Original articleTrends in surveillance data of human Lyme borreliosis from six federal states in eastern Germany, 2009–2012
Introduction
Lyme borreliosis (LB, Lyme disease) caused by the spirochaete Borrelia (B.) burgdorferi senso lato is the most frequent vector-borne disease in the northern hemisphere. It is transmitted by bites of hard ticks of the Ixodes ricinus complex. Germany is considered an area with a high disease prevalence (Lindgren and Jaenson, 2006).
LB is a potentially serious infection and can affect the skin, the joints, the nervous system, and less frequently the heart and the eyes (Stanek et al., 2012, Strle and Stanek, 2009). The most common disease manifestation is erythema migrans (EM), a characteristic expanding skin lesion with or without central clearing. Additionally, LB can present in more severe manifestations as neuroborreliosis (NB) and Lyme arthritis (LA). NB affects the central or peripheral nervous system, solely or in combination. Clinical manifestations include radiculopathy, lymphocytic meningitis, and cranial neuropathy (most often a facial neuropathy). LA presents as mono- or oligoarthritis, persisting or with recurrent attacks.
Surveillance data from mandatory disease notification systems are only available from a few European countries and are collected on the basis of different case definitions and different technical implementations (voluntary reporting, laboratory reporting vs. physician reporting, or hospital diagnoses) (Rizzoli et al., 2011). In Europe, annual incidences of notified cases of 80.0/100,000 inhabitants or higher are reported from Slovenia, Austria, and southern Sweden. Incidence is also high in the Netherlands and Switzerland while Poland and France report incidences below 20.0/100,000 (Lindgren and Jaenson, 2006).
This report provides an analysis of the frequency and distribution of notified cases of LB in eastern Germany. Associations between demographic characteristics and clinical manifestations were assessed, and geographical patterns and time trends were analyzed.
Section snippets
Materials and methods
LB is not a nationwide notifiable disease in Germany. However, in the 6 neighbouring federal states Berlin, Brandenburg, Mecklenburg-Western Pomerania, Saxony, Saxony-Anhalt, and Thuringia (hereafter referred to as eastern Germany) systems of mandatory disease notification were established by special legal ordinance between 1991 and 1997. In 5 out of 6 states, the physicians, and in 4 out of 6 states the laboratories, have to report cases of LB to the local health authority of their place of
Demographic characteristics
From 2009 to 2012, 18,894 cases of LB were reported in the study area. The highest incidence was observed in 2009 (34.9 cases per 100,000 inhabitants) and the lowest incidence in 2012 (19.54 cases per 100,000 inhabitants). There was a bimodal distribution of age-specific incidence of LB (Fig. 1). The first maximum occurred in children aged 5–9 years. Incidence rose again in adults from the 25–29-year-old to the second and more prominent peak in the 50–69-year-old. Across all age groups, LB
Demographics
This is the first epidemiological analysis of the German surveillance data after the introduction of the revised case definition in January 2009, which also includes LA as a newly notifiable disease manifestation. Furthermore, the revised case definition differentiates between the laboratory evidence for radiculoneuritis, meningitis, and cranial neuritis. The definition for the most common manifestation EM has remained unmodified. Therefore, we think this change had only minor influence on
Limitations
There are two groups of limitations in this study which are inherent to the dataset. Firstly, it can be assumed that especially patients with an EM, which is usually easily treatable by general practitioners, are often not reported to the local health office. Furthermore, there may be cases reported as LB with disease due to another cause. Difficulties in diagnosing severe disease manifestations can lead to insufficient case ascertainment in LB surveillance (ECDC, 2012, Müller et al., 2012,
Conclusions
Population-based seroprevalence studies and surveys for pathogens in vectors should be used to complement the data from notification systems. Altogether, this should provide a better understanding of the key epidemiological features and may allow better estimation of the burden of this disease in the future.
The risk of acquiring LB is significant in Germany. Thus, personal protection, e.g. wearing appropriate clothing as well as regularly searching the body for ticks and prompt removal of ticks
Acknowledgements
We thank physicians and laboratories reporting the patients and district health authorities and the federal state authorities of Berlin, Brandenburg, Mecklenburg-Western Pomerania, Saxony, Saxony-Anhalt, and Thuringia for the establishment of the surveillance system.
References (36)
- et al.
Epidemiological aspects and molecular characterization of Borrelia burgdorferi s.l. from southern Germany with special respect to the new species Borrelia spielmanii sp. nov
Int. J. Med. Microbiol.
(2008) - et al.
Borrelia burgdorferi in urban parks
Lancet
(1991) - et al.
Prospective study on the incidence of infection by Borrelia burgdorferi sensu lato after a tick bite in a highly endemic area of Switzerland
Ticks Tick-borne Dis.
(2011) - et al.
Foci of tick-borne diseases in southwest Germany
Int. J. Med. Microbiol.
(2002) - et al.
Lyme borreliosis
Lancet
(2012) Tick-borne encephalitis 2010: epidemiology, risk areas, and virus strains in Europe and Asia – an overview
Ticks Tick-borne Dis.
(2011)- et al.
Lyme Borreliosis: situation report from the Federal States of Berlin, Brandenburg, Mecklenburg-West-Pomerania, Saxony, Saxony-Anhalt and Thuringia, 2007–2009
UMID
(2010) - et al.
Surveillance for Lyme disease – United States, 1992–2006
MMWR Surveill. Summ.
(2008) - et al.
An epidemiologic study of Lyme disease in southern Sweden
N. Engl. J. Med.
(1995) - et al.
Three species of Borrelia burgdorferi sensu lato (B. burgdorferi sensu stricto, B. afzelii, and B. garinii) identified from cerebrospinal fluid isolates by pulsed-field gel electrophoresis and PCR
J. Clin. Microbiol.
(1996)
The geographical distribution of tick bites and erythema migrans in general practice in The Netherlands
Int. J. Epidemiol.
Seropositivity of Lyme borreliosis and associated risk factors: a population-based study in children and adolescents in Germany (KiGGS)
PLoS ONE
European Centre for Disease Prevention and Control: second expert consultation on tick-borne diseases with emphasis on Lyme borreliosis and tick-borne encephalitis
Effect of surveillance method on reported characteristics of Lyme disease, Connecticut, 1996–2007
Emerg. Infect. Dis.
Exploring gaps in our knowledge on Lyme borreliosis spirochaetes – updates on complex heterogeneity, ecology, and pathogenicity
Ticks Tick-borne Dis.
Epidemiological situation of Lyme borreliosis in Germany: surveillance data from six eastern German States, 2002 to 2006
Parasitol. Res.
Effects of climate change on ticks and tick-borne diseases in Europe
Interdiscip. Perspect. Infect. Dis.
Incidence of Lyme borreliosis in the Würzburg region of Germany
Eur. J. Clin. Microbiol.
Cited by (86)
Incidence of Lyme Borreliosis in Germany: A retrospective observational healthcare claims study
2024, Ticks and Tick-borne DiseasesEpidemiology of Lyme Disease
2022, Infectious Disease Clinics of North AmericaIncidence and occurrence of tick-borne encephalitis and neuroborreliosis in Germany
2022, Ticks and Tick-borne DiseasesCitation Excerpt :Only individual cases, when the attending physician had considered the possibility of TBE, were reported from regions that were previously not known as at risk (Dekker et al., 2019). Field studies on ticks show that TBE viruses also occur in regions that have not yet been defined as risk (Boelke et al., 2019; Chitimia-Dobler et al., 2019; Liebig et al., 2020; Walter et al., 2020). To obtain a better picture of the distribution of TBE in Germany, nationwide serological diagnostics would be required in all cases of a febrile inflammatory disease of the nervous system.
Emergence of Lyme borreliosis in the province of Verona, Northern Italy: Five-years of sentinel surveillance
2021, Ticks and Tick-borne DiseasesLyme Disease Management: Antibiotics and Beyond
2024, Rising Contagious Diseases: Basics, Management, and Treatments