Surge in Anaplasmosis Cases in Maine, USA, 2013–2017

Susan P. Elias; Jessica Bonthius; Sara Robinson; Rebecca M. Robich; Charles B. Lubelczyk; Robert P. Smith, Jr.

Disclosures

Emerging Infectious Diseases. 2020;26(2):327-331. 

In This Article

The Study

MECDC provided the number of confirmed and probable cases for Maine residents during 2008–2017, available by county of residence and age of onset. For 2013–2017, we obtained the annual number of hospitalizations for Lyme disease and HGA for Maine residents, with age and county of residence at admission, from the Maine Health Data Organization.

We obtained the annual number of multipathogen (including HGA) PCR tick panel orders during 2013–2017 from NorDx and Mayo Medical Laboratories (MML). NorDx (Scarborough, ME, USA) started using its panel for the agents of HGA and babesiosis in 2015 (H. Webber, NorDx, pers. comm., 2018 Sep 12). All orders were for Maine patients (travel history not specified). MML provided data from 2 branch laboratories, Mayo Clinic Rochester (MCR; Rochester, MN, USA) and Mayo Medical Laboratories, New England (MMLNE; Andover, MA, USA). MML has offered the panel for ≈10 years; the panel contains a PCR test for the agents of human monocytic ehrlichiosis, HGA, babesiosis, and Borrelia miyamotoi infections (B. Pritt, MML, pers. comm., 2018 Aug 3). MML data comprised specimens sent to MML from Maine clients, without patient residence or travel history (B. Pritt, A. Boerger, MML, pers. comm., 2018 Oct 8). We were unable to obtain data from other laboratories; however, MML and NorDx combined accounted for 72% of HGA test reports sent to MECDC during 2013–2017. The MML panel had sensitivity and specificity of 1 for detection of A. phagocytophilum compared with standard PCR.[7] The NorDx panel had sensitivity and specificity of 1 compared with panels of MML and other laboratories (H. Webber, pers. comm., 2019 Aug 29).

The HGA incidence rate, hospitalization rate, complications, and death rate increase with age,[8] whereas Lyme incidence has a bimodal distribution, with peaks in young children and older adults.[9] We tabulated HGA cases and incidence for 2008–2017 overall and by age class and tabulated HGA hospitalizations 2013–2017 overall and by age class and annual laboratory testing effort. For comparison, we included annual overall Lyme incidence and hospitalizations. We compared percentage changes from 2013 to 2017 in disease incidence and hospitalizations. To visualize geographic expansion of HGA, we plotted side-by-side maps of county-level incidence and population-adjusted hospitalization rates for 2013 versus 2017.

During 2013–2017, a total of 1,505 anaplasmosis cases were reported.[10] Of these, 85.6% (1,289) were confirmed (1,286 by PCR and 3 by 4-fold antibody titer increase) and 14.4% (216) probable (203 with a single titer result, 8 with <4-fold titer increase, 5 with morulae visualization). Statewide, anaplasmosis incidence rose from 7 cases/100,000 persons in 2013 to 50 cases/100,000 persons in 2017, a 602% increase, compared with a 33% increase for Lyme disease incidence (Table 1). Hospitalizations for HGA rose from 36 in 2013 to 119 in 2017, a 231% increase, compared with a 27% decline in hospitalizations for Lyme disease (Table 2). Combined tick panel use by MML and NorDx rose from 773 in 2013 to 9,157 in 2017, a 1,085% increase (Table 2).

Among 39 pediatric HGA cases, 1 occurred in 2010 and the remaining 38 during 2014–2017, representing 1.7%–5.2% of total cases per year during 2014–2017 (Table 1). Even though hospitalizations increased for persons 18–64 and ≥65, there were no hospitalizations for children.

Anaplasmosis incidence and hospitalizations underwent geographic range expansion during 2013– 2017 (Figures 1, 2). Anaplasmosis incidence was highest in Lincoln and Knox Counties, in Maine's midcoast region, where incidence ranged from 29 cases/100,000 persons in 2013 to 278 cases/100,000 persons in 2017 (Figure 1, panels A, B).

Figure 1.

Human granulocytic anaplasmosis incidence (cases/100,000 persons), Maine, USA, 2013 (A) and 2017 (B). Statewide incidence increased 602% during 2013–2017.

Figure 2.

Hospitalizations (per 100,000 persons) for human granulocytic anaplasmosis, Maine, USA, 2013 (A) and 2017 (B). Statewide hospitalizations increased 231% during 2013–2017.

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