THE PUBLIC-HEALTH IMPACT OF LYME-DISEASE IN MARYLAND

The purpose of this study was to estimate the health burden imposed by Lyme disease (LD) in Maryland during 1992 and 1993. A cross-sectional 1-in-15 survey of physicians (total, 1200) in Maryland was conducted to estimate the incidence of diagnosed LD, presumptive cases of LD, pa tients with tick bites, and diagnostic tests ordered for LD. Results s how that LD is underreported by 10- to 12-fold in Maryland, that 80% o f cases are managed by primary care physicians, and that there is disc ordance between the actual clinical treatment of patients and the reco mmended approach. In addition, the much greater numbers of patients tr eated for presumptive LD, seen and given prophylaxis for tick bites, a nd having diagnostic tests indicate that real and perceived LD is a fa r greater public health problem and uses more medical resources than o fficial surveillance data suggest.