Lyme Disease in Children Rising in Pennsylvania: An Inside Look
Lyme disease in children is rising rapidly in Pennsylvania, with cases increasing exponentially and spreading beyond rural areas into suburban and urban communities.
According to the CDC, nearly 38% of all reported Lyme disease cases in 2016 occurred in Pennsylvania. In addition, infected ticks are now detectable in every county, with infection rates comparable to traditionally endemic Northeastern regions.
A 10-year study of pediatric Lyme disease in western Pennsylvania provides important insight into how this epidemic is evolving.
What the Study Found: 773 Children Over 10 Years
Researchers reviewed 773 pediatric Lyme disease cases diagnosed between 2003 and 2013 at Children’s Hospital of Pittsburgh.
Cases increased exponentially over the study period, with a doubling time of approximately 1.6 years.
The burden of disease shifted from rural areas to non-rural and urban communities.
Importantly, the authors note that the true number of cases is likely higher due to incomplete capture of all regional patients.
Who Is Affected—and When
- Average age: 8.1 years
- 67% were under age 10
- 59% were male
- Only 29% reported a known tick bite
- 62% were diagnosed between May and August
Many children did not recall a tick bite, highlighting the need for clinical suspicion.
Common Symptoms in Children
- 56% erythema migrans rash
- 47% joint pain
- 45% fever
- 31% joint swelling
- 30% headache and fatigue
- 22% difficulty walking
Neurologic findings included cranial nerve palsy (12%) and neck stiffness (11%).
Nearly half of children were diagnosed without the classic rash.
Treatment and Who Makes the Diagnosis
Most children were treated with doxycycline (47%) or amoxicillin (44%).
Over time, diagnosis shifted away from specialists toward primary care providers and emergency departments.
This reflects both increased awareness—and the growing burden on front-line clinicians.
From Rural to Suburban and Urban Spread
More than 500 children lived in non-rural areas, including 169 in Pittsburgh.
The authors highlight a critical trend: Lyme disease is no longer confined to rural environments.
Similar expansion is now being observed in other previously low-risk states, including Ohio, Illinois, North Dakota, and Iowa.
Why This Matters Clinically
Lyme disease in children is evolving—not just in frequency, but in geography and presentation.
Clinicians should:
- Consider Lyme disease even without a rash
- Maintain suspicion in suburban and urban settings
- Recognize that lack of a tick bite history does not exclude diagnosis
Clinical Takeaway
This study highlights a rapidly expanding pediatric Lyme epidemic in Pennsylvania. With cases rising exponentially and spreading beyond rural areas, early recognition depends on clinical awareness—not just classic presentations.
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
My six-year-old son is a “statistic” in this study. Here in a suburb of Pittsburgh the general population is largely unaware of how high-risk our region has become. There is very little public awareness effort being generated from anywhere including the major health institution the doctors who authored the study are employed by (UPMC). No public awareness media campaigns, no awareness and prevention education at schools, very little coming from county government, just information on their website. The local news coverage of this study was minimal. It should have been headline news in this region. It is getting more attention in the Lyme community but we’re the ones who already know Lyme is a huge, growing problem. Thank you Dr. Cameron for highlighting this important information and including more detail than I could find anywhere else.