Heartland virus disease is a rare illness caused by a virus spread mainly through the bite of the lone star tick (Amblyomma americanum). Most people who get sick develop fever, fatigue, and body aches, typically within a few days to several weeks after a tick bite. There is no vaccine or specific antiviral treatment, so care is supportive and the best protection is avoiding tick bites. Cases have been reported in the eastern, southeastern, and south-central United States, where the lone star tick is common.
Last reviewed: 2026-07-20 · Educational only — not medical advice.
Carried by the Lone Star tick. Spread by: Lone star tick.
What is heartland virus disease?
Heartland virus is a phlebovirus first identified in patients in Missouri in 2009. According to the CDC, the lone star tick (Amblyomma americanum) is primarily responsible for spreading it to people. The disease is uncommon: as of November 2022, the CDC reported that more than 60 cases had been identified across the eastern, southeastern, and south-central U.S. Its early symptoms closely resemble ehrlichiosis, another lone star tick illness, which is one reason clinicians consider it when an ehrlichiosis-like illness does not improve with standard antibiotics. Because it is a virus, antibiotics do not treat it.
Symptoms
Fever
Fatigue (feeling very tired)
Decreased appetite
Headache
Nausea
Diarrhea
Muscle or joint pain
Lower-than-normal white blood cell count (leukopenia) on lab tests
Lower-than-normal platelet count (thrombocytopenia) on lab tests
Mild to moderate elevation of liver enzymes (transaminases)
How soon do symptoms appear?
A few days to several weeks after a tick bite. According to the CDC, the incubation period (the time from tick bite to feeling sick) ranges from a few days to several weeks. Most patients reported being exposed to ticks in the two weeks before their illness began, and most had illness onset from May through September.
Diagnosis
Heartland virus disease is diagnosed based on symptoms, a history of tick exposure or being in areas where the lone star tick lives, and laboratory testing. Routine bloodwork often shows low white blood cell counts, low platelet counts, and mildly elevated liver enzymes. There are no commercially available tests in the United States; molecular (RT-PCR) and antibody (serologic) testing are performed at the CDC, with specimens submitted through state health departments. Providers may specifically consider Heartland virus in patients being treated for ehrlichiosis who do not improve on doxycycline.
Treatment
There are no antiviral medicines or vaccines for Heartland virus, and antibiotics do not treat it because it is a virus. Care is supportive and focused on relieving symptoms, such as rest, fluids, and over-the-counter medicine to reduce fever and pain. Some patients have needed hospital care for supportive treatment. Rarely, severe illness and death have occurred, most often in people with weakened immune systems or multiple other health conditions. Anyone who feels ill after a tick bite should contact a healthcare provider.
Prevention
Because there is no vaccine, preventing tick bites is the best protection. The CDC recommends using EPA-registered insect repellents (such as those with DEET, picaridin, IR3535, oil of lemon eucalyptus, PMD, or 2-undecanone), treating clothing and gear with 0.5% permethrin, and avoiding tall grass and brushy areas where lone star ticks wait for hosts. After being outdoors, check your whole body for ticks, shower within about two hours, and tumble dry clothes on high heat for 10 minutes to kill any ticks. Check pets and gear too, and remove any attached tick promptly.
Where it occurs
Heartland virus cases have been reported in the eastern, southeastern, and south-central United States, which matches the range of the lone star tick. Reported cases have clustered in states across the Midwest and South, including Missouri and neighboring areas, but the tick's range is expanding. Cases remain rare, and the true number of infections may be higher than reported because the disease can be mistaken for other illnesses.
When to seek care: Contact a healthcare provider if you develop fever, fatigue, headache, muscle aches, nausea, or diarrhea within a few days to a few weeks of a tick bite or of spending time in tick habitat, especially in areas where the lone star tick is common. Tell your provider about the possible tick exposure. Seek care promptly if you are being treated for another tick illness like ehrlichiosis and are not improving, or if you have a weakened immune system or other serious health conditions. This page is educational and is not a substitute for professional medical advice, diagnosis, or treatment. For emergencies such as trouble breathing or anaphylaxis, call emergency services. Educational information only — not medical advice. See our sources and disclaimer.
The CDC identifies the lone star tick (Amblyomma americanum) as the tick primarily responsible for spreading Heartland virus to people. The Asian longhorned tick has been shown to be a competent vector in laboratory studies, but it has not been confirmed to spread the virus to people in the wild.
How long after a tick bite do Heartland virus symptoms start?+
According to the CDC, symptoms can appear anywhere from a few days to several weeks after a tick bite. Most patients reported being exposed to ticks in the two weeks before they got sick, and most became ill between May and September.
Is Heartland virus the same as Lyme disease, and does the lone star tick spread Lyme?+
No. Heartland virus and Lyme disease are different illnesses. Importantly, the lone star tick does NOT transmit Lyme disease. Lyme is spread by the blacklegged (deer) tick in the East and Midwest and the western blacklegged tick on the West Coast.
Does the lone star tick spread Rocky Mountain spotted fever?+
No. The lone star tick is not a primary vector of Rocky Mountain spotted fever (RMSF). RMSF is mainly spread by the American dog tick, Rocky Mountain wood tick, and brown dog tick. Despite its name, most U.S. RMSF cases occur in South-Central states.
Is there a treatment or vaccine for Heartland virus?+
No. There are no vaccines to prevent Heartland virus and no antiviral medicines to treat it. Antibiotics do not work because it is a virus. Treatment is supportive, and some patients need hospital care.
How common is Heartland virus?+
It is rare. As of November 2022, the CDC reported that more than 60 cases had been identified across the eastern, southeastern, and south-central United States, though the true number may be higher because it can be mistaken for other illnesses.
Step-by-step guidance for removing an attached tick.
CDC
Share card
LoneStarMap.com
Heartland Virus Disease
Heartland virus is a rare illness spread mainly by the lone star tick in the eastern, southeastern, and south-central U.S. Learn the symptoms, onset window, and how to prevent tick bites. Educational, not medical advice.
LoneStarMap