title: Are the current notification criteria for Lyme borreliosis in Norway suitable? Results of an evaluation of Lyme borreliosis surveillance in Norway, 1995-2013.
abstract: The approach to surveillance of Lyme borreliosis varies between countries, depending on the purpose of the surveillance system and the notification criteria used, which prevents direct comparison of national data. In Norway, Lyme borreliosis is notifiable to the Surveillance System for Communicable Diseases (MSIS). The current notification criteria include a combination of clinical and laboratory results for borrelia infection (excluding Erythema migrans) but there are indications that these criteria are not followed consistently by clinicians and by laboratories. Therefore, an evaluation of Lyme borreliosis surveillance in Norway was conducted to describe the purpose of the system and to assess the suitability of the current notification criteria in order to identify areas for improvement.
  
  
  
  The CDC Guidelines for Evaluation of Surveillance Systems were used to develop the assessment of the data quality, representativeness and acceptability of MSIS for surveillance of Lyme borreliosis. Data quality was assessed through a review of data from 1996 to 2013 in MSIS and a linkage of MSIS data from 2008 to 2012 with data from the Norwegian Patient Registry (NPR). Representativeness and acceptability were assessed through a survey sent to 23 diagnostic laboratories.
  
  
  
  Completeness of key variables for cases reported to MSIS was high, except for geographical location of exposureThe NPR-MSIS linkage identified 1047 cases in both registries, while 363 were only reported to MSIS and 3914 were only recorded in NPR. A higher proportion of cases found in both registries were recorded as neuroborreliosis in MSIS (84.4 %) than those cases found only in MSIS (20.1 %). The trend (average yearly increase or decrease in reported cases) of neuroborreliosis in MSIS was not significantly different from the trend for all other clinical manifestations recorded in MSIS in negative binomial regression (p = 0.3). The 16 surveyed laboratories (response proportion 70 %) indicated differences in testing practices and low acceptability of the notification criteria.
  
  
  
  Given the challenges associated with diagnosing Lyme borreliosis, the selected notification criteria should be closely linked with the purpose of the surveillance system. Restricting reportable Lyme borreliosis to neuroborreliosis may increase validity, while a more sensitive case definition (potentially including erythema migrans) may better reflect the true burden of disease. We recommend revising the current notification criteria in Norway to ensure that they are unambiguous for clinicians and laboratories.
authors: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403, Oslo, Norway. emily.macdonald@fhi.no.|European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden. emily.macdonald@fhi.no.
authors: Emily
authors: E
authors: MacDonald
authors: Department Bacteriology and Immunology Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.|European Programme for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control, Stockholm, Sweden.
authors: Didrik Frimann
authors: DF
authors: Vestrheim
authors: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403, Oslo, Norway.|Department of Health Statistics, Norwegian Institute of Public Health, Oslo, Norway.
authors: Richard A
authors: RA
authors: White
authors: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403, Oslo, Norway.
authors: Kirstin
authors: K
authors: Konsmo
authors: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403, Oslo, Norway.|European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden.
authors: Heidi
authors: H
authors: Lange
authors: Department Bacteriology and Immunology Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors: Audun
authors: A
authors: Aase
authors: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403, Oslo, Norway.
authors: Karin
authors: K
authors: Nygård
authors: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403, Oslo, Norway.|European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden.
authors: Pawel
authors: P
authors: Stefanoff
authors: Department Bacteriology and Immunology Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors: Ingeborg
authors: I
authors: Aaberge
authors: Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, P.O. Box 4404, Nydalen, NO-0403, Oslo, Norway.
authors: Line
authors: L
authors: Vold
mesh_terms: D003141:Communicable Diseases; D006801:Humans; D007753:Laboratories; D008193:Lyme Disease / Q000175:diagnosis / Q000453:epidemiology*; D009664:Norway / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D012042:Registries; D011795:Surveys and Questionnaires
keywords: Borrelia burgdorferi; Lyme disease; Public health surveillance