Lyme borreliosis in the Netherlands - Lyme disease

georgia · medicine forum Guru Joined: 06 May 2005 Posts: 505

http://www.eurosurveillance.org/ew/2006/060622.asp#2

Lyme borreliosis in the Netherlands: strong increase in GP
consultations
and hospital admissions in past 10 years

A Hofhuis1 (Agnetha.Hofhuis@rivm.nl), JWB van der Giessen1, F
Borgsteede2, PR Wielinga1, DW Notermans1, W van Pelt1

1Centre for Infectious Disease Control, National Institute for Public
Health and the Environment Bilthoven, The Netherlands.
2Animal Sciences Group Wageningen University & Research, Lelystad, The
Netherlands
Lyme borreliosis (Lyme disease) is not notifiable in the Netherlands,
and so retrospective studies to determine the national occurrence of
tick bites, erythema migrans and Lyme borreliosis have been carried
out.
In 1995, 2002 and 2006, all general practitioners in the country
(approximately 8000 GPs with population coverage of 88%, 68% and 71%,
respectively) were asked to complete a postal questionnaire on tick
bites and erythema migrans case-patients seen in the previous year.
Annual counts of hospital admissions for Lyme borreliosis were obtained

from a database of the Dutch National Medical Register, which covers
nearly all hospitals in the Netherlands, using version 9 of the
International Classification of Diseases (ICD-9) code 104.8. This code
represents 'other spirochetal infections', and includes Lyme
borreliosis, leptospirosis, intestinal spirochetosis, non-syphilis
treponemas and Plaut-Vincent angina. A majority of 'code 104.8'
infections are Lyme borreliosis, because most of the other infections
have their own codes.

Based on the survey responses, the incidence of erythema migrans
consultations was estimated at 39 per 100 000 population in 1994, which

doubled to 74 per 100 000 in 2001, and tripled to 103 per 100 000 in
2005. The incidence of tick bite consultations increased from 191/100
000 people in 1994 to 372/100 000 in 2001, and continued to increase to

446/100 000 in 2005.

The greatest increase in tick bites and erythema migrans was seen in
the
south and northeast of the country, and several locations along the
coast in the west (Figure). Hospital admissions coincided
geographically
with locations where physicians were consulted for tick bites and
erythema migrans. The estimated annual number of hospital admissions
for
Lyme borreliosis increased from 170 patients in 1994 to 229 in 2001,
228
in 2002, 331 in 2003, 411 in 2004, and 435 patients in 2005, with the
greatest increase occurring between 2002 and 2004.

Figure. The geographical distribution of erythema migrans cases per 100

000 inhabitants of the Netherlands in 1994, 2001, 2005. Source: GP
survey

It is not certain that the increase of hospital admissions in recent
years represents a true doubling in the occurrence of Lyme borreliosis,

as a new guideline concerning diagnosis and treatment of Lyme disease
was published in mid-2003. This guideline encouraged treatment of
severe
Lyme borreliosis with intravenous antibiotics, which are usually
administered in hospital. Analyses of the role of and changes in
ecological risk factors and outdoor recreation, between regions and
years, are forthcoming.

Lyme borreliosis appears to be an increasingly important healthcare
problem in the Netherlands. Another study, carried out in the
Netherlands between 2000 and 2004, demonstrated that between 0.8% and
11% of the collected ticks were contaminated with Borrelia burgdorferi
sensu lato, varying between years and types of vegetation.
Contamination
of ticks with other pathogens like Anaplasma / Ehrlichia (1%-15%),
Rickettsia (45%-60%), and Babesia (0%-1%) was also found [1]. A
prospective study in sentinel general practices to determine the
regional differences in the level of infection of ticks removed from
patients for different tick-borne pathogens is planned for 2007.
Serological tests will also be performed for erythema migrans cases
seen
at these general practices and their clinical outcome will be observed.

To increase awareness about the severity, diagnosis and treatment of
Lyme disease, the results of the GP surveys in 1994, 2001 and 2005 were

communicated to all general practitioners in the Netherlands. This
information was also sent to municipal health centres, with extra
information about the availability of our new brochure about ticks and
Lyme disease. In 2002 and 2006, the RIVM issued a press release to
alert
the public about the increase in erythema migrans case-patients, which
received much media attention [2]. Both press releases referred to the
fact sheets and questions and answers on the RIVM website.

References:

1. Borgsteede F, Gaasenbeek C, de Boer A, Dijkstra J, Jagers op
Akkerhuis G, Dimmers w, et al. Het verloop van tekenpopulaties en de
besmetting met Borrelia en Ehrlichia, rapportnummer ASG 06/II00015/mak.

Lelystad: Animal Sciences Group WUR; 2006. [in Dutch]
(http://www.asg.wur.nl/NR/rdonlyres/5D0117E1-72EE-42F8-A6D2-5A1899A23716/23387/Tekenpopulatiesenhunbesmetting.pdf)
2. RIVM. Ziekte van Lyme neemt toe. Press release, 27 April 2006. [in
Dutch] (http://www.rivm.nl/persberichten/2006/toenameziektevanlyme.jsp)

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