Erythema migrans (EM) is a red, slowly expanding rash associated with tick bites. European doctors observed EM in patients in the early 20th century and theorized that it was caused by a tick-borne bacterium. Later, in the 1970s, a doctor observed groups of children suffering from arthritis in and around Lyme, Connecticut. Upon further investigation it was discovered that the arthritis occurred following the presence of tick bites followed by EM skin lesions. It was not until 1984 that conclusive evidence demonstrated that the spirochete bacterium Berrelia burgdorferi caused Lyme disease. In 2002, Lyme disease caused more than 23,000 infections in the United States (1). Lyme disease is a zoonotic disease caused by the spirochete bacterium B. burgdorferi which transmits the bacterium to humans through the bite of western black-legged deer ticks (Ixodes scapular). This tick is much smaller than that of dogs or livestock and feeds by inserting its mouth into the skin of the host and slowly receiving the vital fluid (1). Early localized Lyme disease occurs 3-30 days after the tick bite. Symptoms include EM, mild muscle pain, fever, headache, and lymphadenopathy. Early disseminated disease occurs 1-4 months after the tick bite. Symptoms include facial palsy of the cranial nerves, meningitis, radiculopathy, and heart block. In the late phase of the disease which begins 3-4 months after the tick bite. Symptoms include arthritis in large joints, stiff headaches, encephalitis, and cognitive impairment. Early localized Lyme disease is treated with doxycycline or amoxicillin for 14 to 21 days. Early and late disseminated Lyme disease is treated for 14-28 days with oral or parental therapy (ceft...... middle of document ...... possible through seasonal feeding activity of the nymph I. scapularis and the increase in outdoor activities the tribe undertakes during these months (4). A total of 23,763 cases of Lyme disease were reported in 2002, more than any previous year (2). Higher incidence rates have occurred in the Northeast, Mid-Atlantic, and North-Central states. Most cases have been reported among ages 5-14 and ages 50-59. Factors influencing this growth in reported cases include a growing deer population, increased residential development of wooded areas and the dispersal of ticks into new areas, improved memory of the disorder in areas where Lyme disease is endemic and better reported (2). The NETSS system is important because it helps determine who is at risk and where the highest incidence rates are located that need targeted preventive measures..