Vital Signs

Trends in Reported Vectorborne Disease Cases — United States and Territories, 2004–2016

Ronald Rosenberg, ScD; Nicole P. Lindsey, MS; Marc Fischer, MD; Christopher J. Gregory, MD; Alison F. Hinckley, PhD; Paul S. Mead, MD; Gabriela Paz-Bailey, MD; Stephen H. Waterman, MD; Naomi A. Drexler, MPH; Gilbert J. Kersh, PhD; Holley Hooks, MPH; Susanna K. Partridge, MPH; Susanna N. Visser, DrPH; Charles B. Beard, PhD; Lyle R. Petersen, MD

Disclosures

Morbidity and Mortality Weekly Report. 2018;67(17):496-501. 

In This Article

Results

Nearly 650,000 cases of vectorborne disease were reported during 2004–2016 (Table). Tickborne diseases, which accounted for >75% of reports, occur throughout the continental United States, but predominate in the eastern part of the country and in areas along the Pacific Coast (Figure 1). Reported cases of tickborne disease have doubled in the 13-year analysis period, with Lyme disease accounting for 82% of cumulative reported tickborne disease. The combined incidence of reported anaplasmosis and ehrlichiosis, which are tickborne bacterial diseases, rose almost every year, as did spotted fever; babesiosis, a tickborne parasitic infection that has been notifiable since 2011, also contributed to the rise. Endemic plague, a fleaborne disease that is transmitted mostly in the rural southwestern United States, did not exceed 17 cases in a year. Tularemia and ehrlichiosis are geographically widespread but more prevalent in the central United States.

Figure 1.

Reported cases* of tickborne disease — U.S. states and territories, 2004–2016
Sources: CDC, National Notifiable Diseases Surveillance System, 2016 Annual Tables of Infectious Disease Data. https://wwwn.cdc.gov/nndss/infectious-tables.html. CDC, Division of Health Informatics and Surveillance. CDC, ArboNET.
Abbreviations: AS = American Samoa; PR/VI = Puerto Rico/U.S. Virgin Islands.
*Data classified by quintile.

By contrast, the occurrence of mosquitoborne viruses was dispersed (Figure 2) and punctuated by epidemics (Table) (Figure 3). WNV was the most commonly transmitted mosquitoborne disease in the continental United States. Its most notable epidemic during 2004–2016 occurred in 2012, especially in Texas. Epidemics of dengue, chikungunya, and Zika viruses were mostly confined to the U.S. territories. All four dengue viruses were endemic in Puerto Rico, which was subject to cyclical epidemics, notably in 2010 and during 2012–2013. Puerto Rico's first chikungunya virus epidemic peaked in 2014, followed by Zika virus in 2016. Travelers infected in the territories and Latin America accounted for >90% of the dengue, chikungunya, and Zika virus disease cases identified in the states and District of Columbia; limited autochthonous transmission of dengue occurred in Florida, Hawaii, and Texas, and of chikungunya and Zika viruses in Texas and Florida. Malaria is diagnosed in approximately 1,500 travelers yearly but no autochthonous transmission was documented during 2004–2016.

Figure 2.

Reported cases* of mosquitoborne disease — U.S. states and territories, 2004–2016
Sources: CDC, National Notifiable Diseases Surveillance System, 2016 Annual Tables of Infectious Disease Data. https://wwwn.cdc.gov/nndss/infectious-tables.html. CDC, Division of Health Informatics and Surveillance. CDC, ArboNET.
Abbreviations: AS = American Samoa; PR/VI = Puerto Rico/U.S. Virgin Islands.
*Data classified by quintile.

Figure 3.

Reported nationally notifiable mosquitoborne,* tickborne, and fleaborne disease cases — U.S. states and territories, 2004–2016
*Mosquitoborne case counts include both locally transmitted and travel-associated cases. Only 305 arbovirus cases were reported from the territories in 2015.
A total of 89 fleaborne disease cases (plague) were reported during 2004–2018, ranging from two cases in 2010 to 16 cases in 2015. The cases are not depicted on the figure.

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