title: Physician reported incidence of early and late Lyme borreliosis.
abstract: BACKGROUND
  Lyme borreliosis is the most common vector-borne disease in Europe and North America. The objective of this study is to estimate the incidence of tick bites and Lyme borreliosis, representative of our entire country, including erythema migrans, disseminated Lyme borreliosis and persisting symptoms attributed to Lyme borreliosis.
  
  
  METHODS
  A questionnaire on clinical diagnoses of Lyme borreliosis was sent to all GPs, company physicians, and medical specialists. To adjust for possible misclassification and telescoping bias, we sent additional questionnaires to categorize reported cases according to likelihood of the diagnosis and to exclude cases diagnosed outside the target period.
  
  
  RESULTS
  Adjusted annual incidence rate for disseminated Lyme borreliosis was 7.7 GP reports per 100,000 inhabitants, and for persisting symptoms attributed to Lyme borreliosis was 5.5 GP reports per 100,000 inhabitants, i.e. approximately 1,300 and 900 cases respectively. GP consultations for tick bites and erythema migrans diagnoses were 495 and 132 per 100,000 inhabitants, respectively, i.e. 82,000 and 22,000 cases in 2010.
  
  
  CONCLUSIONS
  This is the first reported nationwide physician survey on the incidence of tick bites and the whole range of manifestations of Lyme borreliosis, including persisting symptoms attributed to Lyme borreliosis. This is crucial for complete assessment of the public health impact of Lyme borreliosis.
authors.affiliation: Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands. Agnetha.Hofhuis@rivm.nl.
authors.forename: Agnetha
authors.initials: A
authors.lastname: Hofhuis
authors.affiliation: Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands. Margriet.Harms@rivm.nl.
authors.forename: Margriet
authors.initials: M
authors.lastname: Harms
authors.affiliation: Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands. Sita.Bennema@rivm.nl.
authors.forename: Sita
authors.initials: S
authors.lastname: Bennema
authors.affiliation: Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands. Kees.van.den.Wijngaard@rivm.nl.
authors.forename: Cees C
authors.initials: CC
authors.lastname: van den Wijngaard
authors.affiliation: Epidemiology and Surveillance Unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands. Wilfrid.van.Pelt@rivm.nl.
authors.forename: Wilfrid
authors.initials: W
authors.lastname: van Pelt
mesh_terms: D000818:Animals; D001733:Bites and Stings / Q000453:epidemiology; D003625:Data Collection; D006801:Humans; D015994:Incidence; D008193:Lyme Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology*; D009426:Netherlands / Q000453:epidemiology; D010820:Physicians; D011795:Surveys and Questionnaires; D013987:Ticks / Q000502:physiology