Lyme borreliosis in a French expatriate in India

Lyme borreliosis is known to be endemic in temperate countries of the Northern hemisphere but is rarely reported in other regions of the world. Here, we describe a rare diagnosis in a traveller returning from India, who presented with two erythema migrans.

Estimated number of symptomatic Lyme borreliosis cases in Germany in 2021 after adjusting for under-ascertainment

BACKGROUND

Although nine of 16 federal states in Germany conduct public health surveillance for Lyme borreliosis (LB), the extent of under-ascertainment is unknown.

OBJECTIVE

As a model for European countries that conduct LB surveillance, we sought to estimate the population-based incidence of symptomatic LB after adjusting for under-ascertainment.

METHODS

Estimating seroprevalence-derived under-ascertainment relies on data from seroprevalence studies, public health surveillance, and published literature. The number of symptomatic LB cases in states that conduct LB surveillance was estimated from studies reporting the seroprevalence of antibodies against Borrelia burgdorferi sensu lato, the proportion of LB cases that are asymptomatic, and the duration of antibody detection. The number of estimated incident symptomatic LB cases was compared with the number of surveillance-reported LB cases to derive under-ascertainment multipliers. The multipliers were applied to the number of 2021 surveillance-reported LB cases to estimate the population-based incidence of symptomatic LB in Germany.

RESULTS

Adjusting for seroprevalence-based under-ascertainment multipliers, the estimated number of symptomatic LB cases in states that conducted surveillance was 129,870 (408 per 100,000 population) in 2021. As there were 11,051 surveillance-reported cases in 2021 in these states, these data indicate there were 12 symptomatic LB cases for every surveillance-reported LB case.

CONCLUSIONS

We demonstrate that symptomatic LB is underdetected in Germany and that this seroprevalence-based approach can be applied elsewhere in Europe where requisite data are available. Nationwide expansion of LB surveillance would further elucidate the true LB disease burden in Germany and could support targeted disease prevention efforts to address the high LB disease burden.

Effectiveness of two doses of tick-borne encephalitis (TBE) vaccine

Vaccine effectiveness (VE) was consistently high following two doses (94.6–97.4%) and three doses (96.1%) of the tick-borne encephalitis (TBE) vaccine. These data support the public health value of providing two doses of the TBE vaccine to a traveller to an endemic area presenting with insufficient time to complete the full three-dose primary series.

Occurrence and Molecular Identification of Hemoparasites in Wild Mammals Kept in Rehabilitation Centers in Brazil

PURPOSE

Hepatozoonosis and piroplasmosis are diseases caused by apicomplexan protozoa that affect different types of animals, including mammals. The present study aimed to evaluate the occurrence of Hepatozoon spp. and piroplasms in wild mammals kept in captivity in rehabilitation centers in the states of Minas Gerais and Goiás, Brazil.

METHODS

For this, blood samples from 152 animals were collected and analyzed by conventional optical microscopy and polymerase chain reaction (PCR). In addition, positive PCR samples were submitted to sequencing for molecular characterization of the specimens found.

RESULTS

Microscopic analysis revealed 53 of the 152 animals (28.3%) parasitized by piroplasms. No Hepatozoon sp. was observed. On the other hand, using the primers HepF300/HepR900 and Piro1F/Piro5R, both amplifying fragments of the 18S rDNA gene, eight animals (5.2%) were positive for Hepatozoon spp. and 40 (26.3%) for piroplasms. From the sequencing of the positive samples Hepatozoon canis, Hepatozoon felis, Theileria cervi, Theileria equi and Cytauxzoon felis were identified. In addition to the aforementioned hemoparasites, some animals were found parasitized by microfilaria. Such data ratify the presence of hemoparasites in captive wild animals, and are unprecedented in the two geographical regions covered by the present study. 19.7% of mammals harbored ectoparasites of the genera Amblyomma and Rhipicephalus.

CONCLUSION

Wild mammals are infected by several pathogens that can also infect domestic animals, some of them potentially zoonotic which can directly contribute to mortality and species reduction. Therefore, a deep understanding of the parasites, the hosts and the diseases is extremely necessary so that prevention, control and treatment measures are effectively applied.

Tick-Borne Disease Prevention Behaviors Among Participants in a Tick Surveillance System Compared with a Sample Of Master Gardeners

Theory-based approaches to health communication and behavior are increasingly applied to interventions that address poor public tick-borne disease prevention knowledge and practices. We sought to understand the tick-borne disease prevention behaviors among participants in a crowdsourced passive tick surveillance system that employs theory-based messages about tick bite risk and prevention strategies. We administered an electronic survey to a randomly selected sample of passive surveillance system users and compared their responses to those from a nationwide sample of Master Gardeners (MG), a group with heighten tick exposure due to outdoor activity. Over 80% of TickSpotters respondents, and over 75% of MG respondents encountered a tick in the past year. Among both groups, tick checks were the most frequently practiced prevention behavior, with over 70% of people performing them most or all the time after outdoor activity. A greater proportion of MGs used skin repellents such as DEET or picaridin than TickSpotters users, but more than 70% of respondents from both groups reported that they never or only sometimes use permethrin-treatment on clothing, and nearly half of both groups reportedly used no peridomestic tick treatments. TickSpotters respondents overwhelmingly reported recording tick encounter information and saving specimens for identification and testing, while only a small percentage of MGs monitored their tick encounters. These findings suggest that while both TickSpotters and MG groups appear to be practicing some important tick bite prevention behaviors, there remain areas that could benefit from targeted theory-based interventional approaches.

Ecology and Epidemiology of Tickborne Pathogens, Washington, USA, 2011-2016

Tickborne diseases are rare in Washington, USA, and the ecology of these pathogens is poorly understood. We integrated surveillance data from humans and ticks to better describe their epidemiology and ecology. During 2011-2016, a total of 202 tickborne disease cases were reported in Washington residents. Of these, 68 (34%) were autochthonous, including cases of Lyme disease, Rocky Mountain spotted fever, tickborne relapsing fever, and tularemia. During May 2011-December 2016, we collected 977 host-seeking ticks, including Ixodes pacificus, I. angustus, I. spinipalpis, I. auritulus, Dermacentor andersoni, and D. variabilis ticks. The prevalence of Borrelia burgdorferi sensu stricto in I. pacificus ticks was 4.0%; of B. burgdorferi sensu lato, 3.8%; of B. miyamotoi, 4.4%; and of Anaplasma phagocytophilum, 1.9%. We did not detect Rickettsia rickettsii in either Dermacentor species. Case-patient histories and detection of pathogens in field-collected ticks indicate that several tickborne pathogens are endemic to Washington.

A Space-Time Permutation Scan Statistic for Evaluating County-Level Tickborne Disease Clusters in Indiana, 2009-2016

The purpose of this study was to identify age group, gender, rural-urban differences, and spatiotemporal clusters of tickborne disease diagnoses in Indiana. We analyzed retrospective surveillance data for Lyme disease, ehrlichiosis, Rocky Mountain spotted fever, typhus/rickettsial diseases, and tularemia diagnosed in Indiana from 2009 to 2016. We used chi-square cross tabulation to test gender, age group, and county classification (rural, rural-mixed, urban) differences in tickborne disease. We used the Kruskal-Wallis test with a post hoc Conover test to identify differences in summated tickborne disease by county classification. Finally, we used retrospective space-time permutation models in SaTScan to test the hypothesis of complete spatiotemporal randomness of tickborne disease. We found more Lyme disease diagnoses among Indiana residents 44 years of age or younger compared with those over 44 years. Conversely, more ehrlichiosis, Rocky Mountain spotted fever, and tularemia were reported in Indiana residents aged over 44 years of age. An analysis of summated tickborne disease by county showed significantly higher diagnosis reported in urban counties, compared with rural and rural-mixed counties. Finally, 2 significant clusters of summated tickborne disease were observed in south-central Indiana in 2014 and in western Indiana from 2010 to 2011. The detection of tickborne disease clusters, coupled with the finding that significant differences exist in the diagnosis of tickborne diseases between urban, rural, and rural-mixed counties in Indiana, suggests a need for continued surveillance of the counties observed within these clusters.

Antibiotic Treatment Response in Chronic Lyme Disease: Why Do Some Patients Improve While Others Do Not?

There is considerable uncertainty regarding treatment of Lyme disease patients who do not respond fully to initial short-term antibiotic therapy. Choosing the best treatment approach and duration remains challenging because treatment response among these patients varies: some patients improve with treatment while others do not. A previous study examined treatment response variation in a sample of over 3500 patients enrolled in the MyLymeData patient registry developed by LymeDisease.org (San Ramon, CA, USA). That study used a validated Global Rating of Change (GROC) scale to identify three treatment response subgroups among Lyme disease patients who remained ill: nonresponders, low responders, and high responders. The present study first characterizes the health status, symptom severity, and percentage of treatment response across these three patient subgroups together with a fourth subgroup, patients who identify as well. We then employed machine learning techniques across these subgroups to determine features most closely associated with improved patient outcomes, and we used traditional statistical techniques to examine how these features relate to treatment response of the four groups. High treatment response was most closely associated with (1) the use of antibiotics or a combination of antibiotics and alternative treatments, (2) longer duration of treatment, and (3) oversight by a clinician whose practice focused on the treatment of tick-borne diseases.

Testing practices and volume of non-Lyme tickborne diseases in the United States

Large commercial laboratories in the United States were surveyed regarding the number of specimens tested for eight tickborne diseases in 2008. Seven large commercial laboratories reported testing a total of 2,927,881 specimens nationally (including Lyme disease). Of these, 495,585 specimens (17%) were tested for tickborne diseases other than Lyme disease. In addition to large commercial laboratories, another 1051 smaller commercial, hospital, and government laboratories in four states (CT, MD, MN, and NY) were surveyed regarding tickborne disease testing frequency, practices, and results. Ninety-two of these reported testing a total of 10,091 specimens for four tickborne diseases other than Lyme disease. We estimate the cost of laboratory diagnostic testing for non-Lyme disease tickborne diseases in 2008 to be $9.6 million. These data provide a baseline to evaluate trends in tickborne disease test utilization and insight into the burden of these diseases.