Study Finds High Lyme Disease Rates in WNC Ticks

A new study conducted in Biltmore Forest is raising concerns about the growing presence of Lyme disease and other tick-borne illnesses in western North Carolina. It's not limited to the Asheville area of Buncombe County. High concentrations of Lyme disease have been documented in Madison, Yancey, Mitchell, Avery, Watauga, Ashe, Alleghany, Surry, and Stokes counties. Additional studies and health data also showed that most people experiencing symptoms from a tick-borne illness could live in any county in the state.

Researchers from the University of North Carolina, North Carolina State University, and the University of South Carolina say findings from a year-long tick survey show Lyme disease is now firmly established in the region.

The study focused on Biltmore Forest, a town of about 1,400 residents surrounded by Interstate 40, Hendersonville Road, the Blue Ridge Parkway, and the Biltmore Estate. Researchers said the community's geography created an ideal location to study the spread of ticks and tick-borne diseases.

From late 2024 through the summer of 2025, scientists collected ticks from residential properties and from residents who submitted ticks removed from themselves or their pets. Testing found that roughly one-third of blacklegged tick samples carried Borrelia burgdorferi, the bacteria that causes Lyme disease. 

It has evolved into an unusually effective way to spread through the body. Despite its corkscrew appearance, the pathogen does not actually bore through tissues. Instead, researchers say it uses specialized surface proteins to latch onto and release from the lining of blood vessels, allowing it to move along vessel walls and avoid being swept away by blood flow. Its spiral shape also helps it navigate dense tissues such as cartilage, tendons and connective tissue, where many other bacteria cannot easily travel. Rather than damaging cells to force its way through, the bacterium can slip between them using the body's own cellular processes, enabling it to reach the joints, heart, nervous system and other organs. This ability to migrate throughout the body is one reason Lyme disease can produce a wide range of symptoms and, in some cases, affect multiple organ systems.

Researchers also identified pathogens linked to anaplasmosis, rickettsiosis, and hard tick relapsing fever.

"This is a wake-up call," said Dr. Ross Boyce, an associate professor of medicine and epidemiology at the UNC School of Medicine. "We've planted a flag and can say Lyme is firmly established in western North Carolina."

The findings build on previous research showing Lyme disease steadily moving south along the Appalachian Mountains. A 2024 study found Lyme disease clusters expanding across northwestern North Carolina, including Buncombe County, with some mountain communities experiencing infection rates comparable to traditional Lyme hotspots in the Northeast.

State health officials have also recognized the growing threat. In a May 2025 advisory to clinicians, the North Carolina Department of Health and Human Services said Lyme disease is now considered endemic in 10 northwestern counties, including Buncombe County. The agency noted that infection rates in blacklegged ticks exceed 20% in several mountain counties and recommends post-exposure preventive treatment in certain cases following high-risk tick bites.

The research effort was inspired in part by Biltmore Forest resident Angela Newnam, who spent years searching for answers after developing a series of debilitating symptoms following what was initially believed to be an insect bite. After eventually testing positive for Lyme-related antibodies, she began working with town leaders to raise awareness and encourage tick surveillance.

Town officials have since formed a task force and are planning educational outreach efforts, including informational kiosks and tick-prevention materials at parks and trailheads.

Researchers hope to expand their work beyond Biltmore Forest and gather similar data from other mountain communities.

Health officials recommend that residents take precautions when spending time outdoors, including using EPA-registered insect repellents, wearing permethrin-treated clothing, checking for ticks after outdoor activities, showering after coming indoors, and promptly removing attached ticks.

Per North Carolina law, clinicians are required to report confirmed or suspected tick-borne illness cases to their local health department. 

Anyone who develops symptoms such as fever, rash, fatigue, joint pain, or flu-like illness after a tick bite should contact a healthcare provider.

The CDC reports that emergency room visits related to tick bites reached unusually high levels this spring, underscoring what researchers say is an increasingly active tick season across the Southeast.