| Literature DB >> 32817454 |
Jerilyn R Izac1, Andrew C Camire1, Edward J A Schuler1, Amanda L Hatke1, Nathaniel S O'Bier1, Lee D Oliver1, Avery Corondi2, Olivia C Plocinski2, Russell P Desmond2, Waheeda A Naimi2, Jason A Carlyon2, Kyle R Van Why3, Jennifer Shelly2, Richard T Marconi4.
Abstract
Lyme disease and anaplasmosis are tick-borne bacterial diseases caused by Borreliella and Anaplasma species, respectively. A comprehensive analysis of the exposure of eastern coyotes (Canis latrans) in the northeastern United States to tick-borne pathogens has not been conducted. In this report, we assess the serological status of 128 eastern coyotes harvested in Pennsylvania in 2015 and 2017 for antibodies to Borreliella burgdorferi and Anaplasma phagocytophilum Immunoblot and dot blot approaches were employed to test each plasma sample by using cell lysates and recombinant proteins as detection antigens. The results demonstrate high seropositivity incidences of 64.8% and 72.7% for B. burgdorferi and A. phagocytophilum, respectively. Antibodies to both pathogens were detected in 51.5% of the plasma samples, indicating high potential for coinfection. Antibodies to the B. burgdorferi proteins DbpB, VlsE, DbpA, BBA36, and OspF (BBO39) were detected in 67.2, 63.3, 56.2, 51.6, and 48.4% of the plasma samples, respectively. Antibodies to the A. phagocytophilum P44 and P130 proteins were detected in 72.7 and 60.9% of the plasma samples, respectively.IMPORTANCE The incidence of Lyme disease (Borreliella burgdorferi) and anaplasmosis (Anaplasma phagocytophilum) are increasing in North America and Europe. The causative agents of these debilitating tick-transmitted infections are maintained in nature in an enzootic cycle involving Ixodes ticks and diverse mammals and birds. It has been postulated that predators directly or indirectly influence the dynamics of the enzootic cycle and disease incidence. Here, we demonstrate high seropositivity of eastern coyotes for B. burgdorferi and A. phagocytophilum As coyotes become established in urban and suburban environments, interactions with humans, companion animals, and urban/suburban wildlife will increase. Knowledge of the pathogens that these highly adaptable predators are exposed to or carry, and their potential to influence or participate in enzootic cycles, is central to efforts to reduce the risk of tick-borne diseases in humans and companion animals.Entities:
Keywords: Anaplasmazzm321990; Borreliazzm321990; Borreliellazzm321990; Canis latranszzm321990; DbpA; Eastern coyotes; Ixodeszzm321990; Lyme disease; P44; VlsE; canines; coyote
Mesh:
Substances:
Year: 2020 PMID: 32817454 PMCID: PMC7426170 DOI: 10.1128/mSphere.00544-20
Source DB: PubMed Journal: mSphere ISSN: 2379-5042 Impact factor: 4.389
Sample collection information and summary of immunoblot and dot blot data
| Plasma sample | Sex | County | Date | Longitude | Latitude | Age | ||
|---|---|---|---|---|---|---|---|---|
| MC2-121 | M | Clinton (NC) | 2/19/17 | 41.178125 | −77.433313 | A | +/+ | +/+ |
| MC2-174 | NR | NR | 2/19/17 | NR | NR | NR | −/− | +/+ |
| MC2-179 | F | Warren (NW) | 2/19/17 | 41.935572 | −79.537863 | A | −/− | +/+ |
| SP0 | NR | NR | NR | NR | NR | NR | +/+ | +/+ |
| SP2 | M | Wyoming (NE) | 1/23/15 | 41.514487 | −75.846361 | SA | +/+ | +/+ |
| SP3 | M | Luzerne (NE) | 1/23/15 | 41.178429 | −76.237376 | A | +/+ | +/+ |
| SP10 | F | Susquehanna (NE) | 1/24/15 | 41.669079 | −75.913765 | A | +/+ | +/+ |
| SP11 | M | Wayne (NE) | 1/24/15 | 41.730075 | −75.388202 | A | +/+ | −/− |
| SP12 | F | Wayne (NE) | 1/24/15 | 41.730075 | −75.388202 | A | +/+ | +/+ |
| SP14 | F | Wayne (NE) | 1/24/15 | 41.730075 | −75.388202 | A | +/+ | +/+ |
| SP15 | F | Wayne (NE) | 1/24/15 | 41.730075 | −75.388202 | A | +/+ | −/+ |
| SP17 | M | Susquehanna (NE) | 1/24/15 | 41.678991 | −76.062398 | SA | +/+ | +/+ |
| SP18 | M | Bradford (NE) | 1/24/15 | 41.667297 | −76.26158 | A | +/+ | +/+ |
| SP20 | M | Wyoming (NE) | 1/25/15 | 41.614243 | −76.046592 | A | +/+ | +/+ |
| SP21 | M | Luzerne (NE) | 1/25/15 | 41.113643 | −75.722647 | A | +/+ | +/+ |
| SP24 | F | Susquehanna (NE) | 1/25/15 | 41.792753 | −75.689743 | A | −/− | −/− |
| SP25 | M | Susquehanna (NE) | 1/25/15 | 41.669079 | −75.913765 | A | +/+ | +/+ |
| SP26 | F | Wyoming (NE) | 1/25/15 | 41.485811 | −75.842651 | SA | +/+ | +/+ |
| SP19 | F | Bradford (NE) | 1/24/15 | 41.667297 | −76.26158 | A | +/+ | −/+ |
| MC12 | M | Clarion (NW) | 2/22/15 | 41.319663 | −79.391605 | J | +/+ | +/+ |
| MC14 | M | Clarion (NW) | 2/22/15 | 41.319663 | −79.391605 | SA | +/+ | +/+ |
| MC15 | M | Clearfield (NC) | 2/22/15 | 41.164035 | −78.384487 | A | +/+ | +/+ |
| MC16 | M | Clearfield (NC) | 2/22/15 | 40.948667 | −78.478513 | A | +/+ | +/+ |
| MC17 | F | Washington (SW) | 2/22/15 | 40.166354 | −80.259005 | J | +/+ | +/+ |
| MC18 | M | Erie (NW) | 2/22/15 | 42.051004 | −79.942131 | SA | −/− | −/− |
| MC19 | M | Erie (NW) | 2/22/15 | 41.935799 | −80.224812 | SA | −/− | −/− |
| MC21 | M | Cumberland (SC) | 2/22/15 | 40.203461 | −77.309962 | A | +/+ | +/+ |
| MC22 | M | Cumberland (SC) | 2/22/15 | 40.314718 | −76.98066 | SA | −/− | +/+ |
| MC26 | M | Clearfield (NC) | 2/22/15 | 40.947123 | −78.214029 | A | +/+ | +/+ |
| MC28 | F | Clearfield (NC) | 2/22/15 | 41.026246 | −78.31673 | J | +/+ | +/+ |
| MC30 | M | Potter (NC) | 2/22/15 | 41.758617 | −78.132091 | A | +/+ | −/− |
| MC32 | F | Fayette (SW) | 2/22/15 | 40.016783 | −79.588829 | J | −/− | −/− |
| MC35 | M | Beaver (SW) | 2/22/15 | 40.589347 | −80.225357 | J | +/+ | −/− |
| MC40-1 | M | Erie (NW) | 2/22/15 | 42.000261 | −80.318307 | A | −/− | +/+ |
| MC40-2 | M | Centre (NC) | 2/22/15 | 40.847732 | −77.686139 | SA | −/− | +/+ |
| MC48 | M | Tioga (NC) | 2/22/15 | 41.875854 | −77.401458 | SA | +/+ | +/+ |
| MC49 | M | Mc Kean (NC) | 2/22/15 | 41.812173 | −78.480503 | A | −/− | −/+ |
| MC53 | F | Clinton (NC) | 2/22/15 | 41.384684 | −77.545175 | J | +/+ | +/+ |
| MC56 | M | Washington (SW) | 2/22/15 | 40.263001 | −80.187993 | A | −/− | +/+ |
| MC57 | F | Allegheny (SW) | 2/22/15 | 40.382434 | −80.116141 | SA | −/− | +/+ |
| MC86 | F | Northumberland (NE) | 2/22/15 | 40.75544 | −76.533517 | A | +/+ | +/+ |
| MC87 | F | Pike (NE) | 2/22/15 | 41.463888 | −75.155292 | A | +/+ | +/+ |
| MC90 | M | Wyoming (NE) | 2/22/15 | 41.525364 | −75.842013 | A | +/+ | +/+ |
| MC97 | F | Mercer (NW) | 2/22/15 | 41.157502 | −80.089206 | A | −/− | −/− |
| MC99 | F | Mercer (NW) | 2/22/15 | 41.186374 | −80.354815 | J | −/− | +/+ |
| MC100 | M | Mercer (NW) | 2/22/15 | 41.186374 | −80.354815 | A | −/− | −/− |
| MC113 | F | Butler (NW) | 2/22/15 | 41.157342 | −79.798464 | SA | +/− | −/− |
| MC114 | M | Butler (NW) | 2/22/15 | 41.132894 | −79.852167 | A | +/+ | +/+ |
| MC115 | F | Tioga (NC) | 2/22/15 | 41.748528 | −77.301304 | A | +/+ | +/− |
| MC130 | NR | NR | 2/22/15 | NR | NR | NR | −/− | −/− |
| MC131 | NR | Erie (NW) | 2/22/15 | 41.942181 | −79.985389 | A | −/− | +/+ |
| MC148 | F | Clarion (NW) | 2/22/15 | 41.125935 | −79.558499 | J | +/+ | −/− |
| MC2-1 | M | Clinton (NC) | 2/17/17 | 41.07909 | −77.412819 | SA | +/+ | −/− |
| MC2-2 | M | Clearfield (NC) | 2/17/17 | 40.99839 | −78.341406 | A | +/+ | +/+ |
| MC2-3 | F | Susquehanna (NE) | 2/17/17 | 41.267904 | −78.156443 | A | +/+ | +/+ |
| MC2-4 | F | Indiana (SW) | 2/17/17 | 40.486455 | −79.451436 | SA | +/+ | −/− |
| MC2-5 | M | Susquehanna (NE) | 2/17/17 | 41.724059 | −75.554157 | A | +/+ | −/− |
| MC2-6 | M | Centre (NC) | 2/17/17 | 41.030891 | −77.949449 | J | +/+ | +/+ |
| MC2-8 | F | Northumberland (NE) | 2/17/17 | 40.961519 | −76.664659 | A | +/+ | +/+ |
| MC2-10 | F | Crawford (NW) | 2/17/17 | 41.63794 | −80.83697 | A | −/− | −/− |
| MC2-11 | F | Crawford (NW) | 2/17/17 | 41.63794 | −80.83697 | A | −/− | −/+ |
| MC2-13 | M | Crawford (NW) | 2/17/17 | 41.751677 | −80.368226 | J | +/+ | +/+ |
| MC2-16 | M | Crawford (NW) | 2/17/17 | 41.63794 | −80.83697 | A | +/+ | −/− |
| MC2-18 | F | Elk (NC) | 2/17/17 | 41.408709 | −78.434756 | A | +/+ | +/+ |
| MC2-19 | M | Clearfield (NC) | 2/17/17 | 41.198563 | −78.770151 | A | +/+ | −/− |
| MC2-20 | F | Clearfield (NC) | 2/17/17 | 41.161638 | −78.088013 | J | +/+ | +/+ |
| MC2-21 | M | Crawford (NW) | 2/18/17 | 41.63794 | −80.83697 | SA | +/+ | +/+ |
| MC2-23 | F | Centre (NC) | 2/18/17 | 41.086628 | −77.823244 | A | +/+ | +/+ |
| MC2-24 | F | Tioga (NC) | 2/18/17 | 41.760218 | −77.293542 | SA | +/+ | +/+ |
| MC2-25 | M | Warren (NW) | 2/18/17 | 41.653763 | −78.96286 | A | +/+ | +/+ |
| MC2-26 | M | Warren (NW) | 2/18/17 | 41.653763 | −78.96286 | A | +/+ | +/+ |
| MC2-28 | F | Clarion (NW) | 2/18/17 | 41.320065 | −79.391665 | J | +/+ | −/− |
| MC2-29 | F | Venango (NW) | 2/18/17 | 41.284381 | −79.762418 | SA | +/− | −/− |
| MC2-33 | M | Centre (NC) | 2/18/17 | 41.030891 | −77.949449 | J | +/+ | +/+ |
| CR-7 | F | Columbia (NE) | 2/8/15 | 41.139421 | −76.477064 | SA | +/+ | −/− |
| CR-4 | F | Clearfield (NC) | 2/8/15 | 40.883834 | −78.59515 | J | +/+ | −/− |
| CR-6 | M | Tioga (NC) | 2/8/15 | 41.876717 | −76.97547 | A | −/− | −/− |
| CR-9 | F | Cambria (SW) | 2/8/15 | 40.605372 | −78.802618 | SA | +/+ | +/+ |
| CR-10 | M | Cambria (SW) | 2/8/15 | 40.605372 | −78.802618 | A | +/+ | −/− |
| CR-11 | M | Jefferson (NW) | 2/8/15 | 41.097298 | −78.888108 | A | +/+ | +/+ |
| CR-12 | M | Somerset (SW) | 2/8/15 | 40.007978 | −79.078024 | A | +/+ | −/− |
| CR-13 | F | Washington (SW) | 2/8/15 | 40.743967 | −80.255714 | A | −/− | −/− |
| CR-14 | F | Washington (SW) | 2/8/15 | 40.243967 | −80.255714 | SA | −/− | −/+ |
| CR-15 | F | Schuylkill (SE) | 2/8/15 | 40.548175 | −76.384797 | A | −/− | +/+ |
| CR-16 | M | Luzerne (NE) | 2/8/15 | 41.051704 | −76.221094 | SA | +/+ | −/− |
| CR-17 | M | Luzerne (NE) | 2/8/15 | 41.051704 | −76.221094 | SA | +/+ | +/+ |
| CR-18 | M | Cambria (SW) | 2/8/15 | 40.580221 | −78.606667 | SA | −/− | −/− |
| MC2-34 | M | Centre (NC) | 2/18/17 | 41.030891 | −77.949449 | SA | +/+ | +/+ |
| MC2-35 | M | Clearfield (NC) | 2/18/17 | 41.140848 | −78.270395 | SA | +/+ | +/+ |
| MC2-36 | F | Bedford (SC) | 2/19/17 | 40.206744 | −78.522794 | SA | −/− | +/+ |
| MC2-37 | M | Bedford (SC) | 2/19/17 | 40.206744 | −78.522794 | J | +/+ | +/+ |
| MC2-39 | M | Huntingdon (SC) | 2/19/17 | 40.241508 | −78.088013 | SA | +/+ | −/+ |
| MC2-41 | M | Warren (NW) | 2/19/17 | 41.945424 | −79.222558 | SA | −/− | +/+ |
| MC2-44 | F | Monroe (NE) | 2/19/17 | 40.855663 | −75.456433 | SA | +/+ | +/+ |
| MC2-47 | M | Elk (NC) | 2/19/17 | 41.427374 | −78.56094 | SA | +/+ | −/− |
| MC2-48 | NR | NR | 2/19/17 | NR | NR | NR | −/− | +/+ |
| MC2-51 | NR | NR | 2/19/17 | NR | NR | NR | +/− | +/+ |
| MC2-52 | M | Clarion (NW) | 2/19/17 | 41.214251 | −79.375163 | A | +/+ | −/− |
| MC2-62 | F | Somerset (SW) | 2/19/17 | 40.176389 | −78.959377 | A | −/− | −/− |
| MC2-65 | M | Clearfield (NC) | 2/19/17 | 41.284381 | −79.762418 | A | +/+ | +/+ |
| MC2-68 | M | Northumberland (NE) | 2/19/17 | 40.709529 | −76.842472 | A | +/− | +/+ |
| MC2-70 | F | Northumberland (NE) | 2/19/17 | 40.709529 | −76.842472 | SA | +/+ | −/− |
| MC2-73 | M | Pike (NE) | 2/19/17 | 41.186231 | −75.305459 | SA | +/+ | +/+ |
| MC2-76 | F | Centre (NC) | 2/19/17 | 40.944512 | −77.444988 | A | +/+ | −/− |
| MC2-79 | F | Crawford (NW) | 2/19/17 | 41.764223 | −80.367763 | J | −/− | −/− |
| MC2-80 | M | Armstrong (SW) | 2/19/17 | 41.006628 | −79.323992 | J | +/+ | +/+ |
| MC2-82 | F | Allegheny (SW) | 2/19/17 | 40.58605 | −80.029207 | A | +/− | +/+ |
| MC2-83 | F | Clarion (NW) | 2/19/17 | 41.214251 | −79.375163 | J | +/+ | −/+ |
| MC2-89 | M | Sullivan (NE) | 2/19/17 | 41.557347 | −76.502521 | A | +/+ | +/+ |
| MC2-92 | F | Montour (NE) | 2/19/17 | 40.974178 | −76.627268 | SA | +/− | −/+ |
| MC2-95 | M | Bradford (NE) | 2/19/17 | 41.656464 | −76.853293 | SA | +/+ | −/− |
| MC2-100 | F | Monroe (NE) | 2/19/17 | 40.972418 | −75.219908 | A | +/+ | +/+ |
| MC2-101 | NR | NR | 2/19/17 | NR | NR | NR | −/− | −/− |
| MC2-104 | NR | NR | 2/19/17 | NR | NR | NR | −/− | −/− |
| MC2-111 | F | Crawford (NW) | 2/19/17 | 41.860922 | −80.134784 | J | −/− | +/+ |
| MC2-113 | M | Crawford (NW) | 2/19/17 | 41.860922 | −80.134784 | A | −/− | −/− |
| MC2-119 | F | Erie (NW) | 2/19/17 | 42.000334 | −80.318119 | A | +/− | +/+ |
| MC2-124 | M | Luzerne (NE) | 2/19/17 | 41.319399 | −76.012652 | SA | +/+ | +/+ |
| MC2-125 | F | Luzerne (NE) | 2/19/17 | 41.314399 | −76.012652 | SA | +/+ | +/+ |
| MC2-131 | F | Susquehanna (NE) | 2/19/17 | 41.685298 | −75.1562604 | SA | +/+ | −/− |
| MC2-134 | F | Westmoreland (SW) | 2/19/17 | 40.164543 | −79.807261 | J | −/− | −/− |
| MC2-141 | M | Potter (NC) | 2/19/17 | 41.872012 | −77.837218 | A | +/− | −/− |
| MC2-146 | M | Crawford (NW) | 2/19/17 | 41.63794 | −80.83697 | A | −/− | −/− |
| MC2-147 | F | Crawford (NW) | 2/19/17 | 41.718945 | −80.147558 | A | +/+ | −/− |
| MC2-150 | F | Cambria (SW) | 2/19/17 | 40.618857 | −78.736284 | A | +/+ | +/+ |
| MC2-155 | M | Centre (NC) | 2/19/17 | 40.847563 | −77.686109 | A | +/+ | −/− |
| MC2-157 | NR | NR | 2/19/17 | NR | NR | NR | +/+ | −/− |
| MC2-170 | F | Erie (NW) | 2/19/17 | 42.161082 | −79.989011 | A | +/+ | +/+ |
Abbreviations: M, male; F, female; NR, not reported.
The geographic sectors of the Commonwealth of Pennsylvania from which coyotes were harvested are indicated as follows: NW, Northwest; NC, North Central; NE, Northeast; SW, Southwest; SC, South Central; SE, Southeast.
Developmental stage (juvenile [J], subadult [SA], or adult [A]) was determined by assessment of tooth wear by wildlife biologists from the USDA and the PGC. This study was conducted under a Special Use: Scientific Study Permit (no. 48548) issued by the Pennsylvania Game Commission. NR, not reported.
For A. phagocytophilum, the Ab screening results for the P44 and P130 proteins are indicated as positive (+) or negative (−).
For the Ab screening for B. burgdorferi, a plus or minus indicates if an animal was positive or negative, respectively, by immunoblot (IB) and dot blot (DB) approaches.
FIG 1High seropositivity for B. burgdorferi and A. phagocytophilum in eastern coyotes. B. burgdorferi B31 and human promyelocytic HL-60 cells (CCL-240; ATCC) and HL-60 cells infected with A. phagocytophilum NCH-1 were cultivated as previously described (14, 15). Cells were harvested by centrifugation, washed, and solubilized in SDS-PAGE buffer. The B. burgdorferi cell lysates (A) and A. phagocytophilum-infected HL-60 cells (B) were separated by SDS-PAGE (AnykD Criterion precast gels; Bio-Rad), immunoblotted, and screened with a 1:1,000 dilution of each plasma sample, as previously described (15). The sector of Pennsylvania from which each animal was harvested is indicated above the immunoblots, with a plus or minus indicating the Ab scoring for each sample (see Table 1, footnote b, for sector abbreviations). The migration positions of native A. phagocytophilum P130 and P44 proteins were determined by screening cell lysate immunoblots with rat anti-P130 and rat anti-P44 antisera (C), generated as previously described (15). Molecular weight markers are indicated.
FIG 2Detection of Abs to defined B. burgdorferi and A. phagocytophilum antigens. Recombinant proteins (indicated on the left) were generated by PCR amplification of B. burgdorferi B31 and A. phagocytophilum NCH-1 genomic DNA or through gene synthesis (codon optimized; GenScript). The A. phagocytophilum strain Dog2 P44 gene sequence (GenBank accession no. AGR82240.1) was used to generate recombinant P44. All primer sequences, the P44 amino acid sequence, and the p44 codon-optimized gene sequence are provided in Table S1 in the supplemental material. The proteins were expressed from pET-45b(+) (Novagen). All cloning and protein production procedures were done as previously described (15). Dot blots were generated by spotting 125 ng of purified protein onto nitrocellulose. The membranes were air dried overnight and then blocked and screened with each plasma sample as detailed in the legend to Fig. 1. All dot blots were imaged simultaneously.
Recombinant proteins used as screening antigens and summary of results
| Species and/or protein | Description | % Ab-positive | Reference |
|---|---|---|---|
|
| |||
| OspA (BBA15) | Surface lipoprotein essential for survival in ticks; | 6.3 (8/128) (equivocal) |
|
| OspB (BBA16) | Same as described above for OspA; forms an operon | 0 (0/128) |
|
| VlsE (BBF0041) | Surface lipoprotein; functions in immune evasion; | 63.3 (81/128) |
|
| DbpA (BBA24) | Decorin binding protein; facilitates dissemination | 56.2 (72/128) |
|
| DbpB (BBA25) | See information for DbpA above | 68.0 (87/128) |
|
| OspE (BBL39) | Factor H binding protein; facilitates complement evasion; | 15.6 (20/128) |
|
| OspE (BBN38) | See information for BBL39 above | 16.4 (21/128) |
|
| OspF (BBR42) | Expression upregulated in mammals; Ab to OspF has been | 43.0 (55/128) |
|
| OspF (BBM38) | See information for BBR42 above | 40.6 (52/128) |
|
| OspF (BBO39) | See information for BBR42 above | 48.4 (62/128) |
|
| Mlp (BBA36) | Surface lipoprotein; expression upregulated in mammals; | 51.6 (66/128) |
|
| Uncharacterized protein (BBK53) | Surface lipoprotein; uncharacterized | 18.8 (24/128) | |
| P35 (BBA73) | Function unknown; surface protein; member of paralogous protein | 48.4 (62/128) |
|
| Protein of unknown function | Function unknown; required for infection in mammals | 27.3 (35/128) |
|
|
| |||
| P130 | Unique to | 60.9 (78/128) |
|
| P44 | Porin protein involved in immune evasion; homologs are | 72.7 (93/128) |
|
| Aph_1235 | Specific to the infectious dense core cell | 3.3 (3/90) |
|
| Asp14 | Adhesin; homologs are found in some | 7.8 (7/90) |
|
| OmpA | Adhesin; homologs are found in some | 18.9 (17/90) |
|
| FhbB | 0 (0/128) |
|
The ORF designations listed are those assigned to B. burgdorferi strain B31.
Summary of Ab screening results
| Parameter | % Ab positive (no. of positive samples/total no.) for: | |
|---|---|---|
|
|
| |
| Gender | ||
| Male | 65.6 (42/64) | 79.7 (51/64) |
| Female | 65.4 (36/55) | 70.9 (39/55) |
| Not reported | 55.6 (5/9) | 33.3 (3/9) |
| Developmental stage | ||
| Adult | 71.8 (46/64) | 75.0 (48/64) |
| Subadult | 69.4 (25/36) | 75.0 (27/36) |
| Juvenile | 80.0 (16/20) | 75.0 (15/20) |
| Not reported | 62.5 (5/8) | 37.5 (3/8) |
| State sector | ||
| Northwest | 63.6 (21/33) | 57.6 (19/33) |
| North Central | 75.9 (22/29) | 86.2 (25/29) |
| Northeast | 82.9 (29/35) | 97.1 (34/35) |
| Southwest | 58.8 (10/17) | 52.9 (9/17) |
| South Central | 100 (5/5) | 60.0 (3/5) |
| Southeast | 1/1 | 0/1 |
| Not reported | 62.5 (5/8) | 37.5 (3/8) |
| Collection yr | ||
| 2015 | 68.8 (42/61) | 68.9 (42/61) |
| 2017 | 62.1 (41/66) | 76.1 (51/66) |
| Total for 2015 and 2017 | 64.8 (83/128) | 72.7 (93/128) |
| Total for | 51.5 (72/128) | |
aDue to sample size limitations, percentages would not be valid and thus were not calculated.