Seroprevalence and disease incidence rates are increased in certain occupational groups, e.g. forestry workers, some recreational groups such as orienteers and tourists to high-endemic areas (Septfons at al. 2023. Euro Surveill. 28(32):2200961; Burn et al. 2023. Vector Borne Zoonotic Dis. 23(4):195-220.). However, identification of high-risk groups is not always straightforward and confounding factors are evidently present. For example, Swedish orienteers, who are thought to be regularly exposed to ticks, have been shown to have similar seroprevalences to the general population despite the relatively high prevalence of the disease in that country (Gustafson et al. 1993. Scand J Infect Dis. 25:605-11), and in Ireland, park rangers who are frequently exposed to ticks in areas where the disease is present, have been found to be seronegative (Robertson et al. 1998. Zentralbl Bakteriol. 288:293-301).

Gender appears to influence seroprevalence and disease incidence rates and most studies report higher rates for males. This is presumed to be due to higher occupational risk and outdoor recreational activity. However, it is interesting to note that in a recent Swedish study on recurrence of erythema migrans (4% of all cases) the majority were recorded in middle-aged women (Bennet et al. 2007. Vector Borne Zoonotic Dis. 7:34-41).

The nature of disease manifestations is also influenced by age. Radiculopathy, a relatively common complication in adults, is rarely seen in children, while facial palsy is the most common paediatric neurological manifestation of Lyme borreliosis. Acrodermatitis chronica atrophicans, the chronic skin manifestation, mainly occurs in older women and while a specific age-related reactivity is not evident in Lyme arthritis, most cases occur in adults. Some reports suggest that Lyme borreliosis incidence is generally higher in children and people > 65 years-old, than in adults in Lyme-endemic areas, because of their greater tendency to make close contact with tick habitat (Stanek and Strle. 2003. Lancet 362:1639-47; Septfons A et al. 2019. Euro Surveill. 24(11):1800134; Burn et al. 2023. Vector Borne Zoonotic Dis. 23(4):195-220)

References

Bennet L, Stjernberg L, Berglund J. Effect of gender on clinical and epidemiologic features of Lyme borreliosis. Vector Borne Zoonotic Dis. 2007;7(1):34-41. doi: 10.1089/vbz.2006.0533.

Burn L, Pilz A, Vyse A, Gutiérrez Rabá AV, Angulo FJ, Tran TMP, Fletcher MA, Gessner BD, Moïsi JC, Stark JH. Seroprevalence of Lyme Borreliosis in Europe: Results from a Systematic Literature Review (2005-2020). Vector Borne Zoonotic Dis. 2023;23(4):195-220. doi: 10.1089/vbz.2022.0069.

Gustafson R, Forsgren M, Gardulf A, Granström M, Svenungsson B. Antibody prevalence and clinical manifestations of Lyme borreliosis and tick-borne encephalitis in Swedish orienteers. Scand J Infect Dis. 1993;25(5):605-11. doi: 10.3109/00365549309008549.

Robertson JN, Gray JS, MacDonald S, Johnson H. Seroprevalence of Borrelia burgdorferi sensu lato infection in blood donors and park rangers in relation to local habitat. Zentralbl Bakteriol. 1998;288(2):293-301. doi: 10.1016/s0934-8840(98)80053-4.

Septfons A, Goronflot T, Jaulhac B, Roussel V, De Martino S, Guerreiro S, Launay T, Fournier L, De Valk H, Figoni J, Blanchon T, Couturier E. Epidemiology of Lyme borreliosis through two surveillance systems: the national Sentinelles GP network and the national hospital discharge database, France, 2005 to 2016. Euro Surveill. 2019;24(11):1800134. doi: 10.2807/1560-7917.ES.2019.24.11.1800134. PMID: 30892181.

Septfons A, Rigaud E, Bénézet L, Velay A, Zilliox L, Baldinger L, Gonzalez G, Figoni J, de Valk H, Deffontaines G, Desenclos JC, Jaulhac B. Seroprevalence for Borrelia burgdorferi sensu lato and tick-borne encephalitis virus antibodies and associated risk factors among forestry workers in northern France, 2019 to 2020. Euro Surveill. 2023;28(32):2200961. doi: 10.2807/1560-7917.ES.2023.28.32.2200961.

Stanek G, Strle F. Lyme borreliosis. Lancet. 2003;362(9396):1639-47. doi: 10.1016/S0140-6736(03)14798-8.