The number of reported cases of tickborne disease has more than doubled over the past 13 years, according to the CDC. Yet, in recent years, mosquito-borne diseases such as Zika and Chikungunya have been a major focus of public attention as outbreaks typically surge causing many cases over a short period. The rise in tickborne diseases, on the other hand, has been more insidious.

To illustrate the need to confront this growing threat, Catharine I. Paules, MD, and colleagues published a perspective paper in the New England Journal of Medicine. “We wanted to highlight an ongoing public health issue of great importance, as well as the gaps in our current ability to combat it,” says Dr. Paules. “Specifically, we wanted to highlight the need for ongoing research particularly in the arenas of vaccine development and improvement of diagnostic modalities for these diseases.”

Dr. Paules says that tickborne diseases are on the rise and should be considered in the differential diagnosis of a compatible clinical illness, particularly when tick activity is high during warmer months. “There are important limitations to our current diagnostic modalities for some of these diseases,” she says. “Understanding which tests to order and how these tests should be used is important. The ranges of many common ticks, including Ixodes scapularis and I. pacificus seem to be expanding. It is possible that we will start seeing infections transmitted by these ticks in regions not previously thought to be endemic. Tick prevention through the use of insect repellant (containing DEET), wearing long sleeves and long pants, the use of permethrin treated gear and tick avoidance should be encouraged by clinicians.


Paules, C, Marston, H, Bloom, M, et al. Tickborne Diseases — Confronting a Growing Threat. N Engl J Med 2018; 379:701-703. Available at: