Lyme disease surveillance summary volume 4, no. 3, June 1993
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      Surveillance for Lyme disease (LD) was initiated by CDC in 1982 (1), and in 1990, the Council of State and Territorial Epidemiologists (CSTE) approved a resolution making LD nationally reportable. During 1982-1991, states reported 40,195 cases of LD. In 1992, LD accounted for more than 90% of ail reported vector-borne illnesses in the United States (CDC, unpublished, 1993). This report summarizes surveillance for LD in the United States during 1991-1992. Forty-nine states and the District of Columbia require reporting of LD. The CSTE/CDC surveillance case definition requires the presence of an erythema migrans rash or at least one objective sign of musculoskeletal, neurologic, or cardiovascular disease and laboratory confirmation of infection (2). During 1991, 47 states reported 9465 cases of LD to CDC (3); during 1992, 45 states reported a provisional total of 9677 cases, representing a 19-fold increase over the 497 cases reported by 11 states in 1982 (1) (Figure 1). Most cases were reported from the northeastern, mid-Atlantic, north central, and Pacific coastal regions (Figure 2). Established enzootic cycles of Borrelia burgdorferi, the causative agent of LD, have been identified in 19 states; these states accounted for 94% of cases reported during 1991-1992. The overall incidence rate of reported LD during 1992 was 3.9 per 100,000 population. During 1992, Connecticut (53.6 cases per 100,000), Wisconsin (10.7), and California (0.8) reported the highest rates in the northeast, north central, and Pacific coastal regions, respectively. Rates in some counties in California, Connecticut, Massachusetts, New York, and Wisconsin exceeded 200 cases per 100,000; the incidence was highest in Nantucket County, Massachusetts (449.1). The number of reported cases in Connecticut and Rhode Island increased 48% and 93%, respectively, over 1991. New York reported a provisional total of 3370 confirmed cases during 1992, a decrease of 574 cases from 1991. From 1991 through 1992, decreases were greatest in Westchester (1762, compared with 1154) and Suffolk (860, compared with 654) counties. In 1992, these two counties accounted for 19% of the national total, compared with 28% in 1991.
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