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Lyme disease is the most common vector-borne human infection in England and Wales. As elsewhere in northern Europe, the spirochaetes (Borrelia burgdorferi) are transmitted by the hard bodied tick, Ixodes ricinus, commonly known as deer or sheep ticks.
Habitats suitable for acquiring infection occur in temperate regions of the northern hemisphere, usually in forested woodland or heathland areas which support the life-cycles of ticks and the small mammals and birds that are the reservoir hosts for B. burgdorferi.
Several pathogenic genospecies of B. burgdorferi have been identified in Europe and there is evidence for some variation in the types of clinical presentation caused by these different genospecies.
Lyme disease is monitored in England and Wales through routine surveillance. Data is published in the quarterly Health Protection Report and annually in the UK Zoonoses Report.
Cases of Lyme disease are not statutorily notifiable by medical practitioners in England, Wales and Northern Ireland. However, since October 2010 under the Health Protection (Notification) Regulations 2010, every microbiology laboratory (including those in the private sector) in England is required to notify all laboratory diagnoses of Lyme disease to Public Health England.
A Lyme disease enhanced surveillance scheme ran between 1997 and 2003 in England to improve reporting and to collect additional clinical and epidemiological information on cases. The data collected helped to enhance knowledge of Lyme disease at that time.
3. Annual totals and rates
The data reported refer to laboratory-confirmed cases of Lyme disease in England and Wales, and do not include cases diagnosed and treated on the basis of clinical features such as erythema migrans (the early rash of Lyme disease) without laboratory tests. It has been estimated that there are between 1,000 and 2,000 additional cases of Lyme disease each year in England and Wales that are not laboratory diagnosed.
Laboratory-confirmed reports of Lyme disease have risen steadily since reporting began in 1986. Mean annual incidence rates for laboratory-confirmed cases have risen from 0.38 per 100,000 population for the period 1997-2000, to 1.64 in 2010, and to 2.70 cases per 100,000 population in 2017.
Although there is some fluctuation in the annual numbers of laboratory confirmed cases, the overall rise in cases is likely due to changes in the distribution of ticks, improved awareness of the disease among the public and healthcare professionals, and increased testing.
3.1 Laboratory reports of Lyme disease in England and Wales: annual totals and rates, 2001 to 2017
|Years||Total laboratory confirmed cases||Mean annual rate per 100,000 population|
4. Demographics and seasonality
Based on laboratory-confirmed Lyme disease, cases occur in people of all ages, with peaks in those aged between 45 and 64 years, followed by those aged from 24 to 44 years.
Lyme disease is more commonly diagnosed during the summer period, coinciding with tick activity, but cases are reported throughout the year. Many of these cases probably acquired infection in late spring and early summer, allowing for the time period between being bitten, developing symptoms, and developing levels of antibodies high enough to give positive results in laboratory tests. This is also consistent with the peak tick feeding period of late spring and early summer.