Emerging infectious diseases continue to threaten human health and healthcare resources across the world, and with the sustained emergence of some like Lyme disease, this trend is only expected to get worse. Even though some research has examined the spread of Lyme disease in different parts of the United States, focusing on its origin, spread, surveillance, and reporting, there has been minimal research on the recent spread of Lyme disease into and within Central and Southern Appalachia. This is an important gap, considering that this region is at the edge of the disease's expanding incidence and range. Considering this factor and the consequences that this disease may have on the residents of Appalachia who already face an array of underlying problems like chronic conditions, decreased access to health care, and exposure through outdoor work like resource extraction, addressing this gap will be important in understanding the current and future spatial range and impacts of the continued emergence of Lyme disease in Appalachia. This study thus sought to examine the extent of the emergence of Lyme disease in Appalachia between 2000 and 2019 using spatial scan statistic. This type of analysis uses spatiotemporal information to quantify disease emergence and diffusion using retrospective case and location data within a GIS environment; hence it helped quantify the spatial distribution and diffusion of Lyme disease into and within Appalachia and identify additional areas that can be targeted with public health prevention measures. We found five statistically significant clusters of Lyme disease across the contiguous US, indicating that the disease expanded spatially over the study period. Lyme disease has more than tripled across the US, with the number of counties with RR>1 increasing from 130 in 2000 to 453 by 2019. Lyme disease also increased more than eightfold in Appalachia, with spread southwards into and within Appalachia. The number of Appalachian counties with RR>1 increased from 16 in 2000 to 127 in 2019. These findings are important in understanding the current and future spatial range and the impacts of the continued emergence of Lyme disease in Appalachia. With this understanding, we can minimize the misdiagnosis of Lyme disease and inform public health action to reduce public vulnerability. / Master of Science / Emerging infectious diseases are diseases that have not been present, the persistence of diseases that were previously unknown, or those diseases that are rapidly increasing in a given location. These diseases continue to threaten human health and healthcare resources across the world, and with the sustained emergence of some like Lyme disease, this trend is only expected to get worse. Even though some research has investigated the spread of Lyme disease in different parts of the United States, focusing on its origin, spread, monitoring, and reporting, there has been minimal research on the recent spread of Lyme disease in Central and Southern Appalachia. This is an important gap, considering that this region is next to areas where the disease has recently spread, thereby making it vulnerable to continued spread. Considering this factor and the consequences that this disease may have on the residents of Appalachia who already face many underlying problems like long-term conditions, decreased access to health care, and exposure through outdoor work like resource extraction, addressing this gap will be important in understanding the current and future geographic occurrence and impacts of the continued spread of Lyme disease in Appalachia. This study thus sought to investigate the extent of the spread of Lyme disease in Appalachia between 2000 and 2019 using statistics and identification of places with a higher than expected number of cases. This type of analysis uses location information to quantify disease occurrence and spread using past case and location data using GIS software; hence it helped identify the distribution and spread of Lyme disease into and within Appalachia and identify additional areas that can be targeted with public health prevention measures. We found five areas with higher than expected number of Lyme disease cases across the contiguous US, indicating that the disease increased over the study period. Lyme disease has more than tripled across the US, with the number of counties with higher cases than expected increasing from 130 in 2000 to 453 by 2019. Lyme disease also increased more than eightfold in Appalachia, with spread southwards into and within Appalachia. The number of Appalachian counties with higher than expected Lyme disease cases increased from 16 in 2000 to 127 in 2019. These findings are important in understanding the current and future spread and the impacts of this continued spread of Lyme disease in Appalachia. With this understanding, we can properly detect Lyme disease and inform public health action to reduce public vulnerability.

The identification of climate temperature-sensitive pathogens and infectious diseases is essential in addressing health risks resulting from global warming. Such research is especially crucial in regions where climate change may have a more significant impact like Russia. Recent studies have reasoned that the abundance of V. cholerae tox- is environmentally driven. The aim of the degree project is to investigate the spatial-temporal trends and thermo-climatic sensitivity of non-toxigenic V. cholerae abundance in Russia. This study employed spatial epidemiology tools to identify persistent clusters of the V. cholerae tox- isolation and areas for exploring temperature-depended patterns of the vibrio distribution. Correlation analysis was used to identify regions with temperature-driven Vibrio abundance – vibrioses and the V. cholerae tox- prevalence in water samples. GAM was applied to evaluate the relationship between V. cholerae tox- prevalence and the mean summer air temperature. The spatial analysis detected 16 persistent (7-8 year) clusters of V. cholerae tox- across the study period 2005-2021. The highest-risk areas are located between 54.70 and 55.15 latitudes. The persistent clusters should become targeted areas to improve sanitation conditions. A distinct significant thermo-climatic effect on the abundance of V. cholerae tox- in water basins was found in three Russian regions with temperate marine (the Kaliningrad region - Dwb) and sharp continental climatic conditions (the Irkutsk region - Dwb and the Republic of Sakha - Dwd). Finally, our results showed significant relationships between ambient summer temperature and vibriosis caused by V. cholerae tox- in the Rostov and Volgograd regions. Heat waves for both regions facilitated the eruption of reported vibriosis in 2007 and 2010. The study offers valuable outcomes to support simplified empirical evaluations of the potential hazards of vibrio abundance that might be useful locally for public health authorities and globally as a part of the warning system of climate change effects in Russia.

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