Ross Boyce, MD, MSc, assistant professor of infectious diseases and epidemiologist with the UNC Institute for Global Health and Infectious Diseases, led a study published in Lancet Regional Health that examined the rapid emergence of Lyme Disease in N.C., between 2010 and 2020.
Dr. Boyce says the results confirm what he has experienced clinically; specifically, an increasing number of cases occurring in the western part of the state. Because of that, he urges medical providers to be aware of common symptoms so that patients receive early treatment.
“Our analysis shows a substantial spread of Lyme Disease along the Blue Ridge Mountains and into northwestern North Carolina over the past decade. Greater awareness is needed among healthcare providers – many of whom trained at a time when Lyme was relatively uncommon in the state – so that patients who present with the symptoms common to the illness can be tested and treated in a timely manner.”
Lyme disease is the most common vector-borne disease in the U.S. with the majority of cases occurring in the Northeast, upper Midwest, and mid-Atlantic regions. While historically considered a low incidence state, North Carolina has reported an increasing number of cases over the past decade.
Lyme Disease can cause flu-like symptoms with aches and pains in muscles and joints, low-grade fever and chills, fatigue, poor appetite and swollen glands. The associated “bullseye” rash, known as erythema migrans, is a hallmark of the disease, but is not always present or noticed by the patient. If untreated, symptoms can progress to involve the joints, heart, and nervous system.
The study conducted with the UNC Gillings School of Global Public Health, the Carolina Population Center, the Division of Public Health, N.C. Department of Human Health and Services and Appalachian State University, found that Lyme disease has rapidly emerged in northwestern NC with some zip codes reporting incidence rates similar to historically high-incidence regions across the U.S. Northeast.
The analysis showed the greatest absolute change occurred in zip codes located in northwestern NC including Ashe, Alleghany, Buncombe, Mitchell, Watauga and Yancey counties. These findings are consistent with entomological studies showing an increase in the tick vector, the Deer or Black-Legged tick, moving down the southern Appalachian Mountains.
Boyce says that he anticipates continued spread of Lyme along the Blue Ridge Mountains, but he would also not be surprised by expansion into the Northern Piedmont region as well.
“I want to be careful with my language, but I don’t think it would be an exaggeration to call this an epidemic,” Boyce says, noting both the large number of cases and rapid pace of the changes. “Lyme is here and it’s not going to go away. We have a lot of work to do to educate and prepare providers, while also doing much more to raise awareness among the public.”
Funding was provided by a “Creativity Hub” award from the UNC Office of the Vice Chancellor for Research and the Southeastern Center of Excellence in Vector Borne Diseases.