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. 2018 Oct 8;8(1):14976.
doi: 10.1038/s41598-018-33136-0.

Incidence of notified Lyme borreliosis in Germany, 2013-2017

Julia Enkelmann  1   2 , Merle Böhmer  3 , Volker Fingerle  3 , Claudia Siffczyk  4 , Dirk Werber  5 , Martina Littmann  6 , Sophie-Susann Merbecks  7 , Carina Helmeke  8 , Sabine Schroeder  9 , Stefan Hell  10 , Uwe Schlotthauer  11 , Florian Burckhardt  12 , Klaus Stark  13 , Anika Schielke  13 , Hendrik Wilking  13
Affiliations

Incidence of notified Lyme borreliosis in Germany, 2013-2017

Julia Enkelmann et al. Sci Rep. .

Erratum in

  • Author Correction: Incidence of notified Lyme borreliosis in Germany, 2013-2017.
    Enkelmann J, Böhmer M, Fingerle V, Siffczyk C, Werber D, Littmann M, Merbecks SS, Helmeke C, Schroeder S, Hell S, Schlotthauer U, Burckhardt F, Stark K, Schielke A, Wilking H. Enkelmann J, et al. Sci Rep. 2021 Jun 21;11(1):13347. doi: 10.1038/s41598-021-92398-3. Sci Rep. 2021. PMID: 34155302 Free PMC article. No abstract available.

Abstract

Lyme borreliosis (LB) is the most commonly reported tick-borne disease in Germany. In 9/16 states, notification of erythema migrans (EM), acute neuroborreliosis (NB) and Lyme arthritis (LA) is mandatory. We describe incidence measures, time trends, geographical distribution and frequencies of manifestations to better understand LB epidemiology and target prevention measures. We used cases notified in the 9 states and confirmed by local health offices, 2013-2017, to calculate incidences by time, place and person. Altogether, we observed 56,446 cases. Disease onset peaked yearly in July. Incidence ranged from 26/100,000 (2015) to 41/100,000 (2013) with mean annual incidences 2013-2017 on district level between 0.5/100,000 and 138/100,000. Median age was 54 years with peaks in boys (5-9 years, mean incidence 36/100,000) and women (50-69 years, mean incidence 57/100,000). 95% experienced EM only, 2.7% NB and 2.1% LA. 54% were female, but more men had NB (56%) and LA (53%, p < 0.001). Hospitalisation was recorded for 10% of LA and 71% of NB cases. LB remains an important public health concern in Germany with marked regional variation. To facilitate early diagnosis and treatment, health authorities should raise awareness among physicians and promote prevention strategies among the general population: tick-bite-protection, prompt tick removal and medical consultation.

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Conflict of interest statement

V.F. is the head of the German National Reference Centre for Borrelia, Expert/head of Borrelia round robin testing (PCR, serology) for QCMID and INSTAND, a member of ESGBOR and ESCMID and an expert witness. V.F. has received honoraria/travel expenses for providing advanced training for medical personnel from DiaSorin, Seramun, Mikrogen and research funding from RKI, ESCMID and INSTAND.

Figures

Figure 1
Figure 1
Number of notified LB cases by year of notification and states grouped according to year of implementation or change in LB surveillance. Data from 2007 to 2012 was included to allow comparison. The following changes were made in the implementation: In 2009 LA was included as notifiable manifestation of LB in all notifying states, in 2011 notification was introduced in RP (July) and SL (August), in 2013 notification was introduced in BY (data included since 1st of April 2013) and extended in BE (data included in Figure 1 since 1st January 2013). *Thuringia (TH), Saxony (SN), Saxony-Anhalt (ST), Brandenburg (BB), Mecklenburg-Western Pomerania (MV), Rhineland-Palatinate (RP), Saarland (SL), Bavaria (BY), Berlin (BE).
Figure 2
Figure 2
Number of LB cases by month of disease onset and year of notification in 9 German states, 2013–2017.
Figure 3
Figure 3
Proportion of LB cases by month of disease onset and clinical manifestation in 9 German states, 2013–2017.
Figure 4
Figure 4
Notified LB incidence by district of residence (n = 56,011). Based on equal distance between lowest and highest recorded incidence, we formed 5 incidence categories. 435 cases with tick exposure in a foreign country were excluded. Among the remaining 33,153 cases with information on place of tick exposure in Germany, district of exposure corresponded with district of residence in 90.6%, 4.9% reported exposure in another district in the same state and 4.5% in another state in Germany.
Figure 5
Figure 5
LB incidence by age group and sex in 9 German states, 2013–2017.
Figure 6
Figure 6
Incidence of LA and different manifestations of NB by age group in 9 German states, 2013–2017.
See this image and copyright information in PMC

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