Rickettsia aeschlimannii in Hyalomma marginatum Ticks, Germany

To the Editor: Rickettsia spp. of the spotted fever group cause worldwide emerging human infections known as tick-borne rickettsioses (1). Data on the occurrence and prevalence of Rickettsia in Germany are still limited (2). Six Rickettsia species have been reported to date (2). R. helvetica, R. felis, R. massiliae, and R. monacensis were detected with a relatively low prevalence in Ixodes ricinus ticks collected in southern Germany (2); R. raoultii was identified with high prevalence in the rapidly expanding area where D. reticulatus ticks are found (2). R. raoultii was recently recognized as an agent of tick-borne lymphadenopathy/Dermacentor-borne necrosis and erythema lymphadenopathy (3). Low prevalence of another tick-borne lymphadenopathy agent, R. slovaca, in Dermacentor marginatus ticks collected in southern Germany was recently reported (4)

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

Background: Lyme 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 Findings: Blood 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/Significance: This 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

Combined ELISA and line blot test results: Stratified seroprevalence of IgG antibodies against <i>B. burgdorferi</i> in children and adolescents aged 1 to 17 years and results of weighted bivariate logistic regression analysis of potential risk factors for seropositivity, 2003–2006, Germany.

*<p>unweighted.</p

Stratified seroprevalence of IgG antibodies against <i>B. burgdorferi</i> detected by ELISA in children and adolescents aged 1 to 17 years and results of weighted bivariate logistic regression analysis of potential risk factors for seropositivity, 2003–2006, Germany.

*<p>unweighted.</p

Results of weighted multivariable logistic regression analysis of potential risk factors for ELISA and combined ELISA and line blot seropositivity (n = 12,297 after exclusion of participants with missing data).

*<p>at mean age of 10.5 years.</p

Lyme-Borreliose: Forschungsbedarf und Forschungsansätze

Die Lyme-Borreliose ist in der nördlichen Hemisphäre nach aktuellem Kenntnisstand die häufigste durch Zecken übertragene Infektionskrankheit. Deutschland ist neben anderen europäischen Ländern ein Hochendemie-Gebiet, daher muss von einer hohen Krankheitslast und entsprechend hohen Kosten für das Gesundheitssystem ausgegangen werden. Der vorliegende Beitrag fasst die Ergebnisse eines interdisziplinären Workshops zur Lyme-Borreliose zusammen, der am 8. und 9. Oktober 2007 am Robert Koch-Institut (RKI) durchgeführt wurde. Ziel des Treffens war es, Forschungsdefizite zur Lyme-Borreliose zu identifizieren und Prioritäten für zukünftige Forschungsprojekte zu setzen. Handlungsbedarf wurde von den Teilnehmern auf unterschiedlichsten Gebieten gesehen: Diagnose, Epidemiologie, Immunologie, Klinik, Ökologie und Versorgungsforschung. Beispiele für Gebiete, die nach Expertenmeinung mit Vorrang zu bearbeiten sind, sind die Standardisierung der serologischen Tests, die Entwicklung von Markern für eine aktive Infektion, die Verbesserung der Datengrundlage zum Vorkommen der Lyme-Borreliose in Deutschland und Untersuchungen zur Bestimmung der Krankheitslast.Lyme borreliosis is currently the most frequent tick-transmitted zoonosis in the northern hemisphere. Germany and other European countries are regarded as highly endemic areas; therefore the burden of disease and consequently the costs for the health systems are considered to be high. This report summarises the results of an interdisciplinary workshop on Lyme borreliosis which aimed to identify research deficits and to prioritise areas which need to be addressed. Research needs have been recognised for different areas: diagnosis, epidemiology, immunology, clinics, ecology and health services research. Examples of research areas which have priority are the standardisation of diagnostic tests, the development of markers to detect an active infection, the improvement of the epidemiological database and the analysis of the burden of disease