West Virginia will report the highest number of Lyme disease cases on record in 2017. As of November 8, 2017, 571 confirmed and probable Lyme disease cases have been reported compared to the previous record of 368 cases in 2016. The geographic distribution of cases has also increased. As of November 8, 2017, 45 counties have reported at least one confirmed or probable Lyme disease case, up from 11 counties in 2012. This increase could be the result of increased reporting, increase in the number of Ixodes scapularis ticks infected with Borrelia burgdorferi in West Virginia, or a recent change in the national surveillance case definition for Lyme disease. Based on the change, West Virginia is considered a high incidence Lyme disease state, and the presence of an erythema migrans (EM) with known exposure in the state is sufficient for a patient to be classified as a confirmed surveillance case.