Public health officials in New Hampshire are monitoring two emerging diseases - spread by the same tick that carries Lyme disease - that are making dozens of New Hampshire residents sick every year.
Anaplasmosis is a tick-borne disease caused by the bacterium Anaplasma phagocytophilum. According to the Centers for Disease Control and Prevention, symptoms include fever, headache, chills and muscle aches that usually develop within a week or two after a tick bite.
Last year, 52 cases of anaplasmosis were reported in New Hampshire, according to Beth Daly, chief of infectious disease surveillance at the state Division of Public Health Services.
That was a big jump from 2011, when 30 cases were reported.
New Hampshire and five other states in the Northeast had among the highest incidences in the country of anaplasmosis in 2010, according to CDC. Most cases are reported in June and July.
Then there's babesiosis, caused by Babesia microti, a protozoan parasite that infects red blood cells. Symptoms include flu-like symptoms, such as fever, chills, sweats, headache, body aches, nausea, fatigue and loss of appetite.
It also can lead to hemolytic anemia and become life-threatening in vulnerable patients such as the elderly or immune-compromised, according to the CDC.
Babesiosis became a nationally notifiable condition on Jan. 1, 2011. But it's been reportable in New Hampshire since 2005, when just two cases were reported.
Last year, 19 cases of babesiosis were reported, up from 14 in 2011, 11 in 2010 and 7 in 2009.
While reports of both diseases are on the rise in New Hampshire, Daly said, the numbers are still far below those reported for Lyme disease.
Last year, there were 1,460 cases of Lyme disease reported in New Hampshire; the state has been among the top three in the country for incidence of the disease for several years.
But 20 years ago, that wasn't the case. In 1993, just 15 cases of Lyme were reported here; in 1994, there were 30, and in 1995, 28.
In the 2000s, the numbers began to increase, and by 2006, 617 Lyme cases were reported. Two years later, there were 1,615 cases of Lyme disease, the most ever reported here.
So, does this mean 20 years from now, hundreds of Granite Staters will be diagnosed with babesiosis or anaplasmosis?
It's difficult to predict, says Dr. Jose Montero, the state director of public health services. But the same conditions that led to an increase in Lyme disease - such as habitat changes that bring humans into closer contact with the deer and mice that harbor the ticks - could mean the other two diseases will become more prevalent, as well, he said.
"As we have been looking in the last couple of years and testing for those, we find them," he said. "There is a potential for them increasing."
Montero said the state health department has sent advisories to physicians to watch for both babesiosis and anaplasmosis infections in their patients.
"We know that in a state like ours, with this high prevalence of Lyme disease that we have ... clinicians need to think about these other two diseases and try to separate and properly identify them so we can properly treat them," he said.
Some physicians now automatically test for the other two diseases when they test patients for Lyme disease, Montero noted.
Meanwhile, Montero said researchers are looking into whether some Lyme patients who suffer ongoing medical problems despite treatment could have been co-infected with another disease organism.
There could even be an as-yet-undiscovered organism that is making some people sick, he said. "That's a real possibility," he said. "Certainly, there are a lot of researchers working and looking into that."
From a public health perspective, Daly said, the important message is prevention. Protecting yourself from a tick bite - wearing light-colored clothing, tucking your pants into your socks and using tick repellent - is the best way to avoid getting any of these diseases.
"Doing daily tick checks is really important, and removing ticks promptly if you do notice them," she said.
With all the media attention to mosquito-borne illnesses such as West Nile Virus and EEE, Daly said, the reality is that "ticks are definitely much more likely to result in illness."
"The good thing is, though, a lot of the prevention measures are applicable to both mosquitoes and ticks," she said.