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INCREASING HEALTH BURDEN OF HUMAN BABESIOSIS IN ENDEMIC SITES

PETER J. KRAUSE^*, KATHLEEN MCKAY^*, JOSEPH GADBAW, DIANE CHRISTIANSON, LINDA CLOSTER, TIMOTHY LEPORE, SAM R. TELFORD, III, VIJAY SIKAND, RAYMOND RYAN, DAVID PERSING, JUSTIN D. RADOLF, AND ANDREW SPIELMAN AND THE TICK-BORNE INFECTION STUDY GROUP

Human infection due to Babesia microti has been regarded as infrequent and a condition primarily affecting the elderly or immunocompromised. To determine whether risk in endemic sites may be increasing relative to that of Borrelia burgdorferi and to define its age-related clinical spectrum, we carried out a 10-year community-based serosurvey and case finding study on Block Island, Rhode Island. Less intensive observations were conducted in nearby sites. Incidence of babesial infection on Block Island increased during the early 1990s, reaching a level about three-fourths that of borrelial infection. The sera of approximately one-tenth of Block Island residents reacted against babesial antigen, a seroprevalence similar to those on Prudence Island and in southeastern Connecticut. Although the number and duration of babesial symptoms in people older than 50 years of age approximated those in people 20 to 49 years of age, more older adults were admitted to hospital than younger adults. Few Babesia-infected children were hospitalized. Babesial incidence at endemic sites in southern New England appears to have risen during the 1990s to a level approaching that due to borreliosis.

Received July 15, 2002. Accepted for publication December 9, 2002.

Acknowledgments: We thank Jean and Bill Crawford, Dorothy and Norman Dahl, Betty Fitzpatrick, Nancy and Malcolm Greenaway, Barbara Hobe, Ruth and Carl Kaufmann, Gerald Lange, Florence Lentz, Claire and Stephen McQueeny, Frankie and Gordon Smith, Martha and William Wilson, Margaret Beck, Cynthia Buffum, Barbara Farrow, Hope Fitton, Heather Pasquazzi, Patricia Richard, and Daniel Whalen for help in acquisition of data and Kenneth Bourell, Michael McCarter, and Claudia Alford for assistance in manuscript preparation.

Financial support: This work was supported in part by grants from the National Institutes of Health: AI-42402 (Peter J. Krause), AI-37993 and AI-39002 (Sam R. Telford III), AI-41103 (David Persing), AI-29735 (Justin D. Radolf), AI-19693 (Andrew Spielman), and the General Clinical Research Center (MO1RR06192).

Authors’ addresses: Peter J. Krause, Kathleen McKay, and Diane Christianson, Connecticut Children’s Medical Center, 282 Washington Street, Hartford, CT 06106. Joseph Gadbaw, Lawrence and Memorial Hospital, 365 Montauk Avenue, New London, CT 06320. Raymond Ryan and Justin D. Radolf, University of Connecticut Health Center, Farmington, Connecticut 06030. Linda Closter, Block Island Medical Center, Block Island, RI 02807. Timothy Lepore, Nantucket Cottage Hospital, Nantucket, MA 02554. Sam R. Telford III and Andrew Spielman, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115. Vijay Sikand, Charter Oak Medical Center, 324 Flanders Road, East Lyme, CT 06333. David Persing, Corixa Corporation, 1124 Columbia Street, Seattle, WA 98104.

Reprint requests: Peter Krause, Connecticut Children’s Medical Center, 282 Washington Street, Hartford, CT 06106, Telephone: 860-545-9490, Fax: 860-545-9371, E-mail: Pkrause{at}ccmckids.org

^* The first two authors contributed equally to this work.

The Tick-Borne Infection Study Group: Ritchard Cable, Ivo Foppa, Richard J. Pollack, Peter Brassard, Ronald Lentz, Sally Brassard, Deborah McGrath, Kathie Freeman, Jaber Aslanzadeh, Kanu Sharan, Diane Pearl, Robert Baltimore, Feliciano Dias, Pamela Fall, Christine Abru, Betsy Ryan, Christopher Lehrach, Jonathan Trouern-Trend, Timothy Sullivan, Richard Geller, Jonathan Covault, Geoffrey Fey, Patricio Tomas, Michael Clawson, Allan Beck, Roger Greene, Norma Grills, Stan Badon, Henry Feder, Juan C. Salazar, and James Sabetta.

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