Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 21, Number 8—August 2015

Geographic Distribution and Expansion of Human Lyme Disease, United States

Kiersten J. KugelerComments to Author , Grace M. Farley, Joseph D. Forrester, and Paul S. Mead
Author affiliations: Centers for Disease Control and Prevention, Fort Collins, Colorado, USA

Main Article


Data for United States counties with high incidence of human Lyme disease during four 5-year periods, 1993–2012*

Location, period No. counties Relative risk, range† Average annual incidence, range‡ No. counties added to high-incidence status No. counties removed from high- incidence status
1993–1997 69 2.3–91.1 10.6–402.7 NA NA
1998–2002 130 2.0–152.6 12.3–912.9 71 10
2003–2007 197 2.0–101.3 15.0–742.8 72 5
Northeastern focus
1993–1997 43 2.3–91.1 10.6–402.7 NA NA
1998–2002 90 2.0–152.6 12.3–912.9 50 3
2003–2007 130 2.0–101.3 15.0–742.8 45 5
North-central focus
1993–1997 22 2.6–41.3 12.1–189.6 NA NA
1998–2002 40 2.0–35.3 12.4–217.3 21 3
2003–2007 67 2.0–29.8 15.0–222.7 27 0
2008–2012 78 2.1–28.1 16.1–220.7 12 1

*In the first period, 4 counties in the southeastern United States met high-incidence criteria but are not included in the geographic focus–specific data. NA, not applicable.
†Relative risk is observed number of cases over a period divided by expected number of cases for the population at risk (4). For this analysis, high-incidence counties had a relative risk of >2.0.
‡Incidence is reported cases per 100,000 residents per year; population used was average population at risk during a period (US census data for midpoint of each period).

Main Article

  1. Stanek  G, Wormser  GP, Gray  J, Strle  F. Lyme borreliosis. Lancet. 2012;379:46173. DOIPubMedGoogle Scholar
  2. Steere  AC, Coburn  J, Glickstein  L. The emergence of Lyme disease. J Clin Invest. 2004;113:1093101. DOIPubMedGoogle Scholar
  3. Adams DA, Jajosky RA, Ajani U, Kriseman J, Sharp P, Onwen DH, et al. Summary of notifiable diseases—United States, 2012. MMWR Morb Mortal Wkly Rep. 2014;61:1121.PubMedGoogle Scholar
  4. National Notifiable Diseases Surveillance System (NNDSS). Lyme disease (Borrelia burgdorferi). Case definitions [cited 2014 Oct 20].
  5. Kulldorff  M. SaTScan: software for the spatial, temporal, and space-time scan statistics. 2011 [cited 2013 Mar15].
  6. Connally  NP, Ginsberg  HS, Mather  TN. Assessing peridomestic entomological factors as predictors for Lyme disease. J Vector Ecol. 2006;31:36470. DOIPubMedGoogle Scholar
  7. Pepin  KM, Eisen  RJ, Mead  PS, Piesman  J, Fish  D, Hoen  AG, Geographic variation in the relationship between human Lyme disease incidence and density of infected host-seeking Ixodes scapularis nymphs in the eastern United States. Am J Trop Med Hyg. 2012;86:106271. DOIPubMedGoogle Scholar
  8. Chen  H, White  DJ, Caraco  TB, Stratton  HH. Epidemic and spatial dynamics of Lyme disease in New York State, 1990–2000. J Med Entomol. 2005;42:899908.PubMedGoogle Scholar
  9. Frank  C, Fix  AD, Pena  CA, Strickland  GT. Mapping Lyme disease incidence for diagnostic and preventive decisions, Maryland. Emerg Infect Dis. 2002;8:4279. DOIPubMedGoogle Scholar
  10. Bacon  RM, Kugeler  KJ, Mead  PS. Surveillance for Lyme disease—United States, 1992–2006. MMWR Surveill Summ. 2008;57:19.PubMedGoogle Scholar
  11. Waller  LA, Goodwin  BJ, Wilson  ML, Ostfeld  RS, Marshall  SL, Hayes  EB. Spatio-temporal patterns in county-level incidence and reporting of Lyme disease in the northeastern United States, 1990–2000. Environ Ecol Stat. 2007;14:83100. DOIGoogle Scholar
  12. Kitron  U, Kazmierczak  J. Spatial analysis of the distribution of Lyme disease in Wisconsin. Am J Epidemiol. 1997;145:55866. DOIPubMedGoogle Scholar
  13. Eisen  RJ, Lane  RS, Fritz  CL, Eisen  L. Spatial patterns of Lyme disease risk in California based on disease incidence data and modeling of vector-tick exposure. Am J Trop Med Hyg. 2006;75:66976.PubMedGoogle Scholar
  14. Teutsch  SM, Churchill  RE, editors. Principles and practices of public health surveillance. 2nd ed. New York: Oxford; 2000.
  15. Wormser  GP, Masters  E, Nowakowski  J, McKenna  D, Holmgren  D, Ma  K, Prospective clinical evaluation of patients from Missouri and New York with erythema migrans-like skin lesions. Clin Infect Dis. 2005;41:95865. DOIPubMedGoogle Scholar

Main Article

Page created: May 11, 2016
Page updated: May 11, 2016
Page reviewed: May 11, 2016
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.