TY - JOUR T1 - Lyme borreliosis in Belgium: a cost-of-illness analysis JF - BMC Public Health Y1 - 2022 A1 - Geebelen, Laurence A1 - Brecht Devleesschauwer A1 - Tinne Lernout A1 - Katrien Tersago A1 - Yves Parmentier A1 - Herman Van Oyen A1 - Niko Speybroeck A1 - Philippe Beutels KW - Belgium KW - Disseminated Lyme borreliosis KW - Economic cost KW - Erythema migrans KW - Late Lyme borreliosis KW - Lyme borreliosis AB -

Background. Lyme borreliosis (LB) is the most common tick-borne disease in Europe and North America, yet its economic burden remains largely unknown. This study aimed to estimate the economic cost associated with the different clinical manifestations of LB in Belgium.

Methods. An incidence approach and societal perspective were used to estimate the total cost-of-illness for LB in Belgium. Costs were calculated for patients with erythema migrans (EM) or disseminated/late LB, including patients who developed post-treatment Lyme disease syndrome (PTLDS). Direct medical, direct non-medical (transportation & paid help) and indirect non-medical costs (productivity losses) were included in the analysis. Ambulatory cost data were collected through a prospective cohort study from June 2016 to March 2020, in which patients with LB were followed up 6 to 12 months after diagnosis. Hospitalization costs were retrieved from the Minimal Clinical Data registry, a mandatory registry for all Belgian hospitals, linked to the Minimal Financial Data registry. Costs were expressed in 2019 euros.

Results. The total annual cost associated with clinical manifestations of LB in Belgium was estimated at €5.59 million (95% UI 3.82–7.98). Of these, €3.44 million (95% UI 2.05–5.48) or 62% was related to disseminated/late LB diagnoses and €2.15 million (95% UI 1.30–3.26) to EM. In general, direct medical costs and productivity losses accounted for 49.8% and 46.4% of the total costs, respectively, while direct non-medical costs accounted for only 3.8%. The estimated mean costs were €193 per EM patient and €5,148 per disseminated/late LB patient. While patients with PTLDS seemed to have somewhat higher costs compared to patients without PTLDS, the number of patients was too small to have representative estimates.

Conclusions. We estimate the total annual direct medical costs, direct non-medical and indirect non-medical costs associated with LB to exceed €5.5 million per year, almost evenly distributed between EM (40%) and disseminated/late LB (60%). EM costs 26 times less per patient but occurs also 16 times more frequently than disseminated/late LB. The cost burden remains limited by comparison to other infectious diseases due to the relative lower incidence.

VL - 22 CP - 1 M3 - 10.1186/s12889-022-14380-6 ER - TY - JOUR T1 - No molecular detection of tick-borne pathogens in the blood of patients with erythema migrans in Belgium JF - Parasites & Vectors Y1 - 2022 A1 - Geebelen, Laurence A1 - Tinne Lernout A1 - Katrien Tersago A1 - Sanne Terryn A1 - Joppe W. Hovius A1 - Arieke Docters van Leeuwen A1 - Steven Van Gucht A1 - Speybroeck, Niko A1 - Sprong, Hein KW - Erythema migrans KW - Ixodes ricinus KW - Lyme borreliosis KW - Neoehrlichosis KW - Neoerhlichia mikurensis KW - Tick-borne pathogens AB -

Background

A number of tick-borne pathogens circulate in the Belgian tick population in addition to the causative agent of Lyme borreliosis. However, so far, only a few patients with tick-borne diseases other than Lyme borreliosis have been reported in Belgium. The aim of this study was to investigate the occurrence of other human tick-borne infections in Belgium and their possible clinical manifestation.

Methods

Patients with fever (> 37.5 °C) after a tick bite or those with erythema migrans (EM) were included in the study. EDTA-blood samples were screened for the presence of DNA from Borrelia burgdorferi sensu lato, Borrelia miyamotoi, Anaplasma phagocytophilum, Neoehrlichia mikurensis, spotted fever group rickettsiae (genus Rickettsia), Babesia spp., Bartonella spp., Spiroplasma ixodetis and tick-borne encephalitis virus, using multiplex PCR methods. A questionnaire on, among others, demographics and clinical symptoms, was also filled in.

Results

Over a period of 3 years, 119 patients with EM and 14 patients with fever after a recent tick bite were enrolled in the study. Three samples initially tested positive for N. mikurensis by quantitative PCR (qPCR), but the results could not be confirmed by other PCR methods, and repetition of the DNA extraction procedure and qPCR test was not successful. The qPCR test results for the other tick-borne pathogens were negative.

Conclusions

In general, only a few patients with fever after a tick bite could be identified. Although no tick-borne pathogens were detected, their occurrence cannot be excluded based on the limited number of patients and the limitations inherent to current methodologies. This study underscores the possibility of false-positive PCR results and the necessity for the development of multiple independent tools for the sensitive and specific detection of emerging tick-borne pathogens.

VL - 15 CP - 1 M3 - 10.1186/s13071-021-05139-w ER - TY - JOUR T1 - Non-specific symptoms and post-treatment Lyme disease syndrome in patients with Lyme borreliosis: a prospective cohort study in Belgium (2016–2020) JF - BMC Infectious Diseases Y1 - 2022 A1 - Geebelen, Laurence A1 - Tinne Lernout A1 - Brecht Devleesschauwer A1 - Benoît Kabamba-Mukadi A1 - Veroniek Saegeman A1 - Leïla Belkhir A1 - Paul De Munter A1 - Bénédicte Dubois A1 - Rene Westhovens A1 - Jean-Baptiste Giot A1 - Philippe Léonard A1 - Riet Vangheluwe A1 - Grégoire Wieërs A1 - Jean-Christophe Marot A1 - Frédéric Evrard A1 - Bénédicte Delaere A1 - Séverine Noirhomme A1 - Els Binnemans A1 - Johan Vanhoof A1 - Herman Van Oyen A1 - Niko Speybroeck A1 - Katrien Tersago KW - Disseminated Lyme borreliosis KW - Erythema migrans KW - Lyme borreliosis KW - Persisting non-specific symptoms KW - Post-treatment Lyme disease syndrome AB -

Background

Patients with Lyme borreliosis (LB) may report persisting non-specific symptoms such as fatigue, widespread musculoskeletal pain or cognitive difficulties. When present for more than 6 months and causing a reduction in daily activities, this is often referred to as post-treatment Lyme disease syndrome (PTLDS). This study aimed to compare the occurrence of symptoms between LB patients and controls, to estimate the proportion of LB patients developing PTLDS and to identify risk factors.

Methods

A prospective cohort study was set up including three subpopulations: patients with an erythema migrans (EM) (i) or disseminated/late LB (ii) and a non-LB control group (iii). At 6- and 12-months follow-up, the occurrence of several symptoms, including six symptoms used to define PTLDS, i.e. muscle pain, joint pain, fatigue, memory problems, difficulties concentrating and problems finding words, and impact on daily activities, was compared between LB patients and controls. Finally, the proportion of LB patients developing PTLDS as defined by the Infectious Disease Society of America was estimated, including a time frame for symptoms to be present.

Results

Although the risk of presenting PTLDS-related symptoms was significantly higher in EM patients (n = 120) compared to controls (n = 128) at 6 months follow-up, the risk of presenting at least one of these symptoms combined with impact on daily activities was not significantly higher in EM patients, at either 6- or 12-months follow-up. A significant association was found between disseminated/late LB (n = 15) and the occurrence of any PTLDS-symptom with an impact on daily activities at both time points. The proportion of patients with PTLDS was estimated at 5.9% (95% CI 2.7–12.9) in EM patients and 20.9% (95% CI 6.8–64.4) in patients with disseminated/late LB (RR = 3.53, 95% CI 0.98–12.68, p = 0.053). No significant risk factors were identified, which may be explained by small sample sizes.

Conclusions

In our study, PTLDS was present in both LB cohorts, yet with a higher percentage in disseminated/late LB patients. Additional research is needed into risk factors for and causes of this syndrome. In addition, development and validation of standardized methods to assess the PTLDS case definition, easily applicable in practice, is of great importance.

VL - 22 CP - 1 M3 - 10.1186/s12879-022-07686-8 ER - TY - RPRT T1 - TekenNet 2019 - Surveillance van tekenbeten in België Y1 - 2020 A1 - Katrien Tersago A1 - Mathias Leroy A1 - Tinne Lernout KW - burgersurveillance KW - Lyme-borreliose KW - preventie KW - risicokaart KW - teken KW - tekenbeten ER - TY - RPRT T1 - TiquesNet 2019 - Surveillance des morsures de tiques en Belgique Y1 - 2020 A1 - Katrien Tersago A1 - Mathias Leroy A1 - Tinne Lernout KW - borréliose de Lyme KW - carte de risque KW - morsures de tiques KW - prevention KW - surveillance citoyenne KW - tiques ER - TY - JOUR T1 - Combining primary care surveillance and a meta-analysis to estimate the incidence of the clinical manifestations of Lyme borreliosis in Belgium, 2015–2017 JF - Ticks and Tick-borne Diseases Y1 - 2019 A1 - Geebelen, Laurence A1 - Dieter Van Cauteren A1 - Brecht Devleesschauwer A1 - S Moreels A1 - Katrien Tersago A1 - Herman Van Oyen A1 - Speybroeck, Niko A1 - Tinne Lernout KW - Belgium KW - Clinical manifestations KW - Erythema migrans KW - incidence KW - Lyme borreliosis KW - systematic review AB -

Lyme borreliosis (LB) is an important tick-borne disease which can cause a broad range of symptoms mainly affecting the skin, the nervous system and the joints. This study aims to estimate the incidence of the different clinical manifestations of LB in Belgium. The incidence of erythema migrans (EM) was estimated through the network of sentinel general practices at 97.6/100,000 inhabitants (uncertainty interval [UI] 82.0–113.0) for the period 2015–2017. This result was used to estimate the incidence of other LB manifestations based on their proportional distribution (ratios) to EM reported in the neighboring countries of Belgium. To estimate these ratios, we performed a systematic review of studies published between February 1, 2008 and January 31, 2018 and pooled the results using a random effects meta-analysis. Six studies were retained in the systematic review, and the meta-analysis estimated the occurrence ratios for Lyme neuroborreliosis/EM, Lyme arthritis/EM and other manifestations/EM at 0.024 (95% confidence interval [CI] 0.016–0.037), 0.022 (95% CI 0.020–0.024) and 0.014 (95% CI 0.012–0.016) respectively. Applying these ratios to the EM incidence in Belgium resulted in an incidence estimation of 2.4/100,000 inhabitants (95% UI 1.5–3.7) for Lyme neuroborreliosis, 2.1/100,000 (95% UI 1.7–2.6) for Lyme arthritis and 1.4/100,000 (95% UI 1.1–1.7) for other less frequent manifestations. Some of these LB manifestations, other than EM, are more severe, hence these estimates are essential to assess the health burden and economic cost of LB which would be highly relevant for patients, healthcare providers and policymakers. As both over- and underestimation of different clinical LB manifestations remain possible due to characteristics of the primary surveillance systems and the disease itself, future studies to validate these estimates would be of great value.

VL - 10 CP - 3 M3 - 10.1016/j.ttbdis.2018.12.007 ER - TY - RPRT T1 - Epidemiologische surveillance van bartonellose – 2018 Y1 - 2019 A1 - Katrien Tersago A1 - Benoît Kabamba Mukadi ER - TY - JOUR T1 - Prevalence of pathogens in ticks collected from humans through citizen science in Belgium JF - Parasites & Vectors Y1 - 2019 A1 - Tinne Lernout A1 - Nick De Regge A1 - Katrien Tersago A1 - Manoj Fonville A1 - Vanessa Suin A1 - Sprong, Hein VL - 12 CP - 1 M3 - 10.1186/s13071-019-3806-z ER - TY - RPRT T1 - Surveillance épidémiologique de la bartonellose – 2018 Y1 - 2019 A1 - Katrien Tersago A1 - Benoît Kabamba Mukadi ER - TY - RPRT T1 - TekenNet 2018 - Surveillance van tekenbeten in België Y1 - 2019 A1 - Katrien Tersago A1 - Mathias Leroy A1 - Tinne Lernout ER - TY - RPRT T1 - TiquesNet 2018 - Surveillance des morsures de tiques en Belgique Y1 - 2019 A1 - Katrien Tersago A1 - Mathias Leroy A1 - Tinne Lernout ER - TY - RPRT T1 - Zoönosen en vectoroverdraagbare ziekten. Samenvattend jaarverslag 2018 Y1 - 2019 A1 - Tinne Lernout A1 - Amber Litzroth A1 - Javiera Rebolledo A1 - Katrien Tersago ER - TY - RPRT T1 - Zoonoses et maladies à transmission vectorielle. Synthèse annuelle 2018 Y1 - 2019 A1 - Tinne Lernout A1 - Amber Litzroth A1 - Javiera Rebolledo A1 - Katrien Tersago ER - TY - RPRT T1 - Epidemiologische surveillance van bartonellose – 2017 Y1 - 2018 A1 - Katrien Tersago A1 - Benoît Kabamba Mukadi ER - TY - RPRT T1 - Onderzoek naar ziektekiemen in teken - tekeninzameling 2017 Y1 - 2018 A1 - Tinne Lernout A1 - Katrien Tersago ER - TY - RPRT T1 - Recherche de pathogènes présents chez les tiques - Collecte de tiques 2017 Y1 - 2018 A1 - Tinne Lernout A1 - Katrien Tersago ER - TY - RPRT T1 - Surveillance épidémiologique de la bartonellose – 2017 Y1 - 2018 A1 - Katrien Tersago A1 - Benoît Kabamba Mukadi ER - TY - RPRT T1 - TekenNet 2017 - Surveillance van tekenbeten in België Y1 - 2018 A1 - Katrien Tersago A1 - Mathias Leroy A1 - Tinne Lernout PB - Sciensano CY - Brussel, België ER - TY - RPRT T1 - TiquesNet 2017 - Surveillance des morsures de tiques en Belgique Y1 - 2018 A1 - Katrien Tersago A1 - Mathias Leroy A1 - Tinne Lernout ER - TY - RPRT T1 - Zoönosen en vectoroverdraagbare ziekten. Samenvattend jaarverslag 2017 Y1 - 2018 A1 - Tinne Lernout A1 - Amber Litzroth A1 - Javiera Rebolledo A1 - Katrien Tersago ER - TY - RPRT T1 - Zoonoses et maladies à transmission vectorielle. Synthèse annuelle 2017 Y1 - 2018 A1 - Tinne Lernout A1 - Amber Litzroth A1 - Javiera Rebolledo A1 - Katrien Tersago ER - TY - JOUR T1 - Excess all-cause and influenza-attributable mortality in Europe, December 2016 to February 2017. JF - Euro Surveill Y1 - 2017 A1 - Vestergaard, Lasse S A1 - Nielsen, Jens A1 - Krause, Tyra G A1 - Espenhain, Laura A1 - Katrien Tersago A1 - Natalia Bustos Sierra A1 - Denissov, Gleb A1 - Innos, Kaire A1 - Virtanen, Mikko J A1 - Fouillet, Anne A1 - Lytras, Theodore A1 - Paldy, Anna A1 - Bobvos, Janos A1 - Domegan, Lisa A1 - O'Donnell, Joan A1 - Scortichini, Matteo A1 - de Martino, Annamaria A1 - England, Kathleen A1 - Calleja, Neville A1 - van Asten, Liselotte A1 - Teirlinck, Anne C A1 - Tønnessen, Ragnhild A1 - White, Richard A A1 - P Silva, Susana A1 - Rodrigues, Ana P A1 - Larrauri, Amparo A1 - Inmaculada Leon A1 - Farah, Ahmed A1 - Junker, Christoph A1 - Sinnathamby, Mary A1 - Pebody, Richard G A1 - Reynolds, Arlene A1 - Bishop, Jennifer A1 - Gross, Diane A1 - Adlhoch, Cornelia A1 - Penttinen, Pasi A1 - Mølbak, Kåre AB -

Since December 2016, excess all-cause mortality was observed in many European countries, especially among people aged ≥ 65 years. We estimated all-cause and influenza-attributable mortality in 19 European countries/regions. Excess mortality was primarily explained by circulation of influenza virus A(H3N2). Cold weather snaps contributed in some countries. The pattern was similar to the last major influenza A(H3N2) season in 2014/15 in Europe, although starting earlier in line with the early influenza season start.

VL - 22 CP - 14 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28424146?dopt=Abstract M3 - 10.2807/1560-7917.ES.2017.22.14.30506 ER - TY - JOUR T1 - The HUMTICK study: protocol for a prospective cohort study on post-treatment Lyme disease syndrome and the disease and cost burden of Lyme borreliosis in Belgium. JF - Arch Public Health Y1 - 2017 A1 - Geebelen, Laurence A1 - Tinne Lernout A1 - Kabamba-Mukadi, Benoît A1 - Saegeman, Veroniek A1 - Sprong, Hein A1 - Steven Van Gucht A1 - Beutels, Philippe A1 - Speybroeck, Niko A1 - Katrien Tersago AB -

BACKGROUND: In Belgium, different routine surveillance systems are in place to follow-up Lyme borreliosis trends. However, accurate data on the disease and monetary burden for the different clinical manifestations are lacking. Despite recommended antibiotic treatment, a proportion of Lyme patients report persisting aspecific symptoms for six months or more (e.g. fatigue, widespread musculoskeletal pain, cognitive difficulties), a syndrome now named "post-treatment Lyme disease syndrome" (PTLDS). Controversy exists on the cause, incidence and severity of PTLDS. This study aims to estimate the incidence of PTLDS in patients with Lyme borreliosis and to quantify the disease burden and economic costs associated with the different clinical manifestations of Lyme borreliosis in Belgium.

METHODS: The project is a prospective cohort study in which about 600 patients with an erythema migrans and 100 patients with disseminated Lyme borreliosis will be followed up. Questionnaires, including the SF-36 vitality and pain subscale, the Cognitive Failure Questionnaire and the EQ-5D-5L, will be used to collect information on acute and persisting symptoms and the impact on quality of life. Symptom frequency and severity will be compared with self-reported pre-Lyme health status, a control group and existing Belgian population norms. Additionally, information on the associated costs and possible risk factors for the development of PTLDS will be collected.

DISCUSSION: A study of the health burden will allow evaluation of the relative importance of Lyme borreliosis in Belgium and information on the economic cost will help to formulate cost-effective measures. There are only few prospective studies conducted estimating the incidence of PTLDS and even though discussion exists about the prevalence of subjective symptoms in the general population, a control group of non-Lyme borreliosis participants has often not been included.

VL - 75 U1 - https://www.ncbi.nlm.nih.gov/pubmed/28794875?dopt=Abstract M3 - 10.1186/s13690-017-0202-z ER - TY - RPRT T1 - TekenNet 2016 - Surveillance van tekenbeten in België Y1 - 2017 A1 - Katrien Tersago A1 - Mathias Leroy A1 - Tinne Lernout ER - TY - RPRT T1 - TiquesNet 2016 - Surveillance des morsures de tiques en Belgique Y1 - 2017 A1 - Katrien Tersago A1 - Mathias Leroy A1 - Tinne Lernout ER - TY - RPRT T1 - Zoönosen en vectoroverdraagbare ziekten. Jaarrapport 2015-2016 Y1 - 2017 A1 - Javiera Rebolledo A1 - Amber Litzroth A1 - Katrien Tersago A1 - Dominique Van Beckhoven A1 - Tinne Lernout ER - TY - RPRT T1 - Zoonoses et maladies à transmission vectorielle. Surveillance épidémiologique en Belgique, 2015-2016 Y1 - 2017 A1 - Javiera Rebolledo A1 - Amber Litzroth A1 - Katrien Tersago A1 - Dominique Van Beckhoven A1 - Tinne Lernout ER - TY - RPRT T1 - TekenNet 2015 - Surveillance van tekenbeten in België Y1 - 2016 A1 - Katrien Tersago A1 - Mathias Leroy A1 - Tinne Lernout ER - TY - RPRT T1 - TiquesNet 2015 - Surveillance des morsures de tiques en Belgique Y1 - 2016 A1 - Katrien Tersago A1 - Mathias Leroy A1 - Tinne Lernout ER - TY - RPRT T1 - Zoönosen en vectoroverdraagbare ziekten. Samenvattend jaaroverzicht 2017 Y1 - 0 A1 - Tinne Lernout A1 - Amber Litzroth A1 - Javiera Rebolledo A1 - Katrien Tersago ER -