Spatial patterns of Lyme disease risk in California based on disease incidence data and modeling of vector-tick exposure.

Ixodes pacificus, particularly the nymphal life stage, is the primary vector to humans of the Lyme disease agent Borrelia burgdorferi in California. During 2004, we collected I. pacificus nymphs from 78 woodland sites in ecologically diverse Mendocino County, which has a moderately high incidence of Lyme disease. Within this county, nymphal density was elevated in forested areas with a growing degree day range of 2,600-3,000 (10 degrees C base). Using a geographic information systems approach, we identified all areas in California sharing these environmental characteristics and thus projected to pose high acarologic risk of exposure to host-seeking nymphal ticks. Such areas were most commonly detected in the northwestern part of the state and along the Sierra Nevada foothills in the northeast, but the analysis also identified isolated areas with high acarologic risk in southern California. This mirrors the spatial distribution of endemic Lyme disease during 1993-2005; most cases occurred in counties to the northwest (58%) or northeast (26%), whereas fewer cases were reported from southern California (16%). Southern zip-codes from which Lyme disease cases had been reported were commonly located in close proximity to areas with high projected acarologic risk. Overall, Lyme disease incidence in zip code areas containing habitat with high projected acarologic risk was 10-fold higher than in zip code areas lacking such habitat and 27 times higher than for zip code areas without this habitat type within 50 km. A comparison of spatial Lyme disease incidence patterns based on county versus zip code units showed that calculating and displaying disease incidence at the zip code scale is a useful method to detect small, isolated areas with elevated disease risk that otherwise may go undetected.