PACVS vs Lyme disease: symptoms, biomarkers, trials and research
A data-driven comparison of Post-Acute COVID-19 Vaccination Syndrome (PACVS) and Lyme Disease built from the Open Source Medicine Foundation biomarker atlases, PubMed literature feeds, ClinicalTrials.gov registry extract and post-acute infection syndrome (PAIS) cohort database.
Both conditions sit at the contested edge of medicine: persistent symptoms after a treated bacterial infection on one side and after vaccination on the other. Each has an established trigger but no accepted biomarker for the chronic phase.
What each condition is
Post-Acute COVID-19 Vaccination Syndrome
Also known as: PCVS, Post-Vac Syndrome, Post-vaccination syndrome
PACVS (also written PCVS or post-vac syndrome) refers to persistent, Long COVID-like symptoms that begin shortly after SARS-CoV-2 vaccination and last for months in a small subset of recipients. It is not a recognised diagnostic entity in most countries and is defined differently across the handful of registry and survey cohorts that exist (Marburg, Yale LISTEN, VITAE). Research is early-stage: the literature is small, the biomarker evidence comes mainly from case series, and only a few interventional studies are registered.
Atlas scope: Molecular, serologic, immunologic, and functional alterations reported in Post-Acute COVID-19 Vaccination Syndrome (PACVS) — persistent symptoms following SARS-CoV-2 vaccination — from PACVS/PCVS primary studies and post-vaccination adverse-event literature.
OSMF resources: biomarker atlas · literature feed
Lyme Disease
Also known as: Lyme borreliosis, Borrelia burgdorferi infection, Post-treatment Lyme disease syndrome (PTLDS), Chronic Lyme
Lyme disease is a tick-borne bacterial infection caused by Borrelia burgdorferi and related species. Early disease is diagnosed by the erythema migrans rash and two-tier serology, and treated with antibiotics. A minority of treated patients develop post-treatment Lyme disease syndrome (PTLDS): fatigue, musculoskeletal pain and cognitive symptoms lasting six months or longer. The OSMF literature feed for this condition focuses on the chronic and post-treatment phase, while the biomarker atlas spans acute serology through neuroborreliosis and persistent-symptom phenotypes.
Atlas scope: Serologic, cerebrospinal fluid, molecular, and inflammatory biomarkers in Borrelia burgdorferi infection — from early localized disease through disseminated, neuroborreliosis, and post-treatment persistent symptom phenotypes.
OSMF resources: biomarker atlas · literature feed
Side-by-side summary
| Measure | PACVS | Lyme disease |
|---|---|---|
| Biomarkers catalogued | 32 | 36 |
| Biomarker categories covered | autoimmune (8), functional (8), spike (4), molecular (4), metabolic (3), serologic (2), inflammatory (2), proteomic (1) | serologic (9), csf (6), inflammatory (6), molecular (4), coinfection (4), chronic (4), functional (3) |
| Markers with LOINC codes | 3 | 6 |
| Literature studies tracked | 15 | 75 |
| Most recent tracked study | 24 Sep 2026 | 05 Jul 2026 |
| Registered trials (all statuses) | 2 | 2 |
| Recruiting / not yet recruiting | 2 | 2 |
| Active, not recruiting | 0 | 0 |
| Completed | 0 | 0 |
| Terminated / withdrawn / suspended | 0 | 0 |
| Unknown status | 0 | 0 |
| Named cohorts in PAIS database | 4 | 1 |
| Therapeutic agents tracked | 7 | 8 |
Trial condition matching: PACVS uses keyword matching on registry condition and title fields; Lyme disease uses keyword matching on registry condition and title fields. Trials listing both conditions: 0.
Shared biomarkers (2)
Markers catalogued in both atlases, matched by normalised name or LOINC code. All shared markers are reported in the same direction in both atlases.
| Biomarker | Category | Direction in PACVS | Direction in Lyme disease | Matched by | Sources |
|---|---|---|---|---|---|
| IL-6 Interleukin-6 (IL-6) in Lyme disease | inflammatory | Increased vs HC | Increased vs HC | LOINC 26881-5 | Mundorf et al. 2024; Lantos et al. 2021 |
| Heart rate variability (HRV) Heart rate variability (PTLDS) in Lyme disease | functional / chronic | Decreased vs HC | Decreased vs HC | name | Mundorf et al. 2024; Aucott et al. 2014 |
Distinct biomarkers
Top 15 markers catalogued for one condition but not matched in the other. Full lists are on the PACVS atlas and the Lyme disease atlas.
Only in PACVS atlas (30)
- S1 in CD16+ monocytes Increased spike
- Circulating spike (post-mRNA myocarditis) Increased spike
- Spike in cutaneous lesions Increased spike
- Spike in neurological tissue Increased spike
- Anti-Spike (Anti-S) antibodies Increased serologic
- Anti-Nucleocapsid (Anti-N) antibodies Decreased serologic
- 2P proteotypic peptides (K986P/V987P) Increased molecular
- Wild-type viral spike peptides Decreased molecular
- BNT162b2 vaccine mRNA (qPCR) Mixed / conflicting molecular
- Vaccine mRNA (hybrid 3'UTR motifs) Mixed / conflicting molecular
- Anti-ACE2 autoantibodies Increased autoimmune
- Anti-AT1R (angiotensin II type 1 receptor) Increased autoimmune
- Anti-MAS1 receptor autoantibodies Increased autoimmune
- Anti-STAB1 autoantibodies Increased autoimmune
- Anti-ADRA2A (α2B adrenergic receptor) Decreased autoimmune
+15 more in the atlas.
Only in Lyme disease atlas (34)
- B. burgdorferi EIA (screening) Increased serologic
- IgG immunoblot (≥5 of 10 bands) Increased serologic
- IgM immunoblot (≥2 of 3 bands) Increased serologic
- C6 peptide ELISA (VisE) Increased serologic
- Anti-VlsE antibodies Increased serologic
- Anti-OspC antibodies Increased serologic
- Anti-OspA antibodies Increased serologic
- Anti-p41 (flagellin) antibodies Increased serologic
- CSF CXCL13 Increased csf
- CSF anti-Bb antibody index Increased csf
- CSF lymphocytic pleocytosis Increased csf
- CSF protein elevation Increased csf
- CSF oligoclonal bands Mixed / conflicting csf
- CSF glucose Mixed / conflicting csf
- Interleukin-10 (IL-10) Increased inflammatory
+19 more in the atlas.
Overlapping therapeutics under investigation (2)
Agents that appear in registered trials or the OSMF therapeutic-agent database for both PACVS and Lyme disease. Inclusion means an agent is being studied, not that it works.
- Intravenous Immunoglobulin (IVIG)
- N-Acetylcysteine (NAC)
Research cohorts
PACVS cohorts (4)
- Post-Vac-Syndrom Deutschland patient survey survey, n=777, biobank not_applicable
- VITAE vaccine-injury survey (Halma & Varon) survey, n=706, biobank not_applicable
- Yale LISTEN post-vaccination syndrome cohort (Krumholz) survey, n=241, biobank active
- PACVS registry cohort (Semmler/Mundorf) cross sectional, n=191, biobank unknown
Lyme disease cohorts (1)
- Johns Hopkins SLICE early-Lyme cohort (Aucott/Rebman) prospective inception, n=234, biobank active
Recent research
Latest PACVS studies
Latest Lyme disease studies
Frequently asked questions
Can you have both PACVS and Lyme disease?
They are not mutually exclusive. Both are diagnosed clinically, and a person can meet criteria for PACVS and Lyme disease at the same time. In the OSMF data the two conditions share 2 catalogued biomarkers, 0 registered trials list both conditions, and 0 cohorts in the PAIS database are relevant to both. Overlap in a dataset is not evidence that one condition causes the other.
How do the biomarker profiles differ?
PACVS has 32 catalogued markers, led by autoimmune (8), functional (8), spike (4). Lyme disease has 36, led by serologic (9), csf (6), inflammatory (6). 2 markers appear in both atlases, and all shared markers are reported in the same direction. Categories unique to PACVS: autoimmune, metabolic, proteomic, spike; unique to Lyme disease: chronic, coinfection, csf.
Which has more active clinical trials?
Both have 2 active or recruiting trials in the OSMF registry (registry snapshot 07 Oct 2026). Totals including completed, terminated and unknown-status studies are 2 for PACVS and 2 for Lyme disease. Condition matching for PACVS, Lyme disease relies on keyword matching of registry condition fields and may miss trials. Trial counts measure research attention, not treatment efficacy.
Which condition has more recent research?
OSMF tracks 15 recent PubMed-indexed studies for PACVS (latest 24 Sep 2026) and 75 for Lyme disease (latest 05 Jul 2026). The feeds hold a rolling window of recent publications, so they indicate current publication pace rather than lifetime output. See the PACVS feed and the Lyme disease feed for the full lists.
Are the same treatments being studied for both?
2 agents appear in the trial registry or therapeutic-agent database for both conditions, including Intravenous Immunoglobulin (IVIG), N-Acetylcysteine (NAC). All of these are investigational for these indications; none is an approved treatment for either condition. Overlap usually reflects shared hypotheses (immune modulation, autonomic support, antiviral or anti-inflammatory strategies) rather than demonstrated efficacy.
Which has larger research cohorts?
The PAIS cohort database lists 4 named cohorts for PACVS and 1 named cohort for Lyme disease, the largest being Post-Vac-Syndrom Deutschland patient survey (777 enrolled) and Johns Hopkins SLICE early-Lyme cohort (Aucott/Rebman) (234 enrolled). Cohorts with stored biospecimens and open external access are the most useful for cross-condition biomarker validation.
Related comparisons
Cite this page
@misc{osmf_pacvs_vs_lyme,
author = {Open Source Medicine Foundation},
title = {PACVS vs Lyme disease: symptoms, biomarkers, trials and research compared},
year = {2026},
howpublished = {\url{https://research.opensourcemed.info/compare/pacvs-vs-lyme.html}},
note = {Data as of 2026-10-07}
}Get OSMF research updates
New biomarker, trial and cohort data, summarised for patients and researchers.
Last updated 07 Oct 2026 (page build). Underlying data: literature feeds 07 Oct 2026 / 08 Jul 2026; trial registry 07 Oct 2026; atlases 30 Jun 2026 / 29 Jun 2026. Generated by scripts/build_compare_pages.py.