Geographic Expansion of Lyme Disease in the Southeastern United States, 2000-2014.


Background.  The majority of Lyme disease cases in the United States are acquired on the east coast between northern Virginia and New England. In recent years the geographic extent of Lyme disease has been expanding, raising the prospect of Lyme disease becoming endemic in the southeast. Methods.  We collected confirmed and probable cases of Lyme disease from 2000 through 2014 from the Virginia Department of Health and North Carolina Department of Public Health and entered them in a geographic information system. We performed spatial and spatiotemporal cluster analyses to characterize Lyme disease expansion. Results.  There was a marked increase in Lyme disease cases in Virginia, particularly from 2007 onwards. Northern Virginia experienced intensification and geographic expansion of Lyme disease cases. The most notable area of expansion was to the southwest along the Appalachian Mountains with development of a new disease cluster in the southern Virginia mountain region. Conclusions.  The geographic distribution of Lyme disease cases significantly expanded in Virginia between 2000 and 2014, particularly southward in the Virginia mountain ranges. If these trends continue, North Carolina can expect autochthonous Lyme disease transmission in its mountain region in the coming years.





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Publication Info

Lantos, Paul M, Lise E Nigrovic, Paul G Auwaerter, Vance G Fowler, Felicia Ruffin, R Jory Brinkerhoff, Jodi Reber, Carl Williams, et al. (2015). Geographic Expansion of Lyme Disease in the Southeastern United States, 2000-2014. Open Forum Infect Dis, 2(4). p. ofv143. 10.1093/ofid/ofv143 Retrieved from

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Paul Michael Lantos

Professor of Medicine

I am interested in the spatial epidemiology of infectious diseases. My research utilizes geographic information systems (GIS) and geostatistical analyses to understand the spatial and spatiotemporal distribution of diseases, and their relationship with environmental and demographic factors. I currently have active studies evaluating the spatial distribution of numerous domestic and international infectious diseases, including SARS-CoV-2 (COVID-19), cytomegalovirus, influenza, and Lyme disease. Additionally I am interested in maternal-child health, and I have a number of ongoing studies of neighborhood health disparities in obstetrical care and birth outcomes. I am interested in GIS education and have conducted workshops on public health GIS in Mongolia and China.


Vance Garrison Fowler

Florence McAlister Distinguished Professor of Medicine

Determinants of Outcome in Patients with Staphylococcus aureus Bacteremia
Antibacterial Resistance
Pathogenesis of Bacterial Infections
Tropical medicine/International Health


Felicia Ruffin

Research Program Leader, Tier 1

William Kuang-Yao Pan

Elizabeth Brooks Reid and Whitelaw Reid Associate Professor

William Pan, DrPH, Elizabeth Brooks Reid and Whitelaw Reid Professor of Population Studies and Global Environmental Health, joined the faculty at Duke in 2011. He holds a joint appointment at DGHI and the Nicholas School of Environment, and is Adjunct Professor in the Department of International Health at Johns Hopkins Bloomberg School of Public Health. He is a biostatistician with expertise in spatial analysis, demography land use science, infectious disease epidemiology and environmental health.  He has over 20-years of experience leading large, multi-institutional and interdisciplinary research teams to study the impact of human-environment dynamics influencing human health in low- and middle-income countries (LMICs).  His work is primarily focused in Latin America, particularly the Amazon region.  His current research focuses on: (1) studying the health effects of mercury and other chemical exposures from artisanal and small-scale gold mining (ASGM); (2) developing tools for forecasting vector-borne disease risk, focusing particularly on the integration and modeling of climate, land use, population and malaria surveillance data; (3) studying the role of migration and social network connectivity influencing infectious disease transmission; (4) understanding the risk of lead exposure among hunters and their families, and to identify solutions to mitigate that risk; and (5) evaluating multi-faceted benefits of nature-based solutions related to agroforestry, climate resilience, livelihoods, and disease mitigation.

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