Lyme Disease Cluster at a North Carolina Camp

A cluster of Lyme disease cases in children attending a wilderness camp in North Carolina highlights the growing risk of Lyme disease in the southern United States.

The number of tick-borne diseases, including Lyme disease, has been steadily rising as tick populations expand into new territories. One study reported that “the trends in these data paint a clear picture of southward expansion of Lyme disease.”

As a result, communities once considered non-endemic for Lyme disease—including parts of the southeastern United States—are now seeing confirmed infections.

The CDC recently reported four children infected with Lyme disease who attended the same wilderness day camp in North Carolina.

The children were between 6 and 8 years old and attended the camp at least one day per week during the fall and spring. Three of the four children were homeschooled but participated regularly in camp activities. Ticks had been removed from three of the children.

Investigators also identified an earlier camp participant who had received a diagnosis of Lyme disease in 2017, suggesting ongoing tick exposure at the site.

Tick Investigation Results

Investigators conducted tick surveillance using a “flagging and dragging” method across approximately 0.27 acres of the camp property.

They collected 37 Ixodes scapularis ticks, commonly known as deer ticks.

Of the 35 ticks tested:

• 6 were positive for Borrelia burgdorferi sensu stricto, the bacterium that causes Lyme disease.
• 1 tick tested positive for Borrelia miyamotoi.

This represented a 17% infection rate among nymphal ticks collected at the campsite.

None of the ticks tested positive for the pathogens responsible for anaplasmosis or Babesia microti.

Clinical Presentations and Diagnosis

Three of the four children had laboratory confirmation of Lyme disease.

Two children developed the characteristic erythema migrans rash. One case was classified as probable Lyme disease because the child tested positive by ELISA and IgM Western blot but not IgG Western blot.

The clinical symptoms reported in the children included:

• Recurrent joint swelling
• Joint pain (arthralgia)
• Fever
• Headaches
• Fatigue
• Loss of appetite

One child developed radiculoneuropathy and Bell’s palsy, both recognized neurologic complications of Lyme disease.

Treatment

All four children were treated with doxycycline.

The report did not specify the duration of treatment or long-term outcomes for the children.

Implications for Lyme Disease in the South

The authors emphasized that clinicians should recognize the growing risk of Lyme disease transmission in North Carolina.

“Clinicians should be aware of the risk for transmission of Lyme disease in North Carolina and consider recommended diagnostic testing and treatment,” the report concluded.

Other studies have also identified ticks infected with the bacteria responsible for Lyme disease throughout the southeastern United States.

As tick populations continue expanding southward, communities once considered non-endemic—including many parts of the South—now face increasing risk of Lyme disease.

Frequently Asked Questions

Is Lyme disease spreading to the southern United States?

Yes. Multiple studies document the southward expansion of Lyme disease as tick populations move into new territories. Areas once considered non-endemic, including North Carolina and other southeastern states, now have established populations of infected ticks and confirmed human cases.

How many children got Lyme disease at the North Carolina camp?

Four children between the ages of 6 and 8 were diagnosed with Lyme disease after attending the same wilderness day camp in North Carolina. An earlier camp participant had also been diagnosed with Lyme disease in 2017, indicating ongoing tick exposure at the site.

What percentage of ticks at the camp were infected with Lyme disease?

Testing revealed that 17% of nymphal deer ticks collected at the campsite were infected with Borrelia burgdorferi, the bacterium that causes Lyme disease.

Can children in the South get Lyme disease from outdoor activities?

Yes. As this camp cluster demonstrates, children participating in outdoor activities in southern states face genuine risk of Lyme disease. Parents and camp administrators should implement tick prevention strategies even in areas historically considered low risk.

Should southern doctors test for Lyme disease in children?

Yes. Clinicians in southern states should maintain awareness of Lyme disease risk and consider appropriate diagnostic testing and treatment when children present with compatible symptoms, especially if they have outdoor exposure in wooded or grassy areas.

Clinical Takeaway

This cluster of four pediatric Lyme disease cases at a single North Carolina wilderness camp provides evidence of the continued geographic expansion of Lyme disease.

With a documented 17% infection rate in nymphal ticks at the site, Lyme disease can no longer be viewed solely as a northern problem.

Clinicians practicing in southern states should maintain appropriate clinical suspicion for Lyme disease in children with compatible symptoms and outdoor exposure.

Parents and camp administrators should implement tick prevention strategies similar to those used in traditional Lyme-endemic regions.

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Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention