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The emerging tick-borne
zoonoses human monocytic ehrlichiosis (HME) and human granulocytic
ehrlichiosis (HGE) are underreported in the United States. From
1986 through 1997, 1,223 cases (742 HME, 449 HGE, and 32 not
ascribed to a specific ehrlichial agent) were reported by state
health departments. HME was most commonly reported from
southeastern and southcentral states, while HGE was most often
reported from northeastern and upper midwestern states. The annual
number of reported cases increased sharply, from 69 in 1994 to 364
in 1997, coincident with an increase in the number of states
making these conditions notifiable. From 1986 through 1997, 827
probable and confirmed cases were diagnosed by serologic testing
at the Centers for Disease Control and Prevention, although how
many of these cases were also reported by states is not known.
Improved national surveillance would provide a better assessment
of the public health importance of ehrlichiosis.
A national ehrlichiosis surveillance program does not exist, so
national incidence rates have not been determined because of wide
variability in state surveillance activities.
The Council of State
and Territorial Epidemiologists recommended that human
ehrlichiosis be made nationally notifiable in 1998, but many
states do not have a system for surveillance and do not test for
ehrlichiosis in state diagnostic laboratories.As of August 1998, only 19 states considered ehrlichiosis
notifiable, and fewer than one fourth of state health departments
offered in-house diagnostic assays for HME or HGE. Average annual
incidence rates, an important indicator of disease prevalence,
could be calculated for only 21 states. These data underscore the
need for better nationwide surveillance of ehrlichiosis
Ehrlichiosis surveillance criteria includes:
Confirmed Case
Probable Case - A person with compatable symptoms and
Suspected Case - A person with compatable symptoms and
For information on Ehrlichiosis visit our Ticks
and Diseases section or search the Center
for Disease Control, the National
Institute of Health or PubMed.
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