E. chaffeensis and E. ewingii are transmitted among reservoir species and to accidental hosts by the lone star tick (amblyomma americanum), which occurs widely throughout the southeastern and south central United States. In the northeastern and midwestern United States, A. phagocytophilum is maintained in white tailed deer and small rodents. Transmission to humans occurs through the bite of the black legged tick (Ixodes scapularis). Tick transmission is believed to be the only epidemiologically important means of acquiring infection (90-93).
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