Department for Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany.
PLoS One. 2012;7(8):e41321. doi: 10.1371/journal.pone.0041321. Epub 2012 Aug 15.
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.
伯氏疏螺旋体（Borrelia burgdorferi）引起的莱姆病（LB）是北半球最常见的蜱传疾病。德国关于该病的分布和危险因素的数据很少。
方法/主要发现：对德国全国性基于人群的横断面研究 2003-2006 年儿童和青少年（1 至 17 岁）的血液样本（n=12614）进行分析，以评估抗伯氏疏螺旋体抗体的血清流行率。利用标准化访谈数据评估潜在危险因素。首先，通过 ELISA 法检测血清中的抗伯氏疏螺旋体抗体。总体流行率为 4.8%（95%置信区间[CI]为 4.3-5.4%）。阳性和边界 ELISA 检测结果通过免疫印迹法得到确认，总流行率为 4.0%（95%CI 为 3.6-4.5%）。ELISA 检测的血清阳性率在男性（比值比[OR]为 1.37；95%CI 为 1.15-1.63）和德国南部（OR 为 1.41；95%CI 为 1.09-1.83）较高，但在有移民背景的儿童和青少年中较低（OR 为 0.33；95%CI 为 0.24-0.44）。家中养猫的研究参与者有更高的血清阳性几率（OR 为 6.7；95%CI 为 5.6-8.0）。在多变量模型中，男孩每增加 1 岁，血清阳性的几率增加 11%，女孩增加 6%。
结论/意义：本研究是德国首例全国性、代表性的儿童和青少年莱姆病血清流行率调查。该研究表明，尽管存在地域差异，伯氏疏螺旋体在德国所有地区均有流行。儿童甚至在年幼时就可能接触到蜱虫叮咬，包括血清阳性。鼓励彻底检查蜱虫并迅速清除蜱虫是减少儿童和青少年莱姆病和其他蜱传疾病风险的关键公共卫生策略。还需要进一步开展流行病学研究，以更好地了解与莱姆病相关的疾病负担。
