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Arch Dermatol. 1989;125(12):1617-1619.

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1. Schmid GP, Horsley R, Steere AC, et al. Surveillance of Lyme disease in the United States, 1982. J Infect Dis 1985;151:1144-9. PUBMED 2. Tsai TF, Bailey RE, Moore PS. National surveillance of Lyme disease, 1987-1988. Conn Med 1989;53:324-6. PUBMED 3. Barbour AG. The diagnosis of Lyme disease: rewards and perils. Ann Intern Med 1989;110: 501-2. FREE FULL TEXT 4. Steere AC. Lyme disease. N Engl J Med 1989;321:586-96. ABSTRACT 5. Cartter ML, Mshar P, Hadler JL. The epidemiology of Lyme disease in Connecticut. Conn Med 1989;53:320-3. PUBMED 6. Steere AC, Taylor E, Wilson ML, Levine JF, Spielman A. Longitudinal assessment of the clinical and epidemiological features of Lyme disease in a defined population. J Infect Dis 1986;154:295-300. PUBMED 7. Lastavica CC, Wilson ML, Berardi VP, Spielman A, Deblinger RD. Rapid emergence of a focal epidemic of Lyme disease in coastal Massachusetts. N Engl J Med 1989;320:133-7. ABSTRACT 8. Hanrahan JP, Benach JL, Coleman JL, et al. Incidence and cumulative frequency of endemic Lyme disease in a community. J Infect Dis 1984; 150:489-96. PUBMED 9. Spielman A, Wilson ML, Levine JF, Piesman J. Ecology of Ixodes dammini-borne human babesiosis and Lyme disease. Annu Rev Entomol 1985;30:439-60. PUBMED 10. Davis JP, Schell WL, Amundson TE, et al. Lyme disease in Wisconsin; epidemiologic, clinical, serologic and entomologic findings. Yale J Biol Med 1984;57:685-96. PUBMED 11. Falco RC, Fish D. A survey of tick bites acquired in a Lyme-disease endemic area in southern New York State. Ann N Y Acad Sci 1988; 539:456-7. 12. Falco RC, Fish D. Prevalence of Ixodes dammini near the homes of Lyme disease patients in Westchester County, New York. Am J Epidemiol 1988;127:826-30. FREE FULL TEXT 13. Piesman J, Mather TN, Sinsky RJ, Spielman A. Duration of tick attachment and Borrellia burgdorferi transmission. J Clin Microbiol 1987;25:557-8. FREE FULL TEXT 14. CDC. Seizures temporally associated with use of DEET insect repellent—New York and Connecticut. MMWR 1989;38:678-80. PUBMED 15. Schreck CE, Snoddy EL, Spielman A. Pressurized sprays of permethrin or DEET on military clothing for personal protection against Ixodes dammini (Acari: Ixodidae). J Med Entomol 1986;23:396-9. PUBMED 16. Mount GA, Snoddy EL. Pressurized sprays of permethrin and DEET on clothing for personal protection against the Lone Star tick and the American dog tick (Acari: Ixodidae). J Econ Entomol 1983;76:529-31. PUBMED * The surveillance case definition for LD varies among states and between states and CDC. Some states use the CDC case definition adopted in 1988, i.e., physician-diagnosed erythema migrans (EM) in a person who acquired infection in a county with endemic LD or, for persons who acquired infection in a county without endemic LD, laboratory evidence of infection in addition to the presence of EM. Other states (e.g., New York, Wisconsin, Connecticut) use a previous, more inclusive, CDC case definition for LD, which counts as cases persons with appropriate systemic manifestations and laboratory evidence of infection.1 Differences in the case definitions used by states must be considered when state and regional incidences are compared.

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