By Peggy Veroneau, MPH, RN
Contributors: Rachel Dildilian, MPS, RN, CIC, CRNI
Elizabeth Pantelick, MPH, RN, CIC
Marcia Robert, MPH, RN

Signs and symptoms of Lyme disease can mimic those associated with other illnesses, such as rheumatoid arthritis, multiple sclerosis, fibromyalgia and chronic fatigue syndrome — leading to misdiagnosis and inappropriate treatment. If treated early, recovery is usually quick and complete (U.S. DHHS, 1997). If left untreated, however, Lyme disease has potentially disabling and irreversible effects. Nurses can play a significant role in diminishing the effects of this disease through assessment, treatment and prevention education efforts.

Geographic Distribution

Since its recognition in 1975, Lyme disease has become the most common tick-borne infectious disease in the United States. Reported in at least 48 states, the disease has also been reported in parts of Europe, Russia and the republics of the former Soviet Union, the People's Republic of China and Japan (Willis, 1991). In the U.S., Lyme disease is most prevalent in the Northeast, particularly coastal areas from Massachusetts to Maryland; upper Midwest, especially Wisconsin and Minnesota; and the West, especially in Pacific coastal Northern California (Figure 1).

Figure 1:

Lyme disease became a nationally notifiable disease in 1990. The Centers for Disease Control and Prevention (CDC) adopted a uniform national case definition for surveillance purposes in 1991. (Figure 2).

Reporting of Lyme disease is now mandatory in all 50 states and accounts for more than 95 percent of all reports of vector-borne infectious diseases in the United States. Table 1 provides a breakdown of cases reported by state of residence, not necessarily state where exposure occurred.