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Lyme neuroborreliosis (LNB) can be a serious manifestation of Lyme borreliosis. We describe the incidence, time trends and geographic distribution of LNB in Denmark. We obtained LNB cases reported by laboratories and physicians (2015-2019) from the online platform maintained by the Statens Serum Institut (SSI) (2021b). The LNB incidence (per 100,000 persons) was calculated by dividing LNB cases by the population data (denominator) obtained from Statistics Denmark (2021). Between 2015 and 2019, laboratories reported annually 162 to 200 LNB cases, while physicians reported 48 to 68 cases. The annual LNB incidence notified by laboratories ranged from 2.8 (95% CI: 2.4‒3.3) to 3.4 (95% CI: 3.0‒4.0) per 100,000 persons for the 5 study years. The average annual LNB incidence per 100,000 persons for 5 Danish regions ranged from 2.3 to 3.3; for 11 provinces, from 1.9 to 7.6; and for 98 municipalities, from 0 to 22.1. Incidence peaks occurred in persons 5‒14 and 65‒74 years of age. Higher incidences were observed among males versus females in all age groups. LNB cases were reported throughout the year, with peaks in July to September. Notified LNB incidence in Denmark was moderate with no evidence of decline. Cases occurred across all regions but were focally concentrated among residents of some municipalities. Expanding the current surveillance system to include other manifestations of LB would be valuable to better understand geographic endemicity to inform targeted preventive measures.

Background Disease incidence is a key indicator for the assessment of population health and to guide public health policies. Defining accurate population denominators is challenging for incidence studies of hospital-based events, for which hospital catchment areas depend on patient choice and geographic proximity and often do not match established town or city boundaries. We describe a new method to accurately define a hospital's population denominator, which we developed for a study designed to estimate the incidence of hospitalisation for adult acute lower respiratory tract disease in Bristol, UK. Methods We examined hospital data for adult acute lower respiratory tract disease to identify general practitioner (GP) practices (n=82) whose patients were treated for adult acute lower respiratory tract disease at study hospitals and confirmed that nearly all patients (9230 [94·5%] of 9764) were registered with practices within the National Health Service's Bristol, North Somerset, and South Gloucestershire Clinical Commissioning Group (CCG). Hospital admission data were linked to aggregated GP practice patient registration data within this CCG for April 1, 2017, to March 31, 2020. The proportion of GP practices' patients who were hospitalised for adult acute lower respiratory tract disease that occurred at a specific study hospital was multiplied by their patient registration count for six age groups to obtain the practices' contribution to that hospital's denominator (eg, if 50% of GP practice admissions were at a specific study hospital among patients aged 50–64 years, the practice contributed half of their patients aged 50–64 years to the denominator). Alternate denominators were calculated using population census data matched to 20-minute drivetime estimates for study hospitals (the method used to define hospital catchment for local health service purposes). Findings The percentage of admissions at study hospitals varied substantially by GP practice (0–100%). 231 342 (86·3%) of 268 093 of the CCG's GP practice registrants aged 18–34 years received treatment at study hospitals (compared with 19 229 [80%] of 23 938 registrants aged or older than 85 years); some received treatment at another local hospital to the south. With 20-minute drivetime as an estimate measure, hospital catchment would be 550 155 (66·5%) of 827 304 individuals in the CCG population. Interpretation Using health-care data stratified by local CCG enables the estimation of local population denominators to support accurate incidence ascertainment within hospital-based surveillance studies. Funding This work was funded by Pfizer.

Background: The molecular epidemiology of rubella virus (RV) based on the analysis of the viral E1 gene sequences indicated the existence of two genotypes that differ from each other by 8 to 10% in their nucleotide sequences: genotype I is present in Europe, North America and Asia; and genotype II is present only in Asia. Objectives: The purpose of the study was to identify the RV genotypes circulating in Brazil. Study design: In this study, we analysed 86 clinical samples collected between 1996 and 1999 during a rubella outbreak and from sporadic cases of rubella in Rio de Janeiro State. For the molecular characterisation of RV strains we have used PCR/nested amplification and direct sequencing of a 513-nucleotide region of the E1 gene. Results: The E1 gene sequences of 14 RVs were obtained and were assigned to two lineages, both within genotype I. The percentage divergence of nucleotide sequence ranged from 3.4 to 5.1% between these two lineages. These results were in agreement with the pattern of variation observed among the sequences obtained from other lineages of RV. Conclusions: This work demonstrated that two new lineages of RV circulated simultaneously between the years 1996 and 1999 in the state of Rio de Janeiro. These results provided new approaches for monitoring the progress of vaccination efforts in Brazil.