservoir of B. burgdorferi"" thought Jaenson & al. (1992) (incompetent host for "B. burgdorferi" and TBE virus) but it is important for feeding the ticks, as red deer and wild boars ("Sus scrofa"), in which one "Rickettsia" and three "Borrelia" species were identified", with high risks of coinfection in roe deer. Nevertheless, in the 2000s, in roe deer in Europe ""two species of Rickettsia and two species of Borrelia were identified"".


title: Lyme disease

text: No human vaccines for Lyme disease are currently available. The only human vaccine to advance to market was LYMErix, which was available briefly before being pulled from the market in 2002. The vaccine candidate VLA15 is scheduled to start a phase 3 trial in the third quarter of 2022, and other research is ongoing. Multiple vaccines are available for the prevention of Lyme disease in dogs.


title: Lyme disease

text: The vaccine LYMErix was available from 1998 to 2002. The recombinant vaccine against Lyme disease, based on the outer surface protein A (OspA) of "B. burgdorferi" with aluminum hydroxide as adjuvant, was developed by SmithKline Beecham. In clinical trials involving more than 10,000 people, the vaccine was found to confer protective immunity to Lyme disease in 76% of adults after three doses with only mild or moderate and transient adverse effects. On 21 December 1998, the Food and Drug Administration (FDA) approved LYMErix on the basis of these trials for persons of ages 15 through 70.


title: Lyme disease

text: Following approval of the vaccine, its entry into clinical practice was slow for a variety of reasons, including its cost, which was often not reimbursed by insurance companies. Subsequently, hundreds of vaccine recipients reported they had developed autoimmune and other side effects. Supported by some advocacy groups, a number of class-action lawsuits were filed against GlaxoSmithKline, alleging the vaccine had caused these health problems. These claims were investigated by the FDA and the Centers for Disease Control, which found no connection between the vaccine and the autoimmune complaints.


title: Lyme disease

text: Despite the lack of evidence that the complaints were caused by the vaccine, sales plummeted and LYMErix was withdrawn from the U.S. market by GlaxoSmithKline in February 2002, in the setting of negative media coverage and fears of vaccine side effects. The fate of LYMErix was described in the medical literature as a "cautionary tale"; an editorial in "Nature" cited the withdrawal of LYMErix as an instance in which "unfounded public fears place pressures on vaccine developers that go beyond reasonable safety considerations." The original developer of the OspA vaccine at the Max Planck Institute told "Nature": "This just shows how irrational the world can be ... There was no scientific justification for the first OspA vaccine LYMErix being pulled."


title: Lyme disease

text: The hexavalent (OspA) protein subunit-based vaccine candidate VLA15 was developed by Valneva. It was granted fast track designation by the U.S. Food and Drug Administration in July 2017. In April 2020 Pfizer paid $130 million for the rights to the vaccine, and the companies are developing it together, performing multiple phase 2 trials.


title: Lyme disease

text: A phase 3 trial of VLA15 was scheduled for late 2022, recruiting volunteers at test sites located across the northeastern United States and in Europe. Participants were scheduled to receive an initial three-dose series of vaccines over the course of five to nine months, followed by a booster dose after twelve months, with both the initial series and the booster dose scheduled to be complete before the year's peak Lyme disease season.