Lyme Borreliosis and Tick Surveillance Epidemiology in the WHO Regions of the Americas, Eastern Mediterranean, Europe, South-East Asia, and Western Pacific: A Systematic Literature Review (2005-2022) Beyond North America (Canada, United States of America), European Union Countries, and China.

Background and Methods: This Lyme borreliosis (LB) and Borrelia burgdorferi sensu lato (Bbsl)-infected Ixodes ticks surveillance review-from the WHO regions of the Americas, Eastern Mediterranean, Europe, South-East Asia, and Western Pacific-is informed by LB cases or incidence, Bbsl antibody seroprevalence, and Ixodes (I.) tick surveillance results from publications (2005-2022) and recent government websites. Results: LB cases, by the WHO region-country, were documented in the following: the Americas-Brazil and México; Europe-Russian Federation and Türkiye; South-East Asia-India; and Western Pacific-Japan, Mongolia, and South Korea. Mean incidence, cases/100,000 population per year (country, period), was as follows: Europe, 4.8 (Russian Federation, 2009-2021); Western Pacific, 0.01 (Japan, 2005-2021) and 0.03 (South Korea, 2012-2021). Two-tier testing Bbsl antibody seroprevalence estimate ranges were as follows: the Americas, 1.0-6.2% (Brazil), 4.6% (Colombia), and 23.1% (México); Europe, 0-15.8% (Türkiye); South-East Asia, 0.4-3.0% (India); and Western Pacific, 0-14.0% (Mongolia). Ixodes tick surveillance was presented by species (nymph, adult, or not reported, NR, life stage and [Bbsl-infected proportion]): the Americas-México, I. scapularis (NR [34.2%]); Eastern Mediterranean-Iran, I. ricinus (adult [0.9% Borrelia]); Europe-Russian Federation, I. ricinus (nymph [27.3%], nymph/adult [33.4%], adult/NR [9.8-80.4%]) and I. persulcatus (adult/NR [12.0-75.3%]) and Türkiye, I. ricinus (adult/NR [19.9%]); and Western Pacific-Japan, I. persulcatus (nymph [0-10.0%], nymph/adult [1.8-23.6%], adult/NR [detected-up to 25.5%]) and Mongolia, I. persulcatus (nymph [detected], nymph/adult [49.4%], adult [7.0-49.7%]). Conclusions: LB burden might be underrecognized in certain countries of the Americas, Eastern Mediterranean, and South-East Asia, whereas LB cases or incidence, Bbsl antibody seroprevalence, and Bbsl-infected tick presence is established in certain countries of WHO Europe (Russian Federation and Türkiye) and Western Pacific (Japan, Korea, and Mongolia), and LB could be present in neighboring countries within these WHO regions (PROSPERO: CRD42021236906).