In Germany a general obligation for physicians or labs to report new (or long lasting) Lyme disease cases does not exist. That makes epidemiological surveys quite difficult. The Robert Koch Institute (RKI), which is responsible for disease reports, uses very old numbers of some local studies. But, this does not represent the actual and real picture.
The eastern states introduced a compulsory registration for special cases (Erythema migrans, acute
neuroborreliosis [i.e. Cranial nerve palsy, radiculoneuritis, meningitis], and since 2009 also acute
Lyme arthritis). But the criteria for case definitions are so restricted, that clinical cases will often not fulfill these criteria. For example a patient with facial palsy after tick bite is not a “case” when not also showing a greater number of intrathecal Bb antibodies than in blood, and pleocytosis in liquor.
RKI, Epidemiologisches Bulletin Nr. 38, 21.9.2007, p. 353 f.:
http://www.rki.de/DE/Content/Infekt/Epi ... cationFile
Für die Neuroborreliose-Fälle entsprach der labordiagnostische Nachweis nur bei 42 der 799 übermittelten Erkrankungen (5%) der Falldefinition (Pleozytose und Nachweis intrathekaler Antikörper: 39 Erkrankungsfälle; Pleozytose und Nukleinsäure-Nachweis im Liquor: 3 Erkrankungsfälle). Ein Nachweis von intrathekalen Antikörpern lag nur bei 234 der 799 übermittelten Erkrankungen (29%) vor. Diese Auswertung zeigt, dass die Kriterien der Falldefinition im Bezug auf die Labordiagnostik der frühen Neuroborreliose nicht zu greifen scheinen.
"For neuroborreliosis cases the diagnostic detection of the laboratory corresponded only in 42 of 799 communicated diseases (5%) with the case definition
(pleocytosis and intrathecal antibody detection: 39 cases of disease; pleocytosis and nucleic acid detection in CSF: 3 cases of disease). A detection of intrathecal antibodies was present only at 234 of 799 reported diseases (29%). This evaluation shows that the criteria of the case definition with respect to the laboratory diagnosis of early neuroborreliosis does not seem to be working.
The sole proof of positive results in serological testing (ELISA and Blot) is not valued as a sign of active infection, but in most cases as a ‘serological relict’ of a former contact with the pathogen Bb.
So, the reported numbers are much lower than the number of really infected and ill patients.
Mostly (> 90 %) the reported cases are based on the diagnosis of EM, in spite of the fact that a great number of physicians, also dermatologists, are not able to recognize this pathognomic sign. Patients often tell us that they were treated with antifungal or corticosteroid ointments. Or they were not treated at all, and should wait and watch the skin lesion.
A quite different picture with high numbers of Lyme patients is given on base of the billing system of the health insurance companies, only looking after the diagnosed Erythema migrans (ICD10: A69.2)
. That is a case definition without a need of serological confirmation
I think, the used test kits in Germany are not of better quality than for example in the US. It is known that you are getting three different results, if you are sending the same blood sample to three different labs using different test kits.
http://www.lymenet.de/literatur/everth_ ... ologie.pdf
http://www.borreliose-gesellschaft.de/U ... z_2009.pdf
http://www.borreliose-nachrichten.de/wp ... a-Blot.pdf