FAQs about Lyme Disease in North Carolina
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of health and North Carolina
human services Public Health
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These Frequently Asked Questions are specific to the occurrence of Lyme disease in North Carolina. For
FAQs about Lyme disease in general, see the CDC’s Lyme disease FAOs (www.cdc.gov/lvme/faq~). For
more information on Lyme disease, see the N.C. DHHS Communicable Disease website at
http://epi.publichealth.nc.gov/cd/diseases/lvme.html and the CDC web site, www.cdc.gov/lyme.
Does Lyme disease occur in North Carolina?
Yes, Lyme disease does occur in North Carolina. In 2012, the state reported 127 cases of Lyme disease to
the CDC, 33 of which were classified as confirmed cases (confirmed by laboratory testing for surveillance
purposes).
Where in the state docs Lyme disease occur?
Since 2008, confirmed or probable cases have been reported from 78 counties across the state. Since
these reports are based on county of residence and not necessarily where the illness or tick bite was
acquired, we do not yet have a clear picture of where it is more likely to occur in North Carolina. Three
counties - Wake, Guilford and Haywood - have been declared endemic for Lyme disease for surveillance
purposes, because two or more people are known to have acquired Lyme disease in each of those
counties.
How does the reporting of diseases work in North Carolina?
Certain communicable diseases are required by law to be reported to the state (see
http://epi.publichealth.nc.gov/cd/reporl.html). Like other reportable diseases, reported cases of Lyme
disease are evaluated to see if they meet the national surveillance case definition for Lyme disease (see
http://epi.publichealth.nc.gov/cd/diseases/lyme.html). The reports are then categorized as confirmed,
probable, suspect, or not a case, based on those standards. Confirmed and probable cases that meet that
surveillance case definition are then reported to the CDC for inclusion in their national disease
surveillance statistics (see wwwn.cdc.gov/nndss). Disease reporting helps the state and CDC determine
which diseases pose a threat to the public’s health, and where to focus prevention activities and resources
to best protect people from those diseases.
What criteria must be met for a Lyme disease case to be defined as confirmed for surveillance
purposes?
Confirmation of cases of Lyme disease for surveillance purposes in North Carolina is based on the
national case definition (see wwwn.cdc.gov/nndss: search for “Lyme disease case definition”). Such
detailed standardized definitions provide uniform criteria for disease reporting, analysis and comparison
of surveillance data across the United States. The Lyme disease case definition is complex and involves
clinical descriptions (signs/symptoms), laboratory testing criteria, exposure criteria, endemicity
requirements, and definitions for classifying a case as suspected, probable or confirmed. It is updated
periodically to reflect new information or discoveries about the disease. Case definitions enable public
health to classify and count cases consistently across reporting jurisdictions, and should not be used by
healthcare providers to determine how to meet an individual patient’s health needs.
What is the difference between a clinical diagnosis and a surveillance diagnosis in North Carolina?
Being diagnosed with Lyme disease by your medical provider is not necessarily the same thing as
meeting the surveillance case definition. For medical management of cases, the 2006 IDSA (Infectious
Diseases Society of America) guidelines provide assistance in establishing a diagnosis of Lyme disease.1'1
These guidelines have been reinforced in subsequent publications and by a formal review.12'3'4'31 Clinical
signs and symptoms can manifest themselves progressively during an illness, so the use of additional
clinical, epidemiological and laboratory data may enable a physician to correctly diagnose a disease, even
though the formal surveillance case definition may not be met.161
April 2013 N.C Dept, of Health & Human Services - Division of Public Health - Epidemiology Section - Communicable Disease Branch Page 1 of 2
http://ncdhhs.gov http://epi.publichealth.nc.gov/cd