Lyme Disease in Children Rising in Pennsylvania
Pediatric Lyme disease increased sharply in western Pennsylvania
Cases shifted from rural to non-rural communities
Children often presented with rash, fever, joint pain, and difficulty walking
According to the CDC, nearly 38% of all reported Lyme disease cases in 2016 occurred in Pennsylvania.
Other studies have reported that ticks infected with Borrelia burgdorferi can now be found in every county in Pennsylvania, with infection rates similar to those seen in traditionally endemic Northeastern states.
A study from western Pennsylvania provides insight into the growing burden of Lyme disease in children. The authors sought to better understand how pediatric Lyme disease changed over a 10-year period and whether patterns of disease spread were evolving.
“In clinical practice, we observed an increase in the number of patients diagnosed with Lyme disease at Children’s Hospital of Pittsburgh (CHP) of the University of Pittsburgh Medical Center (UPMC), which prompted our investigation,” state Eddens and colleagues.1
The investigators reviewed records from 773 children diagnosed with Lyme disease between 2003 and 2013 at Children’s Hospital of Pittsburgh, evaluating clinical presentation, healthcare utilization patterns, and geographic distribution.
They found that Lyme disease cases increased exponentially during the study period, with the highest burden of infection gradually shifting from rural to non-rural areas.
“An exponential increase in Lyme disease occurred in the pediatric population of western Pennsylvania,” the authors wrote.
The true burden may be even greater. Because not all children in western Pennsylvania were captured within the hospital’s electronic medical record system, the authors believe their findings likely underestimate the total number of pediatric Lyme disease cases.
What did the study find?
- The average age was 8.1 years;
- 22% of children were between 0 and 4 years old;
- 45% were between 5 and 9 years old;
- 59% were male;
- 29% reported a tick bite;
- 62% were diagnosed between May and August.
Common Lyme disease symptoms in children
The most common findings were consistent with classic Lyme disease symptoms seen in children.
An erythema migrans rash was present in 56% of cases. Joint pain affected 47% of children, while 45% experienced fever. Joint swelling was reported in 31%, and 30% complained of headache or fatigue. Nearly one-quarter of children had difficulty walking.
Neurologic symptoms were less common. Cranial nerve palsy occurred in 12% of cases, while 11% of children reported neck stiffness.
How were children treated?
Most children were treated with oral antibiotics. Doxycycline was prescribed in 47% of cases, while 44% received amoxicillin.
Outpatient intravenous antibiotics were reserved for more complicated presentations, including 15 cases of Lyme meningitis and one case of Lyme arthritis.
Children were evaluated and treated by a variety of specialists. Rheumatologists initially identified the first cases, but as the epidemic expanded, Infectious Disease specialists, Orthopedic Surgery, Neurology, and Cardiology clinicians also became involved.
During the latter years of the study, most children were diagnosed by emergency departments and primary care pediatricians as awareness of Lyme disease increased.
Where were the cases occurring?
The geographic expansion of Lyme disease was one of the study’s most important findings.
There was a calculated doubling time of only 1.6 years, reflecting rapid growth in pediatric Lyme disease throughout western Pennsylvania.
More than 500 children lived in non-rural ZIP codes, while 169 children resided within the city of Pittsburgh.
The authors note that this pattern is not unique to Pennsylvania. States that were once considered Lyme-naïve, including Ohio, Illinois, North Dakota, and Iowa, have reported expanding populations of infected ticks and increasing Lyme disease risk.
Frequently Asked Questions
Is Lyme disease increasing among children in Pennsylvania?
Yes. This study found an exponential increase in pediatric Lyme disease cases in western Pennsylvania over a 10-year period, with cases expanding from rural into non-rural communities.
What are common Lyme disease symptoms in children?
Common symptoms include an erythema migrans rash, fever, headache, fatigue, joint pain, joint swelling, and difficulty walking. Some children also develop neurologic symptoms such as cranial nerve palsy.
What age group is most affected?
Children between 5 and 9 years of age represented the largest group in this study, although Lyme disease occurred across all pediatric age groups.
Clinical Takeaway
This study highlights the rapid expansion of pediatric Lyme disease in western Pennsylvania. Cases increased exponentially, spread beyond rural communities, and most commonly affected school-aged children.
The findings suggest that Lyme disease in children is no longer confined to traditionally rural areas and should remain on the diagnostic radar throughout Pennsylvania and other regions experiencing expanding tick populations.
Related Articles
Pediatric Lyme disease: diagnosis and treatment
What does a Lyme disease rash look like?
How accurate are Lyme disease tests?
Lyme disease symptoms guide
References
- Eddens T, Kaplan DJ, Anderson AJM, Nowalk AJ, Campfield BT. Insights from the Geographic Spread of the Lyme Disease Epidemic. Clin Infect Dis. 2018.
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.