Epidemiological Surveillance of Lyme Borreliosis in Bavaria, Germany, 2013-2020

Overview

Journal Microorganisms

Specialty Microbiology

Date 2021 Sep 28

PMID 34576768

Citations 10

Authors

Merle Margarete Bohmer

Katharina Ens

Stefanie Bohm

Susanne Heinzinger

Volker Fingerle

Affiliations

Soon will be listed here.

Abstract

Lyme borreliosis (LB) is the most common tick-borne disease in Germany. Mandatory notification of acute LB manifestations (erythema migrans (EM), neuroborreliosis (NB), and Lyme arthritis (LA)) was implemented in Bavaria on 1 March 2013. We aimed to describe the epidemiological situation and to identify LB risk areas and populations. Therefore, we analyzed LB cases notified from March 2013 to December 2020 and calculated incidence (cases/100,000 inhabitants) by time, place, and person. Overall, 35,458 cases were reported during the study period (EM: 96.7%; NB: 1.7%; LA: 1.8%). The average incidence was 34.3/100,000, but annual incidence varied substantially (2015: 23.2; 2020: 47.4). Marked regional differences at the district level were observed (annual average incidence range: 4-154/100,000). The Bavarian Forest and parts of Franconia were identified as high-risk regions. Additionally, high risk for LB was found in 5-9-year-old males and in 60-69-year-old females. The first group also had the highest risk of a severe disease course. We were able to identify areas and populations in Bavaria with an increased LB risk, thereby providing a basis for targeted measures to prevent LB. Since LB vaccination is currently not available, such measures should comprise (i) avoiding tick bites, (ii) removing ticks rapidly after a bite, and (iii) treating LB early/adequately.

Citing Articles

Excess Healthcare Costs and Resource Utilisation of Lyme Borreliosis in Germany: A Propensity Score-Matched Cohort Study.

Brestrich G, Diesing J, Kossack N, Stark J, Pilz A, Yu H Zoonoses Public Health. 2024; 72(1):23-31.

PMID: 39238143 PMC: 11695699. DOI: 10.1111/zph.13180.

Differentiating Lyme arthritis: a case-based review.

Unlu A, Andersen N, Larsen S, Skarphedinsson S, Chrysidis S, Knudtzen F Rheumatol Int. 2024; 44(11):2671-2678.

PMID: 38795123 DOI: 10.1007/s00296-024-05618-0.

Combining Double-Dose and High-Dose Pulsed Dapsone Combination Therapy for Chronic Lyme Disease/Post-Treatment Lyme Disease Syndrome and Co-Infections, Including Bartonella: A Report of 3 Cases and a Literature Review.

Horowitz R, Fallon J, Freeman P Microorganisms. 2024; 12(5).

PMID: 38792737 PMC: 11124288. DOI: 10.3390/microorganisms12050909.

Knowledge, Attitudes and Behaviors regarding Tick-Borne Encephalitis Vaccination and Prevention of Tick-Borne Diseases among Primary Care Physicians in Bavaria and Baden-Wuerttemberg, Germany, May-September 2022.

Coyer L, Sogan-Ekinci A, Greutelaers B, Kuhn J, Saller F, Hailer J Microorganisms. 2023; 11(4).

PMID: 37110384 PMC: 10146000. DOI: 10.3390/microorganisms11040961.

Incidence of Lyme Borreliosis in Germany: Exploring Observed Trends Over Time Using Public Surveillance Data, 2016-2020.

Skufca J, Tran T, Brestrich G, Pilz A, Vyse A, Malerczyk C Vector Borne Zoonotic Dis. 2023; 23(4):237-246.

PMID: 37071399 PMC: 10122258. DOI: 10.1089/vbz.2022.0046.

References

Strle F, Stanek G . Clinical manifestations and diagnosis of lyme borreliosis. Curr Probl Dermatol. 2009; 37:51-110. DOI: 10.1159/000213070. View

Stanek G, Fingerle V, Hunfeld K, Jaulhac B, Kaiser R, Krause A . Lyme borreliosis: clinical case definitions for diagnosis and management in Europe. Clin Microbiol Infect. 2010; 17(1):69-79. DOI: 10.1111/j.1469-0691.2010.03175.x. View

Randolph S . Evidence that climate change has caused 'emergence' of tick-borne diseases in Europe?. Int J Med Microbiol. 2004; 293 Suppl 37:5-15. DOI: 10.1016/s1433-1128(04)80004-4. View

Lindgren E, Talleklint L, Polfeldt T . Impact of climatic change on the northern latitude limit and population density of the disease-transmitting European tick Ixodes ricinus. Environ Health Perspect. 2000; 108(2):119-23. PMC: 1637900. DOI: 10.1289/ehp.00108119. View

Rauter C, Hartung T . Prevalence of Borrelia burgdorferi sensu lato genospecies in Ixodes ricinus ticks in Europe: a metaanalysis. Appl Environ Microbiol. 2005; 71(11):7203-16. PMC: 1287732. DOI: 10.1128/AEM.71.11.7203-7216.2005. View

Strle F, Lusa L, Ruzic-Sabljic E, Maraspin V, Lotric Furlan S, Cimperman J . Clinical characteristics associated with Borrelia burgdorferi sensu lato skin culture results in patients with erythema migrans. PLoS One. 2014; 8(12):e82132. PMC: 3873257. DOI: 10.1371/journal.pone.0082132. View

Enkelmann J, Bohmer M, Fingerle V, Siffczyk C, Werber D, Littmann M . Incidence of notified Lyme borreliosis in Germany, 2013-2017. Sci Rep. 2018; 8(1):14976. PMC: 6175818. DOI: 10.1038/s41598-018-33136-0. View

Kuehn B . CDC estimates 300,000 US cases of Lyme disease annually. JAMA. 2013; 310(11):1110. DOI: 10.1001/jama.2013.278331. View

Wilking H, Fingerle V, Klier C, Thamm M, Stark K . Antibodies against Borrelia burgdorferi sensu lato among Adults, Germany, 2008-2011. Emerg Infect Dis. 2014; 21(1):107-10. PMC: 4285254. DOI: 10.3201/eid2101.140009. View

10.

Raileanu C, Silaghi C, Fingerle V, Margos G, Thiel C, Pfister K . Sensu Lato in Questing and Engorged Ticks from Different Habitat Types in Southern Germany. Microorganisms. 2021; 9(6). PMC: 8230558. DOI: 10.3390/microorganisms9061266. View

11.

Wormser G, Jacobson E, Shanker E . Negative impact of the COVID-19 pandemic on the timely diagnosis of tick-borne infections. Diagn Microbiol Infect Dis. 2020; 99(1):115226. PMC: 7518953. DOI: 10.1016/j.diagmicrobio.2020.115226. View

12.

Koedel U, Fingerle V, Pfister H . Lyme neuroborreliosis-epidemiology, diagnosis and management. Nat Rev Neurol. 2015; 11(8):446-56. DOI: 10.1038/nrneurol.2015.121. View

13.

Hofmann H, Fingerle V, Hunfeld K, Huppertz H, Krause A, Rauer S . Cutaneous Lyme borreliosis: Guideline of the German Dermatology Society. Ger Med Sci. 2017; 15:Doc14. PMC: 5588623. DOI: 10.3205/000255. View

14.

Reimer B, Erbas B, Lobbichler K, Truckenbrodt R, Kapeller N, Hansen M . Seroprevalence of Borrelia infection in occupational tick-exposed people in Bavaria (Germany). Int J Med Microbiol. 2002; 291 Suppl 33:215. DOI: 10.1016/s1438-4221(02)80055-8. View

15.

Septfons A, Goronflot T, Jaulhac B, Roussel V, De Martino S, Guerreiro S . Epidemiology of Lyme borreliosis through two surveillance systems: the national Sentinelles GP network and the national hospital discharge database, France, 2005 to 2016. Euro Surveill. 2019; 24(11). PMC: 6425552. DOI: 10.2807/1560-7917.ES.2019.24.11.1800134. View

16.

Fulop B, Poggensee G . Epidemiological situation of Lyme borreliosis in germany: surveillance data from six Eastern German States, 2002 to 2006. Parasitol Res. 2008; 103 Suppl 1:S117-20. DOI: 10.1007/s00436-008-1060-y. View

17.

Rauer S, Kastenbauer S, Hofmann H, Fingerle V, Huppertz H, Hunfeld K . Guidelines for diagnosis and treatment in neurology - Lyme neuroborreliosis. Ger Med Sci. 2020; 18:Doc03. PMC: 7174852. DOI: 10.3205/000279. View

18.

Dehnert M, Fingerle V, Klier C, Talaska T, Schlaud M, Krause G . Seropositivity of Lyme borreliosis and associated risk factors: a population-based study in Children and Adolescents in Germany (KiGGS). PLoS One. 2012; 7(8):e41321. PMC: 3419690. DOI: 10.1371/journal.pone.0041321. View

19.

Michel H, Wilske B, Hettche G, Gottner G, Heimerl C, Reischl U . An ospA-polymerase chain reaction/restriction fragment length polymorphism-based method for sensitive detection and reliable differentiation of all European Borrelia burgdorferi sensu lato species and OspA types. Med Microbiol Immunol. 2003; 193(4):219-26. DOI: 10.1007/s00430-003-0196-8. View

20.

Fingerle V, Schulte-Spechtel U, Ruzic-Sabljic E, Leonhard S, Hofmann H, Weber K . 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. 2007; 298(3-4):279-90. DOI: 10.1016/j.ijmm.2007.05.002. View