Lyme borreliosis in England and Wales: 2008

The following information is derived from a dynamic database, remains provisional and is subject to revision.

To date, 813 new laboratory confirmed cases have been identified in England and Wales during 2008.  This gives an incidence of 1.52/100,000 total population, including the 91 cases known to have acquired their infections overseas. Excluding known overseas acquired cases, the total population incidence is 1.33/100,000 population.

The age, sex and seasonal distributions of serologically confirmed cases show trends similar to those reported in previous years. People of all ages are susceptible to Lyme borreliosis with the highest proportion of cases occurring in those aged between 30 and 59 years of age with the highest age-specific rates occurring in the 50-59 (2.04/100,000) and 60-69 (2.92/100,000) age groups. Similar numbers of infections are reported in both males and females across all age groups.

Seasonality

The seasonal pattern in 2008 was similar to that seen in 2007 and in earlier years. Approximately 60% of patients were tested in July, August and September; representing a likely peak of onset of symptoms in the early summer. This is consistent with the major tick feeding period which occurs in the late spring and early summer months. Twenty two percent of blood samples were received and tested during the last quarter of the year, again consistent with exposure to ticks and 'ticky' environments in the late summer and early autumn.

Symptoms

The most commonly reported clinical presentation was erythema migrans, which was reported by 32% of patients, with a history of one or more tick bites given by 325 (40%) of patients. Preliminary assessment of the data suggests that neuroborreliosis was identified in 40 (5%) of patients, of whom 65% reported a facial palsy.

Location of exposure

Approximately two-thirds of indigenously-acquired infections were reported in residents of the southern counties of England (the South-West and South-East Health Regions, with population-specific rates of 4.10/100,000 and 3.26/100,000 respectively). These include well known regional foci of Lyme borreliosis around the New Forest, Salisbury Plain, Exmoor, the South Downs, parts of Wiltshire and Berkshire and the Thetford Forest.

Table. Cases of Lyme borreliosis in 2008 by region

*  Provisional

** Rates calculated per 100,000 population, using ONS mid-year population estimates for 2007

Travel

Cases of Lyme borreliosis continue to be diagnosed following overseas travel; these cases are mainly in holidaymakers visiting the USA, Germany, France, Hungary, Switzerland, Italy and Austria, the Nordic countries  and other European countries including Poland, Slovenia, Slovakia, and the Czech Republic.

Last reviewed: 26 May 2009