Impact of Revised Diagnostic Testing Algorithms and Case Definitions on Lyme Disease Surveillance in a Low-Incidence State: An Interrupted Time Series Analysis

Gayoung Lee; Brandon D Hollingsworth; Dana A Giandomenico; Teresa G Fisher; Carl Williams; Ross M Boyce

doi:10.1093/cid/ciae545

Impact of Revised Diagnostic Testing Algorithms and Case Definitions on Lyme Disease Surveillance in a Low-Incidence State: An Interrupted Time Series Analysis

Clin Infect Dis. 2025 Sep 16;81(2):403-406. doi: 10.1093/cid/ciae545.

Authors

Gayoung Lee¹, Brandon D Hollingsworth^{2

3}, Dana A Giandomenico⁴, Teresa G Fisher⁵, Carl Williams⁵, Ross M Boyce^{1

4}

Affiliations

¹ Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
² Department of Entomology, Cornell University, Ithaca, New York, USA.
³ Cornell Institute of Host Microbe Interaction and Disease, Cornell University, Ithaca, New York, USA.
⁴ Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
⁵ Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA.

PMID: 39589149
DOI: 10.1093/cid/ciae545

Abstract

We evaluated the impact of the endorsement of modified 2-tiered testing and its inclusion in updated Lyme disease case definitions in North Carolina using surveillance data from 2017-2023. After the implementation of modified 2-tiered testing, confirmed cases increased by 117%, with comparable decreases in probable cases compared with prior periods.

Keywords: Lyme disease; case definition; diagnostic testing; modified 2-tiered testing; surveillance.

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MeSH terms

Algorithms*
Diagnostic Tests, Routine* / methods
Epidemiological Monitoring*
Humans
Incidence
Interrupted Time Series Analysis
Lyme Disease* / diagnosis
Lyme Disease* / epidemiology
North Carolina / epidemiology
Population Surveillance

Abstract

MeSH terms

Grants and funding