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The incidence of Lyme borreliosis varies considerably from region to region (an overview is given by Hubalek[7]). In Germany, Lyme borreliosis must legally be notified to local health services in the six eastern states only. Between 2002 and 2009, the reported incidence in these six territories varied between 17.8 and 37.5 per 100,000 inhabitants.[8] In a prospective, population-based study covering the region of Würzburg, the incidence was 111/100,000 per year.[9] The individual probability of becoming infected with B. burgdorferi by a tick bite depends on several factors:
Considering the necessary duration of feeding and the proportion of infected ticks, spirochetal inoculation after a tick bite is the exception and not the rule. A study from south-west Germany has shown that only approximately 2.6% of all tick bites lead to a clinically apparent infection.[16]
The most frequent manifestation of Lyme borreliosis – accounting for approximately 90% of cases – is erythema migrans, while the CNS is the most frequent destination of dissemination. According to population-based prospective studies performed both in Germany and Sweden, the incidence of Lyme neuroborreliosis (LNB) is approximately 3–11/100,000 per year.[9,17]