Biltmore Forest is a small town, with just under 1,500 residents. While the new research found 17 Lyme disease cases in the area, Biltmore Forest town manager Jonathan Kanipe said he’d been hearing anecdotal reports of the illness for years.
The ticks that cause it were clearly abundant.
“We’ve had public works employees pulling ticks off of them at what I would call a pretty steady rate,” Kanipe said. He recalled a time when he was simply walking around a parking lot to survey where a planned trail would be built, and finding ticks on his hands. “It freaked me out because I wasn’t even walking in the woods. I was just next to grass,” he said.
Newman and Kanipe mobilized a community group to raise awareness of the tick-borne threat. The efforts caught the attention of UNC’s Boyce and led to the research published Thursday; Kanipe and Newman are citizen co-authors.
Lyme disease is the most prevalent tick-borne illness in the U.S., with cases increasing dramatically since the mid-1990s. Most infections have been concentrated in the Northeast and the Upper Midwest, where blacklegged ticks are most prevalent. It’s estimated that nearly a half million people are diagnosed every year in the U.S.
As winters become warmer, deer, mice and other rodent populations move to different parts of the country. The ticks that feed on those animals go with them, expanding the tick-borne illness landscape and increasing infections nationwide.
An increasing number of communities are at risk “as infected ticks continue to expand geographically,” Lars Eisen, a research epidemiologist at the CDC’s Division of Vector-Borne Diseases in Fort Collins, Colorado, wrote in an email. “It’s important people understand the changing risks for Lyme and other tick-borne diseases.” The Fort Collins lab provided testing for the ticks in the new research.
Another tick-borne bacteria that can cause Lyme called Borrelia mayonii was previously only ever detected in Minnesota and Wisconsin, but recently discovered in New York.
Alpha-gal syndrome, the tick-borne illness that triggers an allergy to red meat and other mammalian products, tends to be concentrated in the East and Midwest but is becoming more prevalent in the Great Lakes and the West. And Powassan virus, a rare but particularly deadly tick-borne disease that can cause brain inflammation, reached a record high number of cases in 2024.
The migration of ticks appears to have outpaced both awareness of the threats and the ability to test for the illnesses ticks cause, notably Lyme disease. Lyme and other tick-borne illnesses can be treated with antibiotics, but only if they’re accurately diagnosed.
A recent editorial published in the Journal of the American Medical Association suggested that many doctors rely on antibody tests that can take up to six weeks to generate results, delaying diagnoses and even missing early infections, according to the editorial’s author.
“Current tests are reliable once patients have been infected for several weeks and have long-term symptoms such as Lyme arthritis, a late-stage complication characterized by sudden, severe swelling in large joints,” the author wrote. “Improved tests could not only help clinicians identify Lyme disease earlier but also better characterize patients for clinical trials and biomarker research.”
Until such research is conducted, Johns Hopkins’ Soloski said emergency room doctors and primary care physicians may want to consider Lyme and other tick-borne illnesses in patients with otherwise unexplained symptoms, even in places where it’s not considered commonplace.
“The niches that these ticks can find that allow them to flourish,” he said, “is only increasing.”
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