Richard C Falco Gary P Wormser and Thomas J Daniels

The suburbs. Mention the word, and many people think of nice houses along tree-lined streets, nestled into pristine wooded areas that serve as the perfect backdrop to an almost idyllic existence. The suburbs are often seen as a retreat, far enough away from the hustle and bustle of the city, yet usually a short commute to urban job centers.

Since World War II, the massive expansion of suburbs has been the way that metropolitan areas grow. As suburbs were created, lawns and parks replaced forests and farms, and entire neighborhoods were built into woodlots. However, the exodus from the nation's older cities to previously unspoiled lands has come at a cost. The suburbs, with their typically wooded properties and increasing human population, have become an important environment for interaction between people and arthropod vectors, particularly ticks. In the United States, the emergence of Lyme disease provides the archetypal example ofjust such a process.

Lyme disease was unheard of in the United States before 1977, and likely would have gone unrecognized for many more years if not for the efforts of two mothers living in suburban towns in Connecticut. They independently reported what appeared to be outbreaks of juvenile rheumatoid arthritis, sometimes associated with a rash, to the Connecticut State Health Department in 1975, which eventually led to the "discovery" of Lyme disease as a distinct clinical entity (Steere et al, 1977a, 1977b; Aronowitz, 1989). While it is probable that the agent of Lyme disease was present in the northeastern United States hundreds of years ago, it likely went unnoticed due to the often more serious, and sometimes fatal, effects of other diseases afflicting North Americans throughout the nineteenth century (Barbour and Fish, 1993). Presently, Lyme disease is the most common tick-borne disease in the United States and Europe (O'Connell et al., 1998; Orloski et al, 2000; CDC, 2004, 2005). In the United States, over the decade 1994 to 2004, Lyme disease case numbers increased, with an average of almost 17,000 cases reported annually (CDC, 2006a; see also Figure 5.1).

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Figure 5.1 Bar chart of US Lyme disease cases. Data from CDC (2006a).

The histories of Lyme disease and suburbanization are intertwined. The spread of suburbia is a relatively new phenomenon in human history, and it has had a tremendous impact on how we interact with nature. It is hoped that the lessons learned from Lyme disease will be applicable to other infectious diseases where the local landscape is a critical factor in the transmission of the pathogen.

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