Seropositivity of Lyme Borreliosis and Associated Risk Factors: A Population-Based Study in Children and Adolescents in Germany (KiGGS)

Abstract

BackgroundLyme borreliosis (LB) caused by spirochetes of the Borrelia burgdorferi sensu lato complex is the most common tick-borne disease in the northern hemisphere. Data on the distribution and on risk factors in Germany are sketchy.Methodology/Principal FindingsBlood samples of a nationwide population-based cross-sectional study from 2003–2006 in children and adolescents aged 1 to 17 years in Germany (KiGGS) were analysed (n = 12,614) to assess the seroprevalence of anti-Borrelia antibodies. Data from standardized interviews were used to assess potential risk factors. First, sera were screened for anti-Borrelia antibodies by ELISA. The overall prevalence was 4.8% (95% confidence interval (CI) 4.3–5.4%). Positive and borderline ELISA test results were confirmed by a line blot revealing a combined prevalence of 4.0% (95% CI 3.6–4.5%). Seroprevalence of ELISA was significantly higher in males (odds ratio (OR) = 1.37; CI 1.15–1.63) and in the southern part of Germany (OR = 1.41; CI 1.09–1.83), but significantly lower in children and adolescents with migration background (OR = 0.33; CI 0.24–0.44). Study participants from households with cats had a higher chance of seropositivity (OR = 6.7; CI 5.6–8.0). In a multivariable model the odds of seropositivity increases by 11% for every year of age for boys and 6% for girls.Conclusions/SignificanceThis survey is the first nationwide, representative seroprevalence survey of LB in children and young adolescents. The study shows that infections with Borrelia burgdorferi are endemic in all parts of Germany despite regional differences. Even at a young age children are exposed to tick bites including seropositivity. Encouraging a thorough check for ticks and promptly removal of ticks are the key public health strategies to reduce the risk of LB and other tick-borne diseases in children and adolescents. Further epidemiological studies are warranted to better understand the burden of disease related to LB.

Sero-epidemiological study of Lyme disease among high-risk population groups in eastern Slovakia

“…Several different studies confirmed the association between the occurrence of antibodies and outdoor activities, e.g., gardening [23] or contact with animals, especially among the cat owners in the households of German children [1] and dog owners [21]. Such a ativities as gardening and hunting appeared as insignificant risk factors in this study (P>0.05).…”

“…burgdorferi antibodies (P= 0.045). Generally, it was confirmed that men work more frequently in the outdoor environment than women [1,3,8,11].…”

“…complex which are transmitted by ticks, in Europe by Ixodes (I.) ricinus [1,2]. B. afzelii and B. garinii are the most common European circulating genospecies [3,4].…”

“…The main clinical manifestations of LB include: early localized disease (erythema migrans), early disseminated disease (neuroborreliosis, arthritis, carditis) and late disease (acrodermatitis chronica atrophicans, Lyme arthritis and late neuroborreliosis) [1,4].…”

“…Specific antibodies from the IgM class are formed 2-4 weeks after the onset of primary infection [9]. IgG antibodies appear in serum 6 weeks after infection, they reach their peak level after 4-6 months and are detectable in serum for more than next 10 years [1,7,10].…”