Tick with Lyme disease bacteria crawling on skin

Where Is Lyme Disease Common?

Medically reviewed on July 13, 2022 by Jordan Stachel, M.S., RDN, CPT. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.


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No matter how much you love spending time outdoors, you may dread the thought of pulling off ticks after a hike, foraging excursion, or camping trip.

Depending on where you live (or explore), you might be at a higher risk of contracting the most common tick-borne infection—Lyme disease. [1]

Where is Lyme disease common? In this guide, we’re exploring the three areas in the US where Lyme infections are most prevalent—the Northeast, the Upper Midwest, and the Northwest. We’ll also break down the basics of the disease and explore four prevention methods that could significantly reduce your likelihood of contracting Lyme disease.

High concentrations of Lyme disease cases

Where is Lyme disease common?

Let’s discuss three US regions where the majority of Lyme cases are reported. But, whether or not you live in one of these regions, you should still remain attentive to Lyme prevention and treat a potential symptom as quickly as possible.

Northeast US

There are seven different tick species found throughout the US—and you can find four of them in the Northeast US, where Lyme infections are very common. [2]

Keep an eye out for:

  • American dog ticks (sometimes called wood ticks)
  • Blacklegged ticks
  • Brown dog ticks (which are found everywhere in the contiguous US)
  • Lone star ticks (which are prevalent in the coastal Northeast)

It’s important to note that, among the ticks listed above, only an infected blacklegged tick that carries Borrelia bacteria that can cause Lyme disease. So, if only one tick species found in this region carries Lyme-causing bacteria, why are infections so prevalent?

  • Biting stages – Typically, only adult female American dog ticks and brown dog ticks will bite humans. However, blacklegged ticks and lone star ticks (which don’t carry Borrelia bacteria, but can still cause other tick-borne illnesses) bite in both the nymph stage and adult stage, increasing infection risk.
  • Year-round biting – While other tick varieties typically only bite in the spring and summer months, blacklegged ticks will search for heat in any temperatures above freezing.

Upper Midwest US

Three tick varieties are common in the Upper Midwestern states: [2]

  • American dog ticks
  • Blacklegged ticks
  • Brown dog ticks

Lone star and Rocky Mountain wood ticks aren’t unheard of in the Upper Midwest, but they’re more common in the Central Midwest.

Just like the Northeast region, the infected blacklegged tick is the only species in the Upper Midwest that carries Borrelia bacteria, and infections are common for the same reasons—blacklegged ticks bite in more than one phase, and they seek hosts year-round.

However, the Upper Midwest has an advantage against blacklegged ticks and their Lyme-causing bacteria—cold winters.

Lyme disease is a vector illness, a type of sickness spread by arthropods (ticks, mosquitos, sandflies, and blackflies). [3] But, arthropods are cold-blooded, going dormant when temperatures dip below freezing. Harsh cold, snowing conditions, and long winters at least slightly reduce Upper Midwesterners’ likelihood of a tick bite.

Northwest US

The Northwest US features three common tick species: [2]

  • Brown dog ticks
  • Rocky Mountain wood ticks
  • Western blacklegged ticks

Like their counterparts in other parts of the US, Western blacklegged ticks carry Borrelia bacteria and can potentially spread Lyme disease to humans.

However, Northwestern residents must stay vigilant against another vector illness—Rocky Mountain Spotted Fever (RMSF), an infection spread by both Rocky Mountain wood ticks and brown dog ticks. There are many similarities and differences between Lyme disease vs. Rocky Mountain Spotted Fever. For example, the symptoms of RMSF can be very similar to Lyme disease effects (fever, headache, and rash are common in both infections), so anyone spending significant time outdoors in the Northwest should take steps to prevent both diseases.

Demystifying Lyme disease

If you live in or travel to any of the regions above, you could be more likely to encounter ticks carrying Lyme disease bacteria. But, what should you expect if you contract a Lyme infection? Let’s explore the disease in more detail.

Causes

Lyme disease is caused by the bite of a tick infected with Borrelia bacteria. [4] The disease isn’t contagious, and tick bites don’t always lead to an infection (partially because not all ticks carry Borrelia bacteria).

When studying the lesions characteristic of a Lyme infection—called erythema migrans—researchers have determined that Borrelia bacteria primarily impact connective tissue cells, lymphatic system cells, and plasma cells. This potentially explains some of the long-term effects of Lyme disease—like joint inflammation and full-body symptoms.

But, since Lyme disease can only be caused by a tick bite, the disease is very preventable—we’ll discuss this further in a later section.

Symptoms and stages

Lyme symptoms vary based on the stages of Lyme disease. There are three major phases of Lyme disease: [4]

  1. Early localized Lyme disease
  2. Early disseminated Lyme disease
  3. Late disseminated Lyme disease

Symptoms increase in severity based on the stage of the infection and include:

  • Erythema migrans (a rash unique to Lyme disease patients)
  • Flu-like symptoms, including fever, headache, fatigue or malaise, body aches, and brain fog
  • Nerve pain or swelling

Many of the symptoms of Lyme disease are indistinguishable from the flu or other infections. There are two major signs that healthcare providers can use to help confirm a Lyme disease diagnosis:

  • Infection timeline – Lyme symptoms can last anywhere from one week to multiple years (if left untreated). Cold and flu symptoms typically fade in a shorter period of time.
  • Erythema migrans – This refers to the classic bull's-eye rash that occurs at the site of the tick bite in many (but not all) cases, and is a key indicator of Lyme disease.

Diagnosis

Healthcare providers typically diagnose Lyme disease based on symptoms and rule-out activities.

ut, they can also perform an antibody test. When your body is introduced to a foreign organism (bacteria or a virus, for instance), it produces antibodies that bind to and kill foreign cells. [6] So, if you’ve contracted a Lyme infection, your body will produce an antibody to fight whichever strain of the Borrelia bacteria is to blame.

Treatment

After a confirmed Lyme disease diagnosis, healthcare providers will prescribe a source of antibiotics. [4] The length of the course depends on the stage of the illness, and the specific medication prescribed depends upon a patient’s...

  • Age
  • Allergies and antibiotic resistance history
  • Other medications
  • Pregnancy status

Three antibiotics are common:

  • Doxycycline is prescribed for most adults
  • Amoxicillin is most effective for children
  • Ceftriaxone is prescribed for pregnant patients

But, a healthcare provider may also recommend over-the-counter (OTC) medications for pain management, fever reduction, or sleep aid.

Preventing Lyme disease

Lyme disease is very treatable, but it’s also preventable. What steps can you take to prevent Lyme disease at home, on the go, and while you’re exploring the outdoors?

Insect Repellants and Pesticides

Using a high-quality insect repellant is an excellent method for preventing tick bites or even helping with tick removal. Look for products that are EPA-registered and contain one or more of the following ingredients: [7]

  • DEET
  • Oil of Lemon Eucalyptus (OLE)
  • Picaridin
  • Para-menthane-diol (PMD)
  • 2-undecanoate

If you live in a region with high instances of Lyme disease, consider using pesticides in your lawn or home. Contact your local extension office to determine which product is right for your area and get safety tips for pesticide application.

Clothing

When you explore the outdoors, your wardrobe can help you prevent tick bites. When dressing for an excursion, consider choosing items that:

  • Provide full coverage of the arms, neck, legs, and trunk
  • Aren’t too tight (tight clothing can help ticks latch to the skin)

In addition, choose clothing that is easy to shake out, remove, or stretch so that you can actively check for ticks during your adventure. You should also untuck your shirt, pull your socks to the side, and examine the waistband of your pants regularly while you’re outdoors.

Vigilance

Occasionally checking for ticks while you’re outside is one way to stay vigilant against ticks. But, you can increase your awareness and prevent infection in other ways, too:

  • Monitor local infection rates and tick population data in your area
  • Manage your pets’ interactions with ticks via tick checks after prolonged time outdoors and tick prevention medications like Bravecto, NexGard, and Simparica Trio
  • Check for ticks after you come home from an outdoor trip

Tick checks can be time-consuming, but they can help you prevent bites and infections. You might need a partner to help you identify and remove ticks from hard-to-reach areas.

#4 Preventative testing

Healthcare providers can perform antibody tests during the diagnosis process, but you can also complete this step at home if you suspect you might have Lyme disease. At-home Lyme disease testing can provide peace of mind, help you detect an infection early, and serve as a diagnostic tool for your medical provider.

You should consider routine preventative testing if you:

  • Work in the outdoors in a tick-dense region
  • Regularly hunt in forested areas
  • Actively work in your yard

Everlywell: Medical tests from the comfort of home

Where is Lyme disease common?

If you live in the Northeast, Upper Midwest, or Northwest, Lyme disease might be more prevalent in your area. Identifying the symptoms of Lyme disease early and actively preventing tick bites are crucial for people spending time outdoors in these regions, but anyone in the US can contract Lyme disease via tick bites.

With help from Everlywell, you can test for Lyme disease at home. Our at-home test kit detects antibodies for three different Lyme-causing bacteria—Borrelia burgdorferi, B. garinii, and B. afzelii. With an at-home Lyme disease test, you can take the first step to receive swift, effective treatment for Lyme disease before symptoms worsen.

What Are the Long-Term Effects of Lyme Disease?

How is Lyme Disease Diagnosed?

Lyme Disease vs. Rocky Mountain Spotted Fever

Stages of Lyme Disease Explained


References

  1. Lyme Disease. US Centers for Disease Control and Prevention. Lyme Disease. URL. Accessed July 13, 2022.
  2. Regions Where Ticks Live. US Centers for Disease Control and Prevention. URL. Accessed July 13, 2022.
  3. Vector-Borne Diseases. European Centre for Disease Prevention and Control. URL. Accessed July 13, 2022.
  4. Lyme Disease. US National Library of Medicine. URL. Accessed July 13, 2022.
  5. Lyme Disease Rashes and Look=Alikes. US Centers for Disease Control and Prevention. URL. Accessed July 13, 2022.
  6. How Does the Immune System Work? US National Library of Medicine. URL. Accessed July 13, 2022.
  7. Ticks on People. US Centers for Disease Control and Prevention. URL. Accessed July 13, 2022.
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