In 2002, two cases of tick-borne encephalitis (TBE) were diagnosed in inhabitants of a tick endemic area on the island of Aspö in southeastern Sweden. During the previous 25 y, only two other cases of TBE had been diagnosed in that region of Sweden. To investigate the presence and evolution of seroprevalence of antibodies to TBE virus (TBEV), we compared inhabitants´ anti-TBEV immunoglobulin G (IgG) levels in blood samples drawn in 1991 and 2002. A significant increase in IgG antibody levels was observed in 24/200 (12.0%) 2002 blood samples compared to 7/200 (3.5%) 1991 samples. However, neutralizing antibodies were detected in only 4 of the two-step enzyme-linked immunosorbent assay (ELISA) IgG positive sera against TBEV, corresponding to a TBEV neutralizing test (NT) prevalence of 2%. Significantly more men than women were seropositive for TBEV antibodies. Compared to other age groups, the greatest increase in TBEV antibody levels was observed in the 20-29 y age group. However, the majority of seropositive samples were from participants >50 y of age. Recommending preventative measures, including vaccination against TBE, to individuals who reside in or regularly visit TBEV endemic areas is suggested.

Objective. To describe the users of herbal medicine products and food supplements with respect to age and gender specifically among persons aged ≥60 years. Design. A descriptive study with baseline data from a longitudinal study of the elderly, stratified into different age cohorts (60-69, 70-79, 80-89 and ≥90 years). Setting. Blekinge county, situated in the southeastern Sweden. Subjects. Totally 1380 persons aged 60-96 years (median age 78 years). Main outcome measures. Current use of herbal medicine products and the use of food supplements. Results. Of the participants, 264/1380 (19.1%) used at least one herbal medicine product, 184/1380 (13.3%) used at least one food supplement and 382/1380 (27.7%) used herbal medicine products and/or food supplements. In all regression models, women had a higher probability to use herbal medicine and/or food supplements in comparison with men. Focusing on the use of herbal medicine products alone and in the combination of using herbal medicine and/or food supplement, a decreased use was seen with increasing age. However, 27.9% were still users of herbal medicine products and/or food supplements in the age group 80-89 years. In comparison, 14% were users in the age group ≥90 years. Age did not have an impact on the probability of taking food supplements. Conclusion. General practitioners need to consider the high use of herbal medicine product and food supplements among elderly when making decisions about treatment.

Background: The aim of this study was to describe and categorize the different predominant patterns of PCR confirmed erythema migrans (EM) and to study possible correlations according to the clinical pictures and Borrelia substrains. Methods: Patients over 18 years old, seeking care with tick exposure and an EM were consecutively included during a study period of three years. We evaluated clinical and laboratory findings with regard to Borrelia burgdorferi s.l. spirochetes detected with nested Osp A PCR in skin biopsy specimens. Laboratory and serology testing were done acute, after 6 weeks and after 6 months. The patients were clinically evaluated at the initial visit and repeatedly after 14 days unitl recovery. Results: 118 patients (women=54, men=64) with a positive B. Burgdorferi s.l. PCR analysis were included. In this area totally 73.7% of the EM were caused by B. afzelii and 26.3% by B. garinii (p=0.0001). Leisons caused by B. garinii had a shorter duration from tick bite to the initial visit (p= 0.001) but there were no differences between the sizes of the EM, indicating a faster development of lesions caused by B. garinii. Patients with lesions caused by B. garinii to a greater extent had presented with fever at the initial visit (p=0.02). Also patients with B. garinii lesions to a greater extent had elevated levels of CRP at the initial visit (p=0.006). 45% of the EM were categorized as “annular”, 27% as “homogeneous”, 19% as “central erythemas” and 9% as “atypical”. The lesions caused by B. afzelii were predominately “annular” and the lesions caused by B. gaarinii were predominately “homogeneous”. Conclusions: In this study most EM were caused by B. afzelii. Leisons caused by B. garinii developed faster and the patients to a greater extent presented with fever and elevated levels of CRP at the initial visit. Leisons caused by B. garinii were mostly homogenous and by B. afzelii were mostly annular.

It is common belief that ticks are more visible and easier to detect on light clothing in comparison with dark clothing. We studied which of the clothing, light or dark, had the least attractive effect on Ixodes ricinus, thus minimizing exposure and thereby in theory help to prevent tick borne diseases in humans. Ten participants, exposed by walking in tick endemic areas, wore alternately light and dark clothing before every new exposure. Nymphal and adult ticks on the clothing were collected and counted. Totally, 886 nymphal ticks were collected. The overall mean in found ticks between the both groups differed significantly, with 20.8 more ticks per person on light clothing. All participants had more ticks on light clothing in all periods of exposure. Dark clothing seems to attract fewer ticks.

En allmän uppfattning är att fästingar syns bättre, och därmed upptäcks lättare på ljusa kläder jämfört med mörka kläder. Vi studerade vilka kläder, ljusa eller mörka, som drog till sig flest fästingar (Ixodes ricinus), i syfte att finna metoder att förebygga fästingburna infektioner hos människor. Tio deltagare, exponerade genom att vandra i områden endemiska för fästingar, bar omväxlande ljusa och mörka kläder vid varje exponering. Nymfer och vuxna fästingar samlades från kläderna och antalet fästingar räknades. Totalt samlades 886 nymfer in. I medelvärde skiljde sig antalet funna fästingarna på ljusa respektiva mörka kläder signifikant med 20,8 flera fästingar per person på de ljusa kläderna. Samtliga deltagare hade flera fästingar på de ljusa kläderna i samtliga exponeringsområden. Mörka kläder verkar dra till sig mindre antal fästingar i jämförelse med ljusa kläder.

Aims: To describe environmental and personal tick preventive measures and their predictors, taken by a population living in a highly tick-endemic area. Methods: Due to the recent confirmation of human tick-borne encephalitis cases, vaccination against tick borne encephalitis was offered to the population living in the endemic area through the use of leaflets and media campaigns. At the time for the initial dose, information and enrollment to this cohort study was carried out. Participants´ characteristics, frequency of tick-bites and preventive measures were included in questionnaires. Logistic analysis was used to determine behavioural differences in activities taken in order to prevent tick-bites. Conclusion: In total, 70% of the permanent residents had themselves vaccinated before the next tick-season. Of the studied participants 356/517 (69%) regularly took preventive measures in their environment and/or personally. Women in particular, and those previously treated for a tick-borne disease took significantly more preventive measures. When analysing all variables together, spending less time in tick-endemic area and being tick-bitten the latest tick-season significantly increased the probability of taking preventive measures. After being tick-bitten, men were more inclined to start taking preventive measures than women. Awareness of the risks caused by living in a high endemic area to ticks influenced the participant’s daily life through preventive activities. Public health action should be considered thus encouraging out-of-door activities for the population, without anxiety for risks for contracting tick-borne disease after being tick-bitten.

Background: To describe environmental and personal tick preventive measures and their predictors, taken by a population living in a highly tick-endemic area. Methods: Due to the recent confirmation of human tick-borne encephalitis cases, vaccination against tick-borne encephalitis was offered to the population living in the endemic area through the use of leaflets and media campaigns. At the time for the initial dose, information and enrollment to this cohort study was carried out. Participants´ characteristics, frequency of tick-bites and preventive measures were included in questionnaires. Logistic analysis was used to determine behavioural differences in activities taken in order to prevent tick-bites. Results: In total, 70% of the permanent residents had themselves vaccinated before the next tick-season. Of the studied participants 356/517 (69%) regularly took preventive measures in their environment (i.e. affecting the surroundings and towards animals) and/or personally (i.e. avoidance of extensive tick-areas, use of naturopathic medicine, use of repellents, clothing/boots, body examination, bath/shower). Of those taking personally preventive measures, 46% limited their time spent out-of-doors in carrying out leisure activities. Women in particular, and those previously treated for a tick-borne disease took significantly more preventive measures. When analysing all variables together, spending less time in tick-endemic area and being tick-bitten the latest tick-season significantly increased the probability of taking preventive measures. After being tick-bitten, men were more inclined to start taking preventive measures than women. Conclusion: Awareness of the risks caused by living in a high endemic area to ticks influenced the participant’s daily life through preventive activities. Public health action should be considered thus encouraging out-of-door activities for the population, without anxiety for risks for contracting tick-borne disease after being tick-bitten.

INTRODUCTION To prevent tick bites, personal precautions such as wearing light-coloured clothing, are generally recommended. It is believed that ticks are easier to detect on light-coloured clothing in comparison with dark-coloured clothing. Studies confirming this supposition have not been found and we do not know whether colour of clothing influences the tick´s choice of hosts. The aim of this study was to determine which colour of clothing had the least attractive effect on Ixodes ricinus and thus help to prevent tick borne diseases in humans. PROCEDURES The study was performed in the archipelago of the south-eastern Sweden. Ten participants, randomised into two standardised groups, were exposed by walking in squares measuring 25x25 meters. They were exposed 12 times, twice in each square; once with light-coloured and once with dark-coloured clothing. The nymphs and adult ticks on the clothing were collected and counted. FINDINGS Totally, 892 nymphal ticks were collected and of these 552 were found on light-coloured clothing and 340 on dark-coloured clothing. The total mean found number of ticks between the both groups differed significantly, with 21.2 more ticks per person on light-coloured clothing (p=0.003, 95% CI 9.37-33.03). CONCLUSIONS All participants had more ticks on light-coloured clothing in all periods of exposure. In view of these straight results, the recommendation to use light-coloured clothing as a personal precaution in tick endemic areas must be questioned. Dark-coloured clothing seems to attract fewer ticks.

The objective of this follow-up study was to determine the long-term outcome in patients treated with antibiotics for strictly classified cases of neuroborreliosis. A one-year prospective population-based survey of Lyme borreliosis was conducted in southern Sweden, 1992-1993. Totally 349 identified cases with suspected neuroborreliosis were registered. Of those, 130 were classified as definitively neuroborreliosis and followed up five years later. Medical records were reviewed and all participants filled in a questionnaire. Totally, 114/130 (88%) completed the follow-up of whom 111/114 (97%) had fulfilled the initial antibiotic treatment. Of these, 86/114 (75%) had recovered completely and 70 (61%) recovered within six months. However 28/114 (25%) suffered from remaining neurological symptoms such as facial palsy, concentration disorder, paresthesia and/or neuropathy. The longer the duration from the neurological symptoms onset to antibiotic treatment the higher was the rate of sequelae. Of those who were treated within 30 days 5/32 (16%) and of those who were treated after 30 days 16/41 (39%) respectively, reported sequelae. Women suffered significantly more from sequelae compared to men, this difference was not seen among the children. No significant differences between the different antibiotic treatments given and experience of sequelae were seen. To conclude, we found that 25% (95% CI 17% to 33%) of the patients suffered from remaining neurological symptoms five years post treatment. However, the clinical outcome of treated neuroborreliosis is favourable as only 14/114 (12%) of the patients had sequelae that influenced their daily activity post treatment and early diagnosis and treatment seems to be of great importance to possibly avoid also these cases.

The incidence and the temporal pattern of tick bites were studied in a population frequently out-of-doors in a tick endemic area in south-eastern Sweden between May 2000-March 2001. The participants, who were well aware of tick-borne diseases, inspected their skin daily from May until September and completed a diary sheet, registering visited geographical places, time out-of-doors, observed tick-bites, etc. The participants were also given questionnaires in both the initial and final stages of the study, asking questions about their earlier history of tick-bites, previous tick-borne diseases and out-of-door activities. The incidence was 0.04 (95% confidence interval 0.02-0.06) tick-bitten participants/10 h spent out-of-doors. In total, the participants registered 1767 tick bites, i.e. an incidence of 0.14 (95% CI 0.10-0.18) tick-bites/10 h spent out-of-doors. Within 6 months after the registration period, 8/235 (3%) had been treated for physician-diagnosed Lyme borreliosis. In conclusion, this study found a 4% risk to be tick-bitten per 10 h spent out-of-doors. The risk of contracting Lyme borreliosis was 1/221 tick bites (0.5%, 95% CI 0.44-0.56). Thus, our results indicate a low risk of acquiring Lyme borreliosis when using daily tick checks and we underline the opinion of not recommending routine prophylactic treatment for observed tick-bites.

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