“…Several recent studies have recognized increasing risk in traditionally low incidence areas. These areas include Illinois (Herrmann, Dahm, Ruiz, & Brown, 2014), Iowa (Lingren, Rowley, Thompson, & Gilchrist, 2005), North Dakota (Russart, Dougherty, & Vaughan, 2014), Ohio (Wang et al, 2014), and Michigan (Lantos et al, 2017). Significant increases in canine prevalence are also seen in some areas that have not yet reported significant human incidence.…”