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Abstract

Introduction

Evidence of nationwide and regional morbidity of Lyme borreliosis (LB) in Germany is lacking.

Aims

We calculated the total number of incident LB cases in Germany in 2019, compared regional variations, investigated the extent of possible under-reporting in notification data and examined the association between high incidence areas and land cover composition.

Methods

We used outpatient claims data comprising information for people with statutory health insurance who visited a physician at least once between 2010 and 2019 in Germany (n = 71,411,504). The ICD-10 code A69.2 was used to identify incident LB patients. Spatial variations of LB were assessed by means of Global and Local Moran’s Index at district level. Notification data were obtained for nine federal states with mandatory notification from the Robert Koch Institute (RKI).

Results

Of all insured, 128,177 were diagnosed with LB in 2019, corresponding to an incidence of 179 per 100,000 insured. The incidence varied across districts by a factor of 16 (range: 40–646 per 100,000). We identified four spatial clusters with high incidences. These clusters were associated with a significantly larger proportion of forests and agricultural areas than low incidence clusters. In 2019, 12,264 LB cases were reported to the RKI from nine federal states, while 69,623 patients with LB were found in claims data for those states. This difference varied considerably across districts.

Conclusions

These findings serve as a solid basis for regionally tailored population-based intervention programmes and can support modelling studies assessing the development of LB epidemiology under various climate change scenarios.

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/content/10.2807/1560-7917.ES.2022.27.32.2101193
2022-08-11
2024-03-29
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2022.27.32.2101193
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References

  1. Rizzoli A, Hauffe H, Carpi G, Vourc H G, Neteler M, Rosa R. Lyme borreliosis in Europe. Euro Surveill. 2011;16(27):19906.  https://doi.org/10.2807/ese.16.27.19906-en  PMID: 21794218 
  2. Stanek G, Wormser GP, Gray J, Strle F. Lyme borreliosis. Lancet. 2012;379(9814):461-73.  https://doi.org/10.1016/S0140-6736(11)60103-7  PMID: 21903253 
  3. Sonenshine DE. Range expansion of tick disease vectors in North America: implications for spread of tick-borne disease. Int J Environ Res Public Health. 2018;15(3):478.  https://doi.org/10.3390/ijerph15030478  PMID: 29522469 
  4. Alkishe AA, Peterson AT, Samy AM. Climate change influences on the potential geographic distribution of the disease vector tick Ixodes ricinus. PLoS One. 2017;12(12):e0189092.  https://doi.org/10.1371/journal.pone.0189092  PMID: 29206879 
  5. Böhmer MM, Ens K, Böhm S, Heinzinger S, Fingerle V. Epidemiological surveillance of Lyme borreliosis in Bavaria, Germany, 2013-2020. Microorganisms. 2021;9(9):1872.  https://doi.org/10.3390/microorganisms9091872  PMID: 34576768 
  6. Huppertz HI, Böhme M, Standaert SM, Karch H, Plotkin SA. Incidence of Lyme borreliosis in the Würzburg region of Germany. Eur J Clin Microbiol Infect Dis. 1999;18(10):697-703.  https://doi.org/10.1007/s100960050381  PMID: 10584895 
  7. Poggensee G, Fingerle V, Hunfeld KP, Kraiczy P, Krause A, Matuschka FR, et al. Lyme-Borreliose: Forschungsbedarf und Forschungsansätze. Ergebnisse eines interdisziplinären Expertentreffens am Robert Koch-Institut. [[Lyme borreliosis: research gaps and research approaches. Results from an interdisciplinary expert meeting at the Robert Koch Institute]]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008;51(11):1329-39. German.  https://doi.org/10.1007/s00103-008-0703-6  PMID: 19043762 
  8. Woudenberg T, Böhm S, Böhmer M, Katz K, Willrich N, Stark K, et al. Dynamics of Borrelia burgdorferi-specific antibodies: seroconversion and seroreversion between two population-based, cross-sectional surveys among adults in Germany. Microorganisms. 2020;8(12):1859.  https://doi.org/10.3390/microorganisms8121859  PMID: 33255673 
  9. Wilking H, Fingerle V, Klier C, Thamm M, Stark K. Antibodies against Borrelia burgdorferi sensu lato among adults, Germany, 2008-2011. Emerg Infect Dis. 2015;21(1):107-10.  https://doi.org/10.3201/eid2101.140009  PMID: 25531140 
  10. Enkelmann J, Böhmer M, Fingerle V, Siffczyk C, Werber D, Littmann M, et al. Incidence of notified Lyme borreliosis in Germany, 2013-2017. Sci Rep. 2018;8(1):14976.  https://doi.org/10.1038/s41598-018-33136-0  PMID: 30297731 
  11. White J, Noonan-Toly C, Lukacik G, Thomas N, Hinckley A, Hook S, et al. Lyme disease surveillance in New York State: an assessment of case underreporting. Zoonoses Public Health. 2018;65(2):238-46.  https://doi.org/10.1111/zph.12307  PMID: 27612955 
  12. Bobe JR, Jutras BL, Horn EJ, Embers ME, Bailey A, Moritz RL, et al. Recent progress in Lyme disease and remaining challenges. Front Med (Lausanne). 2021;8(666554):666554.  https://doi.org/10.3389/fmed.2021.666554  PMID: 34485323 
  13. Stanek G, Fingerle V, Hunfeld KP, Jaulhac B, Kaiser R, Krause A, et al. Lyme borreliosis: clinical case definitions for diagnosis and management in Europe. Clin Microbiol Infect. 2011;17(1):69-79.  https://doi.org/10.1111/j.1469-0691.2010.03175.x  PMID: 20132258 
  14. Kuehn BM. CDC estimates 300,000 US cases of Lyme disease annually. JAMA. 2013;310(11):1110.  https://doi.org/10.1001/jama.2013.278331  PMID: 24045727 
  15. Müller I, Freitag MH, Poggensee G, Scharnetzky E, Straube E, Schoerner Ch, et al. Evaluating frequency, diagnostic quality, and cost of Lyme borreliosis testing in Germany: a retrospective model analysis. Clin Dev Immunol. 2012;2012(595427):595427.  https://doi.org/10.1155/2012/595427  PMID: 22242037 
  16. Barrios JM, Verstraeten WW, Maes P, Aerts JM, Farifteh J, Coppin P. Relating land cover and spatial distribution of nephropathia epidemica and Lyme borreliosis in Belgium. Int J Environ Health Res. 2013;23(2):132-54.  https://doi.org/10.1080/09603123.2012.708918  PMID: 22894742 
  17. Federal Institute for Drugs and Medical Devices (BfArM). ICD-10-GM. International Statistical Classification of Diseases. German modification. 10th revision. Bonn/Köln: BfArM; 2021. Available from: https://www.bfarm.de/EN/Code-systems/Classifications/ICD/ICD-10-GM/_node.html
  18. Robert Koch Institute (RKI). SurvStat@RKI 2.0. Notified cases of Lyme borreliosis. Berlin: RKI. [Accessed: 7 Jul 2021]. Available from: https://survstat.rki.de
  19. European Environmental Agency (EEA). Copernicus Land Monitoring Service - Corine Land Cover. Copenhagen: EEA; 2000/2006/2012/2018. Available from: http://www.eea.europa.eu/data-and-maps/data/copernicus-land-monitoring-service-corine
  20. Moran P. The interpretation of statistical maps. J R Stat Soc Series B Stat Methodol. 1948;10(2):243-51.
  21. Anselin L. Local indicators of spatial association - LISA. Geogr Anal. 1995;27(2):93-115.  https://doi.org/10.1111/j.1538-4632.1995.tb00338.x 
  22. Agresti A, Coull B. Approximate is better than "exact" for interval estimation of binomial proportions. Am Stat. 1998;52(2):119-26.
  23. Federal Statistical Office (Destatis). Population statistics. Wiesbaden: Destatis. [Accessed: 5 Nov 2021]. Available from: https://www.destatis.de
  24. R Core Team. R: A language and environment for statistical computing. Version 3.3.2. Vienna: R Foundation for Statistical Computing; 2020. Available from: https://www.R-project.org
  25. Fülöp B, Poggensee G. Epidemiological situation of Lyme borreliosis in Germany: surveillance data from six eastern German States, 2002 to 2006. Parasitol Res. 2008;103(S1) Suppl 1;S117-20.  https://doi.org/10.1007/s00436-008-1060-y  PMID: 19030893 
  26. Wilking H, Stark K. Trends in surveillance data of human Lyme borreliosis from six federal states in eastern Germany, 2009-2012. Ticks Tick Borne Dis. 2014;5(3):219-24.  https://doi.org/10.1016/j.ttbdis.2013.10.010  PMID: 24656810 
  27. Rutz H, Hogan B, Hook S, Hinckley A, Feldman K. Impacts of misclassification on Lyme disease surveillance. Zoonoses Public Health. 2019;66(1):174-8.  https://doi.org/10.1111/zph.12525  PMID: 30242983 
  28. Lindgren EL, Jaenson TGT. Lyme borreliosis in Europe: influences of climate and climate change, epidemiology, ecology and adaption measures. Geneva: WHO; ‎2006. Available from: https://apps.who.int/iris/handle/10665/107800
  29. Sykes RA, Makiello P. An estimate of Lyme borreliosis incidence in Western Europe. J Public Health (Oxf). 2017;39(1):74-81. PMID: 26966194 
  30. Cairns V, Wallenhorst C, Rietbrock S, Martinez C. Incidence of Lyme disease in the UK: a population-based cohort study. BMJ Open. 2019;9(7):e025916.  https://doi.org/10.1136/bmjopen-2018-025916  PMID: 31362975 
  31. Nelson CA, Saha S, Kugeler KJ, Delorey MJ, Shankar MB, Hinckley AF, et al. Incidence of clinician-diagnosed Lyme disease, United States, 2005-2010. Emerg Infect Dis. 2015;21(9):1625-31.  https://doi.org/10.3201/eid2109.150417  PMID: 26291194 
  32. Erler A, Beyer M, Muth C, Gerlach FM, Brennecke R. [Garbage in - garbage out? Validity of coded diagnoses from GP claims records]. Gesundheitswesen. 2009;71(12):823-31. German.  https://doi.org/10.1055/s-0029-1214399  PMID: 19387933 
  33. Tulloch JSP, Semper AE, Brooks TJG, Russell K, Halsby KD, Christley RM, et al. The demographics and geographic distribution of laboratory-confirmed Lyme disease cases in England and Wales (2013-2016): an ecological study. BMJ Open. 2019;9(7):e028064.  https://doi.org/10.1136/bmjopen-2018-028064  PMID: 31362976 
  34. Zanzani SA, Rimoldi SG, Manfredi M, Grande R, Gazzonis AL, Merli S, et al. Lyme borreliosis incidence in Lombardy, Italy (2000-2015): Spatiotemporal analysis and environmental risk factors. Ticks Tick Borne Dis. 2019;10(6):101257.  https://doi.org/10.1016/j.ttbdis.2019.07.001  PMID: 31285164 
  35. Altpeter E, Zimmermann H, Oberreich J, Péter O, Dvořák C, Swiss Sentinel Surveillance Network. Tick related diseases in Switzerland, 2008 to 2011. Swiss Med Wkly. 2013;143:w13725.  https://doi.org/10.4414/smw.2013.13725  PMID: 23299974 
  36. Bleyenheuft C, Lernout T, Berger N, Rebolledo J, Leroy M, Robert A, et al. Epidemiological situation of Lyme borreliosis in Belgium, 2003 to 2012. Arch Public Health. 2015;73(1):33.  https://doi.org/10.1186/s13690-015-0079-7  PMID: 26146553 
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