Citing poor sales, the only approved Lyme disease vaccine, LYMErix, was pulled from the shelves this winter by manufacturer GlaxoSmithKline, leaving health officials in a quandary as the tiny deer ticks, infamous for the disease that they carry. Alfred DeMaria, director of communicable diseases for the state of Massachusetts, said the threat is no longer just restricted to a few regions, but the whole state is now at risk. Massachusetts is one of eight states located in the Northeastern United States that accounts for at least 90 percent of the Lyme disease cases nationwide every year. LYMErix is the only vaccine against Lyme disease, approved for use by the Food and Drug Administration (FDA) in 1998; however, some people said it caused lasting side affects including arthritis and nerve injuries. The FDA last year conducted an inquiry into 905 adverse events reports involving the vaccine, and it concluded that most of the cases were consistent with the adverse effects noted during clinical testing. The agency said that further studies were needed of the vaccine users who developed arthritis or facial paralysis.