JMIR Publications

ABSTRACT

Background:

The fragmentation and limited accessibility of tickborne disease (TBD) data in the United States (U.S.) represent a significant and growing public health challenge. Ticks account for over 75% of all vector-borne disease cases annually in the U.S., and TBDs are rapidly expanding geographically due to ecological and climate changes. Despite this urgency, national surveillance data are principally available only at aggregate state and federal levels, with more granular-level data rarely available in a consistent or systematic format, and also lacking in historical context. This critical deficiency limits more detailed analyses and TBD surveillance, diagnosis, prevention, and public health communication. Adopting a One Health perspective — i.e., recognizing the interconnectedness of people, animals, and their shared environments — canine disease data represent a well-established proxy indicator for human TBD risk. Canines serve as sentinels for human exposure to tick vectors, and integrating canine serological data with human surveillance data through triangulation can improve the reliability of geographic risk assessments and reduce reporting bias. Oklahoma presents an especially valuable use case: it is a known center for TBDs, including Rocky Mountain Spotted Fever (RMSF), ehrlichiosis, tularemia, Heartland virus infection, and anaplasmosis, and contains significant vulnerable populations with particularly elevated poverty rates. Public health data in Oklahoma date back to 1928 and, although inconsistently formatted, offer a rich longitudinal record that can be examined at the county level for a finer-grained, more comprehensive analysis than found in typical aggregate state-level studies.

Objective:

This research demonstrates how a One Health triangulation approach—integrating human TBD surveillance data with canine disease reports and historical records at the county level—can improve the geographic and epidemiological understanding and analysis of TBD spread and impact. With Oklahoma as a use case, we sought to (1) identify geographic patterns and disparities in human TBD reporting at the county level; (2) compare human TBD distribution with canine disease data to assess underreporting and geographic risk gaps; and (3) illustrate and consider the effect of long-term disease trends and data inconsistencies across reporting periods.

Methods:

This is an exploratory and descriptive analytic triangulation study utilizing publicly available surveillance data. The unit of analysis was the Oklahoma county (n=77). Given earlier consistency and coverage concerns, data were summarized using 1990-forward statewide human reporting histories, parsed human county tables for 2004-2007, and Companion Animal Parasite Council (CAPC) canine testing summaries for 2012-2026. An additional environmental data stream integrated National Oceanic and Atmospheric Administration (NOAA) 1991–2020 30-year Climate Normals for all 77 Oklahoma counties to derive a composite Tick Season Risk Index (temperature-weighted 55%, precipitation-weighted 45%) summarizing county-level climatic suitability for tick activity. Primary outcome measures were reported human cases, human county rates where available, canine positive tests, canine total tests, and canine percent-positive values. Findings were presented as trend, county burden, rate, and regional graphs; 2026 CAPC values were treated as year-to-date.

Results:

Statewide human reports showed historically high RMSF/SFR and ehrlichiosis values in the 2000s-2010s, lower reported values after 2019, and continued low but persistent tularemia case reports. County graphs showed that raw reported human volume (2004-2007) was highest in Tulsa, Oklahoma, Pittsburg, LeFlore, and Pottawatomie counties, while average rates were highest in Latimer, Pushmataha, Pittsburg, Haskell, and Adair. CAPC canine data (2012-2026) showed highest positive-test volume in Oklahoma, Tulsa, Cleveland, Rogers, and Washington counties, but highest Ehrlichiosis percent-positive in Haskell, Cherokee, Sequoyah, Mayes, and McIntosh among counties with at least 500 tests. The Tick Season Risk Index derived from NOAA Climate Normals indicated that western counties with few or no reported human cases nonetheless fall within a moderate climatic-suitability range (approximately 45–65/100), consistent with conditions supporting relevant tick activity.

Conclusions:

Using trend, county burden, rate, and regional graphs illuminates variations that would not be apparent in more aggregate state-level analyses. Central metro counties carry the largest testing and case volume, while eastern, northeastern, and southeastern counties show stronger disproportionate burden signals. County-level climatic suitability derived from NOAA Climate Normals further indicates that several low-reporting western counties fall within a moderate Tick Season Risk Index range, supporting the interpretation that their sparse human case reports reflect surveillance gaps rather than a true absence of risk. These findings support integrated county-level human, canine, and environmental surveillance and graph-based communication that distinguish raw volume from percent positivity and rates, providing valuable insights on One Health affected endemic patterns and epidemiological trends impacting public health outcomes and approaches.