Abstract
Lyme borreliosis (LB) caused by Borrelia burgdorferi spp. is the most common human tick-borne disease in Europe. Although seroprevalence studies are conducted in several countries, rates of seroconversion and seroreversion are lacking, and they are essential to determine the risk of infection. Seropositivity was determined using a two-step approach—first, a serological screening assay, and in the event of a positive or equivocal result, a confirmatory immunoblot assay. Seroconversion and seroreversion rates were assessed from blood samples taken from participants included in two nation-wide population-based surveys. Moreover, the impact of antigen reactivity on seroreversion rates was assessed. The seroprevalence of antibodies reacting against B. burgdorferi spp. in the German population was 8.5% (95% CI 7.5–9.6) in 1997–99 and 9.3% (95% CI 8.3–10.4) in 2008–2011. Seroprevalence increased with age, up to 20% among 70–79 year-olds. The age-standardized seroprevalence remained the same. The yearly seroconversion rate was 0.45% (95% CI: 0.37–0.54), and the yearly seroreversion rate was 1.47% (95% CI: 1.24–2.17). Lower levels of antibodies were associated with seroreversion. Participants with a strong response against antigen p83 had the lowest odds on seroreversion. Given the yearly seroreversion rate of 1.47% and a seroprevalence up to 20% in the oldest age groups, at least 20% of the German population becomes infected with B. burgdorferi in their lifetime. The slight increase in seroprevalence between the two serosurveys was caused by an aging population.
Highlights
Lyme borreliosis (LB) is a disease caused by spirochaetal bacteria belonging to the Borrelia burgdorferi sensu latu complex transmitted by Ixodes spp ticks [1]
The overall weighted seroprevalence increased from 8.5% in 1997–1999 to 9.3% in 2008–2011
The study provides important data for assessing the distribution of disease burden for Lyme borreliosis in Germany. It enables a quantification of the incidence of B. burgdorferi infections
Summary
Lyme borreliosis (LB) is a disease caused by spirochaetal bacteria belonging to the Borrelia burgdorferi sensu latu complex (thereafter referred to as B. burgdorferi) transmitted by Ixodes spp ticks [1]. In North America, B. burgdorferi sensu stricto and B. mayonii are the only species causing LB, whereas in Europe, at least five species cause LB, namely B. burgdorferi sensu stricto, B. afzelii, B. bavariensis, B. garinii, and B. spielmanii. Clinical presentations can be observed in several organs [2]. Erythema migrans (EM), an early local infection of the skin, is the most common presentation and occurs several days to weeks after a tick bite [2,3]. The surveillance of Lyme borreliosis is problematic due to the fact that a clear stand-alone meaningful laboratory diagnostic test is not available, the need for notification among physicians, and the predictable effects of underreporting and diagnostic inaccuracy
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