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)
2New York424342430
3New Jersey361936190
6New Hampshire171017100
12Rhode Island9719710
13West Virginia8858850

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. 

County-Level Distribution of Ixodes and Lyme Disease Spirochetes in US

This new summary article by employees of the CDC, presents the first county-level map of the distribution of Lyme disease spirochetes in host seeking Ixodes ticks between 2004-2019 in the contiguous United States. Data compiled for this summary was from literature searches; publicly available tick-borne pathogen surveillance databases (ArboNet Tick module); and internal CDC pathogen testing databases to map the county-level distribution of Lyme disease spirochetes reported in host-seeking Ixodes pacificus and Ixodes scapularis across the contiguous US. 

Investigators narrowed their search to include only host-seeking ticks, because ticks in this state are most likely to bite humans, and because host-seeking ticks provide enhanced spatial precision compared to ticks collected from mobile hosts. Data used was restricted to studies that collected ticks by flagging, dragging or CO2 Traps. Ticks that were collected from mobile hosts such as wildlife, pets, and livestock were excluded because county of exposure could not be confirmed. County level pathogen infection data was included from these sources when provided. 

Authors report B. burgdorferi s.s. infected I. scapularis from 384 counties in 26 eastern states of the Northeastern, North Central and Mid-Atlantic regions. B. burgdorferi s.s. infected I. pacificus were reported from 20 counties 2 western states, primarily from northern and north-coastal California. Borrelia mayonii was reported in I. scapularis in 10 counties in Minnesota and Wisconsin, where records of B. burgdorferi s.s. were also reported. 

Important caveats that the authors state in regard to this mapping effort:

  • The reported distribution of  B. burgdorferi s.s and B. mayonii in host seeking ticks is almost certainly an underestimate of the actual distribution of these disease agents.”
  •  “Though support for and participation in tick and tick-borne pathogen surveillance has increased in the US in recent years, collection and pathogen testing efforts have been limited with most efforts focused on US regions where Lyme disease cases are most commonly reported.” 
  • “In some instances, lack of records could represent lack of sampling effort or low prevalence of pathogens within sampled tick populations.” 

The authors were confident in the distribution of tick presence records, but for counties where Lyme disease spirochete has not been documented in ticks, they were unable to determine whether this represented a true absence of pathogen or a merely a failure to detect the pathogen. Lack of data is especially evident in the Rocky Mountain region, Western plains and Southwestern region in regard to both tick presence and pathogen detection; and in the Southeastern region and Western states for pathogen detection. Continued surveillance and reporting will likely result in additional counties to be added to the map, and reporting densities of infected host-seeking ticks for many jurisdictions may be possible in the future.

In comparison to a broad distribution of vector ticks, the resulting map shows a more limited distribution of Lyme disease spirochetes.

Reported distribution of Lyme disease spirochetes, B. burgdorferi s.s. and B. mayonii in host-seeking I. scapularis (eastern United States) or I. pacificus (western United States), relative to the previously reported distribution of these vector species. Ticks were considered present in a county if at least one tick was recorded (Eisen et al. [2016] or CDC [2020]). Counties where ticks have been reported without records of infection may be reported as such either if ticks were not tested or if the pathogen was not detected in tested samples.
LDA NOTE: Contained in the journal article: This work is written by (a) US Government employee(s) and is in the public domain in the US.


Read full article here
Amy C Fleshman, Christine B Graham, Sarah E Maes, Erik Foster, Rebecca J Eisen, Reported County-Level Distribution of Lyme Disease Spirochetes, Borrelia burgdorferi sensu stricto and Borrelia mayonii (Spirochaetales: Spirochaetaceae), in Host-Seeking Ixodes scapularis and Ixodes pacificus Ticks (Acari:Ixodidae) in the Contiguous United States, Journal of Medical Entomology, 2021;tjaa283, https://doi.org/10.1093/jme/tjaa283

Read Entomology Today Press Release here



New Estimates of People Diagnosed/Treated for Lyme: 476,000 Annually

Fig. 1: Prepared by LDA, Jan. 2021

476,000 People Diagnosed & Treated for Lyme Annually: The Centers for Disease Control and Prevention (CDC) published in the February edition of its Emerging Infectious Diseases two new papers pertaining to Lyme disease.

CDC states on its How Many People Get Lyme Disease? webpage (reviewed Jan 13, 2021), “A recently released estimate based on insurance records suggests that each year ~ 476,000 Americans are diagnosed & treated for Lyme disease.1,2  This number is likely an over-estimate of actual infections because patients are sometimes treated presumptively in medical practice. Regardless, this number indicates a large burden on the health care system and the need for more effective prevention measures.”

The researchers found ~ 476,000 people are diagnosed with and treated for Lyme disease each year in the U.S.  The prior Lyme estimates by CDC from 2005 to 2010 indicated “~300,000 people get Lyme disease  each year.”  Both estimates are based in part on insurance claim data.  Based on CDC’s estimates the LDA calculated a 59% increase in the estimated number of people diagnosed & treated for Lyme disease annually. (See Fig. 1)  

The CDC clearly states on its website, “It’s important to emphasize that 476,000 is the estimated number of people treated for Lyme disease and likely includes some patients who were not actually infected.”  Read the two papers below for their discussion on this new estimated number. 

The two 2021 research papers on which the new 476,000 estimate is based are:

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

The two research papers on which the prior 300,000 estimate was based are:


Fig. 2: New CDC Data Dashboard

CDC Creates New Tick-Bite Data Dashboard:  The CDC posted a new page, syndromic surveillance of emergency department visits for tick bites, to its website, last reviewed on January 4, 2021, showing tick bites by time, age/sex and region. (See Fig. 2)  

According to a CDC official, “Unlike some tickborne disease surveillance data, the data shown in the charts [on the above webpage] are updated weekly, rather than annually. These data can indicate when people in different parts of the country might be at highest risk for tick bites. We think this is the closest we have come to providing real-time risk data for tickborne diseases ….”  CDC also indicated they are working with data providers to make this type of data state-specific verse region-specific.

Syndromic surveillance is a term unfamiliar to the general public. In its September 2004 MMWR CDC describes syndromic surveillance, “Although syndromic surveillance was developed for early detection of a large-scale release of a biologic agent, current surveillance goals reach beyond terrorism preparedness. Medical-provider reporting remains critical for identifying unusual disease clusters or sentinel cases. Nevertheless, syndromic surveillance might help determine the size, spread, and tempo of an outbreak after it is detected (5), or provide reassurance that a large-scale outbreak is not occurring, particularly in times of enhanced surveillance (e.g., during a high-profile event). Finally, syndromic surveillance is beginning to be used to monitor disease trends, which is increasingly possible as longitudinal data are obtained and syndrome definitions refined. The fundamental objective of syndromic surveillance is to identify illness clusters early, before diagnoses are confirmed and reported to public health agencies, and to mobilize a rapid response, thereby reducing morbidity and mortality. Epidemic curves for persons with earliest symptom onset and those with severe illness can be depicted graphically …

Stakeholders need to understand the advantages and limitations of syndromic surveillance systems. Syndromic surveillance systems might enhance collaboration among public health agencies, health-care providers, information-system professionals, academic investigators, and industry. However, syndromic surveillance does not replace traditional public health surveillance, nor does it substitute for direct physician reporting of unusual or suspect cases of public health importance.”


Lyme Disease Association, Inc. (LDA) Response:  It is important that data surrounding Lyme and other tick-borne diseases be continuously collected and distributed to safeguard the health of the public.  Since the above material has just been released by the CDC, the LDA will review the material and comment further if necessary in the near future.


Click on Image to Watch CDC Video Tweet: The burden of Lyme disease in the U.S.








Other Links:

2016 Final Lyme Case Numbers: Wondering If Surveillance Can Get More Confusing?

LDA Maps for Lyme Cases

CDC Surveillance for Lyme Disease – US

Pike County Ticks Exceed PA State Average for Carrying Tick-Borne Diseases

Deer Tick Questing
Blacklegged Deer Tick (Ixodes scapularis)

The results of a study to collect ticks from Pike County, Pennsylvania, conducted by the Northeast Wildlife DNA Laboratory of East Stroudsburg University included real time PCR analysis of ticks countywide. The county was divided into 9 grids, each with several collection sites. The sites were based on use by community members and presence of favorable tick habitat and included: state parks, state game lands, township buildings, schools, township parks, communities and hiking trails.

All life stages of Ixodes scapularis ticks (deer tick) were collected, but only nymphs and adults were tested. Other tick species were collected and counted but were not tested for organisms. I. scapularis samples were tested for Borrelia burgdorferiBorrelia miyamotoiAnaplasma phagocytophilumBabesia microti, Bartonella species, Mycoplasma species, and Powassan Virus lineage ll.

Borrelia burgdorferi prevalence in I. scapularis ticks overall was 39%, with Bartonella spp. next with 18.5%. Percentages were significantly less for the other organisms tested.

Further publications by the University on this study are expected within the next few months.

The Centers for Disease Control & Prevention (CDC) recognizes that ticks carry Bartonella but does not believe there is evidence proving transmission to humans at this time.

In 2018, the Lyme Disease Association, Inc. awarded a grant to Pike County to help support this project.

News Report


CDC Nat’l Framework: Strategy for Vector-Borne Diseases Prevention & Control

First announced at the HHS Tick-Borne Disease Working Group’s (TBDWG) September 22 meeting, the Centers for Disease Control (CDC), in a Capitol Hill Announcement, presented plans to join with five federal departments and the Environmental Protection Agency in developing the National Public Health Framework for the Prevention and Control of Vector-Borne Diseases in Humans (Framework). The CDC acknowledges that over the past 15 years, the number of vector-borne disease cases has dramatically increased due to expanding vector ranges and the proliferation of emerging pathogens. The Framework will address Americans’ continually increasing risk for contracting vector-borne diseases, which are a growing public health threat that the U.S. has not sufficiently responded to.

National Public Health Framework for the Prevention and Control of Vector-Borne Diseases in Humans (CDC.gov)
Framework Schematic (CDC.gov)

Vision & Mission
The vision of the Framework is to achieve “a nation where vector-borne diseases are no longer a threat to human health and well-being” with a mission “to protect people from illness, suffering, and death due to vector-borne diseases” (CDC.gov).  The CDC’s website outlines the following goals of the federal alliance:

  • Better understand when, where, and how people are exposed to and get sick or die from vector-borne diseases
  • Develop, evaluate, and improve tools and guidance for the diagnosis and detection of vector-borne diseases
  • Develop, evaluate, and improve tools and guidance for the prevention and control of vector-borne diseases
  • Develop and assess drugs and treatment strategies for vector-borne diseases
  • Disseminate and support the implementation of effective public health and vector control products, tools, and programs to prevent, detect, diagnose, and respond to vector-borne disease threats – (CDC.gov)

Strategy & Stakeholders
The strategy, authorized by the Kay Hagan TICK Act of 2019, establishes priorities and lays a framework for critical vector-borne disease prevention and control activities. However, in their statement, the CDC acknowledges that the federal government cannot tackle the complex challenges presented by vector-borne diseases alone, and therefore outlines a multidisciplinary set of stakeholders including state, tribal, local, and territorial health departments; vector control agencies; healthcare providers; academic and industry partners; policy and decision-makers, including Congress and elected community leaders; public health partners, such as nonprofit organizations and associations of medical, entomological, and vector control professionals; and the public (including patients).

Participating Federal Agencies & Departments 
Other federal agencies and departments participating in the Framework include Food and Drug Administration (FDA), National Institutes of Health (NIH), Department of Defense (DOD), Department of Agriculture (USDA), and Department of The Interior (DOI).

The CDC’s brochure for the National Public Health Framework for the Prevention and Control of Vector-Borne Diseases in Humans states that, “To protect the nation and save lives, success depends on continued collaboration, support, leadership, and excellence in innovation and program implementation.”

Learn More About the Framework 
To learn more read the CDC’s brochure, A National Public Health Framework for the Prevention and Control of Vector-Borne Diseases in Humans from the CDC website.

Click here to review the National Framework fact sheet from the CDC website.

New Tick Repellent Ingredient Registered by EPA

Protecting children from biting insects with repellent.

On July 20, 2020, the Environmental Protection Agency (EPA) registered a new active ingredient called nootkatone, which repels and kill ticks, mosquitoes, and other pests including bed bugs, and fleas. The Center for Disease Control (CDC) discovered and developed the new ingredient, a non-toxic chemical found in Alaska yellow cedar trees and grapefruit skin in minute amounts. Nootkatone smells and tastes like grapefruit, and is used in the fragrance industry for perfumes and food industry for flavoring. It can be used on humans and pets.

Nootkatone apparently kills bugs differently than previous classes of insecticides, including pyrethroids, organophosphates, carbamates, and cyclodienes. Since it is a new chemical — the first insecticide approved in 11 years — it can kill bugs that are resistant to currently available pesticides. It lasts on skin and clothing for several hours.

CDC’s exclusively licensed partner, Evolva, and HHS Biomedical Advanced Research Development Authority were crucial to nootkatone development. Evolva can produce large amounts of nootkatone for low-cost, as it takes several tons of grapefruit to produce 2.2 lbs of nootkatone.

Dr. Brian Fallon, director of the Lyme and Tick-Borne Diseases Research Center at Columbia University in New York City, said of nootkatone, “I think it’s a major contribution to our arsenal of repellents.”(nbcnews.com)

Tick-borne diseases represent almost 80 percent of reported vector-borne disease cases in the U.S.  Reported cases of vector-borne diseases doubled from 2004 to 2018.  Companies interested to develop brand name products will be required to submit a registration package to EPA for review, and products could be available in stores as early as 2022.

Current ingredients registered by the EPA as skin-applied insect repellents include Catnip oil, Oil of citronella, DEET, IR 3535, p-Methane-3,8-diol (pmd), Oil of lemon eucalyptus, Picardin, 2-undecanone, and now nootkatone.

LDA’s Tick-Insect Repellents: Check the Facts
LDA’s TBD & Prevention Page

CDC Press release
CDC Digital Press Kit
NY Times:  Citrus Flavoring Is Weaponized Against Insect-Borne Diseases
Nbcnews.com: First new insect repellent approved in 11 years smells like grapefruit