Is Lyme Disease Common in North Carolina? What Recent Cases Show
Lyme disease is rapidly emerging in western North Carolina
Recent studies document expanding infected tick populations
Early recognition remains important despite lower statewide rates
Is Lyme disease common in North Carolina? Historically, North Carolina has reported far fewer Lyme disease cases than the Northeast. However, recent research shows that Lyme disease is rapidly emerging in the western part of the state. Investigators have documented expanding populations of infected blacklegged ticks (Ixodes scapularis) and growing clusters of locally acquired Lyme disease, particularly along the Blue Ridge Mountains.
One of the earliest warning signs came from a cluster of four children who developed Lyme disease after attending a wilderness camp in western North Carolina. Since then, statewide epidemiologic studies and tick surveillance have confirmed that Lyme disease is becoming established in portions of northwestern North Carolina, highlighting the need for increased awareness among both clinicians and the public.
Four children developed Lyme disease after attending a North Carolina wilderness camp
In 2020, the Centers for Disease Control and Prevention (CDC) described four cases of Lyme disease involving children between six and eight years of age who attended an outdoor wilderness camp in Buncombe County, North Carolina.
Three of the four children recalled tick bites while attending camp. The fourth child did not remember a tick bite but developed symptoms consistent with Lyme disease after participating in the same outdoor activities.
The report represented the southernmost cluster of Lyme disease associated with a common exposure documented in the United States at that time and provided important evidence that locally acquired Lyme disease was occurring in western North Carolina.
READ MORE: Lyme Disease Symptoms: A Complete Guide
Investigators found infected blacklegged ticks at the camp
To determine whether Lyme disease was being transmitted locally, investigators returned to the camp and collected ticks using flagging and dragging techniques.
They collected 37 Ixodes scapularis ticks, commonly known as blacklegged or deer ticks. Of the 35 ticks tested, six (17%) carried Borrelia burgdorferi, the bacterium that causes Lyme disease. One tick also tested positive for Borrelia miyamotoi, another pathogen capable of causing tick-borne illness.
The investigators did not detect Anaplasma phagocytophilum or Babesia microti in the ticks collected during this investigation.
Why these findings matter
The wilderness camp investigation was an early warning that Lyme disease was becoming established in western North Carolina. Since then, larger statewide studies have shown that the camp cluster reflected a broader regional trend rather than an isolated event.
A 2024 statewide epidemiologic study found that Lyme disease has rapidly emerged in northwestern North Carolina, with several ZIP codes reporting incidence rates comparable to traditionally high-incidence regions of the northeastern United States. Investigators also documented a southwestward expansion of high-incidence clusters by approximately 80 to 100 miles along the Blue Ridge Mountains between 2010 and 2020. The authors concluded that greater physician awareness is needed as Lyme disease continues to expand in the region. :contentReference[oaicite:0]{index=0}
These epidemiologic findings were reinforced by a 2025 statewide tick surveillance study. Investigators found expanding populations of infected Ixodes scapularis ticks in western North Carolina, with the highest tick densities and Borrelia burgdorferi infection rates occurring in the Blue Ridge Mountains. The study also detected Borrelia miyamotoi and Anaplasma phagocytophilum, confirming that multiple tick-borne pathogens are now established in portions of the state. :contentReference[oaicite:1]{index=1}
Together, these studies provide strong evidence that Lyme disease risk is increasing in western North Carolina and support continued surveillance, clinician education, and public awareness.
Learn more about the symptoms of Lyme disease and why early Lyme disease tests can be negative.
Symptoms and Diagnosis
Three of the four children met the CDC case definition for confirmed Lyme disease. Two developed the characteristic erythema migrans (EM) rash. The fourth child was classified as a probable case because the blood test was positive by ELISA and IgM Western blot but did not meet the IgG Western blot criteria.
The children presented with recurrent episodes of fever, headaches, fatigue, loss of appetite, joint swelling, and arthralgia. One child also developed radiculoneuropathy and Bell’s palsy, illustrating that neurologic Lyme disease can occur in children even in regions traditionally considered low incidence.
Because antibody tests may remain negative during the first several weeks of infection, Lyme disease continues to be a clinical diagnosis supported by the patient’s history, physical examination, and risk of tick exposure. Learn more about Lyme disease test accuracy and why early Lyme disease tests can be negative.
Treatment
All four children were treated with doxycycline. The CDC report did not specify the duration of therapy or provide long-term follow-up, but the cases illustrate the importance of recognizing Lyme disease promptly in regions where clinicians may be less likely to suspect the diagnosis.
Early diagnosis and treatment remain the best strategy for reducing the risk of neurologic, cardiac, and arthritic complications. Learn more about current approaches to Lyme disease treatment.
North Carolina’s changing Lyme disease landscape
The wilderness camp investigation represented one of the earliest reports of locally acquired Lyme disease in western North Carolina. Since that publication, human surveillance and statewide tick surveillance have shown that this was not an isolated event but part of an expanding pattern of Lyme disease transmission.
The 2024 epidemiologic study identified increasingly concentrated clusters of Lyme disease in northwestern North Carolina, with incidence rates in some ZIP codes approaching those reported in historically high-incidence regions of the Northeast. Investigators also found that disease clusters became progressively more established between 2010 and 2020, supporting ongoing geographic expansion. :contentReference[oaicite:0]{index=0}
The complementary 2025 statewide tick survey documented a parallel expansion of infected Ixodes scapularis ticks throughout the Blue Ridge Mountains. The highest densities of ticks and the greatest prevalence of Borrelia burgdorferi infection were found in counties bordering Virginia, supporting the hypothesis that northern tick populations are continuing to spread southward along the Appalachian Mountains. :contentReference[oaicite:1]{index=1}
What should patients and clinicians know?
Although North Carolina remains a lower-incidence state overall than many parts of the Northeast, Lyme disease risk is no longer evenly distributed across the state. Residents and visitors who spend time hiking, camping, gardening, hunting, or working outdoors in western North Carolina should practice careful tick avoidance and perform daily tick checks.
Clinicians should continue to consider Lyme disease in patients with erythema migrans, facial palsy, meningitis, unexplained fever, headaches, fatigue, migratory joint pain, or other compatible symptoms following possible tick exposure, particularly in western North Carolina where the epidemiology continues to evolve.
Frequently Asked Questions
Can you get Lyme disease in North Carolina?
Yes. Although North Carolina remains a lower-incidence state overall than many Northeastern states, locally acquired Lyme disease is increasingly recognized in western North Carolina. Recent epidemiologic studies and statewide tick surveillance demonstrate expanding human disease clusters and growing populations of infected blacklegged ticks in the Blue Ridge Mountains. :contentReference[oaicite:0]{index=0} :contentReference[oaicite:1]{index=1}
Is Lyme disease spreading in North Carolina?
Evidence strongly suggests that it is. Investigators documented expanding clusters of Lyme disease between 2010 and 2020, while statewide tick surveillance confirmed the recent expansion of infected Ixodes scapularis ticks into western North Carolina. :contentReference[oaicite:2]{index=2} :contentReference[oaicite:3]{index=3}
Where is Lyme disease most common in North Carolina?
Current evidence indicates that the highest risk is in the Blue Ridge Mountains and northwestern North Carolina, where investigators found the highest densities of infected blacklegged ticks and the greatest concentration of reported Lyme disease cases.
What symptoms did the children develop?
The children experienced erythema migrans, fever, headaches, fatigue, loss of appetite, recurrent joint swelling, arthralgia, and, in one case, radiculoneuropathy with Bell’s palsy.
Can Lyme disease tests be negative early?
Yes. Antibody testing may be negative during the first several weeks of infection. Patients with a characteristic erythema migrans rash can often be diagnosed clinically before laboratory testing becomes positive.
Do North Carolina ticks carry infections besides Lyme disease?
Yes. In addition to Borrelia burgdorferi, investigators have identified Borrelia miyamotoi and Anaplasma phagocytophilum in blacklegged ticks collected in western North Carolina. :contentReference[oaicite:4]{index=4}
Clinical Takeaway
In my practice, these studies reinforce an important clinical lesson: Lyme disease should not be dismissed simply because a patient lives in or has traveled to North Carolina. Although the state continues to report a lower overall incidence than many Northeastern states, the epidemiology has changed substantially over the past decade.
The original wilderness camp cluster was an early signal that locally acquired Lyme disease was occurring in western North Carolina. Since then, statewide epidemiologic research has documented expanding human disease clusters, while comprehensive tick surveillance has confirmed the parallel spread of infected Ixodes scapularis ticks throughout the Blue Ridge Mountains. Together, these studies provide strong evidence that Lyme disease is becoming established in parts of western North Carolina rather than occurring only as isolated cases. :contentReference[oaicite:5]{index=5} :contentReference[oaicite:6]{index=6}
For clinicians and patients alike, the message is straightforward: consider Lyme disease when compatible symptoms follow possible tick exposure, regardless of historical assumptions about where Lyme disease occurs. Early recognition and individualized treatment remain the best opportunity to reduce the risk of neurologic, cardiac, and rheumatologic complications.
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References
- Barbarin AM, Seagle SW, Creede S. Notes from the Field: Four Cases of Lyme Disease at an Outdoor Wilderness Camp—North Carolina, 2017 and 2019. MMWR Morb Mortal Wkly Rep. 2020;69(4):114-115. doi:10.15585/mmwr.mm6904a5.
- Lantos PM, Nigrovic LE, Auwaerter PG, et al. Geographic Expansion of Lyme Disease in the Southeastern United States, 2000–2014. Open Forum Infect Dis. 2015;2(4):ofv143. doi:10.1093/ofid/ofv143.
- Mokashi NV, Marusiak AB, Giandomenico D, et al. Spatiotemporal patterns of Lyme disease in North Carolina, 2010–2020. Lancet Reg Health Am. 2024;35:100792. doi:10.1016/j.lana.2024.100792.
- Garshong RA, Adams DR, Seagle SW, et al. Expanding range of Ixodes scapularis Say (Acari: Ixodidae) and Borrelia burgdorferi infection in North Carolina counties, 2018–2023. PLoS One. 2025;20(7):e0329511. doi:10.1371/journal.pone.0329511.
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
