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Coinfection Ecology and Pathogen Emergence in a Borrelia -Endemic Landscape: Five Years of Borrelia burgdorferi, Anaplasma phagocytophilum , and Babesia microti Surveillance in Maryland
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Coinfection Ecology and Pathogen Emergence in a Borrelia -Endemic Landscape: Five Years of Borrelia burgdorferi, Anaplasma phagocytophilum , and Babesia microti Surveillance in Maryland

Greg Joyner, Olifan Abil, Maria J Sanches, Amy Schwartz, Julia Poje, Kathryn Arnold, Christine Petersen and Maria Gomes Solecki
medRxiv : the preprint server for health sciences
Cold Spring Harbor Laboratory
12/04/2025
DOI: 10.64898/2025.12.03.25341558
PMCID: PMC12706617
PMID: 41409673
url
https://doi.org/10.64898/2025.12.03.25341558View
Preprint (Author's original)This preprint has not been evaluated by subject experts through peer review. Preprints may undergo extensive changes and/or become peer-reviewed journal articles. Open Access

Abstract

The emergence of tick-borne pathogens depends on ecological opportunity and barriers to persistence within vectors and hosts. is firmly entrenched in the mid-Atlantic, whereas and remain patchily distributed. Five years of integrated surveillance (2020-2024) at three Maryland sites allowed us to track and establishment by screening questing nymphs, -fed nymphs, and by qPCR, then contextualizing results with paired county-level human case data. was consistently detected in all sites and sample types, with prevalence stable at approximately 5-20% in questing nymphs and exceeding 30% in hosts, confirming long-term enzootic maintenance. By contrast, and were initially sporadic but increased in prevalence, particularly in rodents and -fed ticks. Over time prevalence significantly increased to above 20% in some -fed nymphal collections despite much lower prevalence in questing ticks, highlighting the early-warning value of bloodmeal-associated surveillance. Coinfections were rare, though enrichment of + in -fed ticks suggests possible facilitation during early establishment. These results indicate that and are actively emerging in Maryland, following their entrenchment in the Northeast and Upper Midwest. Combining surveillance from questing nymphal ticks, -fed nymphal ticks, and reservoir hosts provides a framework for detecting enzootic cycles before they appear in questing populations or human case counts, offering critical early-warning capacity for public health preparedness. Understanding why some tick-borne pathogens become ecosystem entrenched while others remain sporadic is central to predicting human disease emergence. By combining surveillance of questing nymphal ticks, -fed nymphal ticks, and reservoir hosts across five years in Maryland, we show that and remain in the early stages of ecological entrenchment whereas is deeply established. This integrated approach demonstrates how pathogen biology within the tick shapes field prevalence and highlights -fed ticks as a powerful xenodiagnostic early-warning tool for detecting emerging pathogens before they are reflected in questing populations or human case data.

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