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Barbara J. Wallace, MD; Geraldine Brady; David M. Ackman, MD; Susan J. Wong, PhD; Germaine Jacquette, MD; Elizabeth E. Lloyd, MS; Guthrie S. Birkhead, MD

Arch Intern Med. 1998;158:769-773.

Background  Human granulocytic ehrlichiosis (HGE), a potentially fatal tick-borne disease, was first described in the upper Midwest in 1994. Following reports of suspected cases of ehrlichiosis from New York physicians, descriptive and case-control studies were conducted to characterize the epidemiology and risk factors for HGE in New York residents.

Methods  Descriptive data were gathered from surveillance and laboratory reports and hospital records. A confirmed case was defined as either (1) a 4-fold change in total antibody titer to Ehrlichia equi by indirect immunofluorescence or (2) a polymerase chain reaction assay positive for Ehrlichia phagocytophila/E equi group DNA. A probable case was defined as an acute febrile illness and either (1) a single E equi titer greater than or equal to 80 or (2) morulae on a peripheral blood smear. The case-control study included patients with confirmed HGE 18 years of age or older with the onset of disease in 1995 and 2 to 3 neighborhood-matched controls.

Results  During 1994 and 1995, the New York State Department of Health, Albany, received reports of 241 residents who were tested for HGE; 30 met the confirmed case definition and 34 met the probable case definition. The median age of patients was 46 years (age range, 9-90 years), 35 (55%) were male, and 25 (45%) were hospitalized. Fever, headache, malaise, and myalgia were the most frequently reported symptoms. Fifty-six (88%) of the 64 patients resided in areas in which Lyme disease is hyperendemic. In the case-control analysis, cases were more likely than controls to have sustained a tick bite during 1995 (matched odds ratio, 5.0; 95% confidence interval, 0.9-49.8). Cases and controls did not differ by occupational exposure to ticks, underlying chronic diseases, or measures taken to prevent tick bites.

Conclusions  This study, which, to our knowledge, is the first population-based study of HGE, demonstrates the recent recognition of HGE in the state of New York. Control measures should be integrated with those for Lyme disease and should focus on minimizing contact with ticks and obtaining early treatment for infection.

From the Epidemic Intelligence Service (Dr Wallace) and the Epidemiology Program Office (Drs Wallace and Ms Lloyd), Centers for Disease Control and Prevention, Atlanta, Ga; the Bureau of Communicable Disease Control (Drs Wallace, Ackman, and Birkhead and Ms Brady) and the Division of Infectious Diseases, Wadsworth Center (Dr Wong), New York State Department of Health, Albany; the Division of Disease Control, Westchester County Department of Health, New Rochelle, NY (Dr Jacquette); and the Department of Epidemiology, School of Public Health, State University of New York at Albany (Drs Ackman and Birkhead).

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