Lyme Disease in Europe

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Abstract
In their article on the epidemiology of Lyme disease in southern Sweden, Berglund et al. (Nov. 16 issue)1 stated that borreliosis is not a notifiable disease in any European country. We would like to correct this statement. Notification of Lyme borreliosis has been mandatory in Slovenia (previously the northernmost republic of the former Yugoslavia) since 1987. Slovenia is a country of 20,256 km2 with a population of approximately 2 million. It has been recognized as a region of endemic Lyme borreliosis since 1986, and borrelial infections have replaced tick-borne meningoencephalitis as the most prevalent tick-borne illness.2 Recently, the presence of Borrelia afzelii, B. garinii, and B. burgdorferi has been documented in Ixodes ricinus ticks from the region3 as well as in the skin and cerebrospinal fluid of patients (unpublished data). In some regions, more than 40 percent of adult I. ricinus ticks were found to be infected with B. burgdorferi. Over the past several years, the Centers for Disease Control and Prevention case definition4 of Lyme disease, with some restrictive modifications, has been used for surveillance. In 1993, 2267 new cases fulfilling these criteria were registered (114 per 100,000 population), as were 2733 cases in 1994 (137 per 100,000). During the same period, the annual incidence was highest in the central part of the country, and erythema migrans was by far the most frequent manifestation.5

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