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Akmatov MK, Holstiege J, Dammertz L, Heuer J, Kohring C, Lotto-Batista M, Boeing F, Ghozzi S, Castell S, Bätzing J. Epidemiology of Lyme borreliosis based on outpatient claims data of all people with statutory health insurance, Germany, 2019. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 35959689 PMCID: PMC9373599 DOI: 10.2807/1560-7917.es.2022.27.32.2101193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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Affiliation(s)
- Manas K Akmatov
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Jakob Holstiege
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Lotte Dammertz
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Joachim Heuer
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Claudia Kohring
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
| | - Martin Lotto-Batista
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Friedrich Boeing
- Department of Computational Hydrosystems, Helmholtz Centre for Environmental Research, Leipzig, Germany
| | - Stéphane Ghozzi
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Jörg Bätzing
- Department of Epidemiology and Health Care Atlas, Central Research Institute of Ambulatory Health Care, Berlin, Germany
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2
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Guillot C, Bouchard C, Berthiaume P, Mascarenhas M, Sauvé C, Villeneuve CA, Leighton P. A Portrait of Sentinel Surveillance Networks for Vector-Borne Diseases: A Scoping Review Supporting Sentinel Network Design. Vector Borne Zoonotic Dis 2021; 21:827-838. [PMID: 34348055 DOI: 10.1089/vbz.2021.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Vector-borne diseases (VBDs) are continuing to emerge globally, requiring new surveillance systems to follow increasing VBD risk for human populations. Sentinel surveillance is an approach that allows tracking of disease risk through time using limited resources. However, there is no consensus on how best to design a sentinel surveillance network in the context of VBDs. We conducted a scoping review to compare VBD sentinel surveillance systems worldwide with the aim of identifying key design features associated with effective networks. Overall, VBD surveillance networks were used most commonly for malaria, West Nile virus, and lymphatic filariasis. A total of 45 criteria for the selection of sentinel unit location were identified. Risk-based criteria were the most often used, and logistic regression showed that using risk-based criteria dependent on host animals is particularly correlated with surveillance system sensitivity (p < 0.018). We identify tools that could prove valuable for sentinel surveillance network design, including a standardized approach for evaluating surveillance systems and a tool to prioritize criteria for selecting optimal geographic locations for spatial sentinel units.
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Affiliation(s)
- Camille Guillot
- Département de pathologie et microbiologie, Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculté de médecine vétérinaire, Université de Montréal, Québec, Canada.,Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Canada.,Centre de recherche en santé publique de l'Université de Montréal et du CIUSSS du Centre-Sud-de-l'île-de-Montréal (CReSP), Montreal, Canada
| | - Catherine Bouchard
- Département de pathologie et microbiologie, Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculté de médecine vétérinaire, Université de Montréal, Québec, Canada.,National Microbiology Laboratory, Public Health Agency of Canada, Public Health Risk Sciences Division, St. Hyacinthe, Canada
| | - Philippe Berthiaume
- National Microbiology Laboratory, Public Health Agency of Canada, Public Health Risk Sciences Division, St. Hyacinthe, Canada
| | - Mariola Mascarenhas
- National Microbiology Laboratory, Public Health Agency of Canada, Public Health Risk Sciences Division, Guelph, Canada
| | - Caroline Sauvé
- Département de pathologie et microbiologie, Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculté de médecine vétérinaire, Université de Montréal, Québec, Canada.,Centre de recherche en santé publique de l'Université de Montréal et du CIUSSS du Centre-Sud-de-l'île-de-Montréal (CReSP), Montreal, Canada
| | - Carol-Anne Villeneuve
- Département de pathologie et microbiologie, Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculté de médecine vétérinaire, Université de Montréal, Québec, Canada.,Centre de recherche en santé publique de l'Université de Montréal et du CIUSSS du Centre-Sud-de-l'île-de-Montréal (CReSP), Montreal, Canada
| | - Patrick Leighton
- Département de pathologie et microbiologie, Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Faculté de médecine vétérinaire, Université de Montréal, Québec, Canada.,Centre de recherche en santé publique de l'Université de Montréal et du CIUSSS du Centre-Sud-de-l'île-de-Montréal (CReSP), Montreal, Canada
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3
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Schwartz AM, Shankar MB, Kugeler KJ, Max RJ, Hinckley AF, Meltzer MI, Nelson CA. Epidemiology and cost of Lyme disease-related hospitalizations among patients with employer-sponsored health insurance-United States, 2005-2014. Zoonoses Public Health 2021; 67:407-415. [PMID: 32462811 DOI: 10.1111/zph.12699] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 01/14/2020] [Accepted: 02/03/2020] [Indexed: 11/27/2022]
Abstract
An estimated 300,000 cases of Lyme disease occur in the United States annually. Disseminated Lyme disease may result in carditis, arthritis, facial palsy or meningitis, sometimes requiring hospitalization. We describe the epidemiology and cost of Lyme disease-related hospitalizations. We analysed 2005-2014 data from the Truven Health Analytics MarketScan Commercial Claims and Encounters Databases to identify inpatient records associated with Lyme disease based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. We estimated the annual number and median cost of Lyme disease-related hospitalizations in the United States in persons under 65 years of age. Costs were adjusted to reflect 2016 dollars. Of 20,983,165 admission records contained in the inpatient databases during the study period, 2,823 (0.01%) met inclusion criteria for Lyme disease-related hospitalizations. Over half of the identified records contained an ICD-9-CM code for meningitis (n = 614), carditis (n = 429), facial palsy (n = 400) or arthritis (n = 377). Nearly 60% of hospitalized patients were male. The median cost per Lyme disease-related hospitalization was $11,688 (range: $140-$323,613). The manifestation with the highest median cost per stay was carditis ($17,461), followed by meningitis ($15,177), arthritis ($13,012) and facial palsy ($10,491). Median cost was highest among the 15- to 19-year-old age group ($12,991). Admissions occurring in January had the highest median cost ($13,777) for all study years. Based on extrapolation to the U.S. population, we estimate that 2,196 Lyme disease-related hospitalizations in persons under 65 years of age occur annually with an estimated annual cost of $25,826,237. Lyme disease is usually treated in an outpatient setting; however, some patients with Lyme disease require hospitalization, underscoring the need for effective prevention methods to mitigate these serious cases. Information from this analysis can aid economic evaluations of interventions that prevent infection and advances in disease detection.
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Affiliation(s)
- Amy M Schwartz
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Manjunath B Shankar
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kiersten J Kugeler
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Ryan J Max
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Alison F Hinckley
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Martin I Meltzer
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina A Nelson
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
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Active neuroborreliosis or inflammation: are the diagnostic guidelines at stake? Acta Neurol Belg 2019; 119:207-214. [PMID: 30556097 DOI: 10.1007/s13760-018-01067-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 12/12/2018] [Indexed: 10/27/2022]
Abstract
Neuroborreliosis can induce a variety of neurological syndromes: e.g., cranial neuritis, plexitis, radiculitis, meningitis, cerebellitis, … We report on five cases of patients with a diagnosis of neuroborreliosis based on clinical symptoms, serologic tests and MR imaging results. However, neither of them fulfils the diagnostic criteria for definite neuroborreliosis. Are the diagnostic criteria still valid or is there a need to revise them? Is our diagnosis correct? Are these cases post-Lyme auto-immune neuronal inflammation, and not due to still active spirochetal infection? Do we need to consider immunosuppressive therapy instead of third-generation cephalosporins?
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5
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The value of seroprevalence data as surveillance tool for Lyme borreliosis in the general population: the experience of Belgium. BMC Public Health 2019; 19:597. [PMID: 31101034 PMCID: PMC6525443 DOI: 10.1186/s12889-019-6914-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 04/29/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Serological surveillance, based on the measurement of the presence of specific antibodies in a given population, can be used in addition to traditional and routine disease surveillance methods. The added value of this has been largely documented for vaccine-preventable diseases, but to a lesser extent for vector-borne diseases. This study aimed to evaluate the utility of seroprevalence data as additional source of information on the epidemiology of Lyme borreliosis in Belgium. METHODS In total, 3215 residual blood samples collected in 2013-2015 were analysed with Liaison® Borrelia IgG kit (DiaSorin S.p.A, Saluggia, Italy). Positive and equivocal results were further examined with immunoblotting (recomLine Borrelia IgG kit, Mikrogen, Neuried, Germany). Crude prevalence estimates of equivocal and seropositive results were calculated and further adjusted accounting for clustered sampling and standardized for age, sex and population per province, according to the Belgian population structure in 2014. The effect of age, sex and region on seropositivity was assessed using log-binomial regression. RESULTS The overall weighted national seroprevalence for Borrelia burgdorferi sensu lato, adjusted for clustered sampling, age, sex and province was 1.06% (95%CI 0.67-1.67). Although not statistically significant, the highest prevalences were observed in men and in those younger than 15 years or older than 59 years of age. At provincial level, the seroprevalence estimates do not follow the geographical distribution of tick bites and diagnoses of Lyme borreliosis as detected through other surveillance systems. CONCLUSIONS Although the use of residual samples for seroprevalence estimates has several advantages, it seems to be a limited tool for serological surveillance of Lyme borreliosis in Belgium, other than follow-up of trends if repeated over time. A population-based sampling strategy might provide a more representative nationwide sample, but would be very time intensive and expensive. Seroprevalence studies within risk groups or risk areas in Belgium could provide a useful alternative approach to complement routine surveillance data of Lyme borreliosis.
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6
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Geebelen L, Van Cauteren D, Devleesschauwer B, Moreels S, Tersago K, Van Oyen H, Speybroeck N, Lernout T. Combining primary care surveillance and a meta-analysis to estimate the incidence of the clinical manifestations of Lyme borreliosis in Belgium, 2015–2017. Ticks Tick Borne Dis 2019; 10:598-605. [DOI: 10.1016/j.ttbdis.2018.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/22/2018] [Accepted: 12/23/2018] [Indexed: 02/07/2023]
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Septfons A, Goronflot T, Jaulhac B, Roussel V, De Martino S, Guerreiro S, Launay T, Fournier L, De Valk H, Figoni J, Blanchon T, Couturier E. Epidemiology of Lyme borreliosis through two surveillance systems: the national Sentinelles GP network and the national hospital discharge database, France, 2005 to 2016. Euro Surveill 2019; 24:1800134. [PMID: 30892181 PMCID: PMC6425552 DOI: 10.2807/1560-7917.es.2019.24.11.1800134] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Lyme borreliosis (LB) is the most frequent vector-borne disease in France. Since 2009, surveillance of LB is conducted by a sentinel network of general practitioners (GPs). This system, in conjunction with the national hospitalisation database was used to estimate the incidence and describe the characteristics of LB in France. AIM To describe the estimated incidence and trends in GP consultations and hospital admissions for LB in France and identify risk groups and high-incidence regions. RESULTS From 2011 to 2016, the mean yearly incidence rate of LB cases was 53 per 100,000 inhabitants (95% CI: 41-65) ranging from 41 in 2011 to 84 per 100 000 in 2016. A mean of 799 cases per year were hospitalised with LB associated diagnoses 2005-16. The hospitalisation incidence rate (HIR) ranged from 1.1 cases per 100,000 inhabitants in 2005 to 1.5 in 2011 with no statistically significant trend. We observed seasonality with a peak during the summer, important inter-regional variations and a bimodal age distribution in LB incidence and HIR with higher incidence between 5 and 9 year olds and those aged 60 years. Erythema migrans affected 633/667 (95%) of the patients at primary care level. Among hospitalised cases, the most common manifestation was neuroborreliosis 4,906/9,594 (51%). CONCLUSION Public health strategies should focus on high-incidence age groups and regions during the months with the highest incidences and should emphasise prevention measures such as regular tick checks after exposure and prompt removal to avoid infection.
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Affiliation(s)
- A Septfons
- Santé publique France, Paris, France,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - T Goronflot
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
| | - B Jaulhac
- Early Bacterial Virulence: Lyme borreliosis Group, Université de Strasbourg, CHRU Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, VBP EA 7290, Strasbourg, France,Centre National de Référence des Borrelia, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - V Roussel
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
| | - S De Martino
- Early Bacterial Virulence: Lyme borreliosis Group, Université de Strasbourg, CHRU Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, VBP EA 7290, Strasbourg, France,Centre National de Référence des Borrelia, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - S Guerreiro
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
| | - T Launay
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
| | - L Fournier
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
| | - H De Valk
- Santé publique France, Paris, France
| | - J Figoni
- Santé publique France, Paris, France
| | - T Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, Paris, France
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Garcia-Marti I, Zurita-Milla R, Harms MG, Swart A. Using volunteered observations to map human exposure to ticks. Sci Rep 2018; 8:15435. [PMID: 30337654 PMCID: PMC6194133 DOI: 10.1038/s41598-018-33900-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/04/2018] [Indexed: 01/01/2023] Open
Abstract
Lyme borreliosis (LB) is the most prevalent tick-borne disease in Europe and its incidence has steadily increased over the last two decades. In the Netherlands alone, more than 20,000 citizens are affected by LB each year. Because of this, two Dutch citizen science projects were started to monitor tick bites. Both projects have collected nearly 50,000 geo-located tick bite reports over the period 2006–2016. The number of tick bite reports per area unit is a proxy of tick bite risk. This risk can also be modelled as the result of the interaction of hazard (e.g. tick activity) and human exposure (e.g. outdoor recreational activities). Multiple studies have focused on quantifying tick hazard. However, quantifying human exposure is a harder task. In this work, we make a first step to map human exposure to ticks by combining tick bite reports with a tick hazard model. Our results show human exposure to tick bites in all forested areas of the Netherlands. This information could facilitate the cooperation between public health specialists and forest managers to create better mitigation campaigns for tick-borne diseases, and it could also support the design of improved plans for ecosystem management.
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Affiliation(s)
- Irene Garcia-Marti
- Department of Geo-Information Processing, Faculty of Geo-Information and Earth Observation (ITC), University of Twente, Enschede, The Netherlands.
| | - Raul Zurita-Milla
- Department of Geo-Information Processing, Faculty of Geo-Information and Earth Observation (ITC), University of Twente, Enschede, The Netherlands
| | - Margriet G Harms
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Arno Swart
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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9
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De Keukeleire M, Vanwambeke SO, Kabamba B, Belkhir L, Pierre P, Luyasu V, Robert A. Time trend of clinical cases of Lyme disease in two hospitals in Belgium, 2000-2013. BMC Infect Dis 2017; 17:748. [PMID: 29207940 PMCID: PMC5718134 DOI: 10.1186/s12879-017-2841-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/20/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND As several studies indicated an increase in Lyme disease (LD), notably in neighbouring countries, concerns have arisen regarding the evolution of Lyme disease in Belgium. In order to confirm or infirm the increase of LD in Belgium, we focused on hospital admissions of patients diagnosed with LD between 2000 and 2013 based on hospital admission databases from two hospitals in Belgium. METHODS Hospital databases are a stable recording system. We did a retrospective analysis of the medical files of patients hospitalized with Lyme disease in two Belgian hospitals between 2000 and 2013. RESULTS The annual number of cases of LD for the two studied Belgian hospitals remained stable between 2000 and 2013, ranging from 1 for the Cliniques universitaires Saint-Luc to 15 for the the Clinique Saint-Pierre. No increasing trend were noted in the estimated annual incidence rate but the average estimated annual incidence rate was higher for the hospital Saint-Pierre (8.1 ± 3.7 per 100,000 inhabitants) than Saint-Luc (2.2 ± 1.5 per 100,000 inhabitants). The number of hospital cases of LD peaked between June and November. CONCLUSIONS Based on hospital admissions with LD, no increasing trend was observed for the period 2000-2013 in the two studied Belgian hospitals. This is in line with other studies carried out in Belgium.
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Affiliation(s)
- Mathilde De Keukeleire
- Earth and Life Institute (ELI), Georges Lemaitre Center for Earth and Climate Research, Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgium
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle Epidémiologie et Biostatistique, Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL), Bruxelles, Belgium
| | - Sophie O. Vanwambeke
- Earth and Life Institute (ELI), Georges Lemaitre Center for Earth and Climate Research, Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgium
| | - Benoît Kabamba
- Division of Clinical Biology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCL), Bruxelles, Belgium
| | - Leila Belkhir
- Department of Internal medicine and infectious diseases, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCL), Bruxelles, Belgium
| | - Philippe Pierre
- Neurology Department, Cliniques St-Pierre, Ottignies, Belgium
| | - Victor Luyasu
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle Epidémiologie et Biostatistique, Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL), Bruxelles, Belgium
| | - Annie Robert
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle Epidémiologie et Biostatistique, Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL), Bruxelles, Belgium
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10
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Geebelen L, Lernout T, Kabamba-Mukadi B, Saegeman V, Sprong H, Van Gucht S, Beutels P, Speybroeck N, Tersago K. The HUMTICK study: protocol for a prospective cohort study on post-treatment Lyme disease syndrome and the disease and cost burden of Lyme borreliosis in Belgium. ACTA ACUST UNITED AC 2017; 75:42. [PMID: 28794875 PMCID: PMC5545865 DOI: 10.1186/s13690-017-0202-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 06/05/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND In Belgium, different routine surveillance systems are in place to follow-up Lyme borreliosis trends. However, accurate data on the disease and monetary burden for the different clinical manifestations are lacking. Despite recommended antibiotic treatment, a proportion of Lyme patients report persisting aspecific symptoms for six months or more (e.g. fatigue, widespread musculoskeletal pain, cognitive difficulties), a syndrome now named "post-treatment Lyme disease syndrome" (PTLDS). Controversy exists on the cause, incidence and severity of PTLDS. This study aims to estimate the incidence of PTLDS in patients with Lyme borreliosis and to quantify the disease burden and economic costs associated with the different clinical manifestations of Lyme borreliosis in Belgium. METHODS The project is a prospective cohort study in which about 600 patients with an erythema migrans and 100 patients with disseminated Lyme borreliosis will be followed up. Questionnaires, including the SF-36 vitality and pain subscale, the Cognitive Failure Questionnaire and the EQ-5D-5L, will be used to collect information on acute and persisting symptoms and the impact on quality of life. Symptom frequency and severity will be compared with self-reported pre-Lyme health status, a control group and existing Belgian population norms. Additionally, information on the associated costs and possible risk factors for the development of PTLDS will be collected. DISCUSSION A study of the health burden will allow evaluation of the relative importance of Lyme borreliosis in Belgium and information on the economic cost will help to formulate cost-effective measures. There are only few prospective studies conducted estimating the incidence of PTLDS and even though discussion exists about the prevalence of subjective symptoms in the general population, a control group of non-Lyme borreliosis participants has often not been included.
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Affiliation(s)
- Laurence Geebelen
- Epidemiology of Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Tinne Lernout
- Epidemiology of Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Benoît Kabamba-Mukadi
- Laboratory of Medical Microbiology, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Veroniek Saegeman
- Department of Microbiology, University Hospitals Leuven, Leuven, Belgium
| | - Hein Sprong
- Laboratory for Zoonoses and Environmental Microbiology, National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands
| | - Steven Van Gucht
- Viral Diseases, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research & Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Niko Speybroeck
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - Katrien Tersago
- Epidemiology of Infectious Diseases, Scientific Institute of Public Health (WIV-ISP), Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
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11
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De Keukeleire M, Robert A, Kabamba B, Dion E, Luyasu V, Vanwambeke SO. Individual and environmental factors associated with the seroprevalence of Borrelia burgdorferi in Belgian farmers and veterinarians. Infect Ecol Epidemiol 2016; 6:32793. [PMID: 27852421 PMCID: PMC5112351 DOI: 10.3402/iee.v6.32793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/30/2016] [Accepted: 10/08/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lyme disease (LD) is a common tick-borne disease in Europe. Diverse factors at various scales determine the spatial distribution of Borrelia burgdorferi infection risk and a better understanding of those factors in a spatially explicit framework is needed for disease management and prevention. While the ecology of ticks and the landscape favoring their abundance have been extensively studied, the environmental conditions favoring an intense contact with susceptible humans, including groups at risk, are sparse. The aim of this study is to assess which individual and environmental factors can favor B. burgdorferi infection in a Belgian group professionally at risk. METHODS Serological results of 127 veterinarians and farmers enrolled in this study were analyzed, taking into account their municipality of residence. Using binary logistic regression and considering interaction terms, the joint effects of landscape composition and configuration, and forest and wildlife management were examined. RESULTS Seven of the 127 workers were seropositive for LD, leading to a seroprevalence of 5.51%. Seropositivity was higher in older persons. The proportion of forest and semi-natural habitats and wetland had a positive impact on LD seroprevalence while arable land-grassland ecotones had a negative one. Our results confirmed the need to consider complex interactions between landscape variables in order to model risk. CONCLUSIONS Our data show that LD has to be considered as a risk for farmers and veterinarians. Rather than focusing either on ecological aspects of tick and pathogen distribution or on purely epidemiological aspects such as individual risk factors, our model highlights the role of human-environment interactions in LD risk assessment.
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Affiliation(s)
- Mathilde De Keukeleire
- Earth and Life Institute (ELI), Georges Lemaitre Center for Earth and Climate Research, Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgique.,Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL), Bruxelles, Belgique;
| | - Annie Robert
- Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL), Bruxelles, Belgique
| | - Benoît Kabamba
- Division of Clinical Biology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCL), Bruxelles, Belgique
| | - Elise Dion
- ARSIA (Association Régionale de Santé et d'Identification Animales), Ciney, Belgique
| | - Victor Luyasu
- Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL), Bruxelles, Belgique
| | - Sophie O Vanwambeke
- Earth and Life Institute (ELI), Georges Lemaitre Center for Earth and Climate Research, Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgique
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De Keukeleire M, Vanwambeke SO, Cochez C, Heyman P, Fretin D, Deneys V, Luyasu V, Kabamba B, Robert A. Seroprevalence of Borrelia burgdorferi, Anaplasma phagocytophilum, and Francisella tularensis Infections in Belgium: Results of Three Population-Based Samples. Vector Borne Zoonotic Dis 2016; 17:108-115. [PMID: 27828762 DOI: 10.1089/vbz.2016.1954] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To estimate the seroprevalence of Borrelia burgdorferi (Bb), Anaplasma phagocytophilum (Ap), and Francisella tularensis (Ft) in Belgium, we tested sera from three population-based samples in which exposure to pathogen is assumed to vary: 148 samples from workers professionally exposed, 209 samples from rural blood donors, and 193 samples from urban blood donors. Sera were tested using ELISA or the immunofluorescence assay test. The seroprevalence of Bb was 5.4% in workers professionally exposed, 2.9% in rural blood donors, and 2.6% in urban blood donors, which is similar to other studies. The fraction of negative results decreases significantly from urban blood donors and rural blood donors to workers. Regarding the seroprevalence of Ap, the cutoff titer of 1:64 recommended by the manufacturer may be set too low and produces artificially high seroprevalence rates. Using a cutoff titer of 1:128, the seroprevalence of Ap was estimated at 8.1% for workers professionally exposed, 6.2% for rural blood donors, and 5.7% for urban blood donors. Tularemia sera confirmed the presence of the pathogen in Belgium at 2.0% for workers and 0.5% for rural and urban blood donors. Our study is one of the few providing an estimation of the seroprevalences of Bb, Ap, and Ft in three different populations in Belgium, filling the gap in seroprevalence data among those groups. Our findings provide evidence that the entire Belgian population is exposed to Bb, Ap, and Ft infections, but a higher exposure is noticed for professionals at risk. Education on the risk factors for tick bites and preventive measures for both professionals exposed and the general population is needed.
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Affiliation(s)
- Mathilde De Keukeleire
- 1 Earth and Life Institute (ELI) , Georges Lemaitre Center for Earth and Climate Research, Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgium .,2 Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL) , Brussels, Belgium
| | - Sophie O Vanwambeke
- 1 Earth and Life Institute (ELI) , Georges Lemaitre Center for Earth and Climate Research, Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgium
| | - Christel Cochez
- 3 Research Laboratory for Vector-Borne Diseases, Queen Astrid Military Hospital , Brussels, Belgium
| | - Paul Heyman
- 3 Research Laboratory for Vector-Borne Diseases, Queen Astrid Military Hospital , Brussels, Belgium
| | - David Fretin
- 4 Veterinary and Agrochemical Research Center (CERVA) , Direction opérationnelle des maladies bactériennes, Zoonoses bactériennes des animaux de rente, Brussels, Belgium
| | - Véronique Deneys
- 5 Blood Transfusion Service of Mont-Godinne and CHU UCL Namur, Yvoir, Belgium
| | - Victor Luyasu
- 2 Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL) , Brussels, Belgium
| | - Benoît Kabamba
- 6 Division of Clinical Biology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL) , Brussels, Belgium
| | - Annie Robert
- 2 Pôle Epidémiologie et Biostatistique, Institut de Recherche Expérimentale et Clinique (IREC), Faculté de Santé Publique (FSP), Université catholique de Louvain (UCL) , Brussels, Belgium
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Assessing the sensitivity and representativeness of the Belgian Sentinel Network of Laboratories using test reimbursement data. ACTA ACUST UNITED AC 2016; 74:29. [PMID: 27504181 PMCID: PMC4976472 DOI: 10.1186/s13690-016-0145-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/25/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Belgian Sentinel Network of Laboratories (SNL) was created in 1983 in order to monitor trends in infectious diseases. Given the evolution of the surveillance system, such as the waivers, fusions and adhesions of laboratories over time, it is important to evaluate whether the SNL is still fit for purpose. This study aims to evaluate aspects of the sensitivity and representativeness of the SNL by means of a test coverage analysis. METHODS We estimated test coverage of the SNL using the ratio of reimbursed tests performed by participating laboratories to the total number of tests performed between 2007 and 2012, for 12 (groups of) pathogens. We further evaluated the geographical difference coverage of the SNL at regional and provincial levels. RESULTS We found that test coverage of the SNL was stable over time and close to, or greater than, 50 % for the 12 (groups of) pathogens studied. These results hold for the three regions of Belgium but not for all provinces. We showed that some provinces had a low test coverage for some pathogens and that test coverage was more variable over time at provincial level. CONCLUSIONS This sensitivity and representativeness study based on test coverage suggests that the SNL is capable to describe trend and to monitor changes in the 12 (groups of) pathogens studied both at national and regional levels. Therefore, the SNL is useful to contribute to estimate the burden of disease and to inform preventive measures. It should however be reinforced to allow to be used as an alert system at provincial level.
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Hofhuis A, Bennema S, Harms M, van Vliet AJH, Takken W, van den Wijngaard CC, van Pelt W. Decrease in tick bite consultations and stabilization of early Lyme borreliosis in the Netherlands in 2014 after 15 years of continuous increase. BMC Public Health 2016; 16:425. [PMID: 27216719 PMCID: PMC4877959 DOI: 10.1186/s12889-016-3105-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 05/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nationwide surveys have shown a threefold increase in general practitioner (GP) consultations for tick bites and early Lyme borreliosis from 1994 to 2009 in the Netherlands. We now report an update on 2014, with identical methods as for the preceding GP surveys. METHODS To all GPs in the Netherlands, a postal questionnaire was sent inquiring about the number of consultations for tick bites and erythema migrans diagnoses (most common manifestation of early Lyme borreliosis) in 2014, and the size of their practice populations. RESULTS Contrasting to the previously rising incidence of consultations for tick bites between 1994 and 2009, the incidence decreased in 2014 to 488 consultations for tick bites per 100,000 inhabitants, i.e., 82,000 patients nationwide. This survey revealed a first sign of stabilization of the previously rising trend in GP diagnosed erythema migrans, with 140 diagnoses per 100,000 inhabitants of the Netherlands. This equals about 23,500 annual diagnoses of erythema migrans nationwide in 2014. CONCLUSIONS In contrast to the constantly rising incidence of GP consultations for tick bites and erythema migrans diagnoses in the Netherlands between 1994 and 2009, the current survey of 2014 showed a first sign of stabilization of erythema migrans diagnoses and a decreased incidence for tick bite consultations.
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Affiliation(s)
- Agnetha Hofhuis
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Sita Bennema
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Margriet Harms
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Arnold J H van Vliet
- Environmental Systems Analysis Group, Wageningen University, Wageningen, The Netherlands
| | - Willem Takken
- Laboratory of Entomology, Wageningen University, Wageningen, The Netherlands
| | - Cees C van den Wijngaard
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Wilfrid van Pelt
- Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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