Systematic Review and Meta-analysis of Lyme Disease Data and Seropositivity for Borrelia burgdorferi, China, 2005‒2020

Since its initial identification in 1986, Lyme disease has been clinically diagnosed in 29 provinces in China; however, national incidence data are lacking. To summarize Lyme disease seropositivity data among persons across China, we conducted a systematic literature review of Chinese- and English-language journal articles published during 2005‒2020. According to 72 estimates that measured IgG by using a diagnostic enzyme-linked assay (EIA) alone, the seropositivity point prevalence with a fixed-effects model was 9.1%. A more conservative 2-tier testing approach of EIA plus a confirmatory Western immunoblot (16 estimates) yielded seropositivity 1.8%. Seropositivity by EIA for high-risk exposure populations was 10.0% and for low-risk exposure populations was 4.5%; seropositivity was highest in the northeastern and western provinces. Our analysis confirms Lyme disease prevalence, measured by seropositivity, in many Chinese provinces and populations at risk. This information can be used to focus prevention measures in provinces where seropositivity is high.

[1]  Takaaki Kobayashi,et al.  Diagnostic Testing for Lyme Disease. , 2022, Infectious disease clinics of North America.

[2]  A. Steere,et al.  Laboratory Diagnosis of Lyme Borreliosis , 2021, Clinical Microbiology Reviews.

[3]  L. Eisen.  Vector competence studies with hard ticks and Borrelia burgdorferi sensu lato spirochetes: A review , 2019, Ticks and tick-borne diseases.

[4]  Sen Li,et al.  A dataset of distribution and diversity of ticks in China , 2019, Scientific Data.

[5]  Quan Liu,et al.  Prevalence and Identification of Borrelia burgdorferi Sensu Lato Genospecies in Ticks from Northeastern China. , 2019, Vector borne and zoonotic diseases.

[6]  A. Çikman,et al.  Geographical Features and Seroprevalence of Borrelia burgdorferi in Erzincan, Turkey , 2018, Journal of arthropod-borne diseases.

[7]  Jia-Fu Jiang,et al.  The prevalence and clinical characteristics of tick-borne diseases at One Sentinel Hospital in Northeastern China , 2018, Parasitology.

[8]  S. Vanwambeke,et al.  Seroprevalence of Borrelia burgdorferi in Belgian forestry workers and associated risk factors , 2018, Parasites & Vectors.

[9]  J. Ollgren,et al.  Population-based Borrelia burgdorferi sensu lato seroprevalence and associated risk factors in Finland. , 2017, Ticks and tick-borne diseases.

[10]  J. Dutkiewicz,et al.  Prevalence of serological response to Borrelia burgdorferi in farmers from eastern and central Poland , 2016, European Journal of Clinical Microbiology & Infectious Diseases.

[11]  P. Forsberg,et al.  A prospective study on the incidence of Borrelia burgdorferi sensu lato infection after a tick bite in Sweden and on the Åland Islands, Finland (2008-2009). , 2016, Ticks and tick-borne diseases.

[12]  S. Vanwambeke,et al.  Individual and environmental factors associated with the seroprevalence of Borrelia burgdorferi in Belgian farmers and veterinarians , 2016, Infection ecology & epidemiology.

[13]  A. Steere,et al.  Lyme borreliosis , 2016, Nature Reviews Disease Primers.

[14]  L. Fang,et al.  Emerging tick-borne infections in mainland China: an increasing public health threat , 2015, The Lancet Infectious Diseases.

[15]  E. Ristanovic,et al.  Seroprevalence of Borrelia burgdorferi in occupationally exposed persons in the Belgrade area, Serbia , 2015, Brazilian journal of microbiology : [publication of the Brazilian Society for Microbiology].

[16]  C. Lass‐Flörl,et al.  Human seroprevalence against Borrelia burgdorferi sensu lato in two comparable regions of the eastern Alps is not correlated to vector infection rates. , 2015, Ticks and tick-borne diseases.

[17]  M. Thamm,et al.  Antibodies against Borrelia burgdorferi sensu lato among Adults, Germany, 2008–2011 , 2015, Emerging infectious diseases.

[18]  M. Tokarska-Rodak,et al.  [Risk of occupational infections caused by Borrelia burgdorferi among forestry workers and farmers]. , 2014, Medycyna pracy.

[19]  Jinsong Zhu,et al.  Distribution of tick-borne diseases in China , 2013, Parasites & Vectors.

[20]  Xiu Jun Yang,et al.  Seroepidemiological investigation of lyme disease and human granulocytic anaplasmosis among people living in forest areas of eight provinces in China. , 2013, Biomedical and environmental sciences : BES.

[21]  A. Lakos,et al.  Recent lesson from a clinical and seroepidemiological survey: low positive predictive value of Borrelia burgdorferi antibody testing in a high risk population. , 2012, Advances in medical sciences.

[22]  G. Poggensee,et al.  Seropositivity of Lyme Borreliosis and Associated Risk Factors: A Population-Based Study in Children and Adolescents in Germany (KiGGS) , 2012, PloS one.

[23]  J. Halperin.  Lyme disease: an evidence-based approach. , 2011 .

[24]  E. Podsiadły,et al.  The occurrence of spotted fever rickettsioses and other tick-borne infections in forest workers in Poland. , 2011, Vector borne and zoonotic diseases.

[25]  K. Wan,et al.  Interpretation criteria for standardized Western blot for the predominant species of Borrelia burgdorferi sensu lato in China. , 2010, Biomedical and environmental sciences : BES.

[26]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement , 2009, BMJ.

[27]  A. H. Parlak,et al.  Seroprevalence of Borrelia burgdorferi infection among forestry workers and farmers in Duzce, north-western Turkey. , 2008, The new microbiologica.

[28]  M. G. Ciufolini,et al.  Prevalence and incidence of antibodies to Borrelia burgdorferi and to tick-borne encephalitis virus in agricultural and forestry workers from Tuscany, Italy , 2005, European Journal of Clinical Microbiology and Infectious Diseases.

[29]  R Ruthazer,et al.  Persistence of immunoglobulin M or immunoglobulin G antibody responses to Borrelia burgdorferi 10-20 years after active Lyme disease. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[30]  Ennis,et al.  Vaccination against Lyme Disease with Recombinant Borrelia burgdorferi Outer-Surface Lipoprotein A with Adjuvant , 2000 .

[31]  C. Schmid,et al.  Vaccination against Lyme disease with recombinant Borrelia burgdorferi outer-surface lipoprotein A with adjuvant. Lyme Disease Vaccine Study Group. , 1998, The New England journal of medicine.

[32]  K. Wan,et al.  [Studies on epidemiology and etiology of Lyme disease in China]. , 1997, Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi.

[33]  A. Barbour,et al.  Lyme borreliosis in Lithuania. , 1994, Scandinavian journal of infectious diseases.

[34]  L. Xiaodong,et al.  Clinical Manifestations and Epidemiological Characteristics of Lyme Disease in Hailin County, Heilongjiang Province, China , 1988 .