Global seroprevalence and sociodemographic characteristics of Borrelia burgdorferi sensu lato in human populations: a systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational seroprevalence studies
PubMed 35697507 · doi:10.1136/bmjgh-2021-007744
What was done
Authors searched PubMed, Embase, Web of Science, and other databases through December 30, 2021, for peer-reviewed observational studies on human *Borrelia burgdorferi* sensu lato (Bb) seroprevalence that reported laboratory detection methods. Risk of bias was evaluated using the Newcastle-Ottawa Quality Assessment Scale. Random-effects meta-analysis and meta-regression were performed to determine pooled global and regional seroprevalence rates and associated demographic and methodological factors.
What was found
Across 89 included studies totaling 158,287 individuals, estimated global Bb seroprevalence was 14.5% (95% CI 12.8% to 16.3%). The highest regional rates were Central Europe (20.7%, 95% CI 13.8% to 28.6%), Eastern Asia (15.9%, 95% CI 6.6% to 28.3%), and Western Europe (13.5%, 95% CI 9.5% to 18.0%). Testing methods lacking Western blot (WB) confirmation showed higher seropositivity detection compared to WB-confirmed methods (OR 1.9, 95% CI 1.6 to 2.2). Higher seropositivity was also observed in individuals with tick bites (18.8%, 95% CI 10.1% to 29.4%), age ≥50 years (12.6%, 95% CI 8.0% to 18.1%), rural residence (8.4%, 95% CI 5.0% to 12.6%), and men (7.8%, 95% CI 4.6% to 11.9%).
Why it matters
This study provides comprehensive global estimates of human exposure to Lyme borreliosis agents and highlights that unconfirmed serological assays substantially inflate seropositivity estimates.
Limits
The primary studies rely on observational designs with variable sampling methods and testing protocols across countries. Seropositivity reflects antibody exposure rather than active infection, and non-standardized assays without Western blot confirmation create a substantial risk of false-positive results.
Cited by
- supports According to BMJ Global Health, one in seven people worldwide has been exposed to Lyme disease.