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Abstract

Background

Lyme borreliosis (LB), caused by (), is the most common tick-borne infection in Germany. Antibodies against are prevalent in the general population but information on temporal changes of prevalence and estimates of seroconversion (seroincidence) and seroreversion are lacking, especially for children and adolescents.

Aim

We aimed at assessing antibodies against and factors associated with seropositivity in children and adolescents in Germany.

Methods

We estimated seroprevalence via two consecutive cross-sectional surveys (2003–2006 and 2014–2017). Based on a longitudinal survey component, we estimated annual seroconversion/seroreversion rates.

Results

Seroprevalence was 4.4% (95% confidence interval (CI): 3.9–4.9%) from 2003 to 2006 and 4.1% (95% CI: 3.2–5.1%) from 2014 to 2017. Seroprevalence increased with age, was higher in male children, the south-eastern regions of Germany and among those with a high socioeconomic status. The annual seroconversion rate was 0.3% and the annual seroreversion rate 3.9%. Males were more likely to seroconvert compared with females. Low antibody levels were the main predictor of seroreversion.

Conclusion

We did not detect a change in seroprevalence in children and adolescents in Germany over a period of 11 years. Potential long-term changes, for example due to climatic changes, need to be assessed in consecutive serosurveys. Seroconversion was more likely among children and adolescents than among adults, representing a target group for preventive measures. Seroreversion rates are over twice as high in children and adolescents compared with previous studies among adults. Thus, seroprevalence estimates and seroconversion rates in children are likely underestimated.

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/content/10.2807/1560-7917.ES.2023.28.34.2200855
2023-08-24
2024-11-01
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2023.28.34.2200855
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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, Strle F. Lyme borreliosis-from tick bite to diagnosis and treatment. FEMS Microbiol Rev. 2018;42(3):233-58.  https://doi.org/10.1093/femsre/fux047  PMID: 29893904 
  3. 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 
  4. Radolf JD, Strle K, Lemieux JE, Strle F. Lyme disease in humans. Curr Issues Mol Biol. 2021;42:333-84.  PMID: 33303701 
  5. 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 
  6. Hofmann H, Fingerle V, Hunfeld K-P, Huppertz H-I, Krause A, Rauer S, et al. Cutaneous Lyme borreliosis: guideline of the German dermatology society. Ger Med Sci. 2017;15:Doc14.  PMID: 28943834 
  7. 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 
  8. Rauer S, Kastenbauer S, Hofmann H, Fingerle V, Huppertz HI, Hunfeld KP, et al. Guidelines for diagnosis and treatment in neurology - Lyme neuroborreliosis. Ger Med Sci. 2020;18:Doc03. PMID: 32341686 
  9. Fingerle V, Sing A, Hofmann H. Lyme-Borreliose: Fallstricke bei Diagnose und Therapie.[Lyme borreliosis: pitfalls in diagnosis and therapy]. Dtsch Arztebl Int. 2015;112(23):15-7.
  10. des Vignes F, Piesman J, Heffernan R, Schulze TL, Stafford KC 3rd, Fish D. Effect of tick removal on transmission of Borrelia burgdorferi and Ehrlichia phagocytophila by Ixodes scapularis nymphs. J Infect Dis. 2001;183(5):773-8.  https://doi.org/10.1086/318818  PMID: 11181154 
  11. Lindgren E, Jaenson TGT. Lyme borreliosis in Europe: influences of climate and climate change, epidemiology, ecology and adaptation measures. Copenhagen: World Health Organization Regional Office for Europe; 2006. Available from: https://apps.who.int/iris/handle/10665/107800
  12. World Health Organization (WHO). International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10 Version:2019). Geneva: WHO; 2019. Available from: https://icd.who.int/browse10/2019/en
  13. Akmatov MK, Holstiege J, Dammertz L, Heuer J, Kohring C, Lotto-Batista M, et al. Epidemiology of Lyme borreliosis based on outpatient claims data of all people with statutory health insurance, Germany, 2019. Euro Surveill. 2022;27(32):2101193.  https://doi.org/10.2807/1560-7917.ES.2022.27.32.2101193  PMID: 35959689 
  14. Skogman BH, Ekerfelt C, Ludvigsson J, Forsberg P. Seroprevalence of Borrelia IgG antibodies among young Swedish children in relation to reported tick bites, symptoms and previous treatment for Lyme borreliosis: a population-based survey. Arch Dis Child. 2010;95(12):1013-6.  https://doi.org/10.1136/adc.2010.183624  PMID: 20702388 
  15. Garro A, Bennett J, Balamuth F, Levas MN, Neville D, Branda JC, et al. Positive 2-tiered Lyme disease serology is uncommon in asymptomatic children living in endemic areas of the United States. Pediatr Infect Dis J. 2019;38(5):e105-7.  https://doi.org/10.1097/INF.0000000000002157  PMID: 30067595 
  16. Dehnert M, Fingerle V, Klier C, Talaska T, Schlaud M, Krause G, et al. 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.  https://doi.org/10.1371/journal.pone.0041321  PMID: 22905101 
  17. 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 
  18. Hoffmann R, Lange M, Butschalowsky H, Houben R, Schmich P, Allen J, et al. KiGGS Wave 2 cross-sectional study - participant acquisition, response rates and representativeness. J Health Monit. 2018;3(1):78-91. PMID: 35586176 
  19. Fingerle V, Eiffert H, Gessner A, Göbel UB, Hofmann H, Hunfeld KP, et al. MIQ12: Lyme-Borreliose. Qualitätsstandards in der mikrobiologisch-infektiologischen Diagnostik. [MIQ12: Lyme borreliosis. Quality standards in microbiological-infectiological diagnostics]. Jena - München: Urban & Fischer; 2017. p. 1-68. German.
  20. R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2020. Available from: https://www.R-project.org
  21. Lange M, Hoffmann R, Mauz E, Houben R, Gößwald A, Rosario AS, et al. KiGGS Wave 2 longitudinal component - data collection design and developments in the numbers of participants in the KiGGS cohort. J Health Monit. 2018;3(1):92-107. PMID: 35586182 
  22. Medlock JM, Leach SA. Effect of climate change on vector-borne disease risk in the UK. Lancet Infect Dis. 2015;15(6):721-30.  https://doi.org/10.1016/S1473-3099(15)70091-5  PMID: 25808458 
  23. Kjær LJ, Soleng A, Edgar KS, Lindstedt HEH, Paulsen KM, Andreassen AK, et al. Predicting and mapping human risk of exposure to Ixodes ricinus nymphs using climatic and environmental data, Denmark, Norway and Sweden, 2016. Euro Surveill. 2019;24(9):1800101.  https://doi.org/10.2807/1560-7917.ES.2019.24.9.1800101  PMID: 30862329 
  24. Semenza JC, Suk JE. Vector-borne diseases and climate change: a European perspective. FEMS Microbiol Lett. 2018;365(2):fnx244.  https://doi.org/10.1093/femsle/fnx244  PMID: 29149298 
  25. Castiglia P, Mura I, Masia MD, Maida I, Solinas G, Muresu E. Indagine sieroepidemiologica sulla presenza di anticorpi anti-Borrelia burgdorferi in giovani del Nord-Sardegna. [Prevalence of antibodies to Borrelia burgdorferi in Sardinian teen-agers]. Ann Ig. 2004;16(1-2):103-8. PMID: 15554516 
  26. van Beek J, Sajanti E, Helve O, Ollgren J, Virtanen MJ, Rissanen H, et al. Population-based Borrelia burgdorferi sensu lato seroprevalence and associated risk factors in Finland. Ticks Tick Borne Dis. 2018;9(2):275-80.  https://doi.org/10.1016/j.ttbdis.2017.10.018  PMID: 29153461 
  27. Lernout T, Kabamba-Mukadi B, Saegeman V, Tré-Hardy M, de Laveleye M, Asikainen T, et al. The value of seroprevalence data as surveillance tool for Lyme borreliosis in the general population: the experience of Belgium. BMC Public Health. 2019;19(1):597.  https://doi.org/10.1186/s12889-019-6914-y  PMID: 31101034 
  28. Santino I, Sessa R, Del Piano M. Lyme borreliosis infection in Europe. Eur J Inflamm. 2006;4(2):69-75.  https://doi.org/10.1177/1721727X0600400201 
  29. Cuellar J, Dub T, Sane J, Hytönen J. Seroprevalence of Lyme borreliosis in Finland 50 years ago. Clin Microbiol Infect. 2020;26(5):632-6.  https://doi.org/10.1016/j.cmi.2019.10.003  PMID: 31622667 
  30. 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 
  31. Killilea ME, Swei A, Lane RS, Briggs CJ, Ostfeld RS. Spatial dynamics of lyme disease: a review. EcoHealth. 2008;5(2):167-95.  https://doi.org/10.1007/s10393-008-0171-3  PMID: 18787920 
  32. Rizzoli A, Silaghi C, Obiegala A, Rudolf I, Hubálek Z, Földvári G, et al. Ixodes ricinus and its transmitted pathogens in urban and peri-urban areas in Europe: new hazards and relevance for public health. Front Public Health. 2014;2:251.  https://doi.org/10.3389/fpubh.2014.00251  PMID: 25520947 
  33. Blazejak K, Raulf MK, Janecek E, Jordan D, Fingerle V, Strube C. Shifts in Borrelia burgdorferi (s.l.) geno-species infections in Ixodes ricinus over a 10-year surveillance period in the city of Hanover (Germany) and Borrelia miyamotoi-specific Reverse Line Blot detection. Parasit Vectors. 2018;11(1):304.  https://doi.org/10.1186/s13071-018-2882-9  PMID: 29776377 
  34. Kowalec M, Szewczyk T, Welc-Falęciak R, Siński E, Karbowiak G, Bajer A. Ticks and the city - are there any differences between city parks and natural forests in terms of tick abundance and prevalence of spirochaetes? Parasit Vectors. 2017;10(1):573.  https://doi.org/10.1186/s13071-017-2391-2  PMID: 29157278 
  35. 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 
  36. Cora M, Kaklıkkaya N, Topbaş M, Çan G, Yavuzyılmaz A, Tosun İ, et al. Determination of seroprevalence of Borrelia burgdorferi IgG in adult population living in Trabzon. Balkan Med J. 2017;34(1):47-52.  https://doi.org/10.4274/balkanmedj.2015.0478  PMID: 28251023 
  37. Okeyo M, Hepner S, Rollins RE, Hartberger C, Straubinger RK, Marosevic D, et al. Longitudinal study of prevalence and spatio-temporal distribution of Borrelia burgdorferi sensu lato in ticks from three defined habitats in Latvia, 1999-2010. Environ Microbiol. 2020;22(12):5033-47.  https://doi.org/10.1111/1462-2920.15100  PMID: 32452153 
  38. Zając V, Pinkas J, Wójcik-Fatla A, Dutkiewicz J, Owoc A, Bojar I. Prevalence of serological response to Borrelia burgdorferi in farmers from eastern and central Poland. Eur J Clin Microbiol Infect Dis. 2017;36(3):437-46.  https://doi.org/10.1007/s10096-016-2813-7  PMID: 27796648 
  39. Finch C, Al-Damluji MS, Krause PJ, Niccolai L, Steeves T, O’Keefe CF, et al. Integrated assessment of behavioral and environmental risk factors for Lyme disease infection on Block Island, Rhode Island. PLoS One. 2014;9(1):e84758.  https://doi.org/10.1371/journal.pone.0084758  PMID: 24416278 
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