UNC study finds Lyme disease firmly established in Western North Carolina

Nearly 40% of blacklegged ticks collected in Biltmore Forest tested positive for the bacteria that causes Lyme disease.

Lyme disease may be far more established in Western North Carolina than previously recognized, according to a new study led by researchers at the University of North Carolina at Chapel Hill.

The study, published Aug. 13 in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report, found that nearly 40% of adult and nymphal blacklegged ticks collected in Biltmore Forest carried Borrelia burgdorferi, the bacterium that causes Lyme disease.

Researchers said the findings show that the region could be experiencing a southward expansion of blacklegged ticks and the pathogens they carry.

The study was conducted by researchers from UNC Chapel Hill’s Institute for Global Health and Infectious Diseases, the University of South Carolina and North Carolina State University in partnership with the town of Biltmore Forest.

The research grew out of local concerns about ticks. Biltmore Forest established a task force in early 2024 after residents raised concerns about tick-borne diseases. UNC Associate Professor of Medicine Ross Boyce subsequently contacted the town after a local news report about ticks and Lyme disease.

“This is one of the most compelling research projects I have conducted,” Boyce said. “We are essentially leveraging the tools of academia to tackle a public health problem, and critically, one that the local community has told us is important.”

Hundreds of ticks collected

Researchers conducted monthly surveillance between November 2024 and August 2025 at 25 properties in Biltmore Forest.

They collected 373 ticks, with more than three-quarters identified as blacklegged ticks, also known as Ixodes scapularis. The species is the primary vector for Lyme disease in the eastern United States.

Testing found that nearly 40% of adult and nymphal blacklegged ticks carried B. burgdorferi.

Researchers also detected Borrelia miyamotoi and Anaplasma phagocytophilum in about 6% of the ticks tested. Both bacteria can cause illness in humans.

The researchers said the findings represent the southernmost detection of those pathogens documented in the study.

The prevalence of Lyme disease bacteria found in the Biltmore Forest ticks was comparable to levels reported in portions of the Northeast, Mid-Atlantic and Upper Midwest, where Lyme disease is well established.

Researchers warn of changing risk

The findings could have implications for doctors and patients across Western North Carolina, researchers said.

Boyce said some health care providers in the region were trained at a time when Lyme disease was considered uncommon in North Carolina. The changing distribution of ticks and tickborne pathogens, he said, makes additional education and surveillance important.

“Lyme disease can be a life-changing diagnosis, especially if not diagnosed and treated early,” Boyce said. “The pace at which we’ve gone from zero-to-sixty, essentially within a 10-year period, means that we are behind.”

Boyce described the situation as requiring a focused regional response.

The research team is working with Biltmore Forest on a response plan that could include efforts to reduce tick populations and improve access to appropriate medical care.

Researchers also plan to expand surveillance into rural counties outside the Asheville area to determine how widespread the emerging risk may be.

Community partnership drives research

The study is an example of community-led research being used to address a local public health concern.

The research was led by co-first authors Sean Sweeney of the University of South Carolina and Ayla Bullock of UNC-Chapel Hill. Co-senior authors were Melissa S. Nolan of the University of South Carolina and Boyce of UNC’s Institute for Global Health and Infectious Diseases.

Other investigators included Michael Reiskind of N.C. State University and Angela Newnam and Jonathan Kanipe of the Biltmore Forest LEADS Task Force.

The researchers said continued surveillance will be important as the distribution of ticks and tick-borne pathogens changes across the Southeast.

For residents and visitors in Western North Carolina, the findings underscore the importance of taking precautions against tick bites and seeking medical attention when symptoms develop following a possible tick exposure.