;jsessionid=4442DBFE52618A3BD9A1C7356CB044C6.f03t03  OPINION

Lyme disease surveillance in the United States: Looking for ways to cut the Gordian knot

Authors:  M. L. Cartter, R. Lynfield, K. A. Feldman, S. A. Hook, A. F. Hinckley
First published: 12 February 2018
DOI: 10.1111/zph.12448

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.


Current surveillance methods have been useful to document geographic expansion of Lyme disease in the United States and to monitor the increasing incidence of this major public health problem. Nevertheless, these approaches are resource-intensive, generate results that are difficult to compare across jurisdictions, and measure less than the total burden of disease. By adopting more efficient methods, resources could be diverted instead to education of at-risk populations and new approaches to prevention. In this special issue of Zoonoses and Public Health, seven articles are presented that either evaluate traditional Lyme disease surveillance methods or explore alternatives that have the potential to be less costly, more reliable, and sustainable. Twenty-five years have passed since Lyme disease became a notifiable condition – it is time to reevaluate the purpose and goals of national surveillance.



Yes, please!  Cut the Gordian Knot!  Better yet, take an ax to the thing!

Thanks to the enduring popularity of the Alexander fable, the phrase “Gordian knot” has entered the lexicon as shorthand for an intricate or intractable obstacle. One of its earliest appearances came in the Shakespeare play Henry V, where the titular character is praised for his ability to “unloose” the Gordian knots of politics. Likewise, the saying “cutting the Gordian knot” is now commonly used to describe a creative or decisive solution to a seemingly insurmountable problem.