title: Decrease in tick bite consultations and stabilization of early Lyme borreliosis in the Netherlands in 2014 after 15 years of continuous increase.
abstract: Nationwide surveys have shown a threefold increase in general practitioner (GP) consultations for tick bites and early Lyme borreliosis from 1994 to 2009 in the Netherlands. We now report an update on 2014, with identical methods as for the preceding GP surveys.
  
  
  
  To all GPs in the Netherlands, a postal questionnaire was sent inquiring about the number of consultations for tick bites and erythema migrans diagnoses (most common manifestation of early Lyme borreliosis) in 2014, and the size of their practice populations.
  
  
  
  Contrasting to the previously rising incidence of consultations for tick bites between 1994 and 2009, the incidence decreased in 2014 to 488 consultations for tick bites per 100,000 inhabitants, i.e., 82,000 patients nationwide. This survey revealed a first sign of stabilization of the previously rising trend in GP diagnosed erythema migrans, with 140 diagnoses per 100,000 inhabitants of the Netherlands. This equals about 23,500 annual diagnoses of erythema migrans nationwide in 2014.
  
  
  
  In contrast to the constantly rising incidence of GP consultations for tick bites and erythema migrans diagnoses in the Netherlands between 1994 and 2009, the current survey of 2014 showed a first sign of stabilization of erythema migrans diagnoses and a decreased incidence for tick bite consultations.
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.
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.
authors.forename: Margriet
authors.initials: M
authors.lastname: Harms
authors.affiliation: Environmental Systems Analysis Group, Wageningen University, Wageningen, The Netherlands.
authors.forename: Arnold J H
authors.initials: AJ
authors.lastname: van Vliet
authors.affiliation: Laboratory of Entomology, Wageningen University, Wageningen, The Netherlands.
authors.forename: Willem
authors.initials: W
authors.lastname: Takken
authors.affiliation: Epidemiology and surveillance unit, Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
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.
authors.forename: Wilfrid
authors.initials: W
authors.lastname: van Pelt
mesh_terms: D015787:Erythema Chronicum Migrans / Q000453:epidemiology; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008193:Lyme Disease / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D064927:Tick Bites / Q000453:epidemiology*
keywords: Early Lyme borreliosis; Erythema migrans; Incidence; Tick bites