2182 © The Author(s) 2022. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Short Communication Assessment of Physician Knowledge, Attitudes, and Practice for Lyme Disease in a Low-Incidence State Sharon I. Brummitt, 1,5, Danielle J. Harvey, 2 Woutrina A. Smith, 1 Christopher M. Barker, 3, and Anne M. Kjemtrup 4,6, 1 Department of Medicine and Epidemiology, School of Veterinary Medicine, One Shields Avenue, University of California Davis, Davis, CA 95616, USA, 2 Department of Public Health Sciences, School of Medicine, Medical Sciences 1C, One Shields Avenue, University of California Davis, Davis, CA 95616, USA, 3 Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, One Shields Avenue, University of California Davis, Davis, CA 95616, USA, 4 California Department of Public Health, Vector- Borne Disease Section, 1616 Capitol Avenue, MS 7307, P.O. Box 997377, Sacramento, CA 95899, USA, 5 Current address: School of Veterinary Medicine, One Shields Avenue, University of California Davis, Davis, CA 95616, USA, and 6 Corresponding author, e-mail: Anne.Kjemtrup@cdph.ca.gov Disclaimer: The fndings and conclusions in this article are those of the author(s) and do not necessarily represent the views or opinions of the California Department of Public Health or the California Health and Human Services Agency. Subject Editor: Rebecca Trout Fryxell Received 17 May 2022; Editorial decision 21 August 2022. Abstract Lyme disease (LD), caused by the bacterium Borrelia burgdorferi, is transmitted to humans in California through the bite of infected blacklegged ticks (Ixodes pacificus). Overall, the incidence of LD in California is low: approximately 0.2 confirmed cases per 100,000 population. However, California’s unique ecological diversity results in wide variation in local risk, including regions with local foci at elevated risk of human disease. The diagnosis of LD can be challenging in California because the prior probability of infection for in- dividual patients is generally low. Combined with nonspecific symptoms and complicated laboratory testing, California physicians need a high level of awareness of LD in California to recognize and diagnose LD effi- ciently. This research addresses an under-studied area of physicians’ knowledge and practice of the testing and treatment of LD in a low-incidence state. We assessed knowledge and practices related to LD diagnosis using an electronic survey distributed to physicians practicing in California through mixed sampling methods. Overall, responding physicians in California had a general awareness of Lyme disease and were knowledge- able regarding diagnosis and treatment. However, we found that physicians in California could benefit from further education to improve test-ordering practices, test interpretation, and awareness of California’s disease ecology with elevated levels of focal endemicity, to improve recognition, diagnosis, and treatment of LD in California patients. Key words: Lyme disease, Borrelia burgdorferi, physician knowledge, incidence, physician attitude Lyme disease (LD), caused by the bacterium Borrelia burgdorferi, is transmitted to humans in California by western blacklegged ticks (Ixodes pacifcus [Cooley & Kohls]) (Burgdorfer et al. 1982, Clover and Lane 1995, Barbour and Benach 2019). Lyme disease has been a reportable disease in California since 1989 and became a nationally notifable disease in the United States in 1991 (Werra 1991, Center for Disease Control and Prevention 2019). On 1 January 2022 the Council of State and Territorial Epidemiologists (CSTE) modifed the LD surveillance case defnition to improve specifcity of reported cases in low-incidence states (CDC 2021a). Though LD is the most common tick-borne disease in the United States with over 30,000 cases reported annually (Center for Disease Control and Prevention 2019, Kugeler et al. 2021, Schwartz et al. 2021), the incidence of LD in California is low, with approximately 100 confrmed cases reported annually (0.2 cases per 100,000 population) (California Department of Public Health 2019). California’s unique ecological diversity contributes to focal high-endemic regions, where human incidence ranges from 1.1 to 6.2 cases per 100,000 (Lane et al. 1992, Journal of Medical Entomology, 59(6), 2022, 2182–2188 https://doi.org/10.1093/jme/tjac137 Advance Access Publication Date: 20 September 2022 Short Communication Downloaded from https://academic.oup.com/jme/article/59/6/2182/6706836 by guest on 05 March 2023