Human Risk of Infection with Borrelia burgdorferi, the Lyme Disease Agent, in Eastern United States

Maria A. Diuk-Wasser Yale School of Public Health, New Haven, Connecticut; Michigan State University, East Lansing, Michigan; Institut National de la Recherche Agronomique, Saint Genès Champanelle, France; California State University, Monterey Bay, Seaside, California; University of California, Irvine, California; Centers for Disease Control and Prevention, Fort Collins, Colorado; Dartmouth Medical School, Lebanon, New Hampshire; University of Richmond, Richmond, Virginia; Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania; University of Nebraska, Lincoln, Nebraska; University of Tennessee, Knoxville, Tennessee; Vilnius University, Vilnius, Lithuania; Emory University, Atlanta, Georgia

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Anne Gatewood Hoen Yale School of Public Health, New Haven, Connecticut; Michigan State University, East Lansing, Michigan; Institut National de la Recherche Agronomique, Saint Genès Champanelle, France; California State University, Monterey Bay, Seaside, California; University of California, Irvine, California; Centers for Disease Control and Prevention, Fort Collins, Colorado; Dartmouth Medical School, Lebanon, New Hampshire; University of Richmond, Richmond, Virginia; Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania; University of Nebraska, Lincoln, Nebraska; University of Tennessee, Knoxville, Tennessee; Vilnius University, Vilnius, Lithuania; Emory University, Atlanta, Georgia

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Paul Cislo Yale School of Public Health, New Haven, Connecticut; Michigan State University, East Lansing, Michigan; Institut National de la Recherche Agronomique, Saint Genès Champanelle, France; California State University, Monterey Bay, Seaside, California; University of California, Irvine, California; Centers for Disease Control and Prevention, Fort Collins, Colorado; Dartmouth Medical School, Lebanon, New Hampshire; University of Richmond, Richmond, Virginia; Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania; University of Nebraska, Lincoln, Nebraska; University of Tennessee, Knoxville, Tennessee; Vilnius University, Vilnius, Lithuania; Emory University, Atlanta, Georgia

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Robert Brinkerhoff Yale School of Public Health, New Haven, Connecticut; Michigan State University, East Lansing, Michigan; Institut National de la Recherche Agronomique, Saint Genès Champanelle, France; California State University, Monterey Bay, Seaside, California; University of California, Irvine, California; Centers for Disease Control and Prevention, Fort Collins, Colorado; Dartmouth Medical School, Lebanon, New Hampshire; University of Richmond, Richmond, Virginia; Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania; University of Nebraska, Lincoln, Nebraska; University of Tennessee, Knoxville, Tennessee; Vilnius University, Vilnius, Lithuania; Emory University, Atlanta, Georgia

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Sarah A. Hamer Yale School of Public Health, New Haven, Connecticut; Michigan State University, East Lansing, Michigan; Institut National de la Recherche Agronomique, Saint Genès Champanelle, France; California State University, Monterey Bay, Seaside, California; University of California, Irvine, California; Centers for Disease Control and Prevention, Fort Collins, Colorado; Dartmouth Medical School, Lebanon, New Hampshire; University of Richmond, Richmond, Virginia; Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania; University of Nebraska, Lincoln, Nebraska; University of Tennessee, Knoxville, Tennessee; Vilnius University, Vilnius, Lithuania; Emory University, Atlanta, Georgia

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Michelle Rowland Yale School of Public Health, New Haven, Connecticut; Michigan State University, East Lansing, Michigan; Institut National de la Recherche Agronomique, Saint Genès Champanelle, France; California State University, Monterey Bay, Seaside, California; University of California, Irvine, California; Centers for Disease Control and Prevention, Fort Collins, Colorado; Dartmouth Medical School, Lebanon, New Hampshire; University of Richmond, Richmond, Virginia; Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania; University of Nebraska, Lincoln, Nebraska; University of Tennessee, Knoxville, Tennessee; Vilnius University, Vilnius, Lithuania; Emory University, Atlanta, Georgia

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Roberto Cortinas Yale School of Public Health, New Haven, Connecticut; Michigan State University, East Lansing, Michigan; Institut National de la Recherche Agronomique, Saint Genès Champanelle, France; California State University, Monterey Bay, Seaside, California; University of California, Irvine, California; Centers for Disease Control and Prevention, Fort Collins, Colorado; Dartmouth Medical School, Lebanon, New Hampshire; University of Richmond, Richmond, Virginia; Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania; University of Nebraska, Lincoln, Nebraska; University of Tennessee, Knoxville, Tennessee; Vilnius University, Vilnius, Lithuania; Emory University, Atlanta, Georgia

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Gwenaël Vourc'h Yale School of Public Health, New Haven, Connecticut; Michigan State University, East Lansing, Michigan; Institut National de la Recherche Agronomique, Saint Genès Champanelle, France; California State University, Monterey Bay, Seaside, California; University of California, Irvine, California; Centers for Disease Control and Prevention, Fort Collins, Colorado; Dartmouth Medical School, Lebanon, New Hampshire; University of Richmond, Richmond, Virginia; Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania; University of Nebraska, Lincoln, Nebraska; University of Tennessee, Knoxville, Tennessee; Vilnius University, Vilnius, Lithuania; Emory University, Atlanta, Georgia

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Forrest Melton Yale School of Public Health, New Haven, Connecticut; Michigan State University, East Lansing, Michigan; Institut National de la Recherche Agronomique, Saint Genès Champanelle, France; California State University, Monterey Bay, Seaside, California; University of California, Irvine, California; Centers for Disease Control and Prevention, Fort Collins, Colorado; Dartmouth Medical School, Lebanon, New Hampshire; University of Richmond, Richmond, Virginia; Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania; University of Nebraska, Lincoln, Nebraska; University of Tennessee, Knoxville, Tennessee; Vilnius University, Vilnius, Lithuania; Emory University, Atlanta, Georgia

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Graham J. Hickling Yale School of Public Health, New Haven, Connecticut; Michigan State University, East Lansing, Michigan; Institut National de la Recherche Agronomique, Saint Genès Champanelle, France; California State University, Monterey Bay, Seaside, California; University of California, Irvine, California; Centers for Disease Control and Prevention, Fort Collins, Colorado; Dartmouth Medical School, Lebanon, New Hampshire; University of Richmond, Richmond, Virginia; Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania; University of Nebraska, Lincoln, Nebraska; University of Tennessee, Knoxville, Tennessee; Vilnius University, Vilnius, Lithuania; Emory University, Atlanta, Georgia

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Jean I. Tsao Yale School of Public Health, New Haven, Connecticut; Michigan State University, East Lansing, Michigan; Institut National de la Recherche Agronomique, Saint Genès Champanelle, France; California State University, Monterey Bay, Seaside, California; University of California, Irvine, California; Centers for Disease Control and Prevention, Fort Collins, Colorado; Dartmouth Medical School, Lebanon, New Hampshire; University of Richmond, Richmond, Virginia; Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania; University of Nebraska, Lincoln, Nebraska; University of Tennessee, Knoxville, Tennessee; Vilnius University, Vilnius, Lithuania; Emory University, Atlanta, Georgia

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Jonas Bunikis Yale School of Public Health, New Haven, Connecticut; Michigan State University, East Lansing, Michigan; Institut National de la Recherche Agronomique, Saint Genès Champanelle, France; California State University, Monterey Bay, Seaside, California; University of California, Irvine, California; Centers for Disease Control and Prevention, Fort Collins, Colorado; Dartmouth Medical School, Lebanon, New Hampshire; University of Richmond, Richmond, Virginia; Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania; University of Nebraska, Lincoln, Nebraska; University of Tennessee, Knoxville, Tennessee; Vilnius University, Vilnius, Lithuania; Emory University, Atlanta, Georgia

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Alan G. Barbour Yale School of Public Health, New Haven, Connecticut; Michigan State University, East Lansing, Michigan; Institut National de la Recherche Agronomique, Saint Genès Champanelle, France; California State University, Monterey Bay, Seaside, California; University of California, Irvine, California; Centers for Disease Control and Prevention, Fort Collins, Colorado; Dartmouth Medical School, Lebanon, New Hampshire; University of Richmond, Richmond, Virginia; Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania; University of Nebraska, Lincoln, Nebraska; University of Tennessee, Knoxville, Tennessee; Vilnius University, Vilnius, Lithuania; Emory University, Atlanta, Georgia

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Uriel Kitron Yale School of Public Health, New Haven, Connecticut; Michigan State University, East Lansing, Michigan; Institut National de la Recherche Agronomique, Saint Genès Champanelle, France; California State University, Monterey Bay, Seaside, California; University of California, Irvine, California; Centers for Disease Control and Prevention, Fort Collins, Colorado; Dartmouth Medical School, Lebanon, New Hampshire; University of Richmond, Richmond, Virginia; Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania; University of Nebraska, Lincoln, Nebraska; University of Tennessee, Knoxville, Tennessee; Vilnius University, Vilnius, Lithuania; Emory University, Atlanta, Georgia

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Joseph Piesman Yale School of Public Health, New Haven, Connecticut; Michigan State University, East Lansing, Michigan; Institut National de la Recherche Agronomique, Saint Genès Champanelle, France; California State University, Monterey Bay, Seaside, California; University of California, Irvine, California; Centers for Disease Control and Prevention, Fort Collins, Colorado; Dartmouth Medical School, Lebanon, New Hampshire; University of Richmond, Richmond, Virginia; Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania; University of Nebraska, Lincoln, Nebraska; University of Tennessee, Knoxville, Tennessee; Vilnius University, Vilnius, Lithuania; Emory University, Atlanta, Georgia

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Durland Fish Yale School of Public Health, New Haven, Connecticut; Michigan State University, East Lansing, Michigan; Institut National de la Recherche Agronomique, Saint Genès Champanelle, France; California State University, Monterey Bay, Seaside, California; University of California, Irvine, California; Centers for Disease Control and Prevention, Fort Collins, Colorado; Dartmouth Medical School, Lebanon, New Hampshire; University of Richmond, Richmond, Virginia; Magee-Women's Hospital of UPMC, Pittsburgh, Pennsylvania; University of Nebraska, Lincoln, Nebraska; University of Tennessee, Knoxville, Tennessee; Vilnius University, Vilnius, Lithuania; Emory University, Atlanta, Georgia

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DOI:
https://doi.org/10.4269/ajtmh.2012.11-0395
Volume/Issue:
Volume 86: Issue 2
Page(s):
320–327
Restricted access
Get Permissions

The geographic pattern of human risk for infection with Borrelia burgdorferi sensu stricto, the tick-borne pathogen that causes Lyme disease, was mapped for the eastern United States. The map is based on standardized field sampling in 304 sites of the density of Ixodes scapularis host-seeking nymphs infected with B. burgdorferi, which is closely associated with human infection risk. Risk factors for the presence and density of infected nymphs were used to model a continuous 8 km×8 km resolution predictive surface of human risk, including confidence intervals for each pixel. Discontinuous Lyme disease risk foci were identified in the Northeast and upper Midwest, with a transitional zone including sites with uninfected I. scapularis populations. Given frequent under- and over-diagnoses of Lyme disease, this map could act as a tool to guide surveillance, control, and prevention efforts and act as a baseline for studies tracking the spread of infection.

Author Notes

*Address correspondence to Maria A. Diuk-Wasser, 60 College St., P.O. Box 208034, New Haven, CT 06520-8034. E-mail: maria.diuk@yale.edu

Financial support: This project was funded by CDC-Division of Vector-Borne Infectious Diseases Cooperative Agreement No. CI00171-01.

Authors' addresses: Maria A. Diuk-Wasser and Paul Cislo, Division of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, E-mails: maria.diuk@yale.edu and prcislo@juno.com. Anne Gatewood Hoen, Community and Family Medicine, Dartmouth Medical School, Lebanon, NH, E-mail: Anne.G.Hoen@dartmouth.edu. Robert Brinkerhoff, Biology Department, University of Richmond, Richmond, VA, E-mail: jbrinker@richmond.edu. Sarah A. Hamer and Jean I. Tsao, Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI, E-mails: hamer@msu.edu and tsao@msu.edu. Michelle Rowland, Magee-Women's Hospital of UPMC, Pittsburgh, PA, E-mail: rowlandmr@upmc.edu. Roberto Cortinas, Department of Entomology, University of Nebraska, Lincoln, NE, E-mail: rcortinas@unlnotes.unl.edu. Gwenaël Vourc'h, Institut National de la Recherche Agronomique, Saint Genès Champanelle, France, E-mail: gvourch@clermont.inra.fr. Forrest Melton, California State University, Monterey Bay, Seaside, CA, E-mail: Forrest.S.Melton@nasa.gov. Graham Hickling, Department of Forestry, Wildlife and Fisheries, University of Tennessee, Knoxville, TN, E-mail: ghicklin@utk.edu. Jonas Bunikis, Vilnius University, Vilnius, Lithuania, E-mail: Jonas.BUNIKIS@ec.europa.e. Alan G. Barbour, Department of Microbiology and Molecular Genetics, University of California, Irvine, CA, E-mail: abarbour@uci.edu. Uriel Kitron, Department of Environmental Studies, Emory University, Atlanta, GA, E-mail: ukitron@emory.edu. Joseph Piesman, Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, E-mail: jfp2@CDC.GOV.

Copyright:
©The American Society of Tropical Medicine and Hygiene 2012
Received:
21 Jun 2011
|
Accepted:
09 Oct 2011
|
Published Online:
01 Feb 2012
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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