{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T04:42:43Z","timestamp":1779943363619,"version":"3.53.1"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,31]],"date-time":"2024-05-31T00:00:00Z","timestamp":1717113600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["KL2TR001115"],"award-info":[{"award-number":["KL2TR001115"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ken and Sherrilyn Fisher Center for Environmental Infectious Diseases"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Lyme disease is a spatially heterogeneous tick-borne infection, with approximately 85% of US cases concentrated in the mid-Atlantic and northeastern states. Surveillance for Lyme disease and its causative agent, including public health case reporting and entomologic surveillance, is necessary to understand its endemic range, but currently used case detection methods have limitations. To evaluate an alternative approach to Lyme disease surveillance, we have performed a geospatial analysis of Lyme disease cases from the Johns Hopkins Health System in Maryland. We used two sources of cases: a) individuals with both a positive test for Lyme disease and a contemporaneous diagnostic code consistent with a Lyme disease-related syndrome; and b) individuals referred for a Lyme disease evaluation who were adjudicated to have Lyme disease. Controls were individuals from the referral cohort judged not to have Lyme disease. Residential address data were available for all cases and controls. We used a hierarchical Bayesian model with a smoothing function for a coordinate location to evaluate the probability of Lyme disease within 100 km of Johns Hopkins Hospital. We found that the probability of Lyme disease was greatest in the north and west of Baltimore, and the local probability that a subject would have Lyme disease varied by as much as 30-fold. Adjustment for demographic and ecological variables partially attenuated the spatial gradient. Our study supports the suitability of electronic medical record data for the retrospective surveillance of Lyme disease.<\/jats:p>","DOI":"10.1371\/journal.pone.0301530","type":"journal-article","created":{"date-parts":[[2024,5,31]],"date-time":"2024-05-31T19:59:07Z","timestamp":1717185547000},"page":"e0301530","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Mapping the distribution of Lyme disease at a mid-Atlantic site in the United States using electronic health data"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2339-1481","authenticated-orcid":true,"given":"Paul M.","family":"Lantos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Janko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lise E.","family":"Nigrovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicia","family":"Ruffin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaaki","family":"Kobayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne","family":"Higgins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul G.","family":"Auwaerter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,5,31]]},"reference":[{"key":"pone.0301530.ref001","unstructured":"Centers for Disease Control and Prevention. Surveillance Data [cited 2022 November 7]. Available from: https:\/\/www.cdc.gov\/lyme\/datasurveillance\/surveillance-data.html?CDC_AA_refVal=https:%2F%2Fwww.cdc.gov%2Flyme%2Fdatasurveillance%2Frecent-surveillance-data.html."},{"issue":"2","key":"pone.0301530.ref002","doi-asserted-by":"crossref","first-page":"320","DOI":"10.4269\/ajtmh.2012.11-0395","article-title":"Human risk of infection with Borrelia burgdorferi, the Lyme disease agent, in eastern United States","volume":"86","author":"MA Diuk-Wasser","year":"2012","journal-title":"The American journal of tropical medicine and hygiene"},{"issue":"6","key":"pone.0301530.ref003","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":"KM Pepin","year":"2012","journal-title":"The American journal of tropical medicine and hygiene"},{"issue":"4","key":"pone.0301530.ref004","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofv143","article-title":"Geographic Expansion of Lyme Disease in the Southeastern United States, 2000\u20132014","volume":"2","author":"PM Lantos","year":"2015","journal-title":"Open Forum Infect Dis"},{"issue":"10","key":"pone.0301530.ref005","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.3201\/eid2010.130782","article-title":"Lyme disease, Virginia, USA, 2000\u20132011","volume":"20","author":"RJ Brinkerhoff","year":"2014","journal-title":"Emerging infectious diseases"},{"issue":"6","key":"pone.0301530.ref006","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.4269\/ajtmh.13-0733","article-title":"Spatial and temporal emergence pattern of Lyme disease in Virginia","volume":"91","author":"J Li","year":"2014","journal-title":"The American journal of tropical medicine and hygiene"},{"issue":"4","key":"pone.0301530.ref007","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1007\/s10393-015-1034-3","article-title":"An Examination of the Demographic and Environmental Variables Correlated with Lyme Disease Emergence in Virginia","volume":"12","author":"SE Seukep","year":"2015","journal-title":"Ecohealth"},{"issue":"2","key":"pone.0301530.ref008","doi-asserted-by":"crossref","first-page":"242","DOI":"10.3201\/eid1802.101219","article-title":"Effect of surveillance method on reported characteristics of Lyme disease, Connecticut, 1996\u20132007","volume":"18","author":"SH Ertel","year":"2012","journal-title":"Emerging infectious diseases"},{"issue":"2","key":"pone.0301530.ref009","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1111\/zph.12307","article-title":"Lyme Disease Surveillance in New York State: an Assessment of Case Underreporting","volume":"65","author":"J White","year":"2018","journal-title":"Zoonoses Public Health"},{"issue":"7","key":"pone.0301530.ref010","doi-asserted-by":"crossref","first-page":"944","DOI":"10.2105\/AJPH.85.7.944","article-title":"Environmental risk factors for Lyme disease identified with geographic information systems","volume":"85","author":"GE Glass","year":"1995","journal-title":"Am J Public Health"},{"key":"pone.0301530.ref011","unstructured":"Maryland Department of Health. Lyme Disease in Maryland by Jurisdiction 2008\u20132019 [updated February 26, 2021December 4, 2023]. Available from: https:\/\/health.maryland.gov\/phpa\/OIDEOR\/CZVBD\/Shared%20Documents\/Lyme%20Disease%20Data%202008%20-%202019.pdf."},{"issue":"5","key":"pone.0301530.ref012","first-page":"391","article-title":"Lyme disease in Maryland: 1987\u20131990","volume":"41","author":"CS Mitchell","year":"1992","journal-title":"Md Med J"},{"issue":"2","key":"pone.0301530.ref013","first-page":"68","article-title":"Incidence rates of Lyme disease in Maryland: 1993 through 1996","volume":"48","author":"CA Pena","year":"1999","journal-title":"Md Med J"},{"issue":"10","key":"pone.0301530.ref014","doi-asserted-by":"crossref","first-page":"2202","DOI":"10.1093\/aje\/kwy133","article-title":"Incidence of Lyme Disease Diagnosis in a Maryland Medicaid Population, 2004\u20132011","volume":"187","author":"AW Rebman","year":"2018","journal-title":"American journal of epidemiology"},{"issue":"7","key":"pone.0301530.ref015","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofz299","article-title":"Misdiagnosis of Lyme Disease With Unnecessary Antimicrobial Treatment Characterizes Patients Referred to an Academic Infectious Diseases Clinic","volume":"6","author":"T Kobayashi","year":"2019","journal-title":"Open Forum Infect Dis"},{"issue":"9","key":"pone.0301530.ref016","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1086\/508667","article-title":"The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America","volume":"43","author":"GP Wormser","year":"2006","journal-title":"Clinical infectious diseases: an official publication of the Infectious Diseases Society of America"},{"key":"pone.0301530.ref017","unstructured":"Centers for Disease Control and Prevention. Lyme Disease (Borrelia burgdorferi) 2011 Case Definition [cited 2023 December 29]. Available from: https:\/\/ndc.services.cdc.gov\/case-definitions\/lyme-disease-2011\/."},{"issue":"4","key":"pone.0301530.ref018","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.amjmed.2021.10.040","article-title":"Mistaken Identity: Many Diagnoses are Frequently Misattributed to Lyme Disease","volume":"135","author":"T Kobayashi","year":"2022","journal-title":"The American journal of medicine"},{"issue":"2","key":"pone.0301530.ref019","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1093\/ije\/dyi284","article-title":"Towards landscape design guidelines for reducing Lyme disease risk","volume":"35","author":"LE Jackson","year":"2006","journal-title":"Int J Epidemiol"},{"issue":"2","key":"pone.0301530.ref020","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1556\/ComEc.7.2006.2.6","article-title":"A comparison of analysis units for associating Lyme disease with forest-edge habitat","volume":"7","author":"LE Jackson","year":"2006","journal-title":"Community Ecology"},{"issue":"528","key":"pone.0301530.ref021","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1080\/01621459.2018.1564670","article-title":"Spatial Variable Selection and An Application to Virginia Lyme Disease Emergence","volume":"114","author":"Y Xie","year":"2019","journal-title":"Journal of the American Statistical Association"},{"issue":"1941","key":"pone.0301530.ref022","doi-asserted-by":"crossref","first-page":"20202278","DOI":"10.1098\/rspb.2020.2278","article-title":"Landscape features predict the current and forecast the future geographic spread of Lyme disease","volume":"287","author":"AM Gardner","year":"2020","journal-title":"Proceedings Biological sciences \/ The Royal Society"},{"issue":"1","key":"pone.0301530.ref023","first-page":"28","article-title":"brms: An R Package for Bayesian Multilevel Models Using Stan","volume":"80","author":"P-C B\u00fcrkner","year":"2017","journal-title":"Journal of Statistical Software"},{"issue":"1","key":"pone.0301530.ref024","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v076.i01","article-title":"Stan: A Probabilistic Programming Language","volume":"76","author":"B Carpenter","year":"2017","journal-title":"Journal of Statistical Software"},{"key":"pone.0301530.ref025","unstructured":"Wood SN. Generalized additive models: an introduction with R. Second edition. ed. Boca Raton: CRC Press\/Taylor & Francis Group; 2017. xx, 476 pages p."},{"key":"pone.0301530.ref026","unstructured":"United States Census Bureau. County Population Totals: 2010\u20132019 [cited 2023 December 5]. Available from: https:\/\/www.census.gov\/data\/datasets\/time-series\/demo\/popest\/2010s-counties-total.html."},{"issue":"3","key":"pone.0301530.ref027","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1093\/jme\/tjaa291","article-title":"Surveillance of Ticks and Tick-Borne Pathogens in Suburban Natural Habitats of Central Maryland","volume":"58","author":"MT Milholland","year":"2021","journal-title":"Journal of medical entomology"},{"issue":"1","key":"pone.0301530.ref028","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/1047-2797(95)00096-8","article-title":"Lyme disease surveillance in Maryland, 1992","volume":"6","author":"SH Steinberg","year":"1996","journal-title":"Annals of epidemiology"},{"issue":"4","key":"pone.0301530.ref029","doi-asserted-by":"crossref","first-page":"427","DOI":"10.3201\/eid0804.000413","article-title":"Mapping Lyme disease incidence for diagnostic and preventive decisions, Maryland","volume":"8","author":"C Frank","year":"2002","journal-title":"Emerging infectious diseases"},{"key":"pone.0301530.ref030","unstructured":"Centers for Disease Control and Prevention. Reported cases of Lyme disease by state or locality, 2006\u20132016 [cited 2018 November 2]. Available from: https:\/\/www.cdc.gov\/lyme\/stats\/tables.html."},{"issue":"2","key":"pone.0301530.ref031","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1111\/zph.12446","article-title":"Exploring an alternative approach to Lyme disease surveillance in Maryland","volume":"65","author":"H Rutz","year":"2018","journal-title":"Zoonoses Public Health"},{"issue":"5","key":"pone.0301530.ref032","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1093\/cid\/ciu397","article-title":"Lyme disease testing by large commercial laboratories in the United States","volume":"59","author":"AF Hinckley","year":"2014","journal-title":"Clinical infectious diseases: an official publication of the Infectious Diseases Society of America"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0301530","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,31]],"date-time":"2024-05-31T19:59:32Z","timestamp":1717185572000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0301530"}},"subtitle":[],"editor":[{"given":"Jon M.","family":"Jacobs","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,5,31]]},"references-count":32,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0301530","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,31]]}}}