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Incidence and management of presumption of Lyme borreliosis in Belgium: recent data from the sentinel network of general practitioners


An increasing incidence of tick bites and Lyme disease has been noticed internationally. The aims of this study are threefold: to estimate the incidence of tick bites and erythema migrans, to assess the compliance of the general practitioners (GPs) with the recommendations about the management of tick bites and erythema migrans, and finally, to have a look at the evolution over time, both on incidence and management. We used data of the Belgian network of sentinel general practitioners (SGP) to study the incidence rates in Belgium, the trend over time, and the degree of compliance of the SGP. The overall Belgian incidence rates in the SGP practice in 2008–2009 were 18.65 (95% CI 17.29–20.08) per 10,000 persons for tick bites and 9.02 (95% CI 8.08–10.03) for erythema migrans. The diagnostic management of patients with an asymptomatic tick bite has worsened over time, while the therapeutic management of erythema migrans has improved over time. The international increasing trend of the incidence was not observed in the SGP. There is still room for improvement concerning the approach of the GPs. Recommendations could help to improve their approach.

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  1. EUCALB—European Union concerted Action on Lyme Borreliosis (2009) Overview. EUCALB. Accessed 16 March 2010

  2. Hugli D, Moret J, Rais O, Moosmann Y, Erard P, Malinverni R, Gern L (2009) Tick bites in a Lyme borreliosis highly endemic area in Switzerland. Int J Med Microbiol 299(2):155–160. doi:10.1016/j.ijmm.2008.06.001

    PubMed  Article  Google Scholar 

  3. Linard C, Lamarque P, Heyman P, Ducoffre G, Luyasu V, Tersago K, Vanwambeke SO, Lambin EF (2007) Determinants of the geographic distribution of Puumala virus and Lyme borreliosis infections in Belgium. Int J Health Geogr 6(1):15–28. doi:10.1186/1476-072X-6-15

    PubMed  Article  Google Scholar 

  4. Nau R, Christen HJ, Eiffert H (2009) Lyme disease—current state of knowledge. Dtsch Arztebl Int 106(5):72–81. doi:10.3238/arztebl.2009.0072

    PubMed  Google Scholar 

  5. Smith RP, Takkinen J (2006) Lyme borreliosis: Europe-wide coordinated surveillance and action needed? Euro Surveill 11(6):E060622

    Google Scholar 

  6. Bacon RM, Kugeler KJ, Mead PS (2008) Surveillance for Lyme disease in the United States, 1992–2006. Department of Health & Human Services, Centers for Disease Control and Prevention, Atlanta, USA

  7. John A, Candis M, Beatriz M, Peter R, Sheila W (2009) Diagnostic challenges of early Lyme disease: lessons from a community case series. BMC Infect Dis 1(9):1–8. doi:10.1186/1471-2334-9-79

    Google Scholar 

  8. Steere AC, McHugh G, Damle N, Sikand VK, Weinstein A (2008) Prospective study of serologic tests for lyme disease. Commentary. Clin Infect Dis 47(2):188–197. doi:10.1086/589242

    PubMed  Article  Google Scholar 

  9. Fülöp B, Poggensee G (2008) Epidemiological situation of Lyme borreliosis in Germany: surveillance data from six Eastern German States, 2002 to 2006. Parasitol Res 103:117–120. doi:10.1007/s00436-008-1060-y

    Article  Google Scholar 

  10. Tijsse-Klasen E, Jacobs JJ, Swart A, Fonville M, Reimerink JH, Brandenburg AH, van der Giessen JW, Hofhuis A, Sprong H (2011) Small risk of developing symptomatic tick-borne diseases following a tick bite in The Netherlands. Parasit Vectors 4:17–24. doi:10.1186/1756-3305-4-17

    PubMed  Article  Google Scholar 

  11. Hofhuis A, van der Giessen JW, Borgsteede FH, Wielinga PR, Notermans DW, van Pelt W (2006) Lyme borreliosis in the Netherlands: strong increase in GP consultations and hospital admissions in past 10 years. Euro Surveill 11(6):E060622

    PubMed  Google Scholar 

  12. Ducoffre G (2010) Jaarverslag van de surveillance van infectieuze aandoeningen door een netwerk van peillaboratoria, 2009 + Epidemiologische Trends 1983-2008. Wetenschappelijk Instituut Volksgezondheid, Afdeling Epidemiologie, Brussel

  13. Hofhuis A, Harms MG, van de Giessen JW, Sprong H, Notermans DW, van Pelt W (2010) Ziekte van Lyme in Nederland 1994–2009. Aantal huisartsconsulten blijft toenemen. Is voorlichting en curatief beleid genoeg? Infectieziekten Bulletin 21(3):84–87

    Google Scholar 

  14. Dennis DT (2005) Rash decisions: Lyme disease, or not? Clin infect Dis 41(7):966–968

    PubMed  Article  Google Scholar 

  15. Bratton RL, Whiteside JW, Hovan MJ, Engle RL, Edwards FD (2008) Diagnosis and treatment of Lyme disease. Mayo Clin Pro 83(5):566–571

    Google Scholar 

  16. EUCALB—European Union concerted Action on Lyme Borreliosis (2009) Epidemiology of European Lyme Borreliosis. EUCALB. Accessed 16 March 2010

  17. Lindgren E, Jaenson TGT (2006) Lyme borreliosis in Europe: influences of climate and climate change, epidemiology, ecology and adaptation measures. World Health Organization, Regional Office for Europe, Copenhagen

    Google Scholar 

  18. Deckers JG, Paget WJ, Schellevis FG, Fleming DM (2006) European primary care surveillance networks: their structure and operation. Fam Pract 23(2):151–158. doi:10.1093/fampra/cmi118

    PubMed  Article  Google Scholar 

  19. Fleming DM, Schellevis FG, Van Casteren V (2004) The prevalence of known diabetes in eight European countries. Eur J Public Health 14(1):10–14

    PubMed  Article  CAS  Google Scholar 

  20. Lobet MP, Stroobant A, Mertens R, Van Casteren V, Walckiers D, Masuy-Stroobant G, Cornelis R (1987) Tool for validation of the network of sentinel general practitioners in the Belgian health care system. Int J Epidemiol 16(4):612–618

    PubMed  Article  CAS  Google Scholar 

  21. Van den Block L, Van Casteren V, Deschepper R, Bossuyt N, Drieskens K, Bauwens S, Bilsen J, Deliens L (2007) Nationwide monitoring of end-of-life care via the Sentinel Network of General Practitioners in Belgium: the research protocol of the SENTI-MELC study. BMC Palliat Care 6:6–13. doi:10.1186/1472-684X-6-6

    PubMed  Article  Google Scholar 

  22. Wauters H, Van Casteren V, Buntinx F (2000) Rectal bleeding and colorectal cancer in general practice: diagnostic study. BMJ 321(7267):998–999

    PubMed  Article  CAS  Google Scholar 

  23. Boffin N, Bossuyt N, Van Casteren V (2010) Kenmerken van de peilartsen en hun praktijk. Situatie in 2008 en vergelijking met voorgaande jaren. Wetenschappelijk Instituut Volksgezondheid, Brussel

    Google Scholar 

  24. EUCALB—European Union concerted Action on Lyme Borreliosis (2010) Diagnosis: Case definition. EUCALB. Accessed 16 March 2010

  25. EUCALB—European Union concerted Action on Lyme Borreliosis (2008) Serology: diagnostic guidelines. EUCALB. Accessed on 2 December 2011

  26. EUCALB—European Union concerted Action on Lyme Borreliosis (2010) Treatment. EUCALB. Accessed on 4 November 2010

  27. Van Casteren V (2009) 30 jaar Huisartsenpeilpraktijken-Registratie van de morbiditeit in België: Het Verleden, een Succes-De Toekomst, een Uitdaling. Wetenschappelijk Instituut Volksgezondheid, Brussel

    Google Scholar 

  28. Tiessen JJ, Reekers RA, Hofhuis A, Broer J (2008) Risico na een tekenbeet? Veel patiënten gaan ter geruststelling naar de huisarts. Infectieziekten Bull 19(9):281–284

    Google Scholar 

  29. Ecopedia (2009) Bebossingindex of bosindex. Accessed on 24 February 2011

  30. Letrilliart L, Ragon B, Hanslik T, Flahault A (2005) Lyme disease in France: a primary care-based prospective study. Epidemiol Infect 133(5):935–942. doi:10.1017/S0950268805004413

    PubMed  Article  CAS  Google Scholar 

  31. den Boon S, Schellekens JFP, Schouls LM, Suijkerbuijk AWM, Docters van Leeuwen B, van Pelt W (2004) Verdubbeling van het aantal consulten voor tekenbeten en Lyme-borreliose in de huisartsenpraktijk in Nederland. Ned Tijdschr Geneeskd 148(14):665–670

    Google Scholar 

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The Belgian network of sentinel GPs is supported by the Flemish and Walloon Ministry of Welfare, Public Health and Family. We wish to thank all sentinel GPs for providing the study data.

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The authors declare that they have no conflict of interest.

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Correspondence to K. Vanthomme.

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Vanthomme, K., Bossuyt, N., Boffin, N. et al. Incidence and management of presumption of Lyme borreliosis in Belgium: recent data from the sentinel network of general practitioners. Eur J Clin Microbiol Infect Dis 31, 2385–2390 (2012).

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  • Lyme Disease
  • Borrelia Burgdorferi
  • Lyme Borreliosis
  • Eastern Province
  • Erythema Migrans