Southampton General Hospital, Southampton, England.
Continuing uncertainty about the extent of the problem posed by Lyme borreliosis, the risk of serious sequelae, and unsatisfactory laboratory techniques to investigate it have led to the collaboration of researchers from 12 European Union (EU) countries and two nations from the former Eastern bloc. The European Union Concerted Action on Lyme Borreliosis (EUCALB), funded by the EU under its Biomed 1 programme, led by Dr Jeremy Gray of University College Dublin, coordinates research on Borrelia burgdorferi’s ecology, molecular biology, taxonomy, and geographical distribution within Europe; the clinical and epidemiological features of Lyme borreliosis in Europe, risk factors for human infection; and prevention measures, including education programmes aimed at endemic areas.
Difficulties in developing laboratory diagnostic methods for Lyme disease have led to the infection being both under- and overdiagnosed. EUCALB aims to standardise well-validated serodiagnostic methods and initiate a external quality assurance (EQA) scheme in Europe. Participants are developing criteria for serodiagnosis and a second pilot batch of EQA samples is being distributed. Discussions with WHO are in progress about the designation of one or more laboratories as European collaborating centres.
The clinical presentation of Lyme disease in Europe is more variable than in North America. Case definitions specific to Europe are required to validate serodiagnostic tests and for use in epidemiological studies. Twenty-five EUCALB clinicians from ten countries have agreed these case definitions, which will be published shortly. Lyme disease is not a notifiable condition in most European countries and its epidemiology is unclear. EUCALB workers are collating published and unpublished data on its incidence throughout Europe and collaborating with ecologists and microbiologists to identify areas with a high risk of human infection and evaluate the feasibility of ecological interventions.
The most important preventive measure remains educating members of the public about Lyme borreliosis and how to avoid tick bites. A register of educational material available in Europe has been established and residents and visitors of endemic areas have been surveyed to assess their knowledge of Lyme disease and how to prevent it (contact Dr Sue O’Connell for further information). Information packs about Lyme disease for health care professionals and the public are being developed and will be made available on a world wide web site.
Dr Jeremy Gray, Department of Environmental Resource Management, University College Dublin, Belfield, Dublin 4, Ireland. Tel: +353 1706 7739; Fax: +353 1706 1102.
Dr Sue O’Connell, Department of Microbiology and Public Health Laboratory, Southampton General Hospital, Southampton SO16 6YD, UK. Tel: +44 1703 796412/796342. Fax: +44 1703 774316.
1. O’Connell, S. Lyme disease: a review. Commun Dis Rep CDR Rev 1993; 3: R111-5.
2. CDC. Lyme disease – United States, 1995. MMWR 1996; 45: 481- 4