Characterizing Lyme Disease Surveillance in an Endemic State.

Area of Science:

• Public Health
• Epidemiology
• Vector-borne Diseases

Background:

• Lyme disease (LD) is the most prevalent vector-borne illness in Maryland and the U.S.
• Effective surveillance is crucial for tracking disease burden, spread, and affected populations.
• Existing surveillance practices in Maryland's local health departments (LHDs) exhibit significant variability and underreporting.

Purpose of the Study:

• To investigate the variability in Lyme disease (LD) surveillance practices across Maryland's 24 LHDs.
• To systematically characterize the LD surveillance process and identify challenges faced by LHDs.

Main Methods:

• Annual survey of Maryland LHDs regarding LD surveillance procedures from 2011 onwards.
• Data collection on investigation protocols (full vs. subset), case reporting, and database entry.
• Analysis of trends in personnel, reporting, and investigation strategies over time.

Main Results:

• Significant loss of LD surveillance personnel in Maryland since 2011.
• Between 2009-2012, 43-55% of LD reports were not entered into surveillance databases.
• Increasing trend of LHDs streamlining investigations to include only lab-confirmed cases (21% in 2008 to 63% in 2013).

Conclusions:

• Wide variability exists in LD investigation methods across Maryland LHDs.
• Reduced personnel and streamlined approaches impact surveillance data quality.
• Need for alternative strategies to manage LD surveillance burden while maintaining data integrity.