Skip to Content

Is it a Lemon or a Lyme?

A Case Study on the Decision to Vaccinate or Not


Kate Rittenhouse-Olson
Department of Biotechnical and Clinical Laboratory Sciences
University at Buffalo


This dilemma case was designed for a junior level immunology course. It could also be used in a microbiology or bacteriology course where the emphasis is on treatment as well as disease. Although the case revolves around a particular microbe that causes Lyme disease, the central question is “Should a person get vaccinated given the associated risks and benefits?”  Students are assigned to one of five groups that cover the epidemiology, etiology and pathology, prevention and treatment, laboratory diagnosis, and vaccine for the disease; each group is given a question to research, which they then present on to the rest of the class.


  • Judge the relative risk of developing Lyme disease in various regions, at different times of the year, and with different activities.
  • Discuss the pathologies caused by the bacteria in Lyme disease.
  • Compare the signs and symptoms of the various stages of Lyme disease.
  • Describe the etiology of Lyme disease.
  • Evaluate appropriate treatment for patients with each stage of the disease and potential adverse side effects of treatment.
  • Describe laboratory assays, including PCR, Western blotting, enzyme immunoassays, and immunofluorescent assays.
  • Describe the vaccine protocol as well as the efficacy, risks, costs, and benefits of the vaccine.
  • Realize that health care decisions should be made after obtaining the knowledge needed to make an informed decision.


Lyme disease; vector-borne infectious disease; spirochete; spirochetal disease; bacteria; Borrelia burgdorferi; deer tick; Ixodes scapularis; Ixodes pacificus; insect; vaccine; vaccination; LYMErix

Topical Areas


Educational Level

Undergraduate lower division, Undergraduate upper division, Graduate, Public & informal education



Type / Methods

Dilemma/Decision, Problem-Based Learning, Student Presentations



Subject Headings

Epidemiology  |   Microbiology  |   Public Health  |  

Date Posted


Teaching Notes

Case teaching notes are password-protected and access to them is limited to paid subscribed instructors. To become a paid subscriber, begin the process by registering.

Teaching notes are intended to help teachers select and adopt a case. They typically include a summary of the case, teaching objectives, information about the intended audience, details about how the case may be taught, and a list of references and resources.


William Siebert
Science Department
Arlington High School
LaGrangeville, NY
Here in Dutchess County, NY (prime Lyme Disease territory), this provided a very useful and relevant first case in a "Contemporary Issues in Biology" course. I did the case pretty much as offered, with each group presenting the topic as a skit, video, or PowerPoint presentation with accompanying handout and bibliography. It was very well received.

I changed the scenario a bit to get more of a bioethics spin on it: "You are a parent who wishes to send a child to a summer camp. The summer camp requires proof of Lyme immunization. Will you have your child immunized or not?"

After all of the group presentations (each group gave a recommendation), I asked the students to make their decisions and give a reason. We then had an open discussion, after which they are asked to again make a decision and give the reason for it. I then changed the scenario slightly:

  • the camp is a music/sports camp and participation almost guarantees the attendees a full scholarship to a prestigious music/sports college program;
  • the camp is a computer camp, which will donate $5K worth of computer equipment to the sponsoring school district; or
  • you want to get rid of your kid for the summer so you and the spouse can go away and work on saving a failing marriage.

This tests to see how many students change their minds when they see other factors and values coming into play.

Some saw no ethical dilemma here until I explained that I know another public school biology teacher in upstate New York who had her children home-schooled rather than submit them to vaccinations on the basis of problems with animal testing, putting foreign substances into the body, etc. I also referred to a "Law and Order" episode on television where parents are charged with failure to get medical attention for their child on religious grounds. It didn't specifically relate to vaccinations, but the principle is the same. Upon hearing these, the students saw how some people could have an ethical problem with this.