Doctors and physicians are not required to report cases of the disease in California, as they would have to for other diseases such as influenza, Lyme and malaria, meaning cases are likely vastly underreported. Gabriel Hamer, an entomologist, told the Times that confirmed human cases in the U.S. represent “just the tip of the iceberg,” and that no one truly knows the true total.
“There’s no standardized reporting system. There’s no active surveillance,”

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