{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T03:44:39Z","timestamp":1793159079810,"version":"4.5.0"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,7,13]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Tickborne disease cases account for over 75% of reported vector-borne disease cases in the United States each year. In addition to transmitting the agents of Lyme disease (Borrelia burgdorferi sensu strict [Spirochaetales: Spirochaetaceae] and Borrelia mayonii [Spirochaetales: Spirochaetaceae]), the blacklegged tick, Ixodes scapularis, and the western blacklegged tick, Ixodes pacificus collectively transmit five additional human pathogens. By mapping the distributions of tickborne pathogens in host-seeking ticks, we can understand where humans are at risk of contracting tickborne diseases and devise targeted strategies to prevent them. Using publicly available tickborne pathogen surveillance databases, internal CDC pathogen testing databases, and SCOPUS search records published since 2000, we mapped the county-level distribution of Borrelia miyamotoi (Spirochaetales: Spirochaetaceae), Anaplasma phagocytophilum (Rickettsiales: Anaplasmataceae), Ehrlichia muris eauclairensis (Rickettsiales: Ehrlichiaceae), Babesia microti (Piroplasmida: Babesiidae), and Powassan virus (Flaviviridae) reported in host-seeking I. scapularis or I. pacificus in the contiguous United States. We also updated recently published maps of the distributions of Borrelia burgdorferi sensu stricto and Borrelia mayonii. All seven pathogen distributions were more limited than the distributions of vector ticks, with at least one of the seven pathogens detected in 30 states out of 41 total states (73.2% of states) where vector ticks are considered to be established. Prevention and diagnosis of tickborne diseases rely on an accurate understanding by the public and health care providers of where people are at risk for exposure to infected ticks. Our county-level pathogen distribution maps expand on previous efforts showing the distribution of Lyme disease spirochetes and highlight counties where further investigation may be warranted.<\/jats:p>","DOI":"10.1093\/jme\/tjac049","type":"journal-article","created":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T12:24:18Z","timestamp":1652876658000},"page":"1328-1335","source":"Crossref","is-referenced-by-count":48,"title":["Reported County-Level Distribution of Seven Human Pathogens Detected in Host-Seeking <i>Ixodes scapularis<\/i> and <i>Ixodes pacificus<\/i> (Acari: Ixodidae) in the Contiguous United States"],"prefix":"10.1093","volume":"59","author":[{"given":"Amy C","family":"Fleshman","sequence":"first","affiliation":[{"name":"Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Fort Collins, CO, 80521 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7094-2747","authenticated-orcid":false,"given":"Erik","family":"Foster","sequence":"additional","affiliation":[{"name":"Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Fort Collins, CO, 80521 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah E","family":"Maes","sequence":"additional","affiliation":[{"name":"Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Fort Collins, CO, 80521 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5942-528X","authenticated-orcid":false,"given":"Rebecca J","family":"Eisen","sequence":"additional","affiliation":[{"name":"Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Fort Collins, CO, 80521 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,5,18]]},"reference":[{"key":"2022071317484771500_CIT0001","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1089\/vbz.2013.1475","article-title":"The prevalence of zoonotic tick-borne pathogens in Ixodes scapularis collected in the Hudson Valley, New York State","volume":"14","author":"Aliota","year":"2014","journal-title":"Vector Borne Zoonotic Dis"},{"key":"2022071317484771500_CIT0002","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.1016\/j.ttbdis.2018.07.006","article-title":"Transmission of the relapsing fever spirochete, Borrelia miyamotoi, by single transovarially-infected larval Ixodes scapularis ticks","volume":"9","author":"Breuner","year":"2018","journal-title":"Ticks Tick. Borne. Dis"},{"key":"2022071317484771500_CIT0003","author":"CDC","year":"2017"},{"key":"2022071317484771500_CIT0004","author":"CDC","year":"2018"},{"key":"2022071317484771500_CIT0005","author":"CDC","year":"2021"},{"key":"2022071317484771500_CIT0006","author":"CDC","year":"2021"},{"key":"2022071317484771500_CIT0007","author":"CDC","year":"2021"},{"key":"2022071317484771500_CIT0008","author":"CDC","year":"2021"},{"key":"2022071317484771500_CIT0009","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1128\/JCM.37.3.558-564.1999","article-title":"Serologic testing for human granulocytic ehrlichiosis at a national referral center","volume":"37","author":"Comer","year":"1999","journal-title":"J. Clin. Microbiol"},{"key":"2022071317484771500_CIT0010","doi-asserted-by":"crossref","first-page":"536","DOI":"10.4269\/ajtmh.1996.55.536","article-title":"Experimental transmission of Powassan virus (Flaviviridae) by Ixodes scapularis ticks (Acari:Ixodidae)","volume":"55","author":"Costero","year":"1996","journal-title":"Am. J. Trop. Med. Hyg"},{"key":"2022071317484771500_CIT0011","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1128\/JCM.41.4.1569-1573.2003","article-title":"Molecular characterization of Anaplasma phagocytophilum and Borrelia burgdorferi in Ixodes scapularis ticks from Pennsylvania","volume":"41","author":"Courtney","year":"2003","journal-title":"J. Clin. Microbiol"},{"key":"2022071317484771500_CIT0012","doi-asserted-by":"crossref","first-page":"1678","DOI":"10.3201\/eid2010.131583","article-title":"Prevalence of Borrelia miyamotoi in Ixodes ticks in Europe and the United States","volume":"20","author":"Crowder","year":"2014","journal-title":"Emerg. Infect. Dis"},{"key":"2022071317484771500_CIT0013","doi-asserted-by":"crossref","first-page":"299","DOI":"10.4269\/ajtmh.15-0691","article-title":"Undetermined human ehrlichiosis and anaplasmosis in the United States, 2008\u20132012: a catch-all for passive surveillance","volume":"94","author":"Dahlgren","year":"2016","journal-title":"Am. J. Trop. Med. Hyg"},{"key":"2022071317484771500_CIT0014","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1093\/jmedent\/35.5.629","article-title":"Forum: reported distribution of Ixodes scapularis and Ixodes pacificus (Acari: Ixodidae) in the United States","volume":"35","author":"Dennis","year":"1998","journal-title":"J. Med. Entomol"},{"key":"2022071317484771500_CIT0015","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.pt.2015.09.008","article-title":"Coinfection by Ixodes tick-borne pathogens: ecological, epidemiological, and clinical consequences","volume":"32","author":"Diuk-Wasser","year":"2016","journal-title":"Trends Parasitol"},{"key":"2022071317484771500_CIT0016","doi-asserted-by":"crossref","first-page":"e115494","DOI":"10.1371\/journal.pone.0115494","article-title":"Borrelia burgdorferi promotes the establishment of Babesia microti in the northeastern United States","volume":"9","author":"Dunn","year":"2014","journal-title":"PLoS One"},{"key":"2022071317484771500_CIT0017","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.pt.2017.12.006","article-title":"The blacklegged tick, Ixodes scapularis: an increasing public health concern","volume":"34","author":"Eisen","year":"2018","journal-title":"Trends Parasitol"},{"key":"2022071317484771500_CIT0018","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/jme\/tjv237","article-title":"County-scale distribution of Ixodes scapularis and Ixodes pacificus (Acari: Ixodidae) in the continental United States","volume":"53","author":"Eisen","year":"2016","journal-title":"J. Med. Entomol"},{"key":"2022071317484771500_CIT0019","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1093\/jme\/tjaa087","article-title":"Tick and tickborne pathogen surveillance as a public health tool in the United States","volume":"58","author":"Eisen","year":"2021","journal-title":"J. Med. Entomol"},{"key":"2022071317484771500_CIT0020","doi-asserted-by":"crossref","DOI":"10.1093\/jme\/tjaa283","article-title":"Reported county-level distribution of Lyme disease spirochetes, Borrelia burgdorferi sensu stricto and Borrelia mayonii (Spirochaetales: Spirochaetaceae), in host-seeking Ixodes scapularis and Ixodes pacificus ticks (Acari: Ixodidae) in the contiguous United States","volume":"58","author":"Fleshman","year":"2021","journal-title":"J. Med. Entomol"},{"key":"2022071317484771500_CIT0021","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s42003-021-02828-1","article-title":"Incrimination of shrews as a reservoir for Powassan virus","volume":"4","author":"Goethert","year":"2021","journal-title":"Commun. Biol"},{"issue":"2","key":"2022071317484771500_CIT0022","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.ttbdis.2017.12.005","article-title":"A molecular algorithm to detect and differentiate human pathogens infecting Ixodes scapularis and Ixodes pacificus (Acari: Ixodidae)","volume":"9","author":"Graham","year":"2018","journal-title":"Ticks Tick. Borne. Dis"},{"key":"2022071317484771500_CIT0023","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.ttbdis.2017.11.010","article-title":"Evaluating acarological risk for exposure to Ixodes scapularis and Ixodes scapularis-borne pathogens in recreational and residential settings in Washington County, Minnesota","volume":"9","author":"Hahn","year":"2018","journal-title":"Ticks Tick. Borne. Dis"},{"key":"2022071317484771500_CIT0024","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.meegid.2014.06.003","article-title":"Increased diversity of zoonotic pathogens and Borrelia burgdorferi strains in established versus incipient Ixodes scapularis populations across the midwestern United States","volume":"27","author":"Hamer","year":"2014","journal-title":"Infect. Genet. Evol"},{"key":"2022071317484771500_CIT0025","doi-asserted-by":"crossref","first-page":"2317","DOI":"10.3390\/microorganisms9112317","article-title":"Ecology of Powassan virus in the United States.","volume":"9","author":"Hassett","year":"2021","journal-title":"Microorg"},{"key":"2022071317484771500_CIT0026","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.3201\/eid1812.111392","article-title":"Reservoir competence of wildlife host species for Babesia microti","volume":"18","author":"Hersh","year":"2012","journal-title":"Emerg. Infect. Dis"},{"key":"2022071317484771500_CIT0027","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1016\/j.ttbdis.2018.07.009","article-title":"Prevalence and distribution of seven human pathogens in host-seeking Ixodes scapularis (Acari: Ixodidae) nymphs in Minnesota, USA","volume":"9","author":"Johnson","year":"2018","journal-title":"Ticks Tick. Borne. Dis"},{"key":"2022071317484771500_CIT0028","doi-asserted-by":"crossref","first-page":"106299","DOI":"10.1016\/j.actatropica.2021.106299","article-title":"Anaplasma phagocytophilum infection rates in questing and host-attached ticks: a global systematic review and meta-analysis","volume":"228","author":"Karshima","year":"2022","journal-title":"Acta Trop"},{"key":"2022071317484771500_CIT0029","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1093\/jmedent\/30.1.295","article-title":"Efficient transmission of tick-borne encephalitis virus between cofeeding ticks","volume":"30","author":"Labuda","year":"1993","journal-title":"J. Med. Entomol"},{"key":"2022071317484771500_CIT0030","doi-asserted-by":"crossref","first-page":"101637","DOI":"10.1016\/j.ttbdis.2020.101637","article-title":"Prevalence of single and coinfections of human pathogens in Ixodes ticks from five geographical regions in the United States, 2013\u20132019","volume":"12","author":"Lehane","year":"2021","journal-title":"Ticks Tick. Borne. Dis"},{"key":"2022071317484771500_CIT0031","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1089\/153036604773082997","article-title":"Acquisition of different isolates of Anaplasma phagocytophilum by Ixodes scapularis from a model animal","volume":"4","author":"Levin","year":"2004","journal-title":"Vector Borne Zoonotic Dis"},{"key":"2022071317484771500_CIT0032","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.ttbdis.2018.11.017","article-title":"An immunocompromised mouse model to infect Ixodes scapularis ticks with the relapsing fever spirochete, Borrelia miyamotoi","volume":"10","author":"Lynn","year":"2019","journal-title":"Ticks Tick. Borne. Dis"},{"key":"2022071317484771500_CIT0033","doi-asserted-by":"crossref","first-page":"467","DOI":"10.3201\/eid0805.010251","article-title":"Genetic variants of Ehrlichia phagocytophila, Rhode Island and Connecticut","volume":"8","author":"Massung","year":"2002","journal-title":"Emerg. Infect. Dis"},{"key":"2022071317484771500_CIT0034","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/0014-4894(90)90085-Q","article-title":"Borrelia burgdorferi and Babesia microti: efficiency of transmission from reservoirs to vector ticks (Ixodes dammini)","volume":"70","author":"Mather","year":"1990","journal-title":"Exp. Parasitol"},{"key":"2022071317484771500_CIT0035","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1093\/oxfordjournals.aje.a008879","article-title":"Entomologic index for human risk of Lyme disease","volume":"144","author":"Mather","year":"1996","journal-title":"Am. J. Epidemiol"},{"key":"2022071317484771500_CIT0036","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.4269\/ajtmh.2012.11-0630","article-title":"Geographic variation in the relationship between human Lyme disease incidence and density of infected host-seeking Ixodes scapularis nymphs in the eastern United States","volume":"86","author":"Pepin","year":"2012","journal-title":"Am. J. Trop. Med. Hyg"},{"issue":"5","key":"2022071317484771500_CIT0037","doi-asserted-by":"crossref","first-page":"e0068221","DOI":"10.1128\/mSphere.00682-21","article-title":"Citizen science provides an efficient method for broad-scale tick-borne pathogen surveillance of Ixodes pacificus and Ixodes scapularis across the United States","volume":"6","author":"Porter","year":"2021","journal-title":"mSphere"},{"key":"2022071317484771500_CIT0038","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1056\/NEJMoa1010493","article-title":"Emergence of a new pathogenic Ehrlichia species, Wisconsin and Minnesota, 2009","volume":"365","author":"Pritt","year":"2011","journal-title":"N. Engl. J. Med"},{"key":"2022071317484771500_CIT0039","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1603\/ME13101","article-title":"Prevalence of Borrelia burgdorferi (Spirochaetales: Spirochaetaceae), Anaplasma phagocytophilum (Rickettsiales: Anaplasmataceae), and Babesia microti (Piroplasmida: Babesiidae) in Ixodes scapularis (Acari: Ixodidae) collected from recreational lands in the Hudson Valley region, New York State","volume":"51","author":"Prusinski","year":"2014","journal-title":"J. Med. Entomol"},{"issue":"17","key":"2022071317484771500_CIT0040","doi-asserted-by":"crossref","first-page":"496","DOI":"10.15585\/mmwr.mm6717e1","article-title":"Vital signs: trends in reported vectorborne disease cases \u2014 United States and territories, 2004\u20132016","volume":"67","author":"Rosenberg","year":"2018","journal-title":"MMWR. Morb. Mortal. Wkly. Rep"},{"key":"2022071317484771500_CIT0041","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1089\/153036601750137624","article-title":"A relapsing fever group spirochete transmitted by Ixodes scapularis ticks","volume":"1","author":"Scoles","year":"2001","journal-title":"Vector Borne Zoonotic Dis"},{"key":"2022071317484771500_CIT0042","first-page":"147","article-title":"Lyme disease and human babesiosis: evidence incriminating vector and reservoir hosts.","volume-title":"The biology of parasitism","author":"Spielman","year":"1988"},{"key":"2022071317484771500_CIT0043","doi-asserted-by":"crossref","first-page":"560","DOI":"10.4269\/ajtmh.1981.30.560","article-title":"Reservoir hosts of human babesiosis on Nantucket Island","volume":"30","author":"Spielman","year":"1981","journal-title":"Am. J. Trop. Med. Hyg"},{"key":"2022071317484771500_CIT0044","doi-asserted-by":"crossref","first-page":"2887","DOI":"10.1128\/JCM.37.9.2887-2892.1999","article-title":"Infection with agents of human granulocytic ehrlichiosis, Lyme disease, and babesiosis in wild white-footed mice (Peromyscus leucopus) in Connecticut","volume":"37","author":"Stafford","year":"1999","journal-title":"J. Clin. Microbiol"},{"key":"2022071317484771500_CIT0045","doi-asserted-by":"crossref","first-page":"6209","DOI":"10.1073\/pnas.93.12.6209","article-title":"Perpetuation of the agent of human granulocytic ehrlichiosis in a deer tick-rodent cycle.","volume":"93","author":"Telford","year":"1996","journal-title":"Proc. Natl. Acad. Sci"},{"key":"2022071317484771500_CIT0046","doi-asserted-by":"crossref","first-page":"165","DOI":"10.3201\/eid0302.970209","article-title":"A new tick-borne encephalitis-like virus infecting New England deer ticks, Ixodes dammini","volume":"3","author":"Telford","year":"1997","journal-title":"Emerg. Infect. Dis"},{"key":"2022071317484771500_CIT0047","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.pt.2015.03.008","article-title":"Borrelia miyamotoi: a widespread tick-borne relapsing fever spirochete","volume":"31","author":"Wagemakers","year":"2015","journal-title":"Trends Parasitol"},{"key":"2022071317484771500_CIT0048","doi-asserted-by":"crossref","first-page":"2968","DOI":"10.1128\/JCM.37.9.2968-2973.1999","article-title":"Inter- and intralaboratory comparison of Ehrlichia equi and human granulocytic ehrlichiosis (HGE) agent strains for serodiagnosis of HGE by the immunofluorescent-antibody test","volume":"37","author":"Walls","year":"1999","journal-title":"J. Clin. Microbiol"},{"issue":"12","key":"2022071317484771500_CIT0049","doi-asserted-by":"crossref","first-page":"3193","DOI":"10.3201\/eid2712.204646","article-title":"Borrelia miyamotoi in human-biting ticks, United States, 2013\u20132019.","volume":"27","author":"Xu","year":"2021","journal-title":"Emerg. Infect. Dis"}],"container-title":["Journal of Medical Entomology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jme\/article-pdf\/59\/4\/1328\/44856756\/tjac049.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jme\/article-pdf\/59\/4\/1328\/44856756\/tjac049.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,13]],"date-time":"2022-07-13T17:50:17Z","timestamp":1657734617000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jme\/article\/59\/4\/1328\/6588091"}},"subtitle":[],"editor":[{"given":"Sarah","family":"Hamer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,5,18]]},"references-count":49,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,5,18]]},"published-print":{"date-parts":[[2022,7,13]]}},"URL":"https:\/\/doi.org\/10.1093\/jme\/tjac049","relation":{},"ISSN":["0022-2585","1938-2928"],"issn-type":[{"value":"0022-2585","type":"print"},{"value":"1938-2928","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2022,7,1]]},"published":{"date-parts":[[2022,5,18]]}}}