Incidence of medically attended Lyme borreliosis across endemic regions of six European countries (BOLD): a prospective multicentre active surveillance study

@article{halsby2026incidence,
  title = {{Incidence of medically attended Lyme borreliosis across endemic regions of six European countries (BOLD): a prospective multicentre active surveillance study}},
  author = {Kate Halsby and Alexandra Loew-Baselli and Anna Moniuszko-Malinowska and Franc Strle and Johan Sanmartin Berglund and Ye Tan and Katherine T. Schneider and Mark W. Cutler and Warren V. Kalina and Raphael Simon and Joppe Hovius and Alje P. van Dam and Brad D. Gessner and Frederick J. Angulo and Juanita Edwards and Andreas Pilz and Elizabeth Begier and James H. Stark and Lenka Dybova and Lenka Dybova and Miroslav Pavlasek and Daniela Verdanova and Joachim Weimer and Christine Kosch and Kai Mehltretter and Hans-Detlev Stahl and Viliam Cibik and Dagmar Zakova and Barbara Nieradko-Iwanicka and Dorota Bielska},
  journal = {The Lancet Regional Health - Europe},
  year = {2026},
  month = oct,
  doi = {10.1016/j.lanepe.2026.101907},
  url = {https://doi.org/10.1016/j.lanepe.2026.101907},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Incidence of medically attended Lyme borreliosis across endemic regions of six European countries (BOLD): a prospective multicentre active surveillance study
AU  - Kate Halsby
AU  - Alexandra Loew-Baselli
AU  - Anna Moniuszko-Malinowska
AU  - Franc Strle
AU  - Johan Sanmartin Berglund
AU  - Ye Tan
AU  - Katherine T. Schneider
AU  - Mark W. Cutler
AU  - Warren V. Kalina
AU  - Raphael Simon
AU  - Joppe Hovius
AU  - Alje P. van Dam
AU  - Brad D. Gessner
AU  - Frederick J. Angulo
AU  - Juanita Edwards
AU  - Andreas Pilz
AU  - Elizabeth Begier
AU  - James H. Stark
AU  - Lenka Dybova
AU  - Lenka Dybova
AU  - Miroslav Pavlasek
AU  - Daniela Verdanova
AU  - Joachim Weimer
AU  - Christine Kosch
AU  - Kai Mehltretter
AU  - Hans-Detlev Stahl
AU  - Viliam Cibik
AU  - Dagmar Zakova
AU  - Barbara Nieradko-Iwanicka
AU  - Dorota Bielska
PY  - 2026
DA  - 2026/10/26
JO  - The Lancet Regional Health - Europe
DO  - 10.1016/j.lanepe.2026.101907
UR  - https://doi.org/10.1016/j.lanepe.2026.101907
AB  - Background: Lyme borreliosis (LB) is endemic in many European countries. Comparing LB incidence between countries is challenging because case definitions and surveillance methodologies are inconsistently implemented. The prospective, epidemiological Burden of Lyme Disease (BOLD) study used active surveillance to characterise LB burden in Europe.  Methods: LB patients were evaluated at 14 healthcare practices in high LB incidence areas in six European countries based on EUCALB-derived case definitions using standard of care (SOC) laboratory diagnostics (April 2021–December 2022). Enrolled cases were interviewed for medical/care histories and underwent additional standardised laboratory testing. OspA types were determined by in-silico sequence analysis where possible.  Findings: Among participating sites, 797 LB cases were identified using SOC diagnostics. The incidence (per 100,000 population per year) of LB was 657 for 2021 and 661 for 2022. Incidence was highest in the Slovakian sites (2021, 3059; 2022, 1860) and lowest in the Polish (2021, 209) and German sites (2022, 75). When standardised laboratory testing was considered for disseminated cases, incidences remained relatively consistent for 5 of the 6 countries. Borrelia afzelii (serotype 2) was identified in 30/33 (91%) isolates.  Interpretation: LB incidence was high in this prospective epidemiological study spanning multiple countries. The heterogeneity in LB incidence across regions illustrates inherent difficulties in aggregating estimates and highlights a need for robust regional monitoring and reporting, and standardised methods. Public health interventions for the prevention of LB should be considered.  Funding: This analysis was supported and jointly funded by Valneva and Pfizer Inc. as part of their co-development of a Lyme Disease vaccine.
SN  - 2666-7762
ER  -