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Goren A, Viljugrein H, Rivrud IM, Jore S, Bakka H, Vindenes Y, Mysterud A. The emergence and shift in seasonality of Lyme borreliosis in Northern Europe. Proc Biol Sci 2023; 290:20222420. [PMID: 36809802 PMCID: PMC9943644 DOI: 10.1098/rspb.2022.2420] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Climate change has had a major impact on seasonal weather patterns, resulting in marked phenological changes in a wide range of taxa. However, empirical studies of how changes in seasonality impact the emergence and seasonal dynamics of vector-borne diseases have been limited. Lyme borreliosis, a bacterial infection spread by hard-bodied ticks, is the most common vector-borne disease in the northern hemisphere and has been rapidly increasing in both incidence and geographical distribution in many regions of Europe and North America. By analysis of long-term surveillance data (1995-2019) from across Norway (latitude 57°58'-71°08' N), we demonstrate a marked change in the within-year timing of Lyme borreliosis cases accompanying an increase in the annual number of cases. The seasonal peak in cases is now six weeks earlier than 25 years ago, exceeding seasonal shifts in plant phenology and previous model predictions. The seasonal shift occurred predominantly in the first 10 years of the study period. The concurrent upsurgence in case number and shift in case timing indicate a major change in the Lyme borreliosis disease system over recent decades. This study highlights the potential for climate change to shape the seasonal dynamics of vector-borne disease systems.
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Affiliation(s)
- Asena Goren
- Centre for Ecological and Evolutionary Synthesis (CEES), Department of Biosciences, University of Oslo, PO Box 1066 Blindern, Oslo NO-0316, Norway
| | - Hildegunn Viljugrein
- Centre for Ecological and Evolutionary Synthesis (CEES), Department of Biosciences, University of Oslo, PO Box 1066 Blindern, Oslo NO-0316, Norway.,Norwegian Veterinary Institute, PO Box 64, NO-1431 Ås, Norway
| | - Inger Maren Rivrud
- Norwegian Institute for Nature Research (NINA), Sognsveien 68, NO-0855 Oslo, Norway
| | - Solveig Jore
- Zoonotic, Food and Waterborne Infections, The Norwegian Public Health Institute, PO Box 4404 Nydalen, NO-0403 Oslo, Norway
| | - Haakon Bakka
- Norwegian Veterinary Institute, PO Box 64, NO-1431 Ås, Norway
| | - Yngvild Vindenes
- Centre for Ecological and Evolutionary Synthesis (CEES), Department of Biosciences, University of Oslo, PO Box 1066 Blindern, Oslo NO-0316, Norway
| | - Atle Mysterud
- Centre for Ecological and Evolutionary Synthesis (CEES), Department of Biosciences, University of Oslo, PO Box 1066 Blindern, Oslo NO-0316, Norway.,Norwegian Institute for Nature Research (NINA), PO Box 5685 Sluppen, NO-7485 Trondheim, Norway
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Blanchard L, Jones-Diette J, Lorenc T, Sutcliffe K, Sowden A, Thomas J. Comparison of national surveillance systems for Lyme disease in humans in Europe and North America: a policy review. BMC Public Health 2022; 22:1307. [PMID: 35799156 PMCID: PMC9264653 DOI: 10.1186/s12889-022-13669-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lyme disease incidence is increasing in Europe, the USA, and Canada. In 2010, a comparison of surveillance systems for Lyme disease (LD) in humans in 28 European countries showed that systems highly varied, making epidemiological comparisons difficult. Details by country were not published. In 2018, one of LD clinical manifestations, neuroborreliosis, was added under European Union (EU) surveillance to standardise definitions. In this study, we identified and compared, 10 years after the European inventory, the characteristics of national surveillance systems and policies for LD in humans, with additional countries. METHODS Thirty-four European and North American countries were included. Information on national "traditional" systems (which compile data reported by clinicians and laboratories) and "public participatory" websites and mobile applications (which collect information directly from the public) were searched in MEDLINE, a systematic evidence map, and Google. An existing framework on LD surveillance was adapted to capture information on the administration level, indicators, reporting entities, coverage, and obligation to report. RESULTS A surveillance system was found for 29 (85%) countries. Twenty-four had a traditional system alone, one had a public participatory system alone, and the remaining had both. Among countries with traditional systems, 23 (82%) administered them at the national level. Nineteen (68%) required mandatory reporting. Sixteen (57%) used both clinicians and laboratories as reporting entities. Eighteen (64%) employed case definitions, most of which considered both neuroborreliosis and erythema migrans (n = 14). Others monitored the number of positive laboratory tests and/or patient consultations. Public participatory systems were only implemented in countries employing either also sentinels or voluntary surveys, or no traditional system, suggesting their use as a complementary tool. Only 56% of EU countries had neuroborreliosis as an indicator. CONCLUSION The situation remains similar to 2010 with persisting heterogeneity between systems, suggesting that countries prioritise different surveillance objectives for LD. Without a common indicator in Europe, it is difficult to get a clear epidemiological picture. We discuss four factors that potentially influence LD surveillance strategies: perceptions of severity, burden on resources, two-way communication, and the medical conflicts about LD. Addressing these with countries might help moving towards the adoption of common practices.
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Affiliation(s)
- Laurence Blanchard
- London School of Hygiene and Tropical Medicine, Faculty of Public Health Policy, London, WC1H 9SH, UK.
| | - Julie Jones-Diette
- University of York, Centre for Reviews and Dissemination, York, YO10 5DD, UK.,Present address: School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Theo Lorenc
- University of York, Centre for Reviews and Dissemination, York, YO10 5DD, UK
| | - Katy Sutcliffe
- University College London, UCL Social Research Institute, London, WC1H 0AA, UK
| | - Amanda Sowden
- University of York, Centre for Reviews and Dissemination, York, YO10 5DD, UK
| | - James Thomas
- University College London, UCL Social Research Institute, London, WC1H 0AA, UK
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Dahl V, Wisell KT, Giske CG, Tegnell A, Wallensten A. Lyme neuroborreliosis epidemiology in Sweden 2010 to 2014: clinical microbiology laboratories are a better data source than the hospital discharge diagnosis register. ACTA ACUST UNITED AC 2020; 24. [PMID: 31115310 PMCID: PMC6530252 DOI: 10.2807/1560-7917.es.2019.24.20.1800453] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundIn a study from 2013 that prioritised communicable diseases for surveillance in Sweden, we identified Lyme borreliosis as one of the diseases with highest priority. In 2014, when the present study was designed, there were also plans to make neuroborreliosis notifiable within the European Union.AimWe compared possibilities of surveillance of neuroborreliosis in Sweden through two different sources: the hospital discharge register and reporting from the clinical microbiology laboratories.MethodsWe examined the validity of ICD-10 codes in the hospital discharge register by extracting personal identification numbers for all cases of neuroborreliosis, defined by a positive cerebrospinal fluid-serum anti-Borrelia antibody index, who were diagnosed at the largest clinical microbiology laboratory in Sweden during 2014. We conducted a retrospective observational study with a questionnaire sent to all clinical microbiology laboratories in Sweden requesting information on yearly number of cases, age group and sex for the period 2010 to 2014.ResultsAmong 150 neuroborreliosis cases, 67 (45%) had received the ICD-10 code A69.2 (Lyme borreliosis) in combination with G01.9 (meningitis in bacterial diseases classified elsewhere), the combination that the Swedish National Board of Health and Welfare recommends for neuroborreliosis. All 22 clinical laboratories replied to our questionnaire. Based on laboratory reporting, the annual incidence of neuroborreliosis in Sweden was 6.3 cases per 100,000 in 2014.ConclusionThe hospital discharge register was unsuitable for surveillance of neuroborreliosis, whereas laboratory-based reporting was a feasible alternative. In 2018, the European Commission included Lyme neuroborreliosis on the list of diseases under epidemiological surveillance.
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Affiliation(s)
- Viktor Dahl
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Public Health Agency of Sweden, Stockholm, Sweden
| | | | - Christian G Giske
- Division of microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of clinical microbiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Anders Wallensten
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Public Health Agency of Sweden, Stockholm, Sweden
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Wolff C, Lange H, Feruglio S, Vold L, MacDonald E. Evaluation of the national surveillance of Legionnaires' disease in Norway, 2008-2017. BMC Public Health 2019; 19:1624. [PMID: 31795996 PMCID: PMC6889696 DOI: 10.1186/s12889-019-7981-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/21/2019] [Indexed: 11/23/2022] Open
Abstract
Background In Norway, Legionnaires’ disease is reportable upon clinical suspicion to public health authorities and mandatorily notifiable through the Norwegian surveillance system for communicable diseases (MSIS) for both clinicians and laboratories. In the summer of 2017, several European countries reported high notification rates for Legionnaires’ disease, which was not observed in Norway. We evaluated MSIS to assess if it meets its objectives of detecting cases and trends in incidence of Legionnaires’ disease. Methods We retrieved MSIS data from 2008 to 2017 and calculated timeliness as days from sampling to notification, and internal completeness for key variables as the proportion of observations with a value. Where possible, we assessed internal validity on the presence of a plausible value. To estimate external completeness and validity we linked MSIS with hospital reimbursement claims in the Norwegian Patient Registry. To assess acceptability and representativeness, we surveyed doctors in 39 hospitals on their units’ diagnostic and notification procedures, and their use of MSIS. Results There were 438 notified cases. Internal completeness and internal validity were high for key variables (≥95%). The median delay from sampling to notification was 4 days. There were 73 patients in MSIS only, 70 in the Norwegian Patient Registry only, and 351 in both registers. The external completeness of MSIS was 83% (95% CI 80–86%). For external validity, the positive predictive value of MSIS was 83% (95% CI 79–86%). Forty-seven respondents from 28 hospitals described testing procedures. These were inconsistent: 29 (62%) reported no systematic application of criteria for requesting legionella testing. Eighteen (38%) reported testing all patients with suspected pneumonia and a travel history. Thirty-one (66%) found the notification criteria clear. Conclusions Our results suggest that the surveillance in MSIS can detect incidence changes for Legionnaires’ disease over time, by place and person, but likely does not detect every case diagnosed in Norway. We recommend wider investigation of diagnostic procedures in order to improve representativeness and awareness of MSIS notification criteria among clinicians in order to improve acceptability of the surveillance. We also recommend a more comprehensive assessment of whether patients only registered in the Norwegian Patient Registry were true Legionnaires’ disease cases.
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Affiliation(s)
- Cecilia Wolff
- Division for Environmental Health and Infectious Disease Control, Norwegian Institute of Public Health, Postboks 222 Skøyen, 0213, Oslo, Norway. .,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | - Heidi Lange
- Division for Environmental Health and Infectious Disease Control, Norwegian Institute of Public Health, Postboks 222 Skøyen, 0213, Oslo, Norway
| | - Siri Feruglio
- Division for Environmental Health and Infectious Disease Control, Norwegian Institute of Public Health, Postboks 222 Skøyen, 0213, Oslo, Norway
| | - Line Vold
- Division for Environmental Health and Infectious Disease Control, Norwegian Institute of Public Health, Postboks 222 Skøyen, 0213, Oslo, Norway
| | - Emily MacDonald
- Division for Environmental Health and Infectious Disease Control, Norwegian Institute of Public Health, Postboks 222 Skøyen, 0213, Oslo, Norway
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Mysterud A, Heylen DJA, Matthysen E, Garcia AL, Jore S, Viljugrein H. Lyme neuroborreliosis and bird populations in northern Europe. Proc Biol Sci 2019; 286:20190759. [PMID: 31138073 PMCID: PMC6545076 DOI: 10.1098/rspb.2019.0759] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/03/2019] [Indexed: 12/17/2022] Open
Abstract
Many vector-borne diseases are transmitted through complex pathogen-vector-host networks, which makes it challenging to identify the role of specific host groups in disease emergence. Lyme borreliosis in humans is now the most common vector-borne zoonosis in the Northern Hemisphere. The disease is caused by multiple genospecies of Borrelia burgdorferi sensu lato bacteria transmitted by ixodid (hard) ticks, and the major host groups transmit Borrelia genospecies with different pathogenicity, causing variable clinical symptoms in humans. The health impact of a given host group is a function of the number of ticks it infects as well as the pathogenicity of the genospecies it carries. Borrelia afzelii, with mainly small mammals as reservoirs, is the most common pathogen causing Lyme borreliosis, and it is often responsible for the largest proportion of infected host-seeking tick nymphs in Europe. The bird-borne Borrelia garinii, though less prevalent in nymphal ticks, is more likely to cause Lyme neuroborreliosis, but whether B. garinii causes disseminated disease more frequently has not been documented. Based on extensive data of annual disease incidence across Norway from 1995 to 2017, we show here that 69% of disseminated Lyme borreliosis cases were neuroborreliosis, which is three times higher than predicted from the infection prevalence of B. garinii in host-seeking ticks (21%). The population estimate of migratory birds, mainly of thrushes, explained part of the annual variation in cases of neuroborreliosis, with a one-year time lag. We highlight the important role of the genospecies' pathogenicity and the host associations for understanding the epidemiology of disseminated Lyme borreliosis.
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Affiliation(s)
- Atle Mysterud
- Centre for Ecological and Evolutionary Synthesis (CEES), Department of Biosciences, University of Oslo, PO Box 1066, Blindern, 0316 Oslo, Norway
- Evolutionary Ecology Group, Department of Biology, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Dieter J. A. Heylen
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Diepenbeek, Belgium
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Erik Matthysen
- Evolutionary Ecology Group, Department of Biology, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | | | - Solveig Jore
- Department of Food, Water, Zoonotic and Vector-borne Infections, The Norwegian Public Health Institute, PO Box 4404, Nydalen, 0403 Oslo, Norway
| | - Hildegunn Viljugrein
- Centre for Ecological and Evolutionary Synthesis (CEES), Department of Biosciences, University of Oslo, PO Box 1066, Blindern, 0316 Oslo, Norway
- Norwegian Veterinary Institute, PO Box 750, Sentrum, 0106 Oslo, Norway
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