Tickborne Diseases in Children in the United States

Jennifer S. Read

doi:10.1542/pir.2018-0304

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Jennifer S. Read, MD, MS, MPH, DTM&H*,^†

^*Department of Pediatrics, University of Vermont Medical Center, Burlington, VT
^†Infectious Disease Epidemiology, Vermont Department of Health, Burlington, VT

AUTHOR DISCLOSURE
Dr Read has disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

CSF:: cerebrospinal fluid
EM:: erythema chronicum migrans
IFA:: immunofluorescent antibody
Ig:: immunoglobulin
RMSF:: Rocky Mountain spotted fever
PCR:: polymerase chain reaction

Practice Gaps

The most common tick-borne infections in the United States are Lyme disease, ehrlichiosis, anaplasmosis, Rocky Mountain spotted fever, and babesiosis. The epidemiology of these infections in the United States is integrally related to the geographic distribution and seasonality of the tick vector of each of the infections. Because these infections can be very serious and sometimes fatal, and because of the inherent delay in obtaining laboratory confirmation (especially with serologic assays requiring acute and convalescent titers), considering early implementation of empirical treatment based on the patient’s clinical presentation is extremely important. Prevention of acquisition of tick-borne diseases requires avoiding tick-infested areas or, if this is not possible or desired, implementing steps to decrease the likelihood of tick bites and the duration of tick attachment.

Objectives

After completing this article, readers should be able to:

Understand the etiologic organisms and the associated ticks responsible for transmission, the geographic distribution of and the reported infections associated with the ticks in the United States, and the seasonality and incubation periods of tick-borne infections in the United States.
Recognize the clinical manifestations and laboratory abnormalities associated with the infections, especially as they relate to children.
Plan for the diagnosis, treatment, and prevention of these infections.

Introduction

Vector-borne diseases, caused by microorganisms transmitted by insects and ticks, are major causes of morbidity and mortality globally. In the United States, vector-borne diseases are occurring more frequently and represent a significant public health concern. (1) The numbers of reported vector-borne disease cases in the United States (tick-borne, mosquito-borne, and flea-borne diseases) are shown in Table 1. (1) The reported incidence of vector-borne diseases most likely significantly underestimates the actual occurrence …