April 2013 N.C. Dept. of Health & Human Services - Division of Public Health - Epidemiology Section - Communicable Disease Branch
http://ncdhhs.gov http://epi.publichealth.nc.gov/cd
Lyme Disease in North Carolina
Lyme disease is a
tick-borne illness caused by the bacterium Borrelia burgdorferi, which is spread by certain types of ticks in
North Carolina and many other states. Symptoms can be varied. Early symptoms of Lyme may occur 3 to 30
days following the bite of an infected tick and may include fatigue, chills, fever, headache, muscle and joint
aches, and swollen lymph nodes. About three out of four infected people also develop a unique rash called
erythema migrans. This non-painful rash can expand over a period of days to as large as 12 inches across, and
can resemble a bull’s eye or target (unlike a bump or redness that can occur at the site of a tick bite). If not
treated early, the infection can spread to a person’s joints, heart and nervous system. Most cases of Lyme
disease can be successfully treated with a few weeks of antibiotics.
During 2012, North Carolina reported 127 confirmed and probable cases of Lyme disease among 54 of the
state’s 100 counties. For the 5-year period from 2008 to 2012, the state reported 438 cases from 78 counties.
Human cases have been diagnosed year-round, with most cases occurring April through July. By the end of
2012, three counties in North Carolina – Haywood, Guilford and Wake – had been classified as endemic for
Lyme disease, meaning that two or more cases have been confirmed in each county and the patients’ travel
histories indicate that the infection was acquired in that county.
The blacklegged tick (Ixodes scapularis) is believed to be the primary vector (carrier) for Lyme disease in
North Carolina. Blacklegged ticks have been found statewide but are more plentiful in the eastern counties.
Although this tick is commonly referred to as the ‘deer
tick’ in other states, the name is misleading in North
Carolina, where blacklegged ticks are only one of many
species of ticks that feed on deer.
In North Carolina, adult blacklegged ticks are active on
warmer days during the winter months, October
through April. The adult ticks are slow-moving and
prefer large mammals as hosts, such as deer.
Encouraging deer and other wildlife in your yard is
also an invitation to blacklegged ticks.
The lifecycle of blacklegged ticks generally lasts two
years. During this time, they go through four life
stages: egg, six-legged larva, eight-legged nymph, and
adult. After the eggs hatch, the ticks must have a blood
meal at every stage to survive. The adults usually mate
on deer, and the females fill with blood before
dropping off to lay their eggs. Each female can lay upwards of 1,000 eggs, which usually hatch in the spring.
The nymphs are active during the summer months and are most likely to transmit disease. The nymphs’
small size and generally painless bite make prevention and detection especially important. When in areas
that may have blacklegged ticks, it is best to wear long pants and long-sleeved shirts, tuck pant legs into socks
and tuck shirt-tails into pants. Using tick repellents can add an additional layer of protection. Thorough tick
checks are especially important and should be done before and after showering. Pay particular attention to
the scalp, back and groin, using a mirror to check areas you cannot easily see. Prompt detection and removal
of ticks can help prevent disease from tick-borne illnesses, including Lyme disease. Blacklegged ticks are also
associated with anaplasmosis and babesiosis.
fact sheet, Making Sense
of Repellents,
the CDC’s web site at