Lyme Disease Detected At Later Stage in Hispanics Interview with:
Christina Nelson, MD, MPH, FAAP
Medical Epidemiologist
Centers for Disease Control and Prevention
Division of Vector-Borne Diseases | Bacterial Diseases Branch
Fort Collins, CO What is the background for this study? What are the main findings?

Dr. Nelson: Since Lyme disease is a nationally notifiable disease, state and local health departments collect reports of Lyme disease cases in their jurisdictions then share this data with CDC. This surveillance data is very informative and can be used to track disease patterns.

Hispanics comprise roughly 45% of the U.S. workforce in outdoor jobs such as grounds maintenance, farming, fishing, and forestry, so they potentially have an increased risk of Lyme disease. Since information on Lyme disease in Hispanics is very limited, we decided to look into this topic further by analyzing surveillance data. What is the background for this study? What are the main findings?

Dr. Nelson: Overall, the trends in Lyme disease among Hispanics were similar to those among non-Hispanics—males were more commonly affected, young and elderly people were affected more than people in their 20s and 30s, and Lyme disease cases occurred in states where we already know Lyme disease to be common (primarily the Northeast, mid-Atlantic states, and Upper Midwest).

We identified a few key differences though. Most notably, Hispanics with Lyme disease were significantly more likely than non-Hispanics to have disseminated infection (a later stage of infection when the bacteria has spread throughout the body) and be diagnosed later in the year (i.e. fall months versus summer months). While the reasons for this are likely multifactorial, this could indicate delays in diagnosis. We also found that the overall incidence of Lyme disease was actually lower among Hispanics than among non-Hispanics. While this could indicate a true lower risk in Hispanics, another possible reason for this is underdiagnosis of Lyme disease, meaning the disease might be present but not detected or reported. Underdiagnosis could result from inadequate access to healthcare, language barriers, and lack of awareness of the disease. What should clinicians and patients take away from your report?

Dr. Nelson: Clinicians should consider Lyme disease when evaluating ill patients from Lyme-endemic areas who have signs of infection, particularly those who work or recreate outdoors often. Hispanics may be at greater risk for disseminated infection due to a variety of factors, so it’s especially important to consider Lyme disease when indicated for Hispanic patients.

Also, it is essential to reach at-risk populations with culturally and linguistically appropriate prevention education. Although some educational materials on preventing Lyme disease and other tickborne illnesses have been translated to Spanish, additional translations and modifications to address cultural differences would be helpful. Furthermore, targeted educational campaigns, particularly by employers, could enhance use of these materials and improve the chances of their employees either taking steps to prevent Lyme disease or getting early treatment with antibiotics. What recommendations do you have for future research as a result of this study?

Dr. Nelson: We need more direct and in-depth assessments of prevention practices, knowledge of Lyme and other tickborne diseases, and risk of Lyme disease among Hispanics. Additionally, we need to know how best to reach people who are at risk of getting tick bites and Lyme disease. Is there anything else you would like to add?

Dr. Nelson: Lyme disease and other tickborne diseases are preventable! Please visit for more information on how to protect yourself from tick bites. Thank you for your contribution to the community.


Nelson CA, Starr JA, Kugeler KJ, Mead PS. Lyme disease in Hispanics, United States, 2000–2013. Emerg Infect Dis. 2016 Mar [date cited].

DOI: 10.3201/eid2203.151273

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Christina Nelson, MD, MPH, FAAP (2016). Lyme Disease Detected At Later Stage in Hispanics