{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T19:50:18Z","timestamp":1769629818800,"version":"3.49.0"},"reference-count":17,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,3,6]],"date-time":"2022-03-06T00:00:00Z","timestamp":1646524800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Zoonoses and Public Health"],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Historically, public health surveillance for Lyme disease has required clinical follow\u2010up on positive laboratory reports for the purpose of case classification. In areas with sustained high incidence of the disease, this resource\u2010intensive activity yields a limited benefit to public health practice. A range of burden\u2010reducing strategies have been implemented in many states, creating inconsistencies that limit the ability to decipher trends. Laboratory\u2010based surveillance, or surveillance based solely on positive laboratory reports without follow\u2010up for clinical information on positive laboratory reports, emerged as a feasible alternative to improve standardization in already high\u2010incidence areas. To inform expectations of a laboratory\u2010based surveillance model, we conducted a retrospective analysis of Lyme disease data collected during 2012\u20132018 from 10 high\u2010incidence states. The number of individuals with laboratory evidence of infection ranged from 1302 to 20,994 per state and year. On average, 55% of those were ultimately classified as confirmed or probable cases (range: 29%\u201386%). Among all individuals with positive laboratory evidence, 18% (range: 2%\u201337%) were determined to be \u2018not a case\u2019 upon investigation and 23% (range: 2%\u201352%) were classified as suspect cases due to lack of associated clinical information and thus were not reported to the Centers for Disease Control and Prevention (CDC). The number of reported cases under a laboratory\u2010based approach to surveillance in high\u2010incidence states using recommended two\u2010tier testing algorithms is likely to be, on average, 1.2 times higher (range: 0.6\u20131.8 times) than what was reported to CDC during 2012\u20132018. A laboratory\u2010based surveillance approach for high\u2010incidence states will improve standardization and reduce burden on public health systems, allowing public health resources to focus on prevention messaging, exploration of novel prevention strategies and alternative data sources to yield information on the epidemiology of Lyme disease.<\/jats:p>","DOI":"10.1111\/zph.12933","type":"journal-article","created":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T03:35:58Z","timestamp":1646624158000},"page":"451-457","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Potential quantitative effect of a laboratory\u2010based approach to Lyme disease surveillance in high\u2010incidence states"],"prefix":"10.1111","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5702-6688","authenticated-orcid":false,"given":"Kiersten J.","family":"Kugeler","sequence":"first","affiliation":[{"name":"Division of 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USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leah","family":"Lind","sequence":"additional","affiliation":[{"name":"Pennsylvania Department of Health  Harrisburg Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Barkley","sequence":"additional","affiliation":[{"name":"Rhode Island Department of Health  Providence Rhode Island USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Broyhill","sequence":"additional","affiliation":[{"name":"Virginia Department of Health  Richmond Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Murphy","sequence":"additional","affiliation":[{"name":"Virginia Department of Health  Richmond Virginia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Crum","sequence":"additional","affiliation":[{"name":"Maryland Department of Health  Baltimore Maryland 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USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2853-5165","authenticated-orcid":false,"given":"Alison F.","family":"Hinckley","sequence":"additional","affiliation":[{"name":"Division of Vector\u2010Borne Diseases Centers for Disease Control and Prevention  Fort Collins Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,3,6]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix943"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13071\u2010016\u20101894\u20106"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/zph.12448"},{"key":"e_1_2_8_5_1","volume-title":"Lyme disease data and statistics","author":"Centers for Disease Control and Prevention","year":"2016"},{"key":"e_1_2_8_6_1","volume-title":"Lyme disease case definitions","author":"Centers for Disease Control and 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