Incidence of Lyme borreliosis in the Wurzburg region of Germany

To assess the incidence of Lyme borreliosis in Central Europe, a 12-month, prospective, population-based surveillance study of Lyme borreliosis was co nducted in the Wurzburg region of central Germany, following an aggressive awareness campaign. The diagnosis of Lyme borreliosis required the presence of (i) erythema migrans (diameter greater than or equal to 5 cm); (ii) lym phocytoma; or (iii) another specific manifestation including Lyme arthritis , neuroborreliosis, carditis or acrodermatitis chronica atrophicans in conj unction with serological confirmation. A total of 313 cases of Lyme borreli osis was diagnosed, giving an incidence of 111 cases/100000 inhabitants, th e highest rates occurring in children and elderly adults living in wooded a s opposed to agricultural areas. The incidence in city dwellers and inhabit ants of rural areas was not significantly different. Erythema migrans was t he only manifestation in 279 (89%) patients. Of the 34 patients with manife stations other than erythema migrans alone, 15 had arthritis, nine neurobor reliosis, six lymphocytoma, four acrodermatitis chronica atrophicans and on e carditis. Children were more likely than adults to have manifestations ot her than erythema migrans alone. Lyme borreliosis was very common in centra l Germany, and one of the most frequent bacterial infections. The observati on of more cases of arthritis than neuroborreliosis was similar to that in the USA. These results may be representative for many parts of central Euro pe and suggest the need for development of a vaccine against borreliosis ca used by European strains of Borrelin species.