Summary of Enhanced surveillance activities.

North Carolina (NC) experiences some of the highest incidence rates of spotted fever rickettsiosis (SFR) and ehrlichiosis in the United States (US). Due to the non-specific nature of clinical symptoms, minimal utilization of molecular methods when appropriate, and limitations of sero-diagnostic methods, accurate case identification and subsequent public health reporting is challenging. Herein we detail the protocol and early enrollment results for an enhanced surveillance project aiming to generate more accurate estimates of tick-borne disease incidence in NC. Secondary outcomes of interest include: (i) increasing the obtainment rate of convalescent samples (ii) defining demographic and socioeconomic, behavioral/knowledge, entomologic, and environmental risk factors for disease, and (iii) describing the spectrum and clinical course of disease among cases of SFR and ehrlichiosis up to 90 days after symptom onset. In addition, we will collect remnant serum to establish a biorepository of well characterized samples that we intend to make available to researchers. Of the 150 participants enrolled, highlighted results include 49.5% of participants reported being exposed in their own home compared to 43.2% being exposed due to work or travel showing the importance of tick control and education. We also reported more confirmed cases of SFR and ehrlichiosis (15 and 20 respectively) where the North Carolina State Health Department only reported 14 and 11 confirmed cases in the entire state in 2022. Findings from the project will be reported in subsequent publications.北卡罗来纳州（North Carolina, NC）是美国（United States, US）斑点热立克次体病（spotted fever rickettsiosis, SFR）与埃立克体病（ehrlichiosis）发病率最高的地区之一。受临床症状缺乏特异性、适宜场景下分子检测手段应用不足，以及血清学诊断方法存在局限性等因素影响，准确的病例识别及后续公共卫生报告工作极具挑战。本文详述了一项强化监测项目的实施方案与早期入组结果，该项目旨在更精准地估算北卡罗来纳州蜱传疾病的发病率。本项目的次要研究目标如下：其一，提升恢复期样本的获取率；其二，明确与疾病相关的人口学、社会经济、行为/认知、昆虫学及环境危险因素；其三，描述症状出现后90天内斑点热立克次体病与埃立克体病病例的疾病谱及临床病程。此外，本项目将收集剩余血清样本，建立经充分表征的生物样本库（biorepository），供后续研究人员使用。本次项目共入组150名参与者，初步结果显示，49.5%的参与者表示暴露地点为自家居所，另有43.2%的暴露源于工作或出行，这凸显了蜱虫防控与健康宣教的重要性。同时，本项目确认的斑点热立克次体病与埃立克体病病例分别为15例和20例，而2022年北卡罗来纳州卫生部门仅在全州范围内报告了14例和11例确诊病例。本项目的研究成果将在后续学术出版物中发表。