Lyme disease, a complex and enigmatic spirochetal illness involving the skin, nervous system, heart, and joints, continues to challenge clinicians, scientists, and public health practitioners. In this issue of JAMA, White et al1 use both passive and active surveillance to describe the geographic and temporal spread of Lyme disease in New York State. The results of their investigation are cause for concern. In New York, which has logged more cases of Lyme disease than any other state, the number of reported cases has increased fourfold in the 4-year period from 1986 through 1989 as compared with 1982 through 1985, the number of designated Lyme disease—endemic counties has doubled (from four to eight) in the same period, and evidence is presented that the tick vector, Ixodes dammini, has expanded its geographic range. National surveillance data reveal similar trends. Eleven states reported 497 cases of Lyme disease to the Centers for
Dennis DT. Lyme DiseaseTracking an Epidemic. JAMA. 1991;266(9):1269–1270. doi:10.1001/jama.1991.03470090103042
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