22 1 76-87 2014

An Estimate of Lyme Borreliosis Incidence in Western Europe

Robert Alexander Sykes


Background: Lyme borreliosis (LB) is the most common zoonotic disease transmitted by ticks in the USA and Europe. This review aims to estimate the regional burden of LB in Western Europe. Data from previous publications were used to calculate the mean incidence. The mean incidence rates were then combined to estimate the regional burden and a population-weighted regional burden of disease based on the standardized incidence from the included studies and the total population at risk.

Methods: Reviews and surveillance reports identified by the initial database search were first assessed for eligibility by their title and abstract, and subsequently by a more detailed review of the source for the most recent data regarding LB. 11 sources of incidence data were included in the review, representing 17 countries in total. Incidence estimates were calculated from reported values and population data.

Results: Countries in Western Europe have a large variance in the incidence rates. The highest reported incidences for LB were reported in southern Sweden with 464 per 100 000 and the lowest in Italy of 0.001 per 100 000. The unweighted mean for the included data provided an incidence of 56.3 per 100 000 persons per year, equating to approximately 232 125 cases in one year throughout the region. The calculated population-weighted average incidence for the regional burden of LB in Western Europe was 22.05 cases per 100 000 person-years.

Conclusions: LB is an emerging disease and the most common zoonotic infection in Western Europe approaching endemic proportions in many European countries. The population-weighted incidence has been estimated by this study to be 22.04 per 100 000 person-years. Concordant and well-conducted surveillance and disease awareness should continue to be encouraged to monitor LB as tick numbers and activity increases.


Lyme Borreliosis, Incidence, Western Europe, Epidemiology

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O’Connell S, Granström M, Gray JS, Stanek G. Epidemiology of European Lyme borreliosis. Zentralbl Bakteriol. 1998 Mar;287(3):229-40.

Rizzoli A, Hauffe HC, Carpi G, Vourc'h GI, Neteler M, Rosà R. Lyme Borreliosis in Europe. Euro Surveill. 2011 Jul 7;16(27). pii: 19906.

Bergström S, Zückert WR. Chapter 6: Structure, function and biogenesis of the Borrellia cell envelope. In: Samuels DS, Radolf J, editors. Borrelia: Molecular Biology, Host Interaction and Pathogenesis. Norfolk, UK: Caister Academic Press; 2010.

Linard C, Lamarque P, Heyman P, Dicoffre G, Luyasu V, Tersago K, et al. Determinants of the geographic distribution of Puumala virus and Lyme borreliosis infections in Belgium. Int J Health Geogr. 2007 May 2;6:15. DOI: 10.1186/1476-072X-6-15.

Smith RP, Takkinen J. Lyme borreliosis: Europe-wide coordinated surveillance and action needed? Euro Surveill. 2006 Jun 22;11(6):E060622.1.

Aucott J, Morrison C, Munoz B, Rowe PC, Schwarzwalder A, West SK. Diagnostic challenges of early Lyme disease: lessons from a community case series. BMC Infect Dis. 2009 Jun 1;9:79. DOI: 10.1186/1471-2334-9-79. DOI: 10.1186/1471-2334-9-79.

Schnarr S, Franz JK, Krause A, Zeidler H. Infection and musculoskeletal conditions: Lyme borreliosis. Best Pract Res Clin Rheumatol. 2006 Dec;20(6):1099-118. DOI: 10.1016/j.berh.2006.08.006.

Santino I, Dastoli F, Sessa R, Del Piano M. Geographical incidence of infection with Borrelia burgdorferi in Europe. Panminerva Med. 1997 Sep;39(3):208-14.

Robertson JN, Gray JS, Stewart P. Tick bite and Lyme borreliosis risk at a recreational site in England. Eur J Epidemiol. 2000;16(7):647-52.

Lindgren E, Jaenson TG. Lyme Borreliosis in Europe: Influences of Climate and Climate Change, Epidemiology, Ecology and Adaptation Measures. World Health Organisation Europe. 2006. http://www.euro.who.int/__data/assets/pdf_file/0006/96819/E89522.pdf?ua=1 (accessed 18 August 2014).

Tälleklint L, Jaenson TG. Increasing geographical distribution and density of Ixodes ricinus (Acari: Ixodidae) in central and northern Sweden. J Med Entomol. 1998 Jul;35(4):521-6.

Slack GS, Mavin S, Yirrell D, Ho-Yen DO. Is Tayside becoming a Scottish hotspot for Lyme borreliosis? J R Coll Physicians Edinb. 2011 Mar;41(1):5-8. DOI: 10.4997/JRCPE.2011.102.

Lindgren E, Tälleklint 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 Feb;108(2):119-23. DOI: 10.2307/3454509.

Cottle LE, Mekonnen E, Beadsworth MBJ, Miller ARO, Beeching NJ. Lyme disease in a British referral clinic. QJM. 2012 Jun;105(6):537-43. DOI: 10.1093/qjmed/hcs003.

Steere AC, Taylor E, McHugh GL, Logigian EL. The overdiagnosis of Lyme disease. JAMA. 1993 Apr 14;269(14):1812-6. DOI: 10.1001/jama.1993.03500140064037.

Mead PS. Global epidemiology of Borrelia burgdorferi infections. In: Halperin JJ, editor. Lyme Disease: An Evidence-Based Approach. Oxford, UK: CABI; 2011. pp. 100-114.

Coumou J, van der Poll T, Speelman P, Hovius JW. Tired of Lyme borreliosis: Lyme borreliosis in the Netherlands. Neth J Med. 2011 Mar;69(3):101-11.

Tonks A. Lyme wars. BMJ. 2007 Nov 3;335(7626):910-2. DOI: 10.1136/bmj.39363.530961.AD.

Ballantyne C. The chronic debate over Lyme disease. Nat Med. 2008 Nov;14(11):1135-9. DOI: 10.1038/nm1108-1135.

Klempner MS, Hu LT, Evans J, Schmid CH, Johnson GM, Trevino RP, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med. 2001 Jul 12;345(2):85-92. DOI: 10.1056/NEJM200107123450202.

Klempner MS. Controlled trials of antibiotic treatment in patients with post-treatment chronic Lyme disease. Vector Borne Zoonotic Dis. 2002;2(4):255-63. DOI: 10.1089/153036602321653842.

Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006 Nov 1;43(9):1089-134. DOI: 10.1086/508667.

Steere AC, Angelis SM. Therapy for Lyme arthritis: Strategies for the treatment of antibiotic-refractory arthritis. Arthritis Rheum. 2006 Oct;54(10):3079-86. DOI: 10.1002/art.22131.

Ljøstad U, Mygland Å. The phenomenon of ‘chronic Lyme’; an observational study. Eur J Neurol. 2012 Aug;19(8):1128-35. DOI: 10.1111/j.1468-1331.2012.03691.x.

The World Bank. Western Europe. The World Bank website.; 2013 (updated 2014). http://go.worldbank.org/7HT50CFQO0 (accessed 18 March 2013).

Hubálek Z. Epidemiology of Lyme borreliosis. Curr Probl Dermatol. 2009;37:31-50. DOI: 10.1159/000213069.

EpiNorth. EpiNorthData: Lyme Borreliosis. EpiNorth Network - A Co-operation Project for Communicable Disease Control in Northern Europe website. http://www.epinorth.org/eway/default.aspx?pid=230&trg=Area_5279&MainArea_5260=5279:0:15,2937:1:0:0:::0:0&Area_5279=5291:44530::1:5290:1:::0:0&diseaseid=20 (accessed 18 August 2014).

Health Protection Agency. Lyme Borreliosis in England and Wales 2011. Public Health England website. 2011 (updated 21 September 2012). http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/LymeDisease/EpidemiologicalData/lym010Lymeborreliosis2011/ (accessed 18 March 2013).

The World Bank. Data: Countries and Economies. The World Bank website. 2013 (updated 2014). http://data.worldbank.org/country (accessed 18 March 2013).

Office for National Statistics. 2011 UK censuses. Office for National Statistics website. http://www.ons.gov.uk/ons/guide-method/census/2011/uk-census/index.html (accessed 19 March 2013).

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

Vanthomme K, Bossuyt N, Boffin N, Van Casteren V. Incidence and management of presumption of Lyme borreliosis in Belgium: recent data from the sentinel network of general practitioners. Eur J Clin Microbiol Infect Dis. 2012 Sep;31(9):2385-90. DOI: 10.1007/s10096-012-1580-3.

Letrilliart L, Ragon B, Hanslik T, Flahault A. Lyme disease in France: a primary care-based prospective study. Epidemiol Infect. 2005 Oct;133(5):935-42. DOI: http://dx.doi.org/10.1017/S0950268805004413.

Hofhuis A, Harms MG, van der Giessen JWB, Sprong H, Notermans DW, van Pelt W. Ziekte van Lyme in Nederland 1994-2009: aantal huisartsconsulten blijft toenemen; is voorlichting en curatief beleid genoeg? Infectieziekten Bull. 2010 Apr;21(3):84-7.

Bennet L, Halling A, Berglund J. Increased incidence of Lyme borreliosis in southern Sweden following mild winters and during warm, humid summers. Eur J Clin Microbiol Infect Dis. 2006 Jul;25(7):426-32. DOI: 10.1007/s10096-006-0167-2.

Smith R, O’Connell S, Palmer S. Lyme disease surveillance in England and Wales, 1986-1998. Emerg Infect Dis. 2000 Jul-Aug;6(4):404-7. DOI: 10.3201/eid0604.000416.

Jaenson TG, Jaenson DG, Eisen L, Petersson E, Lindgren E. Changes in the geographical distribution and abundance of the tick Ixodes ricinus during the past 30 years in Sweden. Parasit Vectors. 2012 Jan 10;5:8. DOI: 10.1186/1756-3305-5-8.

Daniel M, Danielová V, Kríz B, Jirsa A, Nozicka J. Shift of the tick Ixodes ricinus and tick-borne encephalitis to higher altitudes in central Europe. Eur J Clin Microbiol Infect Dis. 2003 May;22(5):327-8. DOI: 10.1007/s10096-003-0918-2.

Estrada-Peña A, Ayllón N, de la Fuente J. Impact of climate trends on tick-borne pathogen transmission. Front Physiol. 2012 Mar 27;3:64. DOI: 10.3389/fphys.2012.00064.

Cumming GS. Comparing climate and vegetation as limiting factors for species ranges of African ticks. Ecology. 2002;83:255-68. DOI: 10.2307/2680136.

Gray JS, Kahl O, Robertson JN, Daniel M, Estrada-Peña A, Gettinby G, et al. Lyme borreliosis habitat assessment. Zentralbl Bakteriol. 1998 Mar;287(3):211-28.

EUCALB. European Concerted Action on Lyme Borreliosis. EUCALB website. 2013 (updated 16 June 2014). http://www.eucalb.com/ (accessed 20 March 2013).

Pascucci I, Cammà C. Lyme disease and the detection of Borrelia burgdorferi genospecies in Ixodes ricinus ticks from central Italy. Vet Ital. 2010 Apr-Jun;46(2):173-80.

HILYSENS. Background. Highly sensitive and specific low-cost lab-on-a-chip system for Lyme disease diagnosis website. 2010. http://www.hilysens.eu/the_project/background (accessed 20 March 2013).

Stanek G, Fingerle V, Hunfield KP, Jaulhac B, Kaiser R, Krause A, et al. Lyme borreliosis: clinical case definitions for diagnosis and management in Europe. Clin Microbiol Infect. 2011 Jan;17(1):69-79. DOI: 10.1111/j.1469-0691.2010.03175.x.x


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