Tick-borne Diseases in Virginia

Virginia is a high-incidence state for several of the most common tick-borne diseases in the United States.  As ticks increase and spread geographically, it is essential to know about the different tick-borne diseases in the region,  including common signs and symptoms. Early diagnosis can mean saving a life or preventing chronic and disabling conditions.  Some tick-borne diseases can be fatal or have long-term, serious health effects if not caught early.   Learn about the most common tick-borne diseases in Virginia here.

Alpha-gal Syndrome

Alpha-gal Syndrome (AGS) is an allergy to red or mammalian meat, and people with AGS can be triggered by some or many of the hundreds of mammalian meat products and byproducts (MMPBs). The American Academy of Allergy Asthma & Immunology (2019) defines Alpha-gal as a "potentially life-threatening allergy to carbohydrate molecule called galactose-alpha-1.3-galactose found in most mammals or red meat." AGS is common in Virginia and is transmitted by the Lone Star tick.  In October 2019, Lynchburg, VA, and Richmond, Virginia, made the top 10 locations represented by members in the two primary Facebook AGS support groups with a combined 11,000+ members.  Gastrointestinal symptoms, hives, and anaphylaxis are common symptoms. Learn more about AGS at Alpha-gal Information.

Lyme Disease

Lyme disease is the most common vector-borne disease in the United States, and is now 1.5 times more common than the estimated number of cases of breast cancer. It has been reported in all 50 states in the United States, and Virginia is considered a high-incidence state.  According to Tick Check, there could be an estimated 200,000 actual cases of Lyme disease in Virginia since 2000.   The CDC estimates nearly half a million new cases of Lyme each year in the United States. Potentially, 40% of Lyme patients end up with long-term health problems or Post Treatment Lyme Disease, and as low as 30% have a bulls-eye rash. When left untreated, Lyme disease can affect the nervous and cardiovascular systems and cause serious long-term health problems. Early signs and symptoms include fever, joint pain, body aches and pains, and other flu-like symptoms. Check out Tick Check's interactive map to see state and county-level data since 2000. 

Rocky Mountain Spotted Fever

Rocky Mountain Spotted Fever (RMSF) cases have been reported throughout the United States, with five states accounting for over 50% of cases.  Virginia is one of these five states, along with Arizona, Missouri, North Carolina, and Tennessee.  The American Dog Tick transmits the disease in Virginia, now reported under Spotted Fever Rickettsiosis (SFR).  About 5-10% of RMSF cases are fatal, with children under 10 representing the highest number of reported deaths. Early signs and symptoms include fever and headaches, and a rash may develop within a few days after the fever begins. Nausea, vomiting, stomach pain, muscle pain, and lack of appetite may also occur. The CDC describes RMSF as "one of the deadliest tick-borne diseases in the Americas." 


Anaplasmosis has been steadily increasing since it first became reportable in 2000.  The black-legged tick, which also transmits Lyme disease, transmits the disease, which has a low fatality rate of less than 1%.  The upper midwestern and northeastern regions of the United States have the highest numbers, and Virginia experiences higher numbers than many states. Early signs and symptoms are fever, chills, severe headache, muscle aches, nausea, vomiting, diarrhea, and loss of appetite.  Learn more about Anaplasmosis from the CDC


Babesiosis has been spreading and increasing across the United States and was reported in 40 states in 2019.  Although yet to be considered endemic in Virginia, in 2019, the Food and Drug Administration included Virginia as one of the 15 states recommended to start screening blood donations for babesiosis. Some people will not have symptoms, whereas others will experience flu-like symptoms, including fever, chills, headache, body aches, joint pain, nausea, fatigue, or loss of appetite. Learn more about Babesiosis from the CDC.  


Ehrlichiosis is most frequently reported in the southeastern and south-central regions of the United States, which includes Virginia.  The state also has some of the highest rates of ehrlichiosis in dogs in the United States.  Early signs and symptoms include fever, chills, headaches, gastrointestinal symptoms, confusion or an altered mental status, and in children, sometimes a rash. CDC warns that antibiotics should not be delayed in patients with suggestive clinical presentation. Learn more about Ehrlichiosis from the CDC. 

Heartland Virus

Heartland Virus (HRTV) is still considered rare in the United States with only about 60 cases reported as of late 2022. Evidence suggests, however, that it is expanding across the United States.  Although not typically found in Virginia, a fatality occurred in 2021 in the Maryland and Virginia region.  HRTV is transmitted by the lone star tick and is considered an emerging tick-borne disease. Symptoms are similar to other tick-borne diseases and include fever, headache, fatigue, headaches, nausea, diarrhea, decreased appetite, and muscle or joint pain. Learn more about Heartland Virus from the CDC.  


Powassan is still considered rare, but the number of reported cases to the CDC has been increasing. Most cases occur in the northeastern states and Great Lakes region, although additional cases have been reported in northern Virginia and North Carolina. A study of ticks from 36 field sites in Appalachian Virginia found two sites in Floyd County with POWV-positive ticks. Both sites were in residential areas with proximity to humans. The blacklegged tick transmits Powassan and can cause severe disease, confusion, coordination loss, difficulty speaking, and seizures. Infection of the brain (encephalitis) or membranes around the brain and spinal cord (meningitis) can occur, and approximately 1 in 10 cases will be fatal. Around half of survivors will experience long-term health problems, including memory problems, recurring headaches, and loss of muscle mass and strength. Early signs include fever, headache, vomiting, and weakness. Learn more about Powassan from the CDC


Tularemia is a less common tick-borne disease but has been reported in all states except Hawaii—the CDC and Virginia Department of Public Health report 2 cases annually in Virginia.  Without adequate treatment, Tularemia can be severe and even fatal.  Patients have often described unusual and severe symptoms.  Symptom onset may be abrupt and include high fevers, chills, body aches and pains, headache, nausea, chest discomfort, gastrointestinal symptoms, and severe throat pain.  Learn more about Tularemia from the CDC.


Southern Tick-Associated Rash Illness (STARI) resembles Lyme disease and is often misdiagnosed, leading to delayed treatment and increased risk of chronic conditions. Transmitted by the lone star tick, STARI occasionally has a circular rash similar to the bulls-eye rash linked to Lyme. Fever, fatigue, headache, and muscle pains may accompany the rash. You can learn more about STARI from the CDC.

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Click to learn more about the types of ticks in Virginia, how to prevent tick bites, and what to do when you are bitten by a tick.