{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T11:50:25Z","timestamp":1793793025821,"version":"4.6.1"},"reference-count":75,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T00:00:00Z","timestamp":1631577600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000156","name":"Fonds de Recherche du Qu\u00e9bec - Sant\u00e9","doi-asserted-by":"publisher","award":["Junior 1 Research Scholar"],"award-info":[{"award-number":["Junior 1 Research Scholar"]}],"id":[{"id":"10.13039\/501100000156","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Lyme disease is a growing public health problem in Qu\u00e9bec. Its emergence over the last decade is caused by environmental and anthropological factors that favour the survival of Ixodes scapularis, the vector of Lyme disease transmission. The objective of this study was to estimate the speed and direction of human Lyme disease emergence in Qu\u00e9bec and to identify spatiotemporal risk patterns. A surface trend analysis was conducted to estimate the speed and direction of its emergence based upon the first detected case of Lyme disease in each municipality in Qu\u00e9bec since 2004. A cluster analysis was also conducted to identify at-risk regions across space and time. These analyses were reproduced for the date of disease onset and date of notification for each case of Lyme disease. It was estimated that Lyme disease is spreading northward in Qu\u00e9bec at a speed varying between 18 and 32 km\/year according to the date of notification and the date of disease onset, respectively. A significantly high risk of disease was found in seven clusters identified in the south-west of Qu\u00e9bec in the sociosanitary regions of Mont\u00e9r\u00e9gie and Estrie. The results obtained in this study improve our understanding of the spatiotemporal patterns of Lyme disease in Qu\u00e9bec, which can be used for proactive, targeted interventions by public and clinical health authorities.<\/jats:p>","DOI":"10.3390\/ijerph18189669","type":"journal-article","created":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T21:47:21Z","timestamp":1631656041000},"page":"9669","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Modelling Spatiotemporal Patterns of Lyme Disease Emergence in Qu\u00e9bec"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0575-3899","authenticated-orcid":false,"given":"Marc-Antoine","family":"Tutt-Gu\u00e9rette","sequence":"first","affiliation":[{"name":"Lady Davis Institute for Medical Research, 3755 Chemin de la C\u00f4te-Sainte-Catherine, Montr\u00e9al, QC H3T 1E2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengru","family":"Yuan","sequence":"additional","affiliation":[{"name":"Centre de Recherche en Sant\u00e9 Publique, 7101 Av du Parc, Montr\u00e9al, QC H3N 1X9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Szaroz","sequence":"additional","affiliation":[{"name":"Centre de Recherche en Sant\u00e9 Publique, 7101 Av du Parc, Montr\u00e9al, QC H3N 1X9, Canada"},{"name":"D\u00e9partement de M\u00e9decine Sociale et Pr\u00e9ventive, \u00c9cole de Sant\u00e9 Publique, Universit\u00e9 de Montr\u00e9al, 7101 Av du Parc, Montr\u00e9al, QC H3N 1X9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Britt","family":"McKinnon","sequence":"additional","affiliation":[{"name":"Centre de Recherche en Sant\u00e9 Publique, 7101 Av du Parc, Montr\u00e9al, QC H3N 1X9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2619-5750","authenticated-orcid":false,"given":"Yan","family":"Kestens","sequence":"additional","affiliation":[{"name":"Centre de Recherche en Sant\u00e9 Publique, 7101 Av du Parc, Montr\u00e9al, QC H3N 1X9, Canada"},{"name":"D\u00e9partement de M\u00e9decine Sociale et Pr\u00e9ventive, \u00c9cole de Sant\u00e9 Publique, Universit\u00e9 de Montr\u00e9al, 7101 Av du Parc, Montr\u00e9al, QC H3N 1X9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille","family":"Guillot","sequence":"additional","affiliation":[{"name":"Centre de Recherche en Sant\u00e9 Publique, 7101 Av du Parc, Montr\u00e9al, QC H3N 1X9, Canada"},{"name":"Research Group on Epidemiology of Zoonoses and Public Health (GREZOSP), Facult\u00e9 de M\u00e9decine V\u00e9t\u00e9rinaire, Universit\u00e9 de Montr\u00e9al, 3200 Rue Sicotte, Saint-Hyacinthe, QC J2S 2M2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Leighton","sequence":"additional","affiliation":[{"name":"Centre de Recherche en Sant\u00e9 Publique, 7101 Av du Parc, Montr\u00e9al, QC H3N 1X9, Canada"},{"name":"Research Group on Epidemiology of Zoonoses and Public Health (GREZOSP), Facult\u00e9 de M\u00e9decine V\u00e9t\u00e9rinaire, Universit\u00e9 de Montr\u00e9al, 3200 Rue Sicotte, Saint-Hyacinthe, QC J2S 2M2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1388-1145","authenticated-orcid":false,"given":"Kate","family":"Zinszer","sequence":"additional","affiliation":[{"name":"Centre de Recherche en Sant\u00e9 Publique, 7101 Av du Parc, Montr\u00e9al, QC H3N 1X9, Canada"},{"name":"D\u00e9partement de M\u00e9decine Sociale et Pr\u00e9ventive, \u00c9cole de Sant\u00e9 Publique, Universit\u00e9 de Montr\u00e9al, 7101 Av du Parc, Montr\u00e9al, QC H3N 1X9, Canada"},{"name":"Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montr\u00e9al, QC H3A 1A2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,14]]},"reference":[{"key":"ref_1","unstructured":"DPH (2018, January 22). A Brief History of Lyme Disease in Connecticut, Available online: https:\/\/portal.ct.gov\/DPH\/Epidemiology-and-Emerging-Infections\/A-Brief-History-of-Lyme-Disease-in-Connecticut."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"20160117","DOI":"10.1098\/rstb.2016.0117","article-title":"Lyme disease ecology in a changing world: Consensus, uncertainty and critical gaps for improving control","volume":"372","author":"Kilpatrick","year":"2017","journal-title":"Philos. Trans. R. Soc. B Biol. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1089\/vbz.2017.2127","article-title":"Brave new worlds: The expanding universe of Lyme disease","volume":"17","author":"Stone","year":"2017","journal-title":"Vector-Borne Zoonotic Dis."},{"key":"ref_4","first-page":"74","article-title":"An estimate of Lyme borreliosis incidence in Western Europe","volume":"39","author":"Sykes","year":"2017","journal-title":"J. Public Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"616","DOI":"10.3201\/eid2702.202731","article-title":"Estimating the frequency of lyme disease diagnoses, United States, 2010\u20132018","volume":"27","author":"Kugeler","year":"2021","journal-title":"Emerg. Infect. Dis."},{"key":"ref_6","unstructured":"CDC (2019, February 02). Recent Surveillance Data, Available online: https:\/\/www.cdc.gov\/lyme\/datasurveillance\/recent-surveillance-data.html."},{"key":"ref_7","unstructured":"Gouvernement du Canada (2017, October 11). Surveillance de la Maladie de Lyme. Available online: https:\/\/www.canada.ca\/fr\/sante-publique\/services\/maladies\/maladie-lyme\/surveillance-maladie-lyme.html."},{"key":"ref_8","unstructured":"Gouvernement du Canada (2018, November 23). Pour les Professionnels de la Sant\u00e9: Maladie de Lyme. Available online: https:\/\/www.canada.ca\/fr\/sante-publique\/services\/maladies\/maladie-lyme\/pour-professionnels-sante-maladie-lyme.html."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"132","DOI":"10.14745\/ccdr.v41i06a03","article-title":"Vector-borne diseases in Canada: Surveillance for Lyme disease in Canada, 2009 to 2012","volume":"41","author":"Ogden","year":"2015","journal-title":"Can. Commun. Dis. Rep."},{"key":"ref_10","unstructured":"Gouvernement du Canada (2018, January 22). Maladie de Lyme. Available online: https:\/\/www.canada.ca\/fr\/sante-publique\/services\/maladies\/maladie-lyme.html."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"46","DOI":"10.5114\/reum.2015.50557","article-title":"Post-Lyme disease syndrome","volume":"53","year":"2015","journal-title":"Reumatologia"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1056\/NEJMra072023","article-title":"A critical appraisal of \u201cchronic Lyme disease\u201d","volume":"357","author":"Feder","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_13","first-page":"187","article-title":"Epidemiology of Lyme disease","volume":"29","author":"Mead","year":"2015","journal-title":"Infect. Dis. Clin."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1172\/JCI21681","article-title":"The emergence of Lyme disease","volume":"113","author":"Steere","year":"2004","journal-title":"J. Clin. Investig."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.tree.2012.10.011","article-title":"Biodiversity and disease: A synthesis of ecological perspectives on Lyme disease transmission","volume":"28","author":"Wood","year":"2013","journal-title":"Trends Ecol. Evol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1111\/j.1365-2664.2012.02112.x","article-title":"Predicting the speed of tick invasion: An empirical model of range expansion for the Lyme disease vector Ixodes scapularis in Canada","volume":"49","author":"Leighton","year":"2012","journal-title":"J. Appl. Ecol."},{"key":"ref_17","unstructured":"IUCN (2019, July 14). Peromyscus\u00a0leucopus. Available online: https:\/\/www.iucnredlist.org\/species\/16669\/115136270."},{"key":"ref_18","unstructured":"IUCN (2019, July 14). Odocoileus\u00a0virginianus. Available online: https:\/\/www.iucnredlist.org\/species\/42394\/22162580."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1093\/jme\/tjv199","article-title":"Linkages of Weather and Climate with Ixodes scapularis and Ixodes pacificus (Acari: Ixodidae), Enzootic Transmission of Borrelia burgdorferi, and Lyme Disease in North America","volume":"53","author":"Eisen","year":"2016","journal-title":"J. Med. Entomol."},{"key":"ref_20","unstructured":"MDDELCC (2018, March 21). Tendances des Temp\u00e9ratures 1961\u20132010. Available online: http:\/\/www.mddelcc.gouv.qc.ca\/climat\/tendances\/."},{"key":"ref_21","unstructured":"Gouvernement du Canada (2018, March 21). Normales Climatiques Canadiennes. Available online: http:\/\/climat.meteo.gc.ca\/climate_normals\/index_f.html."},{"key":"ref_22","unstructured":"MDDELCC (2019, July 14). Faits Saillants. Available online: http:\/\/www.environnement.gouv.qc.ca\/climat\/Faits-saillants\/index.htm."},{"key":"ref_23","unstructured":"Soucy-Gonthier, N., Marceau, D., Delage, M., Cogliastro, A., Domon, G., and Bouchard, A. (2018, March 21). D\u00e9tection de L\u2019\u00c9volution des Superficies Foresti\u00e8res en Mont\u00e9r\u00e9gie Entre Juin 1999 et Ao\u00fbt 2002 \u00e0 Partir D\u2019Images Satellitaires Landsat-TM. Available online: https:\/\/www.irbv.umontreal.ca\/wp-content\/uploads\/cogliastro-deboisement2003.pdf."},{"key":"ref_24","first-page":"95","article-title":"Cadre m\u00e9thodologique pour restaurer la connectivit\u00e9 \u00e9cologique, de la planification \u00e0 la conservation: \u00c9tude de cas en Mont\u00e9r\u00e9gie","volume":"136","author":"Cormier","year":"2012","journal-title":"Le Nat. Can."},{"key":"ref_25","unstructured":"Cogliastro, A., and D\u2019Orangeville, L. (2018, March 21). Organiser la Cohabitation Agriculture-For\u00eat en Mont\u00e9r\u00e9gie. Available online: https:\/\/www.irbv.umontreal.ca\/wp-content\/uploads\/cogliastro-caaaq.pdf."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1111\/eva.12165","article-title":"Climate change and habitat fragmentation drive the occurrence of Borrelia burgdorferi, the agent of Lyme disease, at the northeastern limit of its distribution","volume":"7","author":"Simon","year":"2014","journal-title":"Evol. Appl."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1046\/j.1523-1739.2003.01260.x","article-title":"Effect of forest fragmentation on Lyme disease risk","volume":"17","author":"Allan","year":"2003","journal-title":"Conserv. Biol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2075","DOI":"10.1002\/ece3.620","article-title":"Genetic structure of the white-footed mouse in the context of the emergence of Lyme disease in southern Quebec","volume":"3","author":"Rogic","year":"2013","journal-title":"Ecol. Evol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1016\/j.ttbdis.2017.03.003","article-title":"The influence of abiotic and biotic factors on the invasion of Ixodes scapularis in Ontario, Canada","volume":"8","author":"Clow","year":"2017","journal-title":"Ticks Tick-Borne Dis."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Fiset, J., Tessier, N., Millien, V., and Lapointe, F.J. (2015). Phylogeographic Structure of the White-Footed Mouse and the Deer Mouse, Two Lyme Disease Reservoir Hosts in Quebec. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0144112"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1007\/s10980-017-0559-y","article-title":"Functional connectivity of the white-footed mouse in Southern Quebec, Canada","volume":"32","author":"Marrotte","year":"2017","journal-title":"Landsc. Ecol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"43","DOI":"10.5604\/12321966.1141368","article-title":"Zoonotic occupational diseases in forestry workers\u2014Lyme borreliosis, tularemia and leptospirosis in Europe","volume":"22","author":"Richard","year":"2015","journal-title":"Ann. Agric. Environ. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1093\/phr\/116.S1.146","article-title":"Risk factors for lyme disease in Chester County, Pennsylvania","volume":"116","author":"Smith","year":"2001","journal-title":"Public Health Rep."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1503\/cmaj.080148","article-title":"The emergence of Lyme disease in Canada","volume":"180","author":"Ogden","year":"2009","journal-title":"Can. Med. Assoc. J."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Cheng, A., Chen, D.M., Woodstock, K., Ogden, N.H., Wu, X.T., and Wu, J.H. (2017). Analyzing the Potential Risk of Climate Change on Lyme Disease in Eastern Ontario, Canada Using Time Series Remotely Sensed Temperature Data and Tick Population Modelling. Remote Sens., 9.","DOI":"10.3390\/rs9060609"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1603\/ME11210","article-title":"Passive Surveillance for I. scapularis Ticks: Enhanced Analysis for Early Detection of Emerging Lyme Disease Risk","volume":"49","author":"Koffi","year":"2012","journal-title":"J. Med Entomol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"46","DOI":"10.3389\/fcimb.2013.00046","article-title":"Changing geographic ranges of ticks and tick-borne pathogens: Drivers, mechanisms and consequences for pathogen diversity","volume":"3","author":"Ogden","year":"2013","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1289\/ehp.0901766","article-title":"Active and Passive Surveillance and Phylogenetic Analysis of Borrelia burgdorferi Elucidate the Process of Lyme Disease Risk Emergence in Canada","volume":"118","author":"Ogden","year":"2010","journal-title":"Environ. Health Perspect."},{"key":"ref_39","unstructured":"MSSS (2019, June 12). Maladie de Lyme. Available online: http:\/\/www.msss.gouv.qc.ca\/professionnels\/zoonoses\/maladie-lyme\/surveillance-de-la-maladie\/."},{"key":"ref_40","unstructured":"Statistique Qu\u00e9bec (2019, March 25). Population et Structure Par \u00c2ge et Sexe. Available online: http:\/\/www.stat.gouv.qc.ca\/statistiques\/population-demographie\/structure\/index.html."},{"key":"ref_41","unstructured":"Statistique Canada (2019, March 29). 2011 Census\u2014Boundary Files. Available online: https:\/\/www12.statcan.gc.ca\/census-recensement\/2011\/geo\/bound-limit\/bound-limit-2011-eng.cfm."},{"key":"ref_42","unstructured":"Morrison, K. (2018, December 18). R Package: Outbreakvelocity. Available online: https:\/\/github.com\/kathryntmorrison\/outbreakvelocity."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/S1473-3099(15)00234-0","article-title":"The velocity of Ebola spread in parts of West Africa","volume":"15","author":"Zinszer","year":"2015","journal-title":"Lancet Infect. Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"91","DOI":"10.3201\/eid2301.161274","article-title":"Reconstruction of Zika virus introduction in Brazil","volume":"23","author":"Zinszer","year":"2017","journal-title":"Emerg. Infect. Dis."},{"key":"ref_45","unstructured":"INSPQ (2019, June 26). La Maladie de Lyme et Les Maladies Transmises Par Les Tiques. Available online: https:\/\/www.inspq.qc.ca\/zoonoses\/maladie-de-lyme."},{"key":"ref_46","unstructured":"Kulldorff, M. (2018, December 14). SaTScan User Guide for Version 9.6. Available online: https:\/\/www.satscan.org\/."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"ofv143","DOI":"10.1093\/ofid\/ofv143","article-title":"Geographic expansion of Lyme disease in the southeastern United States, 2000\u20132014","volume":"3","author":"Lantos","year":"2015","journal-title":"Open Forum Infect. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1093\/jmedent\/43.2.403","article-title":"Investigation of ground level and remote-sensed data for habitat classification and prediction of survival of Ixodes scapularis in habitats of southeastern Canada","volume":"43","author":"Ogden","year":"2006","journal-title":"J. Med. Entomol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Roy-Dufresne, E., Logan, T., Simon, J.A., Chmura, G.L., and Millien, V. (2013). Poleward Expansion of the White-Footed Mouse (Peromyscus leucopus) under Climate Change: Implications for the Spread of Lyme Disease. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0080724"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"328","DOI":"10.3201\/eid2502.180771","article-title":"Lyme Disease Emergence after Invasion of the Blacklegged Tick, Ixodes scapularis, Ontario, Canada, 2010\u20132016","volume":"25","author":"Kulkarni","year":"2019","journal-title":"Emerg. Infect. Dis."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"74","DOI":"10.14745\/ccdr.v40i05a01","article-title":"Lyme disease: Environmental risk from Lyme disease in central and eastern Canada: A summary of recent surveillance information","volume":"40","author":"Ogden","year":"2014","journal-title":"Can. Commun. Dis. Rep."},{"key":"ref_52","first-page":"693","article-title":"The increasing risk of Lyme disease in Canada","volume":"56","author":"Bouchard","year":"2015","journal-title":"Can. Vet. J."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Ogden, N., Bouchard, C., Badcock, J., Drebot, M., Elias, S., Hatchette, T., Koffi, J., Leighton, P., Lindsay, L., and Lubelczyk, C. (2019). What is the real number of Lyme disease cases in Canada?. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-7219-x"},{"key":"ref_54","first-page":"176","article-title":"The Genetic Signature of Range Expansion in a Disease Vector\u2014The Black-Legged Tick","volume":"108","author":"Leo","year":"2016","journal-title":"J. Hered."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/j.ttbdis.2015.06.004","article-title":"How far north are migrant birds transporting the tick Ixodes scapularis in Canada? Insights from stable hydrogen isotope analyses of feathers","volume":"6","author":"Ogden","year":"2015","journal-title":"Ticks Tick-Borne Dis."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/s10393-004-0139-x","article-title":"Effect of climate change on Lyme disease risk in North America","volume":"2","author":"Brownstein","year":"2005","journal-title":"EcoHealth"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1016\/j.ttbdis.2015.05.005","article-title":"Climate change influences on the annual onset of Lyme disease in the United States","volume":"6","author":"Monaghan","year":"2015","journal-title":"Ticks Tick-Borne Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1093\/aje\/kwg014","article-title":"Effects of climate on variability in Lyme disease incidence in the northeastern United States","volume":"157","author":"Subak","year":"2003","journal-title":"Am. J. Epidemiol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1742","DOI":"10.1093\/aje\/kwz130","article-title":"Risk Factors for Bites and Diseases Associated With Black-Legged Ticks: A Meta-Analysis","volume":"188","author":"Fischhoff","year":"2019","journal-title":"Am. J. Epidemiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"16090","DOI":"10.1038\/nrdp.2016.90","article-title":"Lyme borreliosis","volume":"2","author":"Steere","year":"2016","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.3201\/eid2308.161273","article-title":"Lyme borreliosis in Finland, 1995\u20132014","volume":"23","author":"Sajanti","year":"2017","journal-title":"Emerg. Infect. Dis."},{"key":"ref_62","unstructured":"Institut de la Statistique du Qu\u00e9bec (2019, June 02). Le Qu\u00e9bec Chiffres en Main. Available online: http:\/\/www.stat.gouv.qc.ca\/quebec-chiffre-main\/pdf\/qcm2018_fr.pdf."},{"key":"ref_63","unstructured":"CIRANO (2019, June 02). R\u00e9partition de la Population Active Selon le Secteur D\u2019activit\u00e9 et le Sexe, Qu\u00e9bec. Available online: https:\/\/qe.cirano.qc.ca\/theme\/marche-travail\/population-active\/tableau-repartition-population-active-selon-secteur-dactivite-sexe-quebec-2017."},{"key":"ref_64","unstructured":"Chaire de Tourisme Transat ESG UQAM (2019, July 05). \u00c9tude des Client\u00e8les, des Lieux de Pratique et Des Retomb\u00e9es \u00c9conomiques et Sociales des Activit\u00e9s Physiques de Plein Air. Available online: https:\/\/chairedetourisme.uqam.ca\/upload\/files\/%C3%89tude_Plein_air_rapport_final.pdf."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1093\/jme\/tjaa212","article-title":"Do-It-Yourself Tick Control: Granular Gamma-Cyhalothrin Reduces Ixodes scapularis (Acari: Ixodidae) Nymphs in Residential Backyards","volume":"58","author":"Bron","year":"2021","journal-title":"J. Med. Entomol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1016\/j.puhe.2014.06.016","article-title":"Lyme disease and post-treatment Lyme disease syndrome: The neglected disease in our own backyard","volume":"128","author":"Crowder","year":"2014","journal-title":"Public Health"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.ttbdis.2017.11.006","article-title":"Risk factors for tick exposure in suburban settings in the Northeastern United States","volume":"9","author":"Mead","year":"2018","journal-title":"Ticks Tick-Borne Dis."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1093\/oxfordjournals.aje.a008728","article-title":"Duration of tick bites in a Lyme disease-endemic area","volume":"143","author":"Falco","year":"1996","journal-title":"Am. J. Epidemiol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1016\/j.ttbdis.2016.09.006","article-title":"Analysis of the human population bitten by Ixodes scapularis ticks in Quebec, Canada: Increasing risk of Lyme disease","volume":"7","author":"Gasmi","year":"2016","journal-title":"Ticks Tick-Borne Dis."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"101347","DOI":"10.1016\/j.ttbdis.2019.101347","article-title":"Lyme disease in children: Data from the Canadian Paediatric Surveillance Program","volume":"11","author":"Ogden","year":"2020","journal-title":"Ticks Tick-Borne Dis."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1016\/j.ttbdis.2016.09.007","article-title":"Evidence of rapid changes in Lyme disease awareness in Canada","volume":"7","author":"Aenishaenslin","year":"2016","journal-title":"Ticks Tick-Borne Dis."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Johnson, K.O., Nelder, M.P., Russell, C., Li, Y., Badiani, T., Sander, B., Sider, D., and Patel, S.N. (2018). Clinical manifestations of reported Lyme disease cases in Ontario, Canada: 2005\u20132014. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0198509"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Gasmi, S., Ogden, N.H., Leighton, P.A., Adam-Poupart, A., Milord, F., Lindsay, L.R., Barkati, S., and Thivierge, K. (2017). Practices of Lyme disease diagnosis and treatment by general practitioners in Quebec, 2008\u20132015. BMC Fam. Pract., 18.","DOI":"10.1186\/s12875-017-0636-y"},{"key":"ref_74","unstructured":"INSPQ (2018, April 02). Plan D\u2019analyse de Surveillance Int\u00e9gr\u00e9e de la Maladie de Lyme. Available online: https:\/\/www.inspq.qc.ca\/sites\/default\/files\/publications\/2257_plan_analyse_surveillance_lyme.pdf."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Lloyd, V.K., and Hawkins, R.G. (2018). Under-Detection of Lyme Disease in Canada. Healthcare, 6.","DOI":"10.3390\/healthcare6040125"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/18\/9669\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:02:25Z","timestamp":1760166145000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/18\/9669"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,14]]},"references-count":75,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["ijerph18189669"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18189669","relation":{"has-preprint":[{"id-type":"doi","id":"10.20944\/preprints202107.0692.v1","asserted-by":"object"}]},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,14]]}}}