In 1982, CDC initiated surveillance for Lyme disease (LD), and in 1990, the Council of State and Territorial Epidemiologists adopted a resolution making LD a nationally notifiable disease. This report summarizes surveillance data for LD in the United States during 1993.
LD is defined as the presence of an erythema migrans rash or at least one objective sign of musculoskeletal, neurologic, or cardiovascular disease and laboratory confirmation of infection.1 In 1993, 8185 cases of LD were reported to CDC by 44 state health departments, 1492 (15%) fewer cases than were reported in 1992 (9677). Most cases were reported from the northeastern, mid-Atlantic, north-central, and Pacific coastal regions. Six states (Alaska, Arizona, Colorado, Mississippi, Montana, and South Dakota) reported no LD cases. The overall incidence rate was 3.3 per 100,000 population. Eight states in established LD-endemic northeastern and upper northcentral regions reported rates of more than 3.3 per 100,000 (Connecticut,