Geographic Expansion of Lyme Disease in Michigan, 2000–2014

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background.</div>Most Lyme disease cases in the Midwestern United States are reported in Minnesota and Wisconsin. In recent years, however, a widening geographic extent of Lyme disease has been noted with evidence of expansion eastwards into Michigan and neighboring states with historically low incidence rates.<div class="boxTitle">Methods.</div>We collected confirmed and probable cases of Lyme disease from 2000 through 2014 from the Michigan Department of Health and Human Services, entering them in a geographic information system. We performed spatial focal cluster analyses to characterize Lyme disease expansion. We compared the distribution of human cases with recent <span style="font-style:italic;">Ixodes scapularis</span> tick distribution studies.<div class="boxTitle">Results.</div>Lyme disease cases in both the Upper and Lower Peninsulas of Michigan expanded more than 5-fold over the study period. Although increases were seen throughout the Upper Peninsula, the Lower Peninsula particularly expanded along the Indiana border north along the eastern shore of Lake Michigan. Human cases corresponded to a simultaneous expansion in established <span style="font-style:italic;">I scapularis</span> tick populations.<div class="boxTitle">Conclusions.</div>The geographic distribution of Lyme disease cases significantly expanded in Michigan between 2000 and 2014, particularly northward along the Lake Michigan shore. If such dynamic trends continue, Michigan—and possibly neighboring areas of Indiana, Ohio, and Ontario, Canada—can expect a continued increase in Lyme disease cases.</span>

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