Factors Associated with Incidence of Lyme Disease in North Carolina By Katherine S. Adams, William J. Taylor, Mark Moore, and Peter Ahiawodzi
Introduction Transmitted by Ixodes scapularis (blacklegged ticks), Lyme disease is a multisystem bacterial infection caused by the spiralshaped bacterium, Borrelia burgdorferi. First documented in 1975 as childhood arthritis, Lyme disease received its name from the small town of Lyme, Connecticut. According to the Centers for Disease Control and Prevention (CDC), Lyme disease is the most commonly reported vector-borne illness in the United States and the fifth most common Nationally Notifiable disease. (2) Recent inquiry suggests that Lyme disease is greater and more widespread across the nation than formerly assumed. According to a recent survey, blacklegged ticks are now discoverable in twice the number of counties as in 1998 (Appendix A). (3) More than 36,000 confirmed cases were reported nationally in 2013; however, the actual number of cases is predicted to be approximately 300,000 per year, costing the U.S. healthcare system between $712 million and $1.3 billion a year – or nearly $3,000 per patient on average. (3-5)
In 2014, 96% of confirmed Lyme disease cases were reported from the following 14 states: Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia and Wisconsin (Appendix B). (2) While most cases are located in the northeast and north central United States, in recent years, the geographical magnitude of disease has expanded raising the prospect that Lyme disease is becoming endemic in the southeast as well. (6) Some states have not always considered Lyme disease to be a serious health concern; therefore, not educating their residents on the possible repercussions of infection and recommended measures to prevent the onset of disease. Consequently, the state of North Carolina, sharing a sizeable boundary with Virginia (1 of the 14 states mentioned previously), has experienced a concerning increase in Lyme disease cases. The conclusions of a geographical study conducted by medical providers associated with Duke University Hospital revealed, “the geographic distribution of Lyme
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disease cases significantly expanded in Virginia between 2000 and 2014, particularly southward in the Virginia mountain ranges. If these trends continue, North Carolina can expect autochthonous Lyme disease transmission in its mountain region in the coming years.” (6) North Carolina reported 173 (39 confirmed and 134 probable) cases in 2013 and 601 (134 confirmed and 467 probable) cases during the 5-year period from 2009 to 2013.1 Four North Carolina counties were classified as endemic for Lyme disease in 2013: Alleghany, Haywood, Guilford and Wake (Appendix C). (1) For a county to be classified as endemic there must be at least two confirmed cases of Lyme disease acquired within the county or an established population of infected blacklegged ticks documented in the county. According to the CDC, 24 of the 173 cases of Lyme disease in 2013 were recorded in Wake County. (2) The number cases in Wake County is quite disturbing given it is one of the fastest growing areas in the nation and secondmost populous county in North Carolina with approximately 1,025,000 residents. (7)
Volume 99 Number 3 Summer 2018
