Contributors to the Production of the MMWR (Weekly) Weekly Notifiable Disease Morbidity Data and 121 Cities Mortality Data Denise Koo, M.D., M.P.H. Deborah A. Adams Timothy M. Copeland Patsy A. Hall Carol M. Knowles Sarah H. Landis Myra A. Montalbano Graphics Support Sandra L. Ford Desktop Publishing Jolene W. Altman The Morbidity and Mortality Weekly Report (MMWR) Series is prepared by the Centers for Disease Contro and Prevention (CDC) and is available free of charge in electronic format and on a paid subscription basis for paper copy. To receive an electronic copy on Friday of each week, send an e-mail message to lists@list.cdc.gov. The body content should read subscribe mmwr-toc. Electronic copy also is available from CDC's World-Wide Web server at http://www.cdc.gov/ or from CDC's file transfer protocol server a ftp.cdc.gov. To subscribe for paper copy, contact Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402; telephone (202) 512-1800. Data in the weekly MMWR are provisional, based on weekly reports to CDC by state health departments The reporting week concludes at close of business on Friday; compiled data on a national basis are officiall released to the public on the following Friday. Address inquiries about the MMWR Series, including materia to be considered for publication, to: Editor, MMWR Series, Mailstop C-08, CDC, 1600 Clifton Rd., N.E., Atlanta GA 30333; telephone (404) 332-4555. All material in the MMWR Series is in the public domain and may be used and reprinted withou permission; citation as to source, however, is appreciated. Director, Centers for Disease Control and Prevention David Satcher, M.D., Ph.D. Deputy Director, Centers for Disease Control and Prevention Claire V. Broome, M.D. Director, Epidemiology Program Office Editor, MMWR Series Richard A. Goodman, M.D., M.P.H. Writers-Editors, MMWR (weekly) Darlene D. Rumph-Person ✩U.S. Government Printing Office: 1996-733-175/47008 Region IV Washington, D.C. 20402 SUPERINTENDENT OF DOCUMENTS UNITED STATES GOVERNMENT PRINTING OFFICE Penalty for Private Use, $300 OFFICIAL BUSINESS DEPOSITED BY UNITED STAYS DiseasERICAnited States, 1995 Lyme disease (LD) is caused by the tickborne spirochete Borrelia burgdorferi sensu lato. Surveillance for LD was initiated by CDC in 1982 and, during 1990, the Council of State and Territorial Epidemiologists designated LD as a nationally notifiable disease. For surveillance purposes, LD is defined as the presence of an erythema migrans rash ≥5 cm in diameter or laboratory confirmation of infection with objective evidence of musculoskeletal, neurologic, or cardiovascular disease (1). This report summarizes cases of LD reported by state health departments to CDC during 1995 and indicates that the number of reported cases declined slightly from 1994. In 1995, 11,603 cases of LD were reported to CDC by 43 states and the District of Columbia (overall incidence 4.4 per 100,000 population), the second highest annual number reported since 1982 but an 11% decrease from the 13,043 cases reported in 1994 (Figure 1). As in previous years, the highest numbers of cases were reported from the northeastern, north-central, and mid-Atlantic regions (Figure 2). Incidences >4.4 per 100,000 were reported by eight states, all in established LD-endemic regions (Connecticut [45.6], Rhode Island [34.9], New York [21.9], New Jersey [21.1], Pennsylvania [16.7], Maryland [9.2], Wisconsin [7.2], and Minnesota [5.8]); these states accounted for 10,640 (92%) of reported cases. In 1995, no LD cases were reported from Alaska, Colorado, Hawaii, Idaho, Montana, North Dakota, or South Dakota. Sixty-three counties each reporting ≥20 cases accounted for 78% of all reported cases. Reported incidences were >100 per 100,000 in 14 counties in Connecticut, Maryland, Massachusetts, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin; the highest reported incidence was in Nantucket County, Massachusetts (838.8) (Figure 3). Compared with 1994, the number of LD case reports in 1995 decreased by 113 (89%) in Georgia, 82 (77%) in Delaware, 76 (58%) in Virginia, 51 (52%) in Oklahoma, 49 (48%) in Missouri, 126 (27%) in Rhode Island, 537 (26%) in Connecticut, and 1222 (24%) in New York. Reported cases increased by 580 (40%) in Pennsylvania and by 61 (29%) in Minnesota. In the remaining states, numbers of reported cases remained stable. The highest proportions of cases occurred among persons aged 0-14 years (2760 [24%]) and adults aged 35-49 years (2797 [24%]). Of 11,504 cases for which sex was reported, 5811 (51%) were male. The University of Michigan U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES / Public Healthcuments Center Lyme Disease - Continued FIGURE 1. Number of reported Lyme disease cases, by year 1982-1995 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995* Year *Provisional data. Reported by: State health departments. Bacterial Zoonoses Br, Div of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, CDC. Editorial Note: The number of reported LD cases has increased steadily from 1982 through 1995, possibly reflecting increased recognition and reporting compliance and a true increase in incidence. The slight decline in the number of LD cases reported in 1995 from 1994 may have resulted from changes in these factors or a decrease in populations of Ixodes scapularis, the principal tick vector in the northeastern and north-central United States, as a result of variations in the environment. For example, light snowfall and dry spring conditions in Rhode Island during 1995 have been temporally associated with a 33% decline in the population of I. scapularis from 1994 (T. Mather, University of Rhode Island, Kingston, personal communication, 1996). Decreases in the number of reported LD cases in Georgia and Missouri may reflect 1) increased awareness among health-care providers that LD is not endemic in these states and 2) the possibility that some tickborne rashes may be related to another etiology. No cases in Missouri or the southern states have been confirmed by isolation of B. burgdorferi. An LD-like illness among some patients in Georgia and Missouri is characterized by a localized, expanding circular skin rash, similar to erythema migrans, and negative serology for B. burgdorferi (2). An uncultivable spirochete (B. lonestari sp. nov) identified in lone star ticks (Amblyomma americanum) collected |