title: [Tick bites and borreliosis in children attending forest kindergarten: a challenge for prevention].
abstract: OBJECTIVE
  The aim of this study was to analyse the influence of preventive measures on the risk of being bitten by a tick and of suffering from borreliosis in children attending so-called 'forest kindergartens' (nurseries located in forested areas where children spend all-season full-time outdoors), compared to children attending regular kindergartens. In addition, we aimed to analyse sources of information and the risk of being bitten more than once.
  
  
  METHODS
  53 kindergartens (25 forest kindergartens, 28 regular kindergartens) in the state of Baden-Württemberg, Germany participated in this study and protective parental behaviour was recorded. In a prospective cohort study, the numbers of tick bites and cases of borreliosis were recorded monthly (March to October 2004) using a questionnaire. The influence of preventive measures was estimated using multivariate log-binomial regression.
  
  
  RESULTS
  Altogether, 1707 children of 'forest kindergartens' (506 children) and regular kindergartens (1201 children) were included. Parental protective behaviour was significantly better in forest kindergartens compared to regular kindergartens. There were no substantial differences between effect estimates after stratification for parental protective behaviour. For children attending a 'forest kindergarten, the adjusted risk ratio of being tick bitten was 2.6 (3.3-3.0) which was only slightly different from the unadjusted risk, ratio.
  
  
  CONCLUSIONS
  Although protective parental behaviour in 'forest kindergarten' children was significantly better compared to regular kindergarten, children in forest kindergartens are at a considerable risk of tick bites and borreliosis. Implementing effective preventive measures against borreliosis represents a public health challenge.
authors.affiliation: Abteilung Klinische Sozialmedizin, Universitätsklinikum Heidelberg. elke.Weisshaar@med.uni-heidelberg.de
authors.forename: E
authors.initials: E
authors.lastname: Weisshaar
authors.forename: C J
authors.initials: CJ
authors.lastname: Apfelbacher
authors.forename: A
authors.initials: A
authors.lastname: Schaefer
authors.forename: T
authors.initials: T
authors.lastname: Bruckner
authors.forename: R
authors.initials: R
authors.lastname: Scheidt
authors.forename: T L
authors.initials: TL
authors.lastname: Diepgen
mesh_terms: D001898:Borrelia; D002656:Child Day Care Centers / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007299:Insect Bites and Stings / Q000453:epidemiology* / Q000517:prevention & control*; D008193:Lyme Disease / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013334:Students / Q000706:statistics & numerical data*; D014197:Trees