title: Geographic Expansion of Lyme Disease in the Southeastern United States, 2000-2014.
abstract: Background.  The majority of Lyme disease cases in the United States are acquired on the east coast between northern Virginia and New England. In recent years the geographic extent of Lyme disease has been expanding, raising the prospect of Lyme disease becoming endemic in the southeast. Methods.  We collected confirmed and probable cases of Lyme disease from 2000 through 2014 from the Virginia Department of Health and North Carolina Department of Public Health and entered them in a geographic information system. We performed spatial and spatiotemporal cluster analyses to characterize Lyme disease expansion. Results.  There was a marked increase in Lyme disease cases in Virginia, particularly from 2007 onwards. Northern Virginia experienced intensification and geographic expansion of Lyme disease cases. The most notable area of expansion was to the southwest along the Appalachian Mountains with development of a new disease cluster in the southern Virginia mountain region. Conclusions.  The geographic distribution of Lyme 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.
authors.affiliation: Divisions of Pediatric Infectious Diseases ; General Internal Medicine.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Lantos
authors.affiliation: Division of Emergency Medicine , Boston Children's Hospital , Massachusetts.
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
authors.affiliation: Division of Infectious Diseases , Johns Hopkins Medical Institutions , Baltimore, Maryland.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Auwaerter
authors.affiliation: Infectious Diseases , Duke University School of Medicine , Durham, North Carolina.
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
authors.affiliation: Infectious Diseases , Duke University School of Medicine , Durham, North Carolina.
authors.forename: Felicia
authors.initials: F
authors.lastname: Ruffin
authors.affiliation: Department of Biology , University of Richmond , Virginia ; University of KwaZulu-Natal , Westville , South Africa.
authors.forename: R Jory
authors.initials: RJ
authors.lastname: Brinkerhoff
authors.affiliation: North Carolina Department of Public Health, Raleigh.
authors.forename: Jodi
authors.initials: J
authors.lastname: Reber
authors.affiliation: North Carolina Department of Public Health, Raleigh.
authors.forename: Carl
authors.initials: C
authors.lastname: Williams
authors.affiliation: Virginia Department of Health, Richmond.
authors.forename: James
authors.initials: J
authors.lastname: Broyhill
authors.affiliation: Duke Global Health Institute ; Nicholas School of the Environment , Duke University , Durham, North Carolina.
authors.forename: William K
authors.initials: WK
authors.lastname: Pan
authors.affiliation: Virginia Department of Health, Richmond.
authors.forename: David N
authors.initials: DN
authors.lastname: Gaines
keywords: GIS; Lyme disease; North Carolina; Virginia; epidemiology