Ticks in Nebraska and Iowa - What Parents Should Know

Ticks in Nebraska and Iowa: What Omaha Parents Need to Know

Written by Amy Patton, DNP, APRN, CPNP-PC — pediatric nurse practitioner and founder of Happy Kid Functional Medicine, Omaha.

The blacklegged tick carries the bacterium behind Lyme disease. It is the only tick in this part of the country that does. And Nebraska now has established populations of it in five counties. That's a newer sentence than most local advice on the internet reflects.

Say you pulled a tick off your kid this weekend. You went looking for answers. You probably found two versions of the story. One says Nebraska doesn't have Lyme disease at all. The other says every tick is a crisis. Neither is right. Neither helps you decide what to do on a Sunday afternoon.

Here's the local picture, current as of this year.

What do parents ask me most about this?

Short answers first. The full reasoning is below.

Do we have Lyme disease in Nebraska?

Yes, and that answer changed in the last six years. Nebraska DHHS has documented established blacklegged tick populations in five counties. Douglas, Sarpy and Saunders came in 2019. Thurston followed in 2021, and Cuming in 2025.

Which ticks are actually here?

Three tick species matter most for families in eastern Nebraska and Iowa. They are the American dog tick, the lone star tick, and the blacklegged tick. Nebraska DHHS lists all three among the medically important species under active surveillance in this state.

What else do our ticks carry?

In Nebraska, Lyme disease is not the biggest tick story. Tularemia is, and the numbers aren't close. Nebraska sits at 126 cases. The average annual incidence is 0.547 per 100,000. That is roughly 8.5 times the national rate, and the fifth-highest of any state.

Could a tick bite explain my child suddenly refusing meat?

It can, and the condition has a name. Alpha-gal syndrome is an allergy to a sugar called galactose-alpha-1,3-galactose. It can develop after a tick bite. It is mainly linked to the lone star tick. CDC describes symptoms usually appearing 2 to 6 hours after eating meat or dairy.

When are ticks worst here, and how do I actually prevent bites?

Nationally, the peak week for Lyme disease onset is the first week of July. June and July are consistently the top two months. But CDC's surveillance data show the Lyme rash was the most commonly reported sign April through November.

Do we have Lyme disease in Nebraska?

Yes, and that answer changed in the last six years. Nebraska DHHS has documented established blacklegged tick populations in five counties. Douglas, Sarpy and Saunders came in 2019. Thurston followed in 2021, and Cuming in 2025. In 2021, ticks collected in Thurston County tested positive for Borrelia burgdorferi. That is the bacterium that causes Lyme disease.

That was the first known detection of the Lyme bacterium in ticks collected in Nebraska. Here is how Nebraska DHHS states its own current position. The state has now identified both the vector and the pathogen locally, alongside documented cases. That "demonstrates that Lyme disease can be acquired in eastern Nebraska. However, Nebraska will likely remain a low-prevalence state for Lyme disease."

Both halves of that sentence matter. So do the numbers.

• Nebraska reported 139 Lyme cases total from 2010 through 2023.

• That averages 7.6 cases a year over 2019–2023.

• In 2021, Nebraska reported 9 cases. Five of them, where exposure could be determined, were acquired in highly endemic parts of the country. Two were acquired in eastern Nebraska.

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So the old line is out of date, and I'd like it retired. That line says every Nebraska Lyme case comes from travel. It isn't true anymore. Telling a family it's true can delay a diagnosis for a child who never left the state.

For scale, compare Iowa. Iowa reported 162 Lyme cases in 2024. That's roughly 20 to 30 times Nebraska's burden, in the same neighborhood of the country. A weekend in northeastern Iowa is a genuinely different exposure than a weekend in Omaha. I ask about that difference by name.

So what does "low prevalence" actually mean for your family? It means the base rate is low. Take a Nebraska child with no exposure story. A positive Lyme test there is more likely to be wrong than right. It does not mean the answer is automatically no. Exposure history is what moves the odds. That's why my first questions are about where your child has been, not about which panel to order. I go deeper on that in how Lyme testing works in children.

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Which ticks are actually in Nebraska and Iowa?

Three tick species matter most for families in eastern Nebraska and Iowa. They are the American dog tick, the Lone Star tick, and the blacklegged tick. Nebraska DHHS lists all three among the medically important species under active surveillance in this state. Iowa has all three as well, in larger numbers.

Tick	Where it is	What it can carry in this region
American dog tick (Dermacentor variabilis)	Under active surveillance in Nebraska. In Iowa, it's in every county and is the tick people encounter most.	Rocky Mountain spotted fever, tularemia
Lone star tick (Amblyomma americanum)	Nebraska DHHS: "found in areas of eastern and central Nebraska and typically one of the two most collected ticks in the state." Now found throughout Iowa and expanding northward.	Ehrlichiosis, tularemia, alpha-gal syndrome
Blacklegged tick (Ixodes scapularis)	Established in 5 Nebraska counties. In Iowa, most abundant in northeastern and eastern counties, but reported in the majority of the state's 99 counties.	Lyme disease

Two things stand out in that table. Most parents are used to hearing only about Lyme.

The first is the Lone Star tick. In eastern Nebraska, it's the one your child is most likely to pick up, not the blacklegged tick. The second is the American dog tick. It is everywhere in Iowa. Knowing which tick it was changes which illnesses I'd watch for over the next two weeks. So it's worth doing. Take a clear photo on a plain background next to a coin before you dispose of it.

One organism parents often ask me about isn't on this list at all. CDC states there's no evidence that Bartonella is spread to people through tick bites. I cover what Bartonella actually looks like in kids separately. The answer there is genuinely different.

What else do our ticks carry?

In Nebraska, Lyme disease is not the biggest tick story. Tularemia is, and the numbers aren't close. Nebraska sits at 126 cases. The average annual incidence is 0.547 per 100,000. That is roughly 8.5 times the national rate, and the fifth-highest of any state.

That comes from CDC's own state table. The table accompanies a 2025 MMWR report on tularemia. Here is the national picture in that report. There were 2,462 cases across the United States from 2011 through 2022. The national average annual incidence was 0.064 per 100,000. That is a 56% increase over the prior decade. Incidence was highest in children aged 5–9. Iowa, by comparison, sits at 0.082. Tularemia spreads through tick and deer fly bites, animal contact, contaminated water, and aerosols from things like mowing.

Three more are worth knowing by name.

Ehrlichiosis. Nebraska DHHS says both Ehrlichia chaffeensis and E. ewingii occur in Nebraska. It also says the lone star tick is the most common vector here. Rash appears in up to 60% of children with ehrlichiosis, but under 30% of adults. So a child's presentation can look different from what a provider expects. Nebraska ehrlichiosis cases are up 166% compared with the prior five-year period.

Rocky Mountain spotted fever. In this region, it's carried by the American dog tick. CDC's 2016 clinical guideline puts present-day case fatality at 5% to 10% overall. That rises to 40% to 50% among patients treated on day 8 or 9 of illness. Children under 10 make up less than 6% of cases. They make up 22% of the deaths. CDC is emphatic about the timing point. Treatment decisions "should never be delayed while awaiting laboratory confirmation." So if your child has a fever and a rash after a tick bite, that is a same-day call. Not a wait-and-see.

Heartland virus. Two facts here, and I'm keeping them separate on purpose. CDC's list of states reporting Heartland virus cases includes Iowa. It does not include Nebraska.

Separately, Nebraska detected Heartland virus in Nebraska-collected lone star ticks in 2025. Virus found in ticks is not the same thing as human cases reported. Both are true. Running them together would overstate what we know.

Could a tick bite explain my child suddenly refusing meat?

It can, and the condition has a name. Alpha-gal syndrome is an allergy to a sugar called galactose-alpha-1,3-galactose. It can develop after a tick bite. It is mainly linked to the Lone Star tick. CDC describes symptoms usually appearing 2 to 6 hours after eating meat or dairy.

That delay is the whole reason this gets missed. A reaction starts 2 to 6 hours after dinner. It lands in the evening or overnight. By then, nobody is still thinking about the meal. A child wakes up with hives, or a stomachache, or vomiting. It gets written off as a bug. Nobody connects it to the burger. That's my reasoning about why the pattern hides, not a CDC statement. I want to be clear about which is which.

Alpha-gal symptoms range from hives and stomach upset all the way to anaphylaxis. It is not a small allergy.

The scale is larger than most people expect. CDC estimated that 96,000 to 450,000 Americans may have been affected since 2010. That is roughly 15,000 new suspected cases a year.

And here's why it takes so long to name. A CDC survey of 1,500 primary care providers found this:

• 42% had never heard of alpha-gal syndrome.

• Only 5% felt very confident diagnosing it.

• Among those who had heard of it, 48% did not know which test to order.

• One study cited in that report found 21% of patients were diagnosed within the first year. The other 79% took an average of 7.1 years.

Two honest limits before you go looking for this in your own child. Nebraska is not on CDC's list of high-prevalence states for alpha-gal syndrome. And CDC's pages do not support the claim that alpha-gal can show up with stomach symptoms alone. Does the picture fit? Ask your pediatrician about the alpha-gal-specific IgE test by name. The survey above suggests the test may not be top of mind.

When are ticks worst here, and how do I actually prevent bites?

Nationally, the peak week for Lyme disease onset is the first week of July. June and July are consistently the top two months. But CDC's surveillance data show the Lyme rash was the most commonly reported sign from April through November. CDC's own conclusion: prevention messages "should not be focused only during the spring and summer season."

So: highest in early summer, real from spring through late fall. October camping counts.

Prevention that actually works doesn't require me to sell you anything. Standard public health advice covers all of this. Permethrin-treated clothing and gear. An EPA-registered repellent, used according to the label for your child's age. Walking the center of the trail instead of the brushy edges. Showering soon after coming in. And running clothes through a hot dryer. You can read the current wording straight from CDC's tick prevention page rather than from me.

The one I'd spend your attention on is the daily full-body tick check. That's where pediatric research earns its keep. In a Swedish cohort of children with Lyme disease, the most common rash location was the head and neck. Children with head and neck rashes were younger. Their median age was 6 versus 10. Facial nerve palsy was significantly more common in that group. Young kids get bitten where you can't see.

So check the scalp, the hairline, and behind the ears first. Then armpits, groin and diaper area, the waistband line, and behind the knees. Use your fingertips in the hair, not just your eyes.

Find one attached? Remove it promptly. Don't wait for an appointment to do it. I walk through the exact steps in what to do after a tick bite. That piece also covers what to watch for over the following weeks.

What I tell Omaha families

Nebraska is a low-risk state for Lyme disease. I'm not going to make you afraid of your own backyard. Your kids should be outside. The creek, the camp, the tall grass at the edge of the soccer field. All of it. The goal is a tick check, not a smaller childhood.

But low risk isn't no risk. The map here has changed in the last six years. Five counties with established blacklegged ticks. The Lyme bacterium was found in Nebraska-collected ticks. Two locally acquired cases in a single year. Those are small numbers that mean something specific. A Nebraska child with a real exposure story deserves a real evaluation. Not a reflex "we don't have that here."

And the diseases our ticks actually carry are worth knowing by name. They're the ones that will show up first. Tularemia, at 8.5 times the national rate. Ehrlichiosis, climbing. Rocky Mountain spotted fever, where the clock matters more than the test. Alpha-gal, hiding in the middle of the night.

So do the boring things. Permethrin on the camp clothes. A tick check at bath time from June through October. Photograph any rash before it fades. Write the date on your phone. Say a bite is followed by fever, a rash, or a change you can't explain. Call your pediatrician that day.

Want help thinking through what a bite or a symptom actually means for your child? I'm glad to talk. You can read more in my Lyme disease and tick-borne illness hub. Or see how Lyme testing works in children. For the honest version of the tick-and-behavior question, read Lyme, PANS and PANDAS. Families who travel to the Upper Midwest or the Northeast may also want Babesia in children. Did a sudden behavior change bring you here? Start with my PANS and PANDAS guide, then send me a note.

You know your kid. If something's off after a summer outside, that's worth a conversation.

Book My Free 15-Minute Call — get clarity and learn more.

Free. No obligation. Not a sales call. Or call or text me directly at 402-988-1873.

References

1. Nebraska DHHS. HAN Update: Tickborne Diseases in Nebraska. May 13, 2026. Source for the five established blacklegged tick counties, the 166% rise in ehrlichiosis, and the 2025 Heartland virus tick detection.

2. Nebraska DHHS. HAN Update: Lyme Disease in Nebraska. May 1, 2024. Source for the 2021 Thurston County detection of Borrelia burgdorferi and the 7.6 cases per year average.

3. Nebraska DHHS. Reported Cases of Lyme Disease in Nebraska by Year, 2010–2023. The year-by-year case counts total 139 cases across 14 years.

4. Nebraska DHHS. HAN Advisory: Lyme Disease in Nebraska. April 28, 2022. The 2021 breakdown: 9 reported cases, five acquired in highly endemic regions, two acquired in eastern Nebraska.

5. Nebraska DHHS. Medically Important Ticks of Nebraska. Lists the American dog tick, lone star tick, and blacklegged tick under active state surveillance.

6. Nebraska DHHS. Ehrlichiosis. Both E. chaffeensis and E. ewingii occur in Nebraska; rash in up to 60% of children versus under 30% of adults.

7. Jesse L, Lewis D, Holscher K, et al. Ticks and Tick-borne Diseases in Iowa. ISU Extension PM2036, revised May 2016. American dog tick in every Iowa county; blacklegged ticks concentrated in the northeast and east; lone star ticks expanding northward.

8. Iowa HHS. Vector-Borne Disease 2025 Weekly Surveillance Report. September 12, 2025. Iowa reported 162 Lyme disease cases in 2024.

9. Rich SN, Hinckley AF, Earley A, Petersen JM, Mead PS, Kugeler KJ. Tularemia – United States, 2011–2022. MMWR 2025;73(51&52):1152–1156. 2,462 cases, national incidence 0.064 per 100,000, a 56% increase, with incidence highest in children aged 5–9.

10. CDC. Supplementary Table: Tularemia frequency and average annual incidence by state, 2011–2022. Nebraska 126 cases at 0.547 per 100,000, fifth-highest state; Iowa 0.082.

11. Biggs HM, Behravesh CB, Bradley KK, et al. Diagnosis and Management of Tickborne Rickettsial Diseases. MMWR Recomm Rep 2016;65(RR-2):1–44. Present-day RMSF case fatality is 5%–10%, rising to 40%–50% when treated on day 8 or 9; never delay treatment for lab confirmation.

12. CDC. Rocky Mountain Spotted Fever: Clinical Signs and Symptoms. Children under 10 are under 6% of spotted fever cases but 22% of the deaths.

13. CDC. Clinical Overview of Ehrlichiosis. E. chaffeensis and E. ewingii, lone star tick vector, doxycycline first-line at all ages.

14. CDC. Data and Maps for Heartland Virus. CDC's list of reporting states includes Iowa and does not include Nebraska.

15. Thompson JM, Carpenter A, Kersh GJ, Wachs T, Commins SP, Salzer JS. Geographic Distribution of Suspected Alpha-gal Syndrome Cases – United States, January 2017–December 2022. MMWR 2023;72(30):815–820. 96,000 to 450,000 Americans possibly affected since 2010, roughly 15,000 new suspected cases a year; Nebraska is not among the high-prevalence states.

16. Carpenter A, Drexler NA, McCormick DW, et al. Health Care Provider Knowledge Regarding Alpha-gal Syndrome – United States, March–May 2022. MMWR 2023;72(30):809–814. Of 1,500 primary care providers, 42% had never heard of alpha-gal syndrome, and 48% of those aware did not know which test to order.

17. CDC. About Alpha-gal Syndrome. Symptoms usually appear 2 to 6 hours after eating meat or dairy, and range from hives to anaphylaxis.

18. Schwartz AM, Hinckley AF, Mead PS, Hook SA, Kugeler KJ. Surveillance for Lyme Disease – United States, 2008–2015. MMWR Surveill Summ 2017;66(SS-22):1–12. Peak week of illness onset is the first week of July, but the rash was most commonly reported April through November.

19. Bremell D, et al. Occurrence of erythema migrans in children with Lyme neuroborreliosis and the association with clinical characteristics and outcome. BMC Pediatr 2018;18:189. The head and neck were the most common rash locations in children; those children were younger and had more facial nerve palsy.

20. CDC. What to Do After a Tick Bite. CDC's tick removal steps, prevention guidance, and its recommendation against acting on results from testing a removed tick.