Epidemiology and Statistics

  • Anaplasmosis is a disease caused by the bacterium Anaplasma phagocytophilum.
  • This organism was previously known by other names, including Ehrlichia equi and Ehrlichia phagocytophilum, and the disease was previously known as human granulocytic ehrlichiosis (HGE).
  • However, a taxonomic change in 2001 identified that this organism belonged to the genus Anaplasma, which resulted in changing the name of the disease to anaplasmosis.
  • In the United States, anaplasmosis was first recognized as human disease in the mid-1990s but did not become nationally notifiable until 1999.
  • CDC compiles the number of cases reported by state and local health departments and reports national trends.

At a glance

  • The number of anaplasmosis cases reported to CDC has increased steadily since the disease became reportable, from 348 cases in 2000, to a peak of 5,762 in 2017. Cases reported in 2018 were substantially lower, but increased to near 2017 numbers in 2019 with 5,655 cases.
  • The case fatality rate (i.e., the proportion of anaplasmosis patients that reportedly died as a result of infection) has remained low, at less than 1%.

Figure 1 – Number of reported cases of anaplasmosis –United States, 2000–2019

The graph displays the number of human cases of anaplasmosis reported to CDC annually from 2000 through 2019.  See table below for data.
Epidemiology Figure 1 – Number of U.S. anaplasmosis cases reported to CDC, 2000–2017
Year of report Number of cases
 2000 351
2001 261
2002 511
2003 362
2004 537
2005 786
2006 646
2007 834
2008 1,009
2009 1,161
2010 1,761
2011 2,575
2012 2,389
2013 2,782
2014 2,800
2015 3,656
2016 4,151
2017 5,762
2018 4,008
2019 5,655

 Top of Page

Seasonality

  • Although cases of anaplasmosis can occur during any month of the year, the majority of cases reported to the CDC have an illness onset during the summer months and a peak in cases typically occurs in June and July.
  • This period is the season for nymphal blacklegged ticks. Nymphal blacklegged ticks bite people and can spread the pathogen.
  • A second, smaller peak occurs in October and November when adult blacklegged ticks are most active.

Figure 2 – Number of reported cases of anaplasmosis, by month of onset–United States, 2000–2019

The figure shows the number of cases reported from 2000 through 2019 by month of onset to give the seasonality of cases. See table below for data.

 

Figure 2 – Number of reported anaplasmosis cases by month of onset, 2000–2017
 Month of onset Number of cases
Jan 308
Feb 229
Mar 525
Apr 1,566
May 5,409
June 10,964
July 9,480
Aug 3,759
Sept 1,933
Oct 2,753
Nov 2,587
Dec 650

 Top of Page

Geography

  • Anaplasmosis is most frequently reported from the upper midwestern and northeastern United States.
  • These areas correspond with the known geographic distribution of the blacklegged tick (Ixodes scapularis), the primary tick vector of A. phagocytophilum.
  • This tick also transmits the bacteria that causes Lyme disease (including Borrelia burgdorferi) and other human pathogens. Co-infections with these organisms have occasionally been reported.
  • The geographic range of anaplasmosis appears to be increasing, which is consistent with the blacklegged tick’s expanding range.
  • Increasing ranges for the blacklegged tick have been documented along the Hudson River Valley, Michigan, and Virginia.
  • Eight states (New York, Massachusetts, Maine, Vermont, Minnesota, Wisconsin, New Hampshire, and Conneticut) account for nearly 9 in 10 of all reported cases of anaplasmosis.
  • Occasionally, anaplasmosis cases are reported in other parts of the United States, including southeastern and south-central states where the pathogen has not been commonly found.
  • Some of these cases might be due to patient travel to states with higher levels of disease, or misdiagnosis of anaplasmosis in patients actually infected with another closely related tickborne disease, ehrlichiosis.

Figure 3 – Annual incidence (per million population) of reported anaplasmosis–United States, 2019. (NN= Not notifiable)

Map of the United States that shows the incidence of anaplasmosis cases by state in 2019 per million persons. See table below for data.

 

Figure 3 – Annual reported incidence (per million population) for anaplasmosis – United States, 2017. (NN= Not notifiable)
 State of Residence  Cases per Million
Alabama 1.43
Alaska NN
Arizona 0.55
Arkansas 2.98
California 0.18
Colorado NN
Connecticut 83.58
Delaware 7.19
District of Columbia 0
Florida 0.98
Georgia 0
Hawaii NN
Idaho NN
Illinois 0.79
Indiana 0.74
Iowa 4.44
Kansas 1.37
Kentucky 0.9
Louisiana 0.22
Maine 509.6
Maryland 2.65
Massachusetts 101.3
Michigan 1.4
Minnesota 71.81
Mississippi 0.67
Missouri 1.3
Montana 0
Nebraska 0.52
Nevada 0
New Hampshire 221.4
New Jersey 15.99
New Mexico NN
New York 87.23
North Carolina 1.05
North Dakota 13.12
Ohio 0.51
Oklahoma 0
Oregon 0.71
Pennsylvania 16.72
Rhode Island 142.5
South Carolina 0
South Dakota 0
Tennessee 1.03
Texas 0.14
Utah 0
Vermont 857.4
Virginia 1.87
Washington 0.13
West Virginia 1.67
Wisconsin 57.36
Wyoming 0

 Top of Page

People at Risk

  • The frequency of reported cases of anaplasmosis is highest among males and people over 40 years of age.
  • People with weakened immune systems (such as those occurring due to cancer treatments, advanced HIV infection, prior organ transplants, or some medications) might be at increased risk of severe outcome.
  • People who live near or spend time in known tick habitats might be at increased risk for infection.

 Top of Page