Estimated number of symptomatic Lyme borreliosis cases in Germany in 2021 after adjusting for under-ascertainment.

BACKGROUND: Although nine of 16 federal states in Germany conduct public health surveillance for Lyme borreliosis (LB), the extent of under-ascertainment is unknown. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Zoonotic diseases in South American camelids in England and Wales.

The number of South American camelids (SACs) in England and Wales is increasing and with this comes a risk of new and emerging infections. Although classified as livestock, these animals are also treated as pets and may be in regular contact with humans. This paper reviews zoonotic diseases that have been identified in SACs in England and Wales, and which pose a potential risk to human health. We also highlight the importance of surveillance continuing to capture information on infections in SACs for the protection of both public and animal health.

Risk factors for acute toxoplasmosis in England and Wales.

Over 300 cases of acute toxoplasmosis are confirmed by reference testing in England and Wales annually. We conducted a case-control study to identify risk factors for Toxoplasma gondii infection to inform prevention strategies. Twenty-eight cases and 27 seronegative controls participated. We compared their food history and environmental exposures using logistic regression to calculate odds ratios (OR) and 95% confidence intervals in a model controlling for age and sex. Univariable analysis showed that the odds of eating beef (OR 10·7, P < 0·001), poultry (OR 6·4, P = 0·01) or lamb/mutton (OR 4·9, P = 0·01) was higher for cases than controls. After adjustment for potential confounders a strong association between beef and infection remained (OR 5·6, P = 0·01). The small sample size was a significant limitation and larger studies are needed to fully investigate potential risk factors. The study findings emphasize the need to ensure food is thoroughly cooked and handled hygienically, especially for those in vulnerable groups.

Epidemiology of Toxocariasis in England and Wales.

Toxocara infection occurs through ingestion of parasite eggs excreted by dogs and cats, and can cause severe morbidity. The burden of disease in England and Wales is not well described, and the impact of public health campaigns conducted in the mid-1990s is uncertain. This paper uses data from two extensive databases to explore the trends in this disease in England and Wales from the 1970s to 2009.

The relationship between meteorological variables and sporadic cases of Legionnaires' disease in residents of England and Wales.

We studied the timing of occurrence of 1676 sporadic, community-acquired cases of Legionnaires' disease in England and Wales between 1993 and 2008, in relation to temperature, relative humidity, rainfall, windspeed and ultraviolet light using a fixed-stratum case-crossover approach. The analysis was conducted using conditional logistic regression, with consideration of appropriate lag periods. There was evidence of an association between the risk of Legionnaires' disease and temperature with an apparently long time lag of 1-9 weeks [odds of disease at 95th vs. 75th centiles: 3·91, 95% confidence interval (CI) 2·06-7·40], and with rainfall at short time lags (of 2-10 days) (odds of disease at 75th vs. 50th centiles: 1·78, 95% CI 1·50-2·13). There was some evidence that the risk of disease in relation to high temperatures was greater at high relative humidities. A higher risk of Legionnaires' disease may be indicated by preceding periods of warmer wetter weather.

The health burden of orphan zoonotic disease in the United Kingdom, 2005-2009.

'Orphan' zoonotic diseases attract disproportionately low scientific and public health attention for the impact that they can have. This article pulls together information on their health burden in the UK from routine and enhanced data sources. These diseases are heterogeneous in nature; some have very low case numbers (e.g. hydatid disease), whilst others affect hundreds of patients each year (e.g. toxoplasmosis). The number of deaths attributed to orphan zoonoses is relatively low, and the majority recorded in this article were caused by toxoplasmosis. There is a clear issue of under-reporting and under-diagnosis in the data sets presented, and further work should be carried out to obtain more accurate estimates of the prevalence of zoonotic infections. Joint human and veterinary studies are especially important for these diseases.

Enhanced surveillance for toxoplasmosis in England and Wales, 2008-2012.

A report on Toxoplasma gondii by the UK Advisory Committee on the Microbiological Safety of Food recommended that more accurate figures on the burden of disease in the UK are needed. We present the first 5 years of data from an enhanced surveillance scheme for toxoplasmosis in England and Wales. Between 2008 and 2012, 1824 cases were reported, with an average of 365 each year. There were 1109 immunocompetent cases, the majority presenting with lymphadenopathy, and 364 immunosuppressed cases, with central nervous system and systemic symptoms most frequently reported. There were also 190 pregnant and 33 congenital cases. Of the pregnant cases, 148 were asymptomatic (probably detected during screening), while 28 suffered a fetal loss or stillbirth. The enhanced surveillance system has led to an improvement in the detection of toxoplasmosis in England and Wales. However, numbers are still likely to be an underestimate, biasing towards the more severe infections.