NeuroSurv - NeuroSurv, a surveillance system on neurological infectious diseases in Belgium

NeuroSurv aims to develop a Belgian voluntary network of neurologists and neuro paediatricians, to collect, on a monthly basis, data on neuroinfectious diseases. First, the surveillance will focus on three diseases:

• Lyme neuroborreliosis (LNB)
• Tick-borne encephalitis (TBE)
• and acute flaccid paralysis (AFP).

Subsequently, the project might be extended to other neuroinfectious diseases. 

Neuroborreliosis surveillance

The ECDC (European Centre of Disease Control) has introduced surveillance of LNB since 2019 as the preferred tool to assess the burden of Lyme borreliosis^(1-2). Partly because of the complexity in diagnosing LNB (based on clinical symptoms and laboratory tests on serum and cerebrospinal fluid), the existing surveillance networks were unable to monitor the number of cases of LNB in Belgium, and a new system for data collection was needed.

Tick-borne encephalitis surveillance

TBE is considered an emerging disease due to its rising incidence and the expansion into new, previously uninfected, areas. In Belgium, surveillance of TBE in humans is based on the reporting of confirmed cases by the National Reference Centre, with few autochthonous TBE cases reported. However, an underdiagnoses of human cases is suspected, because mild infections likely go undiagnosed and laboratory investigation of viral encephalitis is generally limited. Enhancing surveillance of TBE in humans through neurologists (thereby raising awareness on the disease) will help to better understand and assess the human risk of TBE in Belgium.

Acute flaccid paralysis surveillance

Although poliovirus has been eradicated in Belgium since 2002, the risk of reintroduction has been evaluated by the WHO as “intermediate”, primarily due to poor surveillance. Surveillance in Belgium is based on notification of cases of AFP in children under the age of 15 years, regardless of cause. Approximately 19 cases are expected to be reported per year, but Belgium has been unable to reach this target since the start of the surveillance. Improving AFP surveillance in Belgium is vital and raising awareness of reporting requirements in practising clinicians is essential. In particular, paediatric neurologists have a higher probability of encountering AFP cases in under 15-year-olds.

^{1.Van den Wijngaard CC, Hofhuis A, Simoes M, Rood E, van Pelt W, Zeller H, et al. Surveillance perspective on Lyme borreliosis across the European Union and European Economic Area. Euro Surveill 2017;22(27).}

^{2. Burn L, Vyse A, Pilz A, Tran TMP, Fletcher MA, Angulo FJ, Gessner BD, Moïsi JC, Stark JH. Incidence of Lyme Borreliosis in Europe: A Systematic Review (2005-2020). Vector Borne Zoonotic Dis. 2023 Apr;23(4):172-194. doi:  10.1089/vbz.2022.0070. PMID: 37071407; PMCID: PMC10122234.}