<unk>  is a nationally notifiable disease in the United States. Cases have been reported in every month of the year, but most cases are reported during April–September. These months are also the peak months for tick activity in the United States. The majority of cases of<unk>  tend to be in the United States. The states affected most include "the southeastern and south-central United States, from the East Coast extending westward to Texas." Since the first case of<unk>  was reported in 2000, cases reported to the CDC have increased, for example, in 2000, 200 cases were reported and in 2019, 2,093 cases were reported. Fortunately, the "proportion of<unk>  patients that died as a result of infection" has gone down since 2000. From 2008 to 2012, the average yearly incidence of<unk>  was 3.2 cases per million persons. This is more than twice the estimated incidence for 2000–2007. The incidence rate increases with age, with the ages of 60–69 years being the highest age-specific years. Children less than 10 years and adults aged 70 years and older have the highest case-fatality rates. A documented higher risk of death exists among persons who are immunosuppressed.
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