Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA.
Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc, 500 Arcola Rd, Collegeville, PA, USA.
Public Health. 2023 Jun;219:1-9. doi: 10.1016/j.puhe.2023.03.002. Epub 2023 Apr 17.
Although nine of 16 federal states in Germany conduct public health surveillance for Lyme borreliosis (LB), the extent of under-ascertainment is unknown.
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.
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.
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.
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.
尽管德国 16 个联邦州中有 9 个州对莱姆病（LB）进行公共卫生监测，但漏报程度尚不清楚。
作为对开展 LB 监测的欧洲国家的模型，我们试图在调整漏报率后估计基于人群的 LB 症状发病率。
通过血清流行率研究、公共卫生监测和已发表文献的数据来估计基于血清流行率的漏报率。通过报告针对 Borrelia burgdorferi sensu lato 抗体血清流行率、无症状 LB 病例比例和抗体检测持续时间的研究，估算开展 LB 监测的各州的 LB 症状病例数量。将估计的 LB 症状病例数量与监测报告的 LB 病例数量进行比较，得出漏报率的倍数。将这些倍数应用于 2021 年监测报告的 LB 病例数量，以估算德国 LB 症状的人群发病率。
根据血清流行率的漏报率倍数进行调整后，2021 年开展监测的各州报告的 LB 症状病例数量为 129870 例（每 10 万人中有 408 例）。2021 年，这些州共报告了 11051 例监测病例，这表明每报告 1 例 LB 病例，就有 12 例 LB 症状病例。
我们证明德国对 LB 症状病例的检测存在漏报，并且这种基于血清流行率的方法可以在欧洲其他有必要数据的地方应用。在德国扩大 LB 监测范围将进一步阐明 LB 疾病的真实负担，并可以支持有针对性的疾病预防措施，以解决 LB 疾病负担高的问题。
