According to a CDC report, Babesiosis is an emerging zoonotic tickborne parasitic disease in the United States and occurs primarily in the Northeast and Midwest.
During 2011-2019, U.S. babesiosis incidence significantly increased in northeastern states. Three states (Maine, New Hampshire, and Vermont) that were not considered to have endemic babesiosis had significantly increasing incidences and reported case counts similar to or higher than those in the seven states with known endemic transmission.
Babesiosis is a tickborne disease caused by intraerythrocytic Babesia parasites.
In the United States, most babesiosis cases are caused by Babesia microti, transmitted from bites of blacklegged ticks, Ixodes scapularis, in northeastern and midwestern states. Transmission can also occur through blood transfusions, transplantation of organs from infected donors, or congenital (mother-to-child) transmission (1). Babesia infection can be asymptomatic or cause mild to severe illness that can be fatal.
Overall, U.S. tickborne disease cases have increased 25%, from 40,795 reported in 2011 to 50,856 in 2019 (2). Babesiosis trends were assessed in 10 states* where babesiosis was reportable during 2011-2019. Incidence increased significantly in Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, and Vermont (p<0.001), with the largest increases reported in Vermont (1,602%, from two to 34 cases), Maine (1,422%, from nine to 138), New Hampshire (372%, from 13 to 78), and Connecticut (338%, from 74 to 328). Unlike the other seven states, Maine, New Hampshire, and Vermont, were not included as states with endemic disease in previous CDC babesiosis surveillance summaries.
These three states should now be considered to have endemic transmission comparable to that in other high-incidence states; they have consistently identified newly acquired cases every year during 2011-2019 and documented presence of Babesia microti in the associated tick vector (3). Because incidence in Northeastern states, including Maine, New Hampshire, and Vermont, is increasing, tick prevention messaging, provider education, and awareness of infection risk among travelers to these states should be emphasized.
Babesiosis can cause illness ranging from asymptomatic or mild to severe; the disease can be fatal, particularly among persons who are immunocompromised or asplenic. Common symptoms include fever, muscle and joint pain, and headache.
In certain patients, severe complications can occur, including thrombocytopenia, renal failure, and acute respiratory distress syndrome. Babesiosis can be treated using a combination of antimicrobial medications, such as azithromycin and atovaquone.
The first case of human babesiosis acquired in the United States was identified in 1969 on Nantucket Island, Massachusetts. In 2011, babesiosis became a nationally notifiable condition. Where babesiosis is reportable, cases are reported to CDC by state health departments. Until now, CDC considered babesiosis to be endemic in seven states: Connecticut, Massachusetts, Minnesota, New Jersey, New York, Rhode Island, and Wisconsin.
In 2019, the U.S. Food and Drug Administration (FDA) recommended screening blood donations for Babesia in states where residents were considered to be at high risk for Babesia infection. As a result, FDA recommended blood donation screening in the following 15 states or jurisdictions: Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, Wisconsin, and the District of Columbia.
Previous studies have examined babesiosis transmission and found increasing case counts or rates in particular geographic areas, such as New York (7) in previous years (2011-2015) (4) and among specific populations, such as those enrolled in Medicare (8). The current study identifies trends in babesiosis in the United States during 2011-2019 and highlights establishment of endemic transmission in new geographic areas. Tracking babesiosis transmission over time provides important data to monitor the transmission risk in areas with and without endemic disease.
Steps can be taken to reduce the risk for babesiosis and other tickborne infections. The use of prevention measures is especially important for people at increased risk for severe babesiosis (for example, people who do not have a spleen). Avoiding exposure to tick habitats is the best defense.
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