Key Objectives:
- Describe current challenges surrounding case-based Lyme disease surveillance
- Describe and discuss modified surveillance methodologies including estimation and sampling methods
- Discuss opportunities for changes and novel approaches to standard surveillance methods for Lyme disease among high incidence states
Brief Summary:
Lyme disease is a tickborne illness caused by infection with the spirochete Borrelia burgdorferi with approximately 30,000 cases reported to CDC each year. Over 95% of these cases occur in high-incidence states in the Northeast (Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia) and upper Midwest (Minnesota, Wisconsin). The number of reported cases in these high-incidence areas has created a burden on both the local and state health departments due to the overall volume of cases reported and the follow up of clinical manifestations required for laboratory reported cases to determine case classification. To address the surveillance burden and create more sustainable Lyme disease surveillance systems, some states and counties have modified the components of their systems (e.g., by dropping laboratory reporting), modified the number of laboratory reports that are investigated (e.g., investigating a sample of reports to generate an estimate), or altered reporting requirements (e.g., requiring only patients with erythema migrans to be reported). While increasing efficiency, this has undermined one of the purposes of making a disease nationally notifiable, which is to standardize case counting. Case-based reporting and investigation for surveillance, as well as the current Lyme disease case definition, should be reconsidered in light of the different objectives and disparate data collected by states, with an emphasis on reconsidering the reasons for making Lyme disease nationally notifiable.