{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T07:10:38Z","timestamp":1761808238377,"version":"3.37.3"},"reference-count":13,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,9,21]],"date-time":"2018-09-21T00:00:00Z","timestamp":1537488000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006088","name":"National Center for Emerging and Zoonotic Infectious Diseases","doi-asserted-by":"publisher","award":["CK000203"],"award-info":[{"award-number":["CK000203"]}],"id":[{"id":"10.13039\/100006088","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Zoonoses and Public Health"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>In Maryland, Lyme disease (LD) is the most widely reported tickborne disease. All laboratories and healthcare providers are required to report LD cases to the local health department. Given the large volume of LD reports, the nuances of diagnosing and reporting LD, and the effort required for investigations by local health department staff, surveillance for LD is burdensome and subject to underreporting. To determine the degree to which misclassification occurs in Maryland, we reviewed medical records for a sample of LD reports from 2009. We characterized what proportion of suspected and \u201cnot a case\u201d reports could be reclassified as confirmed or probable once additional information was obtained from medical record review, explored the reasons for misclassification, and determined multipliers for a more accurate number of LD cases. We reviewed medical records for reports originally classified as suspected (<jats:italic>n<\/jats:italic>\u00a0=\u00a044) and \u201cnot a case\u201d (<jats:italic>n<\/jats:italic>\u00a0=\u00a092). Of these 136 records, 31 (23%) suspected cases and \u201cnot a case\u201d reports were reclassified. We calculated multipliers and applied them to the case counts from 2009, and estimate an additional 269 confirmed and probable cases, a 13.3% increase. Reasons for misclassification fell into three general categories: lack of clinical or diagnostic information from the provider; surveillance process errors; and incomplete information provided on laboratory reports. These multipliers can be used to calculate a better approximation of the true number of LD cases in Maryland, but these multipliers only account for underreporting due to misclassification, and do not account for cases that are not reported at all (e.g., LD diagnoses based on erythema migrans alone that are not reported) or for cases that are not investigated. Knowing that misclassification of cases occurs during the existing LD surveillance process underscores the complexities of LD surveillance, which further reinforces the need to find alternative approaches to LD surveillance.<\/jats:p>","DOI":"10.1111\/zph.12525","type":"journal-article","created":{"date-parts":[[2018,9,22]],"date-time":"2018-09-22T12:40:41Z","timestamp":1537620041000},"page":"174-178","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impacts of misclassification on Lyme disease surveillance"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4352-0685","authenticated-orcid":false,"given":"Heather","family":"Rutz","sequence":"first","affiliation":[{"name":"Emerging Infections Program Maryland Department of Health Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brenna","family":"Hogan","sequence":"additional","affiliation":[{"name":"Emerging Infections Program Maryland Department of Health Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Hook","sequence":"additional","affiliation":[{"name":"Division of Vector\u2010Borne Diseases Centers for Disease Control and Prevention Fort Collins Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2853-5165","authenticated-orcid":false,"given":"Alison","family":"Hinckley","sequence":"additional","affiliation":[{"name":"Division of Vector\u2010Borne Diseases Centers for Disease Control and Prevention Fort Collins Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Feldman","sequence":"additional","affiliation":[{"name":"Emerging Infections Program Maryland Department of Health Baltimore Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,9,21]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"CDC(2008).Lyme disease 2008 case definition. Retrieved fromhttps:\/\/wwwn.cdc.gov\/NNDSS\/script\/casedef.aspx?CondYrID=751&DatePub=2008-01-01"},{"key":"e_1_2_8_3_1","unstructured":"COMAR(2015).Reportable diseases conditions outbreaks and unusual manifestations; submitting clinical materials. Retrieved fromhttp:\/\/www.dsd.state.md.us\/comar\/getfile.aspx?file=10.06.01.03.htm"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/173.5.1260"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciu397"},{"key":"e_1_2_8_6_1","unstructured":"Maryland Code Health\u2010General(2018).Maryland Code and Court Rules Health\u2010General \u00a7\u00a7 18\u2013201 and 205 disease prevention. Retrieved fromhttps:\/\/govt.westlaw.com\/mdc\/Document\/NF23134A064DB11DE91F5EACF50AC3B69?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)"},{"key":"e_1_2_8_7_1","first-page":"1743","article-title":"Epidemiology of Lyme disease in Olmstead county, MN, 1975\u20131990","volume":"19","author":"Matteson E.","year":"1992","journal-title":"Journal of Rheumatology"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00124784-199623000-00017"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/155.12.1120"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2109.150417"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a009462"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/zph.12446"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/zph.12275"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/zph.12414"}],"container-title":["Zoonoses and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fzph.12525","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/zph.12525","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T12:39:36Z","timestamp":1694090376000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/zph.12525"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,21]]},"references-count":13,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,2]]}},"alternative-id":["10.1111\/zph.12525"],"URL":"https:\/\/doi.org\/10.1111\/zph.12525","archive":["Portico"],"relation":{},"ISSN":["1863-1959","1863-2378"],"issn-type":[{"type":"print","value":"1863-1959"},{"type":"electronic","value":"1863-2378"}],"subject":[],"published":{"date-parts":[[2018,9,21]]},"assertion":[{"value":"2018-06-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-08-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-09-21","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}