Lyme Disease Awareness: 2026 Updates for Healthcare Providers

Lyme Disease Awareness activities emphasize the importance of understanding how tickborne diseases affect communities in Ohio and across the country. Lyme disease is spread by the blacklegged tick, Ixodes scapularis. The first known established population of blacklegged ticks in Ohio was discovered in 2010. Since then, the tick's range has expanded in Ohio, and Lyme disease has dramatically increased and continues to significantly impact Ohioans.

Be TICK Smart!

The best way to prevent Lyme disease is to prevent tick bites. If you find a tick on your body, remove it quickly to reduce the risk of contracting Lyme disease or other tickborne illnesses. If you develop symptoms, see a healthcare provider. Lyme disease is curable, early diagnosis and treatment are important to avoid further health problems related to Lyme disease.

Actions for Ohio Clinicians

Consider tickborne diseases, including Lyme disease, as a differential diagnosis when evaluating patients with febrile illness, with or without a rash. Many tickborne diseases present with non-specific clinical signs such as fever, headache, fatigue, myalgia, arthralgia, cytopenia, and rashes that can vary in presentation. When clinically appropriate, ask about recent tick exposure, outdoor activities such as yard work, hiking, camping, or hunting, and contact with pets that may carry ticks into the home. For more information on symptoms of tickborne diseases, visit Centers for Disease Control and Prevention (CDC)'s Tickborne Diseases Symptoms website.

1. Familiarize yourself with the laboratory tests available to diagnose tickborne illness.
   • Lyme disease: Testing remains two-tiered, using the same blood sample.
     • Standard two-tier test (STTT).
       1. First tier testing: Enzyme immunoassay (EIA).
          • If positive of equivocal first-tier screening assay, test sample with second-tier test.
          • If negative, consider alternative diagnosis. Patients infected recently may test negative.
       2. Second tier testing: Western blot assay.
          • If positive on both the first and second testing, patient is considered positive overall.
     • Modified two-tier test (MTTT).
       1. Positive or equivocal first-tier screen, followed by a second, sequential positive or equivocal EIA in lieu of an immunoblot as a second-tier test.
       2. MTTT testing generally offers higher sensitivity, particularly for early infection, and quicker testing results.
   • Anaplasmosis, ehrlichiosis, and spotted fever group rickettsiosis:
     • Polymerase chain reaction (PCR) on whole blood during the acute phase.
     • Immunofluorescence assay (IFA): paired serology on acute and convalescent samples taken two to four weeks apart.
     • Note: Serologic sensitivity is poor in the early stages of infection. If serology is negative in patients with possible early infection, repeat serology collected 2-10 weeks after the acute specimen may demonstrate seroconversion.
   • Babesiosis:
     • Light microscopy of Giemsa- or Wright-stained thick and thin blood smears.
     • PCR on whole blood during the acute phase.
     • Serological evidence of a four-fold change in IgG-specific antibody titer to B. microti via IFA.
   • Powassan virus:
     • Contact the ODH Zoonotic Disease Program at 614-995-5599 to arrange for testing by CDC.
       
2. Promptly report suspected cases of tickborne infections to the local health department where the patient resides.

Lyme Disease Prophylaxis After Tick Bite

The Centers for Disease Control and Prevention (CDC) and other medical groups recommend prophylactic treatment for certain tick bites in high-risk areas. While the state of Ohio has not historically met this threshold, Lyme disease activity has increased substantially over the past decade. In areas of Ohio with increased Lyme disease activity, such as eastern Ohio, timely prophylactic treatment following identification of a blacklegged tick that has fed (i.e., is engorged) should be considered to prevent Lyme disease. Post-exposure prophylaxis is only recommended for bites from blacklegged ticks, not other types of ticks.

Additional information on treatment of tickborne diseases can be found at CDC's Tickborne Diseases website.

Treatment for Tickborne Illnesses

Anaplasmosis, ehrlichiosis, Lyme disease, or spotted fever group rickettsiosis:

• Do not delay therapy pending diagnosis, as anaplasmosis, ehrlichiosis, and spotted fever group rickettsioses are potentially fatal.
• Doxycycline is the recommended first-line treatment for all patients, including children.

Babesiosis:

• Atovaquone PLUS azithromycin (preferred).
• Clindamycin PLUS quinine (alternative).

Powassan:

• No specific treatment; provide supportive care.

Additional information on treatment of tickborne diseases can be found at CDC's Tickborne Diseases website.

Additional Information

Tickborne disease information and educational materials for patients:

Helpful contacts: