Abstract
Due to the life cycle of its vector, Lyme disease has known seasonal variation. However, investigations focused on children have been limited. Our objective was to evaluate the seasonality of pediatric Lyme disease in three endemic regions in the United States. We enrolled children presenting to one of eight Pedi Lyme Net participating emergency departments. Cases were classified based on presenting symptoms: early (single erythema migrans (EM) lesion), early-disseminated (multiple EM lesions, headache, cranial neuropathy, or carditis), or late (arthritis). We defined a case of Lyme disease by the presence of an EM lesion or a positive two-tier Lyme disease serology. To measure seasonal variability, we estimated Fourier regression models to capture cyclical patterns in Lyme disease incidence. While most children with early or early-disseminated Lyme disease presented during the summer months, children with Lyme arthritis presented throughout the year. Clinicians should consider Lyme disease when evaluating children with acute arthritis throughout the year.
Highlights
Lyme disease is the most commonly reported vector-borne illness in the UnitedStates [1], and children are disproportionately affected [2]
We enrolled children undergoing clinical evaluation for Lyme disease presenting between 1 June 2015 and 20 July 2021 to one of the eight Pedi Lyme Net participating emergency departments, with exact enrollment dates varying by participating centers [4]
Children with early and early-disseminated Lyme disease most frequently presented in the summer months (June through August), while children with Lyme arthritis presented throughout the year (Figure 1)
Summary
Lyme disease is the most commonly reported vector-borne illness in the UnitedStates [1], and children are disproportionately affected [2]. Though capable of biting throughout the year, adult ticks are much larger and often removed prior to disease transmission [3]. Recognizing this seasonal transmission cycle, clinicians are quick to suspect Lyme disease in the summer and early fall but may not consider Lyme disease during the winter months. EM lesions, headache, cranial neuropathy, or carditis) can present within days to weeks of a tick bite, late disease (arthritis) often manifests months later [3]. Lyme arthritis may present throughout the year, even when clinicians are less likely to consider
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