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. 2024 Sep 5;17(1):378.
doi: 10.1186/s13071-024-06449-5.

Incidence of symptomatic Borrelia burgdorferi sensu lato infection in Romania, 2018-2023

Frederick J Angulo  1 , Julia Olsen  2   3 , Veronica Purdel  4 , Mihaela Lupșe  5 , Adriana Hristea  6 , Violeta Briciu  5 , Emily Colby  2 , Andreas Pilz  7 , Kate Halsby  8 , Patrick H Kelly  2 , Gordon Brestrich  9 , Jennifer C Moïsi  10 , James H Stark  11
Affiliations

Incidence of symptomatic Borrelia burgdorferi sensu lato infection in Romania, 2018-2023

Frederick J Angulo et al. Parasit Vectors. .

Abstract

Background: Lyme borreliosis (LB), caused by Borrelia burgdorferi sensu lato (Bbsl), is the most common tick-borne disease in Europe. Although public health surveillance for LB has been conducted in Romania since 2007, the extent of under-detection of Bbsl infections by LB surveillance has not been estimated. We therefore estimated the under-detection of symptomatic Bbsl infections by LB surveillance to better understand the LB burden in Romania.

Methods: The number of incident symptomatic Bbsl infections were estimated from a seroprevalence study conducted in six counties (population 2.3 M) and estimates of the symptomatic proportion and duration of persistence of anti-Bbsl immunoglobulin G (IgG) antibodies. The number of incident symptomatic Bbsl infections were compared with the number of surveillance-reported LB cases to derive an under-detection multiplier, and then the under-detection multiplier was applied to LB surveillance data to estimate the incidence of symptomatic Bbsl infection from 2018 to 2023.

Results: We estimate that there were 1968 individuals with incident symptomatic Bbsl infection in the six counties where the seroprevalence study was conducted in 2020, compared with the 187 surveillance-reported LB cases, resulting in an under-detection multiplier of 10.5 (i.e., for every surveillance-reported LB case, there were 10.5 symptomatic incident Bbsl infections). The incidence of symptomatic Bbsl infection in the six counties was 86.9/100,000 population in 2023, similar to the incidence in 2018-2020 (86.0) and higher than in 2021-2022 (40.3).

Conclusions: There is a higher incidence of symptomatic Bbsl infection than is reported through public health surveillance for LB in Romania. Additional efforts are needed to strengthen disease prevention and address the important public health problem of LB.

Keywords: Disease burden; Epidemiology; Lyme borreliosis; Tick-borne disease.

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Conflict of interest statement

Frederick J. Angulo, Veronica Purdel, Emily Colby, Andreas Pilz, Kate Halsby, Patrick H. Kelly, Gordon Brestrich, Jennifer C. Moïsi, and James H. Stark are employees of Pfizer and may hold stock or stock options. Violeta Briciu, Mihaela Lupșe, and Adriana Hristea have previously received honoraria for lecturing activities from Pfizer. Violeta Briciu and Mihaela Lupșe are members of the ESCMID study group for Lyme borreliosis (ESGBOR). Adriana Hristea received a research grant from Pfizer to conduct tick-borne encephalitis research.

Figures

Fig. 1
Fig. 1
Pyramid of Borrelia burgdorferi sensu lato infections
Fig. 2
Fig. 2
Seroprevalence of anti-Borrelia burgdorferi sensu lato IgG antibodies from the 2019–2020 seroprevalence study in six counties in Romania
Fig. 3
Fig. 3
Number of surveillance-reported Lyme borreliosis cases, Romania, 2010–2023
See this image and copyright information in PMC

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