The tick-bite season is beginning in France. An awareness day on Lyme disease and other tick-borne illnesses is being organized on May 25, 2023, by the reference centers that treat these conditions. This will provide Santé publique France with an opportunity to assess the current situation and share the results of the Health Barometer survey conducted in the Grand-Est region, where the incidence rate is among the highest.
thematic dossier
Lyme borreliosis, or Lyme disease, is an infectious disease caused by bacteria of the Borrelia burgdorferi sensu lato complex, which is transmitted to humans through the bites of infected ticks.
TIQUES & YOU - 1st Awareness Day on Tick-Borne Diseases, May 25, 2023
The objectives of this event are to widely disseminate preventive measures against these diseases, raise awareness of the early clinical signs to look for, and share the latest scientific and medical knowledge. Santé publique France is participating to discuss the epidemiology of Lyme disease and the results of the Health Barometer in a webinar format.
Every year, spring marks the start of tick season, providing an opportunity to assess the prevalence of Lyme borreliosis (or Lyme disease), which is transmitted by these arthropods, in France. In France, as in many European countries, Lyme borreliosis is currently the most widespread “vector-borne” disease—that is, a disease transmitted by ticks. In 2021, it is estimated that nearly 47,000 cases were diagnosed in primary care, representing an incidence of 71 cases per 100,000 inhabitants in France.
To assess the public’s knowledge, behaviors, and perceptions regarding Lyme disease and tick bites, a specific module on Lyme disease was included in the Santé publique France Public Health Barometer in 2016 and 2019, with results published in 2022. In addition to these national data, Santé publique France sought to present these results at the Grand Est regional level, where Lyme borreliosis has been a focus of attention for nearly 20 years, both for the public and for regional health authorities, in order to support and guide the regional prevention strategy.
Furthermore, since 2016 and the implementation of the action plan to combat Lyme disease and tick-borne diseases by the Ministry of Health, information and awareness campaigns targeting the general public—reminding people of prevention measures and personal protection—have been developed and disseminated, particularly in the regions most affected. There is no vaccine against Lyme disease; therefore, preventive measures—particularly those against tick bites—are essential to prevent the risk of infection.
In 2021, it is estimated that nearly 47,000 cases were diagnosed in primary care, representing an incidence of 71 cases per 100,000 inhabitants in France. Since 2009, the estimated number of Lyme disease cases diagnosed in primary care has fluctuated between 25,000 and 68,530 cases per year. The annual incidence rate fluctuated around an estimated average of 62 cases per 100,000 inhabitants, ranging from 41 per 100,000 inhabitants (2011) to 104 per 100,000 inhabitants (2018) in metropolitan France.
Furthermore, approximately 810 cases are hospitalized for Lyme borreliosis each year. In more than half of these cases, hospitalized patients present with neurological symptoms.
Although cases of Lyme borreliosis are reported every year, the majority are diagnosed in primary care and in hospitals between June and October, which corresponds to the peak tick activity season in France. People over the age of 60 appear to be most affected by the disease, but cases are reported across all age groups.
Lyme disease is present throughout mainland France but is unevenly distributed.
The eastern and central regions have the highest incidence rates (>100 cases per 100,000 inhabitants), while the western and southeastern Mediterranean regions have the lowest rates (<50 cases per 100,000 inhabitants).
This distribution is linked, among other factors, to regional characteristics such as vegetation types, varying climates, and interactions between the disease’s hosts and vectors, as well as between vectors and humans.
Santé publique France coordinates the surveillance of Lyme disease nationwide and relies on several partners for this purpose, notably the Sentinelles network and the National Reference Center for Borrelia.
Annual surveillance data are based on cases diagnosed in primary care and in hospitals; these data make it possible to describe the different forms of the disease and track trends.
Learn more about the surveillance of Lyme disease
Exposure to tick bites is measured using the Santé publique France Barometer, a national survey repeated over time that assesses the attitudes, knowledge, and practices of the general French population regarding various health topics, as well as estimates the frequency of several health risks faced by the French population, including tick bites, which were addressed in 2016 and 2019. It was thus estimated in 2016 that approximately one-quarter of the population had been bitten by a tick at some point in their lives, a proportion that increased to nearly one-third in 2019. Furthermore, 4% of respondents in 2016 and 6% in 2019 reported a tick bite in the previous year.
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With the free smartphone app “Signalement tique” available at: https://www.citique.fr/signalement-tique/, it is possible to report tick bites, whether found on a human or an animal.
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Furthermore, 79% of the French population reported having heard of Lyme disease in 2019 (versus 64% in 2016). Although this figure is rising, a significant portion of the population still needs to be made aware of the issue.
Additionally, 42% of the population considered themselves well-informed about the disease in 2019, compared to 28% in 2016. This increase in perceived knowledge was observed across all metropolitan regions. Women, people over 45, and those living in rural areas, in smaller urban areas, and in regions known to have higher incidence rates felt better informed.
In 2019, 66% of people bitten by a tick reported using a tick remover or fine-tipped tweezers to remove the tick, while 32% reported using other, non-recommended methods.
Among those who felt exposed to tick bites, 17% reported using a repellent, and 74% reported wearing long clothing as a means of protection when exposed. Finally, 53% reported checking their bodies and removing ticks after exposure.
Despite feeling exposed to tick bites, a significant portion of the population reported never checking their bodies after exposure or wearing long clothing for protection.
These results indicate high acceptance but still limited use of protective measures, even though these steps are essential for preventing tick bites and reducing the risk of infection.
In 2019, compared to the rest of France, the population of the Grand Est region was characterized by:
A higher reported lifetime prevalence of insect bites (46% vs. 29%)
More reported insect bites in the past twelve months (11% vs. 5%)
Bites occurring mainly in forests (68%) followed by gardens (14%)
Greater use of tick removers (72% vs. 65%)
A stronger sense of exposure (35% vs. 24%)
Higher frequency of use of recommended protective measures
Greater awareness of Lyme disease (90% vs. 78%)
A higher level of information (58% vs. 40%)
Greater concern about contracting the disease (28% vs. 18%)
Compared to 2016 data, the population of the Grand Est region is characterized by:
More reported bites in the past 12 months (12% vs. 8%)
More frequent wearing of long clothing (82% vs. 73%)
Greater awareness of Lyme disease (90% vs. 85%)
Learn more: 2016–2019 Health Barometer Summary
Ticks are small and hard to spot. When walking in the woods, in meadows, or while gardening, follow these tips to protect yourself from bites:
Cover up by wearing long sleeves and pants, a hat, and tucking your pant legs into your socks;
stay on the trails and avoid brush, ferns, and tall grass;
use skin repellents.
When returning home after a walk in the woods or after gardening, it is advisable to:
examine yourself and carefully check your entire body;
if bitten, remove the tick(s) as quickly as possible using a tick remover or, if unavailable, fine-tipped tweezers.
Brochures and prevention materials are available to healthcare professionals and the general public to raise awareness about tick-borne diseases. Materials have also been created for children to teach them preventive measures against tick bites from an early age.
Download:
Advice from ‘Prudence’: the anti-tick strategy (information leaflet for children)
Prudence’s Tips: The Anti-Tick Strategy (poster for children)
According to the 2016 and 2019 editions of the Santé publique France Barometer, information on prevention against tick bites and Lyme disease appears to be improving over time, coinciding with a national prevention campaign and strategy launched in 2016. To further improve the use of preventive measures, a better understanding of the barriers to their use is now necessary (lack of knowledge, feelings of discomfort, or the cost of these measures, etc.).
