2024’s Worst States for Tick-Borne Illnesses

A group of hikers walk past a sign reading “Beware of Ticks!” in the forest

Where should hikers, parents, and pet lovers be on the lookout for ticks?

To mark May as National Lyme Disease Awareness Month, Pest Gnome ranked 2024’s Worst States for Tick-Borne Illnesses.

We compared the 50 states based on 6 categories. We looked at annual rates of tick-borne diseases like Lyme disease, ehrlichiosis, and Rocky Mountain spotted fever (RMSF). We also considered environmental factors like forest area, hiking trails, and length of tick and flea season, among 25 total metrics.

Enjoy nature safety with help from our ranking below. To learn how we ranked the states, see our methodology.

Contents

State Rankings

See how each state fared in our ranking:

Top 5 Close Up

Check out the slideshow below for highlights on each of our 5 most at-risk states for tick-borne illnesses.

Hikers looking at Lake Ausable at Indian head trail and Rainbow waterfalls near Keene in New York State.
No. 1: New York | Overall Score: 54.33

Total Lyme Disease Cases (Most Recent Year): 16,798 | Rank: 1
Lyme Disease Annual Rates: 84.6 | Rank: 6
Tick-Borne Pathogen Distribution: 225 | Rank: 2
Number of Hiking Trails: 3,689 | Rank: 3
Blacklegged Tick and Western Blacklegged Tick Distribution: 124 | Rank: 8

Local tips: 
Everything to Know About Termites in New York
What to Do About Rats in New York City
Everything to Know About Bed Bugs in New York City

Photo Credit: Thomas / Adobe Stock / License
A sign welcoming visitors to Pennsylvania
No. 2: Pennsylvania | Overall Score: 46.21

Total Lyme Disease Cases (Most Recent Year): 8,413 | Rank: 2
Lyme Disease Annual Rates: 64.7 | Rank: 9
Tick-Borne Pathogen Distribution: 263 | Rank: 1
Forest Areas: 7,430 kilohectares (kha) | Rank: 6
Blacklegged Tick and Western Blacklegged Tick Distribution: 134 | Rank: 5

Local tips: 
Everything to Know About Termites in Pennsylvania

Photo Credit: andreykr / Adobe Stock / License
A field of Texas bluebonnets with the sun setting in the distance
No. 3: Texas | Overall Score: 42.93

Total Lyme Disease Cases (Most Recent Year): 23 | Rank: 30
Forest Areas: 7,260 kilohectares (kha) | Rank: 8
Number of Farms: 230,662 | Rank: 1
Blacklegged Tick and Western Blacklegged Tick Distribution: 97 | Rank: 17
Number of Months in Tick and Flea Season: 12 | Rank: 1 (tie)

Local tips: 
Everything to Know About Bed Bugs in Texas
Everything to Know About Termites in Texas
When is Mosquito Season in Texas?
How to Get Rid of Mosquitoes in Texas

Photo Credit: kanonsky / Adobe Stock / License
Hiking trail going through redwood forest of Muir Woods National Monument, North San Francisco bay
No. 4: California | Overall Score: 41.69

Total Lyme Disease Cases (Most Recent Year): 77 | Rank: 23
Tick-Borne Pathogen Distribution: 48 | Rank: 9
Forest Areas: 10,800 kilohectares (kha) | Rank: 2
Number of Hiking Trails: 10,748 | Rank: 1
Number of Months in Tick and Flea Season: 12 | Rank: 1 (tie)

Local tips: 
Bed Bugs in California: Everything You Need to Know
Everything to Know About Termites in California
When is Mosquito Season in California?

Photo Credit: Sundry Photography / Adobe Stock / License
A sign welcoming visitors to Wisconsin
No. 5: Wisconsin | Overall Score: 40.96

Total Lyme Disease Cases (Most Recent Year): 5,208 | Rank: 4
Lyme Disease Annual Rates: 88.6 | Rank: 5
Tick-Borne Pathogen Distribution: 83 | Rank: 6
Forest Areas: 6,390 kilohectares (kha) | Rank: 12
Blacklegged Tick and Western Blacklegged Tick Distribution: 119 | Rank: 11

Local tips: 
Everything to Know About Termites in Wisconsin

Photo Credit: Mark / Adobe Stock / License

The Upshot

Keep your socks pulled up over your pant legs when outdoors in the Northeast. Lyme disease is most prevalent in states like New York (No. 1), Pennsylvania (No. 2), and New Jersey (No. 30). New York recorded the highest number of Lyme disease cases in 2022, with around 16,800. Rhode Island (No. 11) claimed the highest rate of Lyme disease cases, 212 per 100,000 residents annually.

12 states tied with the longest tick and flea season, 12 months, including Texas (No. 3), California (No. 4), and Washington (No. 17). While Texas reported lower instances of Lyme disease, it tied with Oklahoma (No. 29) for having the most diverse tick species — including American Dog, Gulf Coast, and Lone Star ticks, which can cause other illnesses like Ehrlichiosis, Southern tick-associated rash illness (STARI), and alpha-gal syndrome.

Utah (No. 48) and Arizona (No. 49) landed toward the bottom alongside Hawaii in last place. Only blacklegged and western blacklegged ticks (aka deer ticks) carry Lyme disease, and none are found in Hawaii or 6 other states — such as Idaho (No. 47) and Alaska (No. 40).

Ask The Experts

A National Pest Management Association survey shows that 25% of Americans are worried about being bitten by ticks and the risk of contracting tick-borne diseases.

Don’t bug out if you find a tick on your clothes or skin after a stroll through the park. We turned to a panel of experts to learn more about ticks and how to prevent and deal with tick bites. Stay informed and prepared with help from their insights below.

  1. What are three misconceptions about ticks?
  2. What are three of the best ways to prevent tick bites?
  3. What are your best three tips for protecting pets and kids from tick bites?
  4. What should you do if you are bitten by a tick?
  5. What should you do if your pet is bitten by a tick?
  6. What three common locations are most notorious for harboring ticks?
Becky Smith
Associate Professor of Epidemiology, Health Innovation Professor
Megan A. Linske, Ph.D., Certified Ecologist
Past President, The Wildlife Society, Northeast Section Assistant Scientist II
Sam Telford
Professor of Infectious Disease and Global Health
Becky Smith
Associate Professor of Epidemiology, Health Innovation Professor
University of Illinois College of Veterinary Medicine, Carle-Illinois College of Medicine

What are three misconceptions about ticks?

1. “They don’t have ticks here.” Ticks can live in more areas than you think, so it’s best to be aware.

2. “Ticks fly and/or climb trees.” If you find a tick on your head, it probably climbed there.

3. “It’s winter, we don’t have to worry about ticks.” Even in winter, when it gets a bit warmer the ticks will emerge and they will be hungry

What are three of the best ways to prevent tick bites?

1. Cover up: long sleeves, pants tucked into socks

2. Use products: permethrin spray for your clothes and repellant spray for your body.

3. Avoidance. Stay away from high-risk areas, like long grass and unmanaged understory and shrubs.

What are your best three tips for protecting pets and kids from tick bites?

1. Regular tick checks every time they’ve been in a high-risk area

2. Use the appropriate products

3. All the tips above

What should you do if you are bitten by a tick?

  • Remove the tick by grasping it as close to the head as possible with tweezers and pulling it straight out.
  • Look for others. Do a thorough tick check, and be sure to check your crevices.
  • Either save the tick (put it in the freezer in a sealed bag with a damp paper towel) or take a picture and dispose of it safely (crushing with your boot or flushing).
  • Watch for symptoms — rash, fever, muscle or joint pain, or headache. If you start to experience these symptoms, see your medical provider and tell them about the tick bite.

What should you do if your pet is bitten by a tick?

  • Same as above for people

What three common locations are most notorious for harboring ticks?

1. Edges of wooded areas and pathways.

2. Long grass.

3. The understory of woodlands.

Megan A. Linske, Ph.D., Certified Ecologist
Past President, The Wildlife Society, Northeast Section Assistant Scientist II
Center for Vector Biology and Zoonotic Diseases, Department of Entomology, The Connecticut Agricultural Experiment Station

What are three misconceptions about ticks?

There are so many. I will note that most of what I hear is predominantly pertaining to blacklegged ticks, as they are the primary species of concern.

With that in mind, some of the top ones are that they drop down from trees, which is incorrect. They reside in the leaf litter and shrubby understory layers of woodland habitats.

Another misconception is that any bite will result in contracting Lyme disease. Most of the pathogens contained within the tick midgut need 24-48 hours to transfer through the bite, which means if you remove them early enough you should be in the clear. You can usually tell if they have been on long enough if they are engorged. If they are still flat, they most likely have not had enough time to transfer those pathogens. You can always send them into our tick testing laboratories though!

The only exception to the 24–48 hour rule is Powassan virus, which is in the tick mouthparts and can be transferred in 15 minutes. That being said, we have detected the virus in less than 1% of our collected ticks.

And I think the final misconception I will mention is that you can only pick up ticks if you are out in the woods. Most people pick them up in the peridomestic habitat, the area surrounding their residential properties.

What are three of the best ways to prevent tick bites?

1. The best prevention strategy is checking yourself regularly for ticks. They like to prioritize areas such as behind the knees, groin, or armpits. However, I also commonly find them around the belt line or under hair. By consistently checking for ticks, you are more apt to remove them before they have had time to feed and transfer pathogens.

2. The second would be to check and treat your outdoor pets. I grew up with plenty of outdoor dogs and cats that would come in inundated with ticks and even if they are treated there are always a couple that crawl on their coats and end up in the house.

3. And then my final suggestion would be to focus on your clothes. I always wear treated socks as this is the “point of entry” for most ticks. I have colleagues who always tuck their pants into their socks. We also recommend wearing lighter color clothing so you can more readily spot ticks on your pants and shirts. And when you come home, take all your clothes and chuck them into the dryer on high heat. This will desiccate any hitchhikers you may have picked up.

What are your best three tips for protecting pets and kids from tick bites?

1. Same as above: check them both thoroughly. You do not need any fancy devices to do a thorough check and remove any crawling or embedded ticks. When you are switching your kids into their pajamas or getting them ready to jump in the tub, these are great times to do a thorough tick check.

2. I also have been teaching my son to check himself. Start early!

3. And then I also suggest treating your pets with appropriate medications.

What should you do if you are bitten by a tick?

Remove the tick immediately. You can use your nails or a set of tweezers, but you should try to grasp them as close to the top of their head as possible so that it doesn’t stay embedded when you remove them.

Check the engorgement status. If they are swollen/engorged, then they may have had time to transfer their pathogens. You can have them tested at CAES.

You should also just be aware and take note of any symptoms that may occur after the bite.

What should you do if your pet is bitten by a tick?

Once again, remove the tick while grasping the head so that you do not leave any part still embedded. Pay attention to the development of any symptoms.

Anytime my dogs started paying extra attention to their joints i.e. licking, gnawing, limping, etc. I would take them in to get tested and treated.

What three common locations are most notorious for harboring ticks?

In the environment: leaf litter, under Japanese barberry or shrubby dense understories, around stone walls (usually in the woods).

Sam Telford
Professor of Infectious Disease and Global Health
Tufts University

What are three misconceptions about ticks?

1. That they are always deadly.

They can indeed transmit burdensome infections, but the vast majority of tick bites do not cause infection. It should be noted that bee stings kill more people each year than tick-transmitted diseases.

2. That there is nothing you can do to prevent tick bites, so you might as well stay inside with your shades drawn.

Mosquito repellents will work — apply as directed by the label to your bare legs and feet, also arms if you are gardening. Permethrin-treated clothing is the most effective way to prevent tick bites — permethrin is extremely safe. Head louse shampoo for toddlers has a greater concentration of permethrin and is FDA-approved to leave on a child’s head for many minutes. American military uniforms have been treated with permethrin for 20 years.

3. That ticks are only found in the woods or fields, so you only have to take precautions when you are hiking.

Ticks may be found around yards, in “green” areas within cities, and wherever wildlife is present. If you have seen ticks in the area, or people in your neighborhood have seen them, then you should use repellent or permethrin-treated clothing when you are going to step where there is leaf litter or brush. We need to promote the routine use of repellent, just like we have our children wear helmets when they ride their bicycles.

What are three of the best ways to prevent tick bites?

1. Awareness

2. Repellent

3. Permethrin-treated clothing

What are your best three tips for protecting pets and kids from tick bites?

There are, ironically, more options to protect dogs from tick bites than for children. Topical treatments, pills, permethrin-treated collars, and bandannas — these all help reduce tick bites on pets. Cats should not be outside due to their wanton destruction of birds. It should be noted that dogs can bring ticks into the home where they may attach to people — this is why permethrin-treated collars or bandannas might be useful because the ticks die quickly.

Children should get into the habit of a quick spray of repellent when they go outside. This also helps protect against mosquito bites and the potential for mosquito-borne disease. Children should be aware that if they chase a ball into the woods, they may encounter ticks.

What should you do if you are bitten by a tick?

Remove it as quickly as possible. Just pull it out. No need for fancy tools. A good pair of tweezers helps but fingernails work too.

It does not matter if you leave the “head” in, it is just like a splinter and will work itself out or will be walled off as a foreign body. Disinfect the site of the bite with an alcohol wipe.

Watch carefully for an expanding rash, or any unexplained fever within the next 3 weeks, and seek medical attention promptly if either is noted. Remember that the vast majority of tick bites are not infectious, and simply finding a tick on you does not merit going to the emergency room. it does mean, however, that you need to up your game in trying to prevent tick bites.

What should you do if your pet is bitten by a tick?

Just pull it out. As with people, watch for signs of illness.

What three common locations are most notorious for harboring ticks?

1. Your own backyard.

2. Woods with lots of leaf litter.

3. Where you see lots of deer, which provide the blood needed for a female tick to produce eggs. A fed deer tick female can produce 2000 eggs. A fed lone star tick female can produce 3500 eggs. A deer can have as many as 100 feeding females on it each week for 16 weeks of the adult tick season. That means a single deer can produce over 3 million baby ticks (larvae).

Behind the Ranking

First, we determined the factors (metrics) that are most relevant to rank the Worst States for Tick-Borne Illnesses. We then assigned a weight to each factor based on its importance and grouped those factors into 6 categories: Infestation Risk, Environmental Factors, Tick Distribution, Climate, Agricultural Factors, and Pest Control. The categories, factors, and their weights are listed in the table below.

For each of the 50 states, we then gathered data on each factor from the sources listed below the table.

Finally, we calculated scores (out of 100 points) for each state to determine its rank in each factor, each category, and overall. A state’s Overall Score is the average of its scores across all factors and categories. The highest Overall Score ranked “Best” (No. 1) and the lowest “Worst” (No. 50).

  • The “Worst” among individual factors may not be No. 50 due to ties.
  • Data for “Total Lyme Disease Cases” was collected from the most recent year available, 2022. 
  • “Tick-Borne Pathogen Distribution” includes the recorded presence of pathogens in blacklegged and western blacklegged ticks, including:
    • Borrelia burgdorferi sensu stricto
    • Borrelia mayonii
    • Borrelia miyamotoi
    • Anaplasma phagocytophilum human active variant
    • Ehrlichia muris eauclairensis
    • Babesia microti
    • Powassan virus
  • Incidence rates calculated by the source were adjusted per 100,000 residents. 

Sources: AllTrails, American Kennel Club, Centers for Disease Control and Prevention, Farmland Information Center, Federal Transit Administration, Global Forest Watch, Google Ads, IBISWorld, National Oceanic and Atmospheric Administration, PlaygroundEquipment.com, TerraGalleria.com, U.S. Census Bureau, and U.S. Department of Agriculture

Final Thoughts

While ticks can transmit at least 17 distinct diseases to humans, over 80% of diagnosed tick-borne illnesses in the U.S. can be attributed to Lyme disease. 

In 2022, local health departments reported over 63,000 cases of Lyme disease to the CDC. However, experts estimate nearly 476,000 people in the U.S. are diagnosed with or treated for Lyme disease annually. According to the most recent CDC data, this would mean more cases of Lyme disease than colon cancer (126,240) and breast cancer (239,612) combined.

Lyme disease can be life-changing — read about our editor Sharon Sullivan’s personal experience, including obstacles to diagnosis and treatment. Lyme, ehrlichiosis, and RMSF are some of the most well-known tick-borne diseases. Other illnesses impacting humans include:

New tick-preventive medication could soon help humans avoid Lyme disease and other tick-borne illnesses. 

Until then, you must act quickly to prevent disease transmission from a tick bite. Know how to identify and remove ticks, and keep an eye out for signs and symptoms like the bulls-eye rash indicating Lyme disease. 

Don’t forget to protect your pets from these parasites, too. Dogs can contract tick-borne illnesses like Lyme disease, canine ehrlichiosis, and hepatozoonosis. Talk with your vet about preventative tick treatments, use tick-resistant landscaping strategies, and be sure to give your pup a thorough check after romping through the woods. 

Ticks love to hitch rides on other critters, like mice and chipmunks, which can transmit pathogens to the ticks. 

Hire a Pest Gnome pro to handle all your pest control needs, including repelling and exterminating ticks and their pesky rodent chauffeurs. 

What is Pest Gnome? 

Pest Gnome — part of the Home Gnome family of home service sites — puts local pest control experts at your fingertips. Pest Gnome is part of the Home Gnome family of home services sites.

Media Resources

  • Lyme disease was first identified in Connecticut (No. 39) in 1975. Connecticut lands near the top of Infestation Risk, meaning there is still a high risk of contracting Lyme disease as well as ehrlichiosis. However, the state lacks rural environments and has a lower distribution of blacklegged and western blacklegged ticks. The state recently received $239,000 in federal funding for tick prevention and research.
  • Known for its hiking and camping scene, California (No. 4) nature lovers enjoy abundant forests and tree cover, and the most hiking trails out of the remaining states, with over 10,700. Unfortunately, locals have been reporting rampant tick sightings in recent weeks following a rainy spring season. 
  • Arkansas (No. 16) reported the highest annual incidence rate of ehrlichiosis and Rocky Mountain spotted fever
  • Virginia (No. 12) and Indiana (No. 27) tied for the highest distribution of blacklegged and western blacklegged ticks which can potentially carry Lyme disease and Powassan virus. 

Main Photo Credit: Heiko Barth / Adobe Stock / License

Editorial Contributors

  • Sav Maive

    Sav Maive

    Author

    Sav Maive is a writer and director based in San Antonio. Sav is a graduate of the University of Virginia and is a loving cat and plant mom.

    Learn more
  • Sharon Sullivan

    Sharon Sullivan

    Editor

    Sharon Sullivan, senior managing editor at Pest Gnome, dreads love bugs in Central Florida and recently battled squirrels that ate the wiring of her car, resulting in a shockingly expensive repair bill.

    Learn more