MacDonald Emily, Vestrheim Didrik Frimann, White Richard A, Konsmo Kirstin, Lange Heidi, Aase Audun, Nygård Karin, Stefanoff Pawel, Aaberge Ingeborg, Vold Line
Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403, Oslo, Norway.
European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden.
BMC Public Health. 2016 Aug 5;16:729. doi: 10.1186/s12889-016-3346-9.
The approach to surveillance of Lyme borreliosis varies between countries, depending on the purpose of the surveillance system and the notification criteria used, which prevents direct comparison of national data. In Norway, Lyme borreliosis is notifiable to the Surveillance System for Communicable Diseases (MSIS). The current notification criteria include a combination of clinical and laboratory results for borrelia infection (excluding Erythema migrans) but there are indications that these criteria are not followed consistently by clinicians and by laboratories. Therefore, an evaluation of Lyme borreliosis surveillance in Norway was conducted to describe the purpose of the system and to assess the suitability of the current notification criteria in order to identify areas for improvement.
The CDC Guidelines for Evaluation of Surveillance Systems were used to develop the assessment of the data quality, representativeness and acceptability of MSIS for surveillance of Lyme borreliosis. Data quality was assessed through a review of data from 1996 to 2013 in MSIS and a linkage of MSIS data from 2008 to 2012 with data from the Norwegian Patient Registry (NPR). Representativeness and acceptability were assessed through a survey sent to 23 diagnostic laboratories.
Completeness of key variables for cases reported to MSIS was high, except for geographical location of exposureThe NPR-MSIS linkage identified 1047 cases in both registries, while 363 were only reported to MSIS and 3914 were only recorded in NPR. A higher proportion of cases found in both registries were recorded as neuroborreliosis in MSIS (84.4 %) than those cases found only in MSIS (20.1 %). The trend (average yearly increase or decrease in reported cases) of neuroborreliosis in MSIS was not significantly different from the trend for all other clinical manifestations recorded in MSIS in negative binomial regression (p = 0.3). The 16 surveyed laboratories (response proportion 70 %) indicated differences in testing practices and low acceptability of the notification criteria.
Given the challenges associated with diagnosing Lyme borreliosis, the selected notification criteria should be closely linked with the purpose of the surveillance system. Restricting reportable Lyme borreliosis to neuroborreliosis may increase validity, while a more sensitive case definition (potentially including erythema migrans) may better reflect the true burden of disease. We recommend revising the current notification criteria in Norway to ensure that they are unambiguous for clinicians and laboratories.
莱姆病的监测方法在不同国家有所不同，这取决于监测系统的目的和所采用的通报标准，这使得各国数据难以直接比较。在挪威，莱姆病需向传染病监测系统（MSIS）通报。当前的通报标准包括伯氏疏螺旋体感染（不包括游走性红斑）的临床和实验室检查结果的综合，但有迹象表明临床医生和实验室并未始终遵循这些标准。因此，对挪威莱姆病监测进行了评估，以描述该系统的目的，并评估当前通报标准的适用性，从而确定改进的领域。
采用美国疾病控制与预防中心（CDC）的监测系统评估指南，对MSIS监测莱姆病的数据质量、代表性和可接受性进行评估。通过审查1996年至2013年MSIS中的数据，以及将2008年至2012年MSIS数据与挪威患者登记处（NPR）的数据进行关联，来评估数据质量。通过向23个诊断实验室发送调查问卷来评估代表性和可接受性。
向MSIS报告的病例关键变量的完整性较高，但暴露地理位置除外。NPR-MSIS关联在两个登记处共识别出1047例病例，而363例仅报告给了MSIS，3914例仅记录在NPR中。在两个登记处均发现的病例中，在MSIS中被记录为神经型莱姆病的比例（84.4%）高于仅在MSIS中发现的病例（20.1%）。在负二项回归中，MSIS中神经型莱姆病的趋势（报告病例的年平均增减）与MSIS中记录的所有其他临床表现的趋势无显著差异（p = 0.3）。接受调查的16个实验室（回复率70%）表明检测方法存在差异，且通报标准的可接受性较低。
鉴于莱姆病诊断存在的挑战，所选的通报标准应与监测系统的目的紧密相关。将可报告的莱姆病限制为神经型莱姆病可能会提高有效性，而更敏感的病例定义（可能包括游走性红斑）可能能更好地反映疾病的真实负担。我们建议修订挪威当前的通报标准，以确保其对临床医生和实验室来说清晰明确。
