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More than 36,000 confirmed and probable Lyme disease cases were reported in the United States in 2013. The true number of cases is estimated to be approximately 300,000 per year.
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Cases are focused in 14 high-incidence states located in the Northeast and North Central United States; discrete areas of risk exist in Pacific Coast states. The number and geographic distribution of cases has been increasing steadily.
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Epidemiologic factors including local incidence should factor heavily when evaluating
Epidemiology of Lyme Disease
Section snippets
Key points
Risk factors
The risk of human infection with B burgdorferi is determined by the geographic distribution of vector tick species, local factors that increase or decrease tick abundance and rates of infection, and human behaviors that affect the likelihood of being bitten. In the Northeast where homes are often situated in heavily tick-infested areas, exposure is thought to occur primarily in the peridomestic environment immediately around the home.44, 45, 46, 47 In the North Central states, areas of highest
United States incidence
Lyme disease has been a nationally notifiable condition in the United States since 1991. Health care providers report cases to state or local health officials, who categorize reports according to standardized surveillance case definitions developed by the Council of State and Territorial Epidemiologists.73 Case definitions are revised periodically, as in 1996 to clarify laboratory criteria and again in 2008 to allow reporting of probable cases.74 Data for each state are shared with the Centers
Europe
Lyme borreliosis is widespread in Europe (Table 2). I ricinus is the principal vector and transmits all 3 major pathogenic genospecies. Populations of I ricinus are found throughout Western, Central, and Eastern Europe, generally at elevations less than 1300 m2. Rates of infection in adult ticks tend to be higher in Eastern as compared with Western Europe, and the relative frequency of infection with the different genospecies seems to vary across regions. Ticks collected in the northern and
Clinical correlation
Given the diverse and sometimes nonspecific clinical manifestations of B burgdorferi infection, clinicians must consider epidemiologic clues when evaluating patients with compatible signs or symptoms. In particular, the potential for exposure to infected ticks should be considered. As with other vector-borne diseases, Lyme disease is a disease of place, whose risk is geographically focal and curtailed by environmental factors. A patient’s whereabouts strongly influence the prior probability of
Discussion
Many factors interact to determine the epidemiology of Lyme disease in humans. These factors include the genospecies of B burgdorferi and its distribution in nature, the abundance and feeding habits of the vector tick species, and the demographic and behavioral characteristics of the exposed human population. Etiologic agents, principal vectors, and clinical manifestations vary by region, as does the underlying risk of infection. A detailed knowledge of Lyme disease epidemiology is clinically
Acknowledgments
The author thanks Anna Perea, Kiersten Kugeler, Alison Hinckley, Sarah Hook, and Mary Baxter for their comments and assistance.
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Disclaimer: The findings and conclusions in this article are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.