International Journal of Epidemiology, Vol 26, 451-457, Copyright © 1997 by International Epidemiological Association
EL de Mik, W van Pelt, BD Docters-van Leeuwen, A van der Veen, JF Schellekens and MW Borgdorff
BACKGROUND: Lyme disease is caused by Borrelia burgdorferi which is
transmitted in Europe by the tick ixodes ricinus. Erythema migrans is a
skin lesion which is pathognomonic of Lyme disease. A retrospective study
was carried out to determine the geographical distribution of the
occurrence of tick bites and erythema migrans in the Netherlands and to
identify ecological risk factors. METHODS: In April 1995, all general
practitioners (GPs) in the Netherlands were asked to complete a postal
questionnaire on the number of tick bites and erythema migrans case-
patients seen in 1994 and the size of the practice. Reminders were sent to
non-responders. Information on ecological risk factors by local government
area was obtained from a geographical information system. RESULTS: The
response rate was 79.9%. In 1994, GPs reported seeing approximately 33,000
patients with tick bites and 6500 with erythema migrans. The incidence rate
of erythema migrans was estimated at 4.3 per 10,000 population. Ecological
risk factors for both tick bites and erythema migrans were the proportion
of the area covered by woods, sandy soil, dry uncultivated land, the number
of tourist-nights per inhabitant and sheep population density. The cattle
population density was a risk factor for erythema migrans. CONCLUSIONS:
Using simple methods, a crude estimate of the incidence rate of erythema
migrans was obtained rapidly, and high risk areas were identified. Lyme
disease appears to be an important problem in the Netherlands.
ARTICLES
The geographical distribution of tick bites and erythema migrans in general practice in The Netherlands
Department for Infectious Diseases Epidemiology, National Institute of Public Health and the Environment, BA Bilthoven, The Netherlands.
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