The surveillance case definition for LD varies among states and between states and CDC. Some states use the CDC case definition adopted in 1988, i.e., physician-diagnosed erythema migrans (EM) in a person who acquired infection in a county with endemic LD or, for persons who acquired infection in a county without endemic LD, laboratory evidence of infection in addition to the presence of EM. Other states (e.g., New York, Wisconsin, Connecticut) use a previous, more inclusive, CDC case definition for LD, which counts as cases persons with appropriate systemic manifestations and laboratory evidence of infection.1 Differences in the case definitions used by states must be considered when state and regional incidences are compared.
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