Synergistic drivers of Lyme disease emergence in North America: an eco-syndemic review.

Lyme disease is a growing public health threat driven by interplay of climatic, ecological and social factors. This review adopts an eco-syndemic framework, viewing Lyme disease emergence as the confluence of multiple synergistic drivers rather than a single- cause phenomenon. We synthesize evidence that climate conditions, ecological circumstances and human behavioural patterns inter- sect to amplify Lyme disease risk. By integrating these seemingly separate domains, our review highlights novel insights; for exam- ple, habitat fragmentation and predator loss may magnify the effects of a warming climate on reservoir or host populations, and human activities in suburban green spaces may mediate infection cycles. This holistic perspective is a departure from reductionist explanations and emphasizes the importance of coupled human-environment systems in studies of disease emergence. We discuss how an eco-syndemic frame can improve surveillance and prevention emphasizing One Health approaches that unite environmental management with animal health and public health outreach. Understanding the interactive and non-linear dynamics of Lyme disease drivers is crucial for developing effective interventions and preparing for future tick-borne disease challenges. While selected com- parative evidence from Europe is used where relevant, the review's primary empirical focus is North America.