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Lyme & Tick-Borne Diseases: An Increasing Health Risk in the U.S.

Open Access Government recently interviewed Paul Mead, Chief of the Lyme & Tick-Borne DiseasesBacterial Diseases Branch, Division of Vector-Borne Diseases, Centers for Disease Control & Prevention (CDC). The interview focuses on the increasing risk that Lyme & tick-borne diseases pose to health in the United States, and covers a number of important topics, including how bites from infected ticks pass pathogens to humans, symptoms that are associated with different tick-borne diseases, as well as steps that outdoor workers can take to prevent tick bites.

 


For More Information:

Read the interview on OpenAccessGovernment.org.

Read more about the spread of Lyme throughout the U.S.  




Review of Ticks Infesting Humans in the US

(Top-L) Adult Female deer tick, adult female dog tick.(Bottom-L) Adult female, adult male, and nymph lone star ticks. Credit J. Occi, PhD (cand.), Rutgers

Ticks and Tick-Borne Diseases, (Lars E.), published a review article “Tick species infesting humans in the United States” in November, 2022*.  The author presents data as a summary table for published records of bites, diseases, and infestations of ticks on humans in the United States (US) to date. The goal of this review is to present data for both native and recently established hard and soft tick species that have been reported on humans regarding the frequency that they have been observed. The author also states that this type of long-term data regarding human/tick encounters is lacking for the public at the national scale, and he provides guidance for future reporting to better track these encounters and the risks. * Version of Record 13 August 2022.

The author found published records that document 36 hard tick species (234,722 specimens) and 13 soft tick species (230 specimens) that have bitten or infested humans in the US to date. Data shows that the top 5 hard tick human encounters were with the blacklegged tick (Ixodes scapularis); the lone star tick (Amblyomma americanum); the American dog tick (Dermacentor variabilis); the western blacklegged tick, (Ixodes pacificus); and the Rocky Mountain wood tick (Dermacentor andersoni).

The most frequently recorded soft tick human encounters were with the spinose ear tick (Otobius megnini); and the pajaroello tick (Ornithodoros coriaceus).

Additional species of note documented by more than 250 encounters with humans included the woodchuck tick (Ixodes cookei); the Pacific Coast tick (Dermacentor occidentalis); the brown dog tick (Rhipicephalus sanguineus sensu lato); the winter tick (Dermacentor albipictus); and the Gulf Coast tick (Amblyomma maculatum).

Interestingly, some ticks widely believed to be “non-human biters” or “nidicolous” in behavior (staying close to the host nest or burrow), were reported from over 100 to over 200 instances, and are species that are known to be competent vectors of Borrelia burgdorferi s.s. bacteria. These ticks included Ixodes muris, Ixodes dentatus, Ixodes angustus, and Ixodes spinipalpis.

 


For More Information

Read Full Journal Article

Other LDA Articles that Relate




Study Confirms Heartland Virus in Lone Star Ticks in Georgia

Heartland Virus in Lone Star Ticks The report of a human death in Georgia from Heartland virus (HRTV) as well as confirmed white-tailed deer exposure to the tick-borne pathogen prompted researchers to collect samples of questing ticks in 2018–2019. The samples were taken from 26 sites near the areas where seropositive deer were captured, as well as the residence of the human patient.

The researchers processed a total of 9,294 Amblyomma Americanum (lone star) ticks in pools by virus isolation in Vero E6 cells and reverse transcription PCR. The positive pools went through whole-genome sequencing with three pools showing the presence of HRTV (minimum infection rate 0.46/1,000 ticks). Cell cultures found HRTV in two pools while none of the ticks tested positive for Bourbon virus. Among the samples, the genome sequencing for the three HRTV isolates exhibited a high degree of similarity, however, there were significant differences with formerly sequenced HRTV isolates.

HRTV was first detected in 2009 and since then approximately 40 more human cases of the disease have been discovered in Missouri, Kansas, Oklahoma, Arkansas, Iowa, Illinois, Tennessee, Indiana, and South Carolina, and, as this study confirms, Georgia. Most of these cases involved patients who had comorbidities and for many, their diseases were serious or deadly.

Studies showing seroprevalence in wildlife suggest an even wider distribution range of HRTV than those states with reported human disease cases. The researchers advise clinicians and those working in public health to be aware of this tick-borne pathogen as it emerges.

Read the study in the CDC’s Emerging Infectious Diseases journal.

Read more about Heartland virus.

Read more about lone star and other tick vectors.




Borrelia miyamotoi in the US

CDC Figure. Borrelia miyamotoi positivity rates in human-biting Ixodes scapularis and I. pacificus ticks, United States, 2013–2019. Gray shading indicates states in which B. miyamotoi was detected in human-biting ticks.

In a recent article published by the Centers for Disease Control (CDC), authors detected Borrelia miyamotoi in ticks from 19 states in the US. Investigators tested 39,198 ticks for B. miyamotoi that were submitted to the public tick testing program at the University of Massachusetts during May 2013–December 2019. All ticks tested were found on humans.

In Oregon and California, B. miyamotoi was found in Ixodes pacificus ticks. Throughout the Northeastern and Midwestern US, B. miyamotoi was detected in Ixodes scapularis ticks. No ticks carrying B. miyamotoi were detected south of Virginia. It was also found that Lyme disease bacterium was 19 times more prevalent than B. miyamotoi in the I. scapularis ticks. Of note, almost 60% of B. miyamotoi–positive I. scapularis ticks had concurrent infections.

Read the full article here

Read additional LDA articles on B. miyamotoi here




COVID Impacts on Lyme Disease Reporting

In a new study published by the CDC, Effects of COVID-19 Pandemic on Reported Lyme Disease, United States, 2020, authors describe how the impacts of COVID-19 might have influenced Lyme disease case reporting in 2020. Investigators explored 4 data sources to assess how the COVID-19 pandemic may have influenced reporting of Lyme disease cases in 2020. Surveys that were conducted indicate that residents in the United States spent more time in the outdoors in 2020 than in 2019, but that reports of tick bite–related ER visits and Lyme disease laboratory tests were fewer. Authors indicate that although outdoor exposures were higher, case reporting for Lyme disease in 2020 may have been “artificially reduced” due to changes in people’s medical care seeking behavior in response to the COVID-19 pandemic. Additionally, many health departments were limited in resources to investigate Lyme disease case reports in 2020 due to the increased workload created by the COVID-19 pandemic. 

Read the full text article here

Read more LDA articles on COVID here

 




Emergency Meeting Planned After Rise in Myocarditis Following Covid Vaccine

Increased cases of myocarditis and pericarditis have been reported in the United States after mRNA COVID-19 vaccination (Pfizer-BioNTech and Moderna) since April 2021, particularly in adolescents and young adults. These rates for ages 16-24 following a second dose are above what is expected. Myocarditis or pericarditis has now been verified in 226 people ages 30 and younger who have received an mRNA COVID-19 vaccine and Federal Health Officials are investigating reports of approximately 250 more cases. 

Due to this increase, the Advisory Committee on Immunization Practices (ACIP) is scheduled to hold an emergency meeting on June 18, 2021 to discuss myocarditis cases and the American Academy of Pediatrics (AAP) plans to closely monitor meeting.  However, at this time, there is no recommended change to vaccination of adolescents 12 and older.

Cases have been reported predominantly in young males 16 years of age and older, with onset of symptoms typically manifesting within several days after mRNA COVID-19 vaccination. Symptoms have more often occurred after the second dose of vaccine than the first dose. 

It is recommended by the CDC that clinicians consider myocarditis and pericarditis in patients who develop acute chest pain, shortness of breath or heart palpitations within a week after vaccination, and to report cases of myocarditis and/or pericarditis after COVID-19 vaccination to the Vaccine Adverse Event Reporting System. (VAERS).

Read full American Academy of Pediatrics article here.

Read more LDA Articles on COVID vaccine here.




Delayed CDC Lyme Final Lyme Case Numbers for 2019 Finally Released

Deer Tick Questing

Lyme Disease Association (LDA) Announces CDC’s 2019 Final Lyme Disease Reported Case Numbers:  The Centers for Disease Control & Prevention (CDC) has just released the 2019 final Lyme disease reported U.S. case numbers–34,945. CDC reported that cases were ~4% more than in 2018, and the geographic distribution of areas with a high incidence of Lyme appears to be expanding based on data reported to National Notifiable Disease Surveillance System (NNDSS). The number of counties with an incidence of ≥10 confirmed cases per 100,000 persons increased from 324 in 2008 to 432 in 2019. 

Reporting Delay Explained  Final Lyme disease case numbers are usually reported in the fall of the next year (for 2019, should have been reported in 2020). The CDC has responded to LDA inquiries over time that reporting was delayed due to the pandemic and thus to shortages of resources/personnel at many government levels, which was no surprise to anyone following the numbers’ delay.  CDC also had a note on the reporting page that “Due to the coronavirus disease 2019 (COVID-19) pandemic, data from some jurisdictions may be incomplete.” 

Past Estimates of Underreporting  In the past,  CDC has reported that only 10% of cases are actually reported─ that translates into 349,450 actual new Lyme cases in the US in 2019.  However, in 2021, the CDC announced that  “A recently released estimate based on insurance records suggests that each year ~ 476,000 Americans are diagnosed & treated for Lyme disease(1,2). ” Prior Lyme estimates based on claims data had indicated “~300,000 people get Lyme disease  each year.”  It appears clear from the number of patients culled from insurance data as being diagnosed and treated annually for Lyme disease in the U.S. that cases are vastly under-reported. 

  1. Schwartz AM, Kugeler KJ, Nelson CA, et al. Use of Commercial Claims Data for Evaluating Trends in Lyme Disease Diagnoses, United States, 2010-2018Emerg Infect Dis. 2021;27(2).
  2. Kugeler KJ, Schwartz AM, Delorey M, et al. Estimating the frequency of Lyme disease diagnoses —United States, 2010-2018Emerg Infect Dis. 2021;27(2).

LDA NOTE: The State of Hawaii does not require reporting of Lyme disease. The State of New York estimates the Lyme numbers in many counties and those numbers are not permitted to be entered into CDC reported case numbers. Massachusetts changed their reporting system and their numbers on paper have dramatically dropped in the past few years, moving them out of the top 15 states.  To see more states that have changed reporting of Lyme disease over time see  LDA Lyme Cases Map Page

Top 15 States  The LDA has ranked the top 15 states based on the CDC total reported Lyme case numbers for 2019 below. This ranking should not be construed to mean that other states do not have reported Lyme cases. They do have reported cases,  Click here for all states, but often patients cannot get diagnosed and/or treated in states that CDC considers “low incidence” states, because  doctors in low incidence states are often either afraid to diagnose Lyme or do not understand that surveillance criteria are not meant as diagnostic criteria.  Read about Diagnosis by Geography

LDA State Ranking by Reported CDC Lyme Cases

 State RankingReported CasesActual Cases (10x = actual cases)
1Pennsylvania899889980
2New York424342430
3New Jersey361936190
4Wisconsin217821780
5Maine216721670
6New Hampshire171017100
7Minnesota152815280
8Maryland141714170
9Connecticut123312330
10Virginia119911990
11Vermont106410640
12Rhode Island9719710
13West Virginia8858850
14Delaware6416410
15Ohio4674670




President's Blog
LDA President’s Blog – CDC Doctor Webinar: Help or Hindrance for Patients?

BACKGROUND During May Lyme Disease Awareness Month, many Lyme groups across the country promote awareness with different projects, programs, and activities to focus on Lyme disease when the Ixodes scapularis poppy seed sized nymph ticks begin feeding in earnest. When the CDC announced a webinar offering continuing education for health care providers for Lyme Awareness Month, some thought it would provide much needed education for doctors about the reality of Lyme disease for patients and what CDC could do to actually help. This assumption was a valid one. The 2nd HHS Tick-Borne Disease Working Group (WG) in its 2020 Report to Congress had a recommendation that CDC should develop such a curriculum with patient involvement. Federal agency arguments at the WG table said patients could not really be present in the development of such programs− too difficult to get patients incorporated into that aspect. But certainly, as the unanimously adopted recommendation reflected, “the final curriculum shall incorporate feedback from patients, clinicians, and research scientists with expertise/experience that represents diverse scientific and clinical experiences on the full spectrum of Lyme disease and other tick-borne diseases/conditions.” So did CDC solicit patient input for this online webinar? By its own admission when asked whether there was patient input at any level of this webinar, the answer was no, because it was a clinical educational tool. MY ASSESSMENT After watching this webinar, Lyme Disease Update and New Educational Tools, several times, I can honestly say any small benefit this conceivably could have had is clearly wiped out by the continued refusal of government to present the reality of Lyme disease. I saw no meaningful help for physicians nor for patients for their illness, and no information or new tools, only old, repackaged dogma.  Read below for details. CDC WEBINAR PRESENTER The webinar itself was presented by Grace Marx, MD, MPH, credentialed as a medical epidemiologist from Bacterial Branch, Division of Vector-Borne Diseases, CDC. No reflection on her personally, but further research online indicated she is board certified in internal medicine and infectious disease, and a member of the epidemiology intelligence service, credentials CDC did not seem inclined to mention in the webinar—despite bias in the latter two areas during the “Lyme Wars.” TRANSMISSION TIME Following CDC’s standard rhetoric, the webinar opening discusses that disease transmission occurs after an infected tick has been attached for at least 24 hours and most transmission occurs after 36 hours.  Instead of providing solid information that the longer a tick is attached, the greater the risk of infection, qualifiers were attached− often precluding doctors from making a timely Lyme diagnose and treatment.  These qualifiers are not supported by all peer review, especially studies that indicate Lyme bacteria are sometimes found in tick salivary glands at time of attachment. So the time necessary to move from the midgut to those glands (which provides the basis for the 36 hr. estimate) is not a factor.  No comment was made on attachment time for other tick-borne diseases—we know, however, there is no safe attachment time for a tick. DENYING LYME THROUGH GEOGRAPHY Stating that ~500,000 people annually are diagnosed and treated for Lyme, Dr. Marx then showed the map of Lyme’s geographic distribution, which only singles out 15 states in yellow — 95% of cases. The old adage, a picture is worth 1,000 words is often used in advertising to communicate ideas that in seconds convey the advertisers message which is, buy what I am selling, no time for the facts. Looking at this map quickly, a harried health care provider or anyone for that matter, can readily conclude Lyme is not a problem in other states. Tens of thousands of Lyme patients have been victims of that erroneous message and continue to be denied or have delayed diagnosis and treatment because of the false assumption that Lyme “doesn’t exist” in their state.  As pointed out by MyLymeData Patient Registry, 72% of patients see four or more physicians before diagnosis and 35% see more than 10. Much of that undoubtedly relates to diagnosis by geography, since patients in low incidence states are often forced to search everywhere in-state to find a doctor not afraid and willing to diagnose and treat Lyme but often end up traveling cross country to get help for their disease. The WG Access to Care 2020 Subcommittee, which I co-chaired, reported to the HHS WG that some of the states believed by CDC to be low incidence for Lyme have some of the highest numbers of insurance claims for Lyme. Citing a Wall Street Journal article featuring a Fair Health study which used a data base of 150 million privately insured individuals, the report indicated in 2016, North Carolina reported 32 Lyme cases to the CDC but made 88,539 health-care claims for a Lyme diagnosis. Also in the report, “in California in 2016, there were only 90 CDC surveillance cases, while Quest Diagnostics (which is just one of the seven most-used Lyme disease testing labs) reported 483 positive tests, and FAIR Health Data showed insurance claims in the state at close to 47,000, making California one of the top five highest states for Lyme disease insurance claims in the U.S.” Dr. Marx pointed out there are case reports in other states but most are travel related. Several years ago I provided CDC with their own reported case numbers over time from the “other than 15 states.” I asked CDC to provide me with data they had proving that most of these cases were travel related. The response: they did not have such data. On the 2nd Working Group, I tried to introduce a Recommendation to Congress that CDC go to the Council of State and Territorial Epidemiologists−who allegedly have control over surveillance criteria guidelines−and ask them to examine the validity of the “diagnosis by geography” portion of the Lyme surveillance criteria based on the inability of patients to get diagnosed due to it. CDC and other agencies at the WG table refused to agree to that reasonable request being put into a recommendation. The only conclusion I can come to is, government does not want Lyme disease to be found outside certain boundaries. They will do and have done everything in their power to prevent it from being found outside their proscriptive boundaries—turning their backs on patients who live there.  ONE DOSE OF DOXY SOLUTION Lyme disease prophylaxis was another topic included in the webinar. In order for a doctor to determine if prophylactic treatment should be used for a bite, 5 questions were listed:

  1. Where the tick bite occurred, are ticks likely to be infected with Borrelia burgdorferi? (Geography)
  2. Was tick removal within 72 hours?
  3. Was the tick body flat or engorged?
  4. Was it an Ixodes (blacklegged tick) tick?
  5. Is doxy safe for the person?

Regarding the above questions, many people, including some physicians, do not know what a flat vs. engorged tick looks like. I have even heard stories of doctors telling patients you cannot get Lyme disease from a big tick, which at times, turned out to be a partially engorged tick. Many scientists who work daily with ticks are reluctant to even identify a tick unless they see it physically, not from a picture, and now doctors are asked to identify ticks and determine engorgement. When I pointed out a fully engorged tick hanging from my mom’s leg in the hospital years ago, the doctor told me it was a mole. I was certainly surprised to find moles had 8 legs…. As to attachment time, most people remove a tick immediately upon finding it and have no idea how long it has been attached. The discussion of prophylaxis centered totally on one dose doxy. As I listened to this discussion, I could “see” the treating doctors and advocates cringing as I was at the CDC trying to justify using that protocol. Although they promote that protocol, Dr. Marx indicated CDC does not recommend tick testing for pathogens as a tool–results can lead to decisions about antibiotic treatment without conducive evidence of patient infection. Interesting statement, since arguments could be and have been made that current tests required by CDC don’t provide that evidence either.  Although there may be some downsides to tick testing, the only tool in CDC’s toolbox is the one dose of doxy protocol—based on a single human trial that did not conclude that single dose doxy could prevent Lyme disease only that it prevented an EM rash in a small group of people. Prescribing one dose of doxy may also interfere with any later testing results. One of the slides contained a link (I accessed after the webinar) entitled Guidance for Clinicians: Recommendations for Patients after a Tick Bite. There is a graphic for tick removal then a statement saying “Save the tick for species ID and degree of tick engorgement (important when determining eligibility for Lyme disease prophylaxis).”  Under that is “Post- exposure prophylaxis for Lyme disease,” the circumstances explaining when a single dose of doxy can lower the risk of Lyme disease– if:

  • the bite occurred in a high incidence state [only map with 15 states highlighted is shown] or in an area where >20% of ticks are infected with Bb—consult your local health department for details
  • the tick can be identified based on adult or nymph blacklegged tick
  • the estimated attachment time >36 hours based on degree of engorgement
  • prophylaxis can be started within 72 hours
  • the patient has no contraindication to doxycycline.

Additionally included in the pdf is a ruler, conceivably for the doctor to judge the  size of engorged ticks based on feed time. Almost sounded to me like CDC does not really want to promote one dose doxy as prophylaxis. VACCINES Patients, advocates and doctors have been concerned that vaccine development has been the force behind refusal to develop safe and effective protocols to treat patients. It certainly has influenced Lyme disease testing protocols− almost the same protocols developed at the 1994 Dearborn conference exist today, with Western Blot banding requirements (“CDC bands”) for Lyme disease influenced by the then upcoming vaccines, especially LYMErix. Bands never changed even after LYMErix was pulled from the market by its manufacturer, citing poor sales. The CDC webinar described LYMErix vaccine as both safe and effective, stating it was pulled from the market but no mention of why.  Dr. Marx indicated up and coming vaccines could be available in the future. No mention was made of the one in current FDA trials having an Osp A base, yet many felt and still feel that an Osp A base contributed to problems of vaccine recipients that led to the manufacturer withdrawing the LYMErix vaccine. After 46 years of Lyme disease, the CDC and NIH do not yet know how to accurately diagnose Lyme or treat it successfully, especially when it has prolonged symptoms after 2 weeks of doxycycline.  Vaccines are certainly important tools when proven to be safe and effective and when they have been developed by a transparent process not being run by the vested interests themselves. The CDC wants to have those vaccines at all costs—with billions made by manufacturers of new vaccines, even when there are potentially viable treatments in sight for Lyme but not being explored.  NIH is no different in that regard. RASH, TREATMENT, TESTING You can listen to the webinar sections yourself about the EM rash issue, treatment, and testing. Most are too painful for discussion here by me, but I mention two issues. So much emphasis is placed upon the rash in diagnosis, so rashes should have been explained and pictures shown not just with a central clearing (bull’s eye), but also without central clearing (not a bull’s eye).  On one of the testing slides, it said, “should patients be tested for Lyme disease: look at pretest probability.” Then, doctors should ask if patients have been in an area where Lyme is common, were likely exposed to ticks, and have symptoms characteristic of Lyme disease. If the answer to any of these questions is no, pretest probability is low, and testing is not advised. If all three answers are yes, moderate to high probability exists, and testing may be helpful depending on disease stage.  Based on that scenario, no testing for those in low incidence states for sure.   COINFECTIONS   Webinar co-infection advice is to talk to your local health department about them in your area. I personally ask that you please contact CDC if you do contact your health department and let CDC know how that advice works.  Since testing of ticks has not been undertaken in many states, and some coinfections are not known or even reportable, this advice can also be a deterrent to patients receiving proper diagnosis and treatment. NIH STUDIES The CDC cites only NIH studies of long-term antibiotic treatment and their conclusions which do not show benefit but can be harmful. No mention of recent research which indicates otherwise or of rebuttals to those studies. At the 2nd term HHS WG table, I fought tenaciously but successfully to keep in the 2020 Report to Congress papers/opinions which contradicted those NIH findings, as NIH and CDC battled to keep them out. HOW TO CARE FOR THOSE ON NOT RECOMMENDED TREATMENTS The slide 43 minutes in on “How I can care for my patients who are receiving treatments that are not recommended for Lyme disease,” will most likely be the last straw for many. Not recommended by whom? Clearly there are published guidelines that meet National Academy of Medicine (formerly IOM) specs that support clinical judgement in treatment of Lyme disease.  The first bullet of six is “to listen to the patient’s story,” the last bullet is to ‘evaluate the risk of Lyme disease and consider an alternate diagnosis.” This slide is accompanied by Dr. Marx’s commentary not on the slide, “the goal is to demonstrate empathy and compassion….” In my 37 years of Lyme advocacy, I haven’t seen that happen yet, and treatments are still withheld. BOTTOM LINE The non-inclusion of patient input into this webinar is probably a good thing after all. No self-respecting patient or advocate would want their names tied to this webinar, especially when they read the slide below—a slap in the face to the hundreds of thousands of patients whose lives have been saved or vastly improved with long term-treatment and to the brave physicians who put their practices on the line to help patients get better.

Post-Treatment Considerations (slide)

  • There is no proven treatment for post treatment symptoms:
    • Additional prolonged antibiotics have not been shown to improve long-term outcomes
  • Long term antibiotic therapy has the potential to cause serious side effects, including:
    • infectious diarrhea
    • antibiotic resistance
    • line associated infections

More than two courses of antibiotics are NOT recommended for the treatment of Lyme disease.

RESPONSIBILITY Who’s responsible for this decades-long Lyme fiasco?  The blame must be laid at the feet of an alliance of public health and some powerful medical “experts,” who have allowed cases to go from 9,908 reported in 1992, to an estimated 500,000 cases annually. While actively seeking to build public trust with the LymeX public-private partnership, public health has not even lived up to its commitment to recommendations they supported on the WG, like CDC including patient input into educational programs.  Yet they court the public/advocates so there will be funds allocated to government agencies to ostensibly provide help to patients. Then they use our public dollars to deny many patients the ability to get early diagnosis and appropriate treatment. Disingenuous? With so many lives at stake, that word seems too kind.

Click here for CDC slides and for a video of the webinar

Click here for Tick-Borne Disease Working Group 2020 Report to Congress

Click here for Pat Smith’s minority response: Effect of Geographic Restrictions on Lyme Diagnosis

 

 

 

 

       




COCA/CDC Lyme Disease Conference Call – May 20th, 2020

The Clinician Outreach and Communication Activity (COCA)/Center for Disease Control is offering a conference call on May 20th, 2020: Lyme Disease Updates and New Educational Tools for Clinicians from 2:00–3:00 P.M. ET.  See right side of page for instructions on how to join the call via zoom or phone. Advanced registration is not required.

During this COCA Call, presenters will review updates in Lyme disease epidemiology, diagnosis, treatment, and prevention and share new educational tools for both healthcare providers and their patients.

Presenters include Grace Marx, MD, MPH –LCDR, U.S. Public Health Service
Medical Epidemiologist, Bacterial Diseases Branch, Division of Vector-Borne Diseases, CDC

Free Continuing Education (CE) credits can be earned for this call, even if you cannot participate live. Click here for info on CE for COCA calls/webinars

Click here for information on the call: Lyme Disease Updates and New Educational Tools for Clinicians

Click here to view prior COCA calls/webinars

Click here for Post-Webinar Analysis by LDA


COCA provides clinicians with the most up to date information and guidance from the Center for Disease Control (CDC) regarding emergency preparedness and response and emerging public health threats.




Surveillance of Babesiosis in the US

New study summarizes human surveillance data from 2011-2018 in the United States for Babesia infections reported to the Centers for Disease Control and Prevention (CDC) through the National Notifiable Diseases Surveillance System (NNDSS). Data shows an increasing trend of reported Babesia cases (14,159 total) during this time period, with white men in the middle and elderly age groups most affected. Data also shows that the New England and the Mid-Atlantic regions of the US reported highest numbers of Babesia cases. 

Access to full article can be found here

Read more LDA articles on Babesia here.