Borelioza mózgu przenoszona przez kleszcze
Epidemiologia

Kleszczowe zapalenie mózgu (TBE) jest wirusową infekcją ośrodkowego układu nerwowego przenoszoną przez kleszcze, stanowiącą istotne zagrożenie zdrowotne w Europie i Azji. Rocznie zgłasza się około 10 000-12 000 przypadków klinicznych, przy czym w UE/EOG w 2022 roku odnotowano 3650 przypadków (współczynnik 0,81/100 000 mieszkańców), co stanowi wzrost o 14% względem 2021 roku. Choroba wykazuje sezonowość z największą liczbą zachorowań od czerwca do listopada, szczególnie w lipcu (n=800). Epidemiologia TBE jest zróżnicowana regionalnie, z wysoką zapadalnością w krajach bałtyckich, Czechach, Słowenii oraz Niemczech (głównie Badenia-Wirtembergia i Bawaria). W ostatnich latach obserwuje się ekspansję geograficzną wirusa na nowe obszary, w tym na wyższe wysokości (do 2100 m n.p.m.) oraz do krajów wcześniej wolnych od TBE, takich jak Holandia, Belgia i Wielka Brytania. Czynniki klimatyczne, zmiany w zachowaniach ludzkich oraz migracje ptaków przyczyniają się do rozprzestrzeniania wirusa. Nadzór epidemiologiczny jest niejednolity, a niedostateczne testowanie i raportowanie prowadzi do niedoszacowania rzeczywistego obciążenia chorobą. W Szwajcarii szacowana roczna zapadalność na zakażenie (objawowe i bezobjawowe) u nieszczepionych wynosi 735/100 000, co jest znacznie wyższe niż liczba zgłoszonych przypadków klinicznych.

  1. Epidemiologia i nadzór nad kleszczowym zapaleniem mózgu
    1. Globalne rozpowszechnienie TBE
    2. Czynniki ryzyka i sezonowość
    3. Różnice regionalne w epidemiologii TBE
  2. Nowe obszary endemiczne i ekspansja geograficzna
    1. Nowe ogniska TBE w Europie Zachodniej
    2. Wzrost wysokościowy i szerokościowy zasięgu TBE
  3. Wyzwania związane z nadzorem i diagnozą
    1. Niejednolite systemy nadzoru
    2. Niedostateczne raportowanie i diagnostyka
    3. Rzeczywista zapadalność vs zgłoszone przypadki
  4. Czynniki wpływające na zmienne epidemiologiczne
    1. Wpływ klimatu i zmian środowiskowych
    2. Zmiany w zachowaniach ludzkich
    3. Wpływ szczepień na epidemiologię
  5. Strategia zapobiegania i nadzoru
    1. Szczepienia jako kluczowa strategia zapobiegawcza
    2. Zagadnienia związane z wyszczepialności
    3. Podnoszenie świadomości i edukacja
  6. Nadzór w populacjach wysokiego ryzyka
    1. Specyficzne populacje ryzyka
    2. Ciężkość choroby i czynniki prognostyczne
  7. Znaczenie standaryzacji nadzoru
    1. Kolejne rozdziały

Epidemiologia i nadzór nad kleszczowym zapaleniem mózgu

Borelioza mózgu przenoszona przez kleszcze, znana również jako kleszczowe zapalenie mózgu (TBE – tick-borne encephalitis), stanowi poważne zagrożenie dla zdrowia publicznego w wielu regionach Europy i Azji. Jest to wirusowa infekcja ośrodkowego układu nerwowego przenoszona głównie przez kleszcze. Liczba zgłaszanych przypadków TBE systematycznie wzrasta w większości krajów endemicznych, co czyni tę chorobę istotnym wyzwaniem dla systemów opieki zdrowotnej.12

Globalne rozpowszechnienie TBE

TBE jest chorobą endemiczną występującą w rozległym obszarze geograficznym rozciągającym się od Europy Zachodniej i Północnej do Azji Północnej i Wschodniej. Rocznie na całym świecie zgłasza się około 10 000-12 000 przypadków klinicznych TBE, jednak liczba ta jest prawdopodobnie znacznie niższa niż rzeczywista całkowita liczba przypadków klinicznych ze względu na niedostateczną diagnostykę i raportowanie.12

W Europie najwyższa zapadalność w ostatnich latach była zgłaszana z krajów bałtyckich (Estonia, Łotwa i Litwa), Czech i Słowenii. W 2022 roku 20 krajów UE/EOG zgłosiło 3650 przypadków TBE, z czego 3516 (96,3%) zostało potwierdzonych. Współczynnik zgłaszalności w UE/EOG za rok 2022 wynosił 0,81 na 100 000 mieszkańców, co stanowi wzrost o 14% w porównaniu z wynikami z 2021 roku.12

W ciągu ostatnich 30 lat zasięg transmisji wirusa TBE rozszerzył się na nowe obszary geograficzne i wyższe wysokości, co sugeruje wpływ zmian klimatycznych i innych czynników środowiskowych na rozprzestrzenianie się choroby.1

Czynniki ryzyka i sezonowość

TBE wykazuje wyraźny wzór sezonowy związany z aktywnością kleszczy. Główny sezon przenoszenia wirusa TBE trwa od kwietnia do listopada, kiedy kleszcze są najbardziej aktywne ze względu na cieplejszą pogodę w półkuli północnej. W 2022 roku 90% potwierdzonych przypadków w UE/EOG wystąpiło między czerwcem a listopadem, przy czym lipiec miał najwyższą liczbę zgłoszonych przypadków (n=800).12

Ryzyko TBE dla indywidualnego podróżnego jest w dużej mierze uzależnione od planowanej trasy i aktywności. Osoby uprawiające aktywności na świeżym powietrzu na obszarach leśnych w krajach endemicznych są narażone na większe ryzyko zakażenia. Przypadki częściej zgłaszane są wśród mężczyzn (stosunek mężczyzn do kobiet: 1,5:1), a większość przypadków odnotowuje się w grupie wiekowej 45-64 lat.12

Różnice regionalne w epidemiologii TBE

Epidemiologia TBE różni się znacznie między regionami, a nawet w obrębie jednego kraju. W Niemczech, które są jednym z głównych obszarów ryzyka w Europie Zachodniej, w latach 2010-2019 odnotowano od minimum 95 (2012) do maksimum 584 przypadków (2018) TBE. Większość zgłoszonych przypadków TBE w latach 2001-2018 pochodziła z Badenii-Wirtembergii i Bawarii (89,0% przypadków z zarejestrowanym miejscem zakażenia w Niemczech).12

W Szwecji, gdzie TBE jest chorobą zgłaszaną obowiązkowo, 75-86% zgłaszanych przypadków TBE wymaga hospitalizacji. W 2022 roku Szwecja zgłosiła 465 przypadków TBE do Europejskiego Centrum Zapobiegania i Kontroli Chorób (ECDC), co stanowiło 13,2% wszystkich zgłoszonych przypadków w Europie. Liczba ta była o 29% wyższa niż 359 przypadków zgłoszonych w 2018 roku.1

W Chinach w latach 2007-2018 zgłoszono łącznie 3364 przypadków TBE, przy rocznej zapadalności wynoszącej od 0,09 do 0,44/100 000. Wśród przypadków TBE 89,92% zgłoszono w obszarach leśnych (41,94% w DaXingAnLing, 8,70% w XiaoXingAnLing i 39,21% w ChangBaiShan) w północno-wschodnich Chinach.1

Nowe obszary endemiczne i ekspansja geograficzna

W ostatnich latach obserwuje się znaczące zmiany w geograficznym rozmieszczeniu TBE. Wirus rozprzestrzenia się na nowe obszary, które wcześniej uważano za wolne od tej choroby, co stanowi poważne wyzwanie dla systemów nadzoru i kontroli.1

Nowe ogniska TBE w Europie Zachodniej

Kraje, które do niedawna uważano za wolne od wirusa TBE, zidentyfikowano w ostatniej dekadzie jako obszary, gdzie wirus krąży w środowisku. Od 2016 roku Holandia, Belgia i Wielka Brytania zgłosiły autochtoniczne (miejscowe) przypadki u ludzi.1

W Wielkiej Brytanii w 2019 roku wykryto wirus TBE (podtyp europejski) w niewielkiej liczbie kleszczy w Thetford Forest i na obszarze na granicy między Hampshire i Dorset. W latach 2022-2023 zidentyfikowano dwa potwierdzone przypadki TBE nabyte w Wielkiej Brytanii, w czerwcu i sierpniu 2022 roku. Były to pierwsze potwierdzone autochtoniczne przypadki ludzkiego TBE w Wielkiej Brytanii.12

Dodatkowo, odkryto nowe ogniska endemiczne wirusa TBE w Armenii i Azerbejdżanie, co wskazuje na potrzebę dalszych badań epidemiologicznych i nadzoru w regionie Kaukazu.1

Wzrost wysokościowy i szerokościowy zasięgu TBE

W ostatnich latach nowe ogniska TBE zgłaszano z wysokości do 2100 metrów nad poziomem morza. Nowe strefy endemiczne w poprzednio niezakażonych regionach alpejskich w zachodniej Austrii i w Szwajcarii zostały ustanowione, a w 2018 roku opublikowano pierwszy raport o wykryciu wirusa TBE w lokalizacjach w Norwegii na szerokości geograficznej powyżej 65°N.1

Ekspansja geograficzna wirusa TBE na północ, zachód, a nawet południe (np. Tunezja) oraz na wyższe wysokości (np. w Alpach) może być wyjaśniona przez różne czynniki, w tym zmiany klimatyczne, zmiany w zachowaniu ludzi, zmiany w dostępności gatunków żywicielskich kleszczy oraz nowe trasy lotów ptaków migrujących, które mogą prowadzić do importu kleszczy zakażonych wirusem TBE na obszary dotychczas wolne od tego wirusa.1

Wyzwania związane z nadzorem i diagnozą

Nadzór nad TBE w Europie jest bardziej sporadyczny niż systematyczny, a przypadki TBE są prawdopodobnie niedostatecznie zgłaszane. Prowadzi to do niedoszacowania rzeczywistego obciążenia chorobą i utrudnia skuteczne działania w zakresie zdrowia publicznego.12

Niejednolite systemy nadzoru

Europejskie Centrum Zapobiegania i Kontroli Chorób (ECDC) definiuje przypadek TBE jako zakażenie wirusem TBE z klinicznymi objawami zapalenia ośrodkowego układu nerwowego (np. zapalenie opon mózgowo-rdzeniowych, zapalenie mózgu). Od 2012 roku ECDC wymaga od wszystkich państw członkowskich UE, a także Islandii i Norwegii, corocznego raportowania danych dotyczących TBE do Europejskiego Systemu Nadzoru (TESSy).12

Wspólne definicje przypadków TBE, oficjalnie wprowadzone przez ECDC w 2012 roku i zaktualizowane w 2018 roku, miały na celu zwiększenie i standaryzację identyfikacji TBE w programach nadzoru w całej UE. Jednak definicje przypadków TBE i raportowanie zostały wdrożone niekonsekwentnie w całej Europie.1

Z 44 krajów regionu europejskiego ONZ, 37 (84%) nakazało obowiązkowe zgłaszanie przypadków TBE, zakażenia wirusem TBE lub ostrego/wirusowego zapalenia opon mózgowo-rdzeniowych/zapalenia mózgu. Dwadzieścia cztery kraje zgłosiły przypadki TBE do ECDC w 2020 roku; jednak nadzór nad TBE w Europie jest niejednorodny.1

Niedostateczne raportowanie i diagnostyka

Niedostateczne raportowanie TBE może być spotęgowane przez klinicystów, którzy nie przeprowadzają testów w kierunku zakażenia wirusem TBE, ponieważ nie rozpoznają możliwości zapalenia OUN. Badanie przeprowadzone w Niemczech wykazało, że wskaźniki testowania TBE wahały się od 54,0% (tylko niespecyficzne objawy neurologiczne) do 65,6% (tylko objawy zapalenia mózgu), co sugeruje, że pacjenci z typowymi objawami TBE są prawdopodobnie niedostatecznie badani, co prowadzi do niedodiagnozowania TBE.12

W krajach, gdzie TBE nie jest chorobą podlegającą obowiązkowemu zgłaszaniu, nadzór nad TBE był ograniczony. Na przykład w Chinach, gdzie TBE nie jest notyfikowalną chorobą zakaźną, nadzór nad TBE był niewystarczający. Doprowadziło to do niepełnego zrozumienia obszarów endemicznych TBE i potencjalnie nieadekwatnych zaleceń dotyczących szczepień.12

Rzeczywista zapadalność vs zgłoszone przypadki

Badanie przeprowadzone w Szwajcarii wykazało, że szacowana roczna zapadalność na zakażenie (objawowe lub abortywne, tj. bezobjawowe lub prezentujące się jako łagodna choroba gorączkowa bez rozwijania formy neurologicznej) u nieszczepionych osób wynosiła 735/100 000, co jest około 150-250 razy wyższe niż zapadalność na klinicznie jawne, zgłoszone przypadki TBE w Szwajcarii. Wskazuje to, że niezdiagnozowane zakażenia są powszechne, a częstość występowania zakażeń wirusem TBE jest znacznie wyższa niż liczba zgłoszonych przypadków klinicznych TBE.1

Czynniki wpływające na zmienne epidemiologiczne

Epidemiologia TBE jest wynikiem złożonej interakcji między zwierzętami rezerwuarowymi, ptakami, kleszczami, roślinami, klimatem, pogodą i zachowaniami ludzkimi (w tym przyjmowaniem szczepionek). Obecne zmiany obejmują zwiększenie geograficznego rozmieszczenia obszarów ryzyka TBE, a także ogólny wzrost liczby zgłaszanych przypadków TBE.1

Wpływ klimatu i zmian środowiskowych

Zmiany klimatyczne sprzyjają ekspansji siedlisk kleszczy i wydłużeniu okresów ich aktywności. W Czechach odnotowano wysoką liczbę przypadków wirusa TBE i tendencję do ciągłego wzrostu tego wskaźnika, co wiązano ze stopniowym przenikaniem wirusa TBE do górskich biocenoz z powodu ocieplenia klimatu.1

Badania nad molekularną epidemiologią wirusa TBE wykazały, że szczepy zarówno podtypu zachodniego, jak i dalekowschodniego można znaleźć w europejskich i azjatyckich regionach byłego Związku Radzieckiego, co wskazuje na złożoność rozmieszczenia geograficznego różnych podtypów wirusa.1

Zmiany w zachowaniach ludzkich

Czynniki społeczne, takie jak zmiany społeczno-polityczne wiążące się ze zmianami w zachowaniach ludzi, czas trwania i rodzaj zajęć w czasie wolnym, wpływają na ekspozycję na zakażone kleszcze. Wzrost aktywności na świeżym powietrzu i turystyki w obszarach endemicznych zwiększa ryzyko kontaktu z kleszczami.1

W Niemczech ryzyko zakażenia zwiększało się wraz z wiekiem, szczególnie u osób powyżej 40 roku życia, i było większe u mężczyzn niż u kobiet. Ogólnie, dla Europy, szacowane ryzyko wynosi około 1 przypadek na 10 000 miesięcy aktywności człowieka w lasach.1

Wpływ szczepień na epidemiologię

Wyszczepialność znacząco modyfikuje liczbę przypadków na obszarze ryzyka TBE, co obrazuje przykład Austrii, gdzie w ostatniej dekadzie zgłasza się rocznie mniej niż 100 przypadków, podczas gdy przed wprowadzeniem programu szczepień liczba ta wynosiła do 700 przypadków rocznie.1

W Szwecji, mimo stosunkowo niskiego poziomu wyszczepienia przeciwko TBE, szczepienia zapobiegły szacunkowo tysiącom przypadków TBE w latach 2018-2022. Skuteczność szczepionki przeciwko TBE po trzech dawkach wynosiła 89,0% (95% przedział ufności 84,3-92,4). Wśród 1890 przypadków ze znaną historią szczepień przeciwko TBE, 82,8% (1564) stanowiły osoby nieszczepione.12

Strategia zapobiegania i nadzoru

Poprawa nadzoru nad TBE w Europie może być osiągnięta poprzez zastosowanie jednolitej definicji przypadku TBE w całej Europie, testowanie wszystkich przypadków aseptycznego zapalenia opon mózgowo-rdzeniowych/zapalenia mózgu o nieznanej etiologii w kierunku zakażenia wirusem TBE, a także poprawę finansowania i dostępu do testów diagnostycznych i placówek badawczych.1

Szczepienia jako kluczowa strategia zapobiegawcza

Szczepienie pozostaje najskuteczniejszą metodą ochrony przed TBE, a dostępne szczepionki przeciwko TBE wykazują wysokie wskaźniki serokonwersji. Jednak zalecenia dotyczące szczepień przeciwko TBE różnią się znacznie w całej Europie. Obecnie tylko Austria i Szwajcaria mają narodowe uniwersalne programy szczepień.1

W obszarach, gdzie choroba jest wysoce endemiczna, WHO zaleca, aby szczepienia były oferowane wszystkim grupom wiekowym, w tym dzieciom. Uważa się, że immunizacja jest najlepszą ochroną przed kleszczowym zapaleniem mózgu.1

W Wielkiej Brytanii, gdzie TBE jest nowo pojawiającą się chorobą, ryzyko jest obecnie oceniane jako bardzo niskie dla ogółu populacji i niskie dla grup wysokiego ryzyka (takich jak osoby mieszkające, pracujące lub odwiedzające dotknięte obszary).1

Zagadnienia związane z wyszczepialności

Wskaźniki przyjmowania szczepionek przeciwko TBE są niskie w wielu krajach i nie wydają się korelować ze świadomością na temat szczepionek. Złożoność schematu szczepień przeciwko TBE, dostępność i refundacja szczepionki przeciwko TBE oraz niska świadomość potencjalnych konsekwencji TBE przyczyniają się do niskich wskaźników przyjmowania szczepień w większości krajów Europy.1

W Szwecji czynniki przyczyniające się do niedostatecznego przyjmowania szczepionek przeciwko TBE obejmują ograniczoną świadomość ryzyka zakażenia wirusem TBE lub ciężkości TBE, cenę szczepień, brak czasu lub możliwości szczepienia oraz niechęć do przyjmowania szczepionek.1

Podnoszenie świadomości i edukacja

Ważne jest podnoszenie świadomości na temat TBE w całej Europie, gdzie widoczne jest, że ryzyko związane z TBE jest niedoszacowane. Kampanie uświadamiające mające na celu edukację społeczeństwa na temat ryzyka TBE okazały się już skuteczne.1

W Wielkiej Brytanii w odpowiedzi na pojawienie się TBE zaleca się podnoszenie lokalnej świadomości na temat środków unikania kleszczy dla społeczeństwa i klinicystów w znanych dotkniętych obszarach, a także aktualizację krajowych wytycznych dotyczących zapalenia mózgu w celu zwiększenia świadomości wśród personelu NHS i zwiększenia testowania w kierunku TBE w przypadku klinicznie zgodnego zapalenia mózgu nabytego w Wielkiej Brytanii lub objawów neurologicznych po chorobie gorączkowej.12

Nadzór w populacjach wysokiego ryzyka

Ryzyko TBE dla personelu wojskowego USA stacjonującego w Europie jest niskie, ale nie nieistotne, i mogło wzrosnąć w ostatnich latach. W badaniu przeprowadzonym wśród amerykańskiego personelu wojskowego i beneficjentów w latach 2006-2018 zidentyfikowano 8 przypadków TBE, z których 7 wystąpiło w 2017 lub 2018 roku.12

Zaleca się, aby dowódcy i personel amerykańskiej służby zdrowia publicznej w Europie znali i przewidywali obszary i działania wysokiego ryzyka, na które amerykański personel może być narażony, oraz zapewnili, że środki kontroli TBE obejmują dokładny i terminowy nadzór, odpowiednie środki ochrony osobistej, unikanie kleszczy i szczepienia oparte na ryzyku.1

Specyficzne populacje ryzyka

Przypadki TBE na obszarach endemicznych dotyczą głównie mężczyzn, osób w grupie wiekowej 40-49 lat. W Chinach przypadki TBE były głównie płci męskiej, stanowiąc 67,15% (2259/3364 przypadków) i w grupie wiekowej 40-49 lat, stanowiąc 31,89% (1073/3364 przypadków).1

Pracownicy domowi i leśnicy stanowili większość przypadków TBE w regionie DaXingAnLing w Chinach, podczas gdy pracownicy domowi i rolnicy w regionach XiaoXingAnLing i ChangBaiShan.1

Niedostateczne raportowanie TBE jest szczególnie prawdopodobne u dzieci, u których objawy choroby są często łagodne i mogą być niespecyficzne, a zatem mogą często nie być prawidłowo diagnozowane.1

Ciężkość choroby i czynniki prognostyczne

Badanie przeprowadzone na Litwie, kraju o wysokiej endemiczności, wykazało, że 14,6% pacjentów miało ciężki przebieg TBE. Najwyższy odsetek ciężkich przypadków, sięgający 41,2%, odnotowano w grupie wiekowej 70-79 lat. Czynniki prognostyczne związane z ciężkim przebiegiem choroby i ciężką postacią zapalenia opon mózgowo-rdzeniowych i mózgu to: starszy wiek, choroby współistniejące, przebieg jednofazowy, gorączka 40°C i powyżej, CRP powyżej 30 mg/l, białko w płynie mózgowo-rdzeniowym powyżej 1 g/l, opóźniona odpowiedź immunologiczna IgG przeciwko wirusowi TBE, patologiczne zmiany w tomografii komputerowej.12

Śmiertelność w tym badaniu wynosiła 0,7%, co jest podobne do niektórych badań łotewskich, polskich i niemieckich.1

Znaczenie standaryzacji nadzoru

Standaryzacja nadzoru nad TBE zwiększyłaby zrozumienie obciążenia chorobą TBE w Europie. Strategie poprawy nadzoru nad TBE i przyjmowania szczepionek powinny koncentrować się na: dostosowaniu kryteriów diagnostycznych i testów w całej Europie; rozszerzeniu obecnych zaleceń dotyczących szczepionek i zmniejszeniu ich złożoności; oraz zwiększeniu edukacji publicznej na temat potencjalnych zagrożeń związanych z zakażeniem wirusem TBE.12

Identyfikacja obszarów endemicznych TBE jest niezbędna do informowania krajowych i międzynarodowych programów zarządzania ryzykiem TBE. Jednak porównanie między regionami i krajami zależy od dokładności i spójności krajowych/regionalnych systemów nadzoru.1

W Rosji, która ma największą liczbę zgłoszonych przypadków TBE, istnieją kontrowersje i nierozwiązane kwestie dotyczące tej choroby. Obecnie istnieją 4 genotypy wirusa TBE: dalekowschodni, europejski, syberyjski i bajkalski, z których każdy ma swój własny obszar występowania i potencjał patogenny dla ludzi.1

Ze względu na brak wysoce skutecznych leków etiotropowych do leczenia TBE, jedyną strategią zmniejszenia zachorowalności na TBE jest masowe szczepienie populacji regionów endemicznych. W związku z wzrostem wskaźnika szczepień w Rosji i krajach europejskich, w celu poprawy nadzoru epidemiologicznego nad TBE, należy doprecyzować normy specyficznej laboratoryjnej diagnostyki choroby wśród osób szczepionych, wyjaśnienie przyczyn zapadalności szczepionych, a także zgonów wśród nich.1

W warunkach połączenia naturalnych ognisk TBE i innych zakażeń przenoszonych przez kleszcze, ważne jest opracowanie algorytmów diagnostycznych, w tym diagnostyki różnicowej tej choroby z innymi infekcjami przenoszonymi przez kleszcze Ixodidae.1

Podsumowując, znaczenie nadzoru nad TBE jest kluczowe dla zrozumienia prawdziwego obciążenia tą chorobą i skutecznego zapobiegania oraz kontroli jej rozprzestrzeniania się na nowe obszary geograficzne.1

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

  1. 10.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Tick-borne encephalitis – Wikipedia
    https://en.wikipedia.org/wiki/Tick-borne_encephalitis
    Tick-borne encephalitis (TBE) is a viral infectious disease involving the central nervous system. The number of reported cases has been increasing in most countries. TBE is posing a concerning health challenge to Europe, as the number of reported human cases of TBE in all endemic regions of Europe has increased by almost 400% within the last three decades. […] As of 2011, the disease was most common in Central and Eastern Europe, and Northern Asia. About ten to twelve thousand cases are documented a year but the rates vary widely from one region to another. Most of the variation has been the result of variation in host population, particularly that of deer. In Germany, during the 2010s, there have been a minimum of 95 (2012) and a maximum of 584 cases (2018) of TBE. The risk of infection was noted to be increasing with age, especially in people older than 40 years and it was greater in men than women. Overall, for Europe, the estimated risk is roughly 1 case per 10,000 human-months of woodland activity. […] Travelers to endemic regions do not often become cases, with only 8 cases reported among U.S. travelers returning from Eurasia between 2000 and 2017, a rate so low that as of 2020 the U.S. Centers for Disease Control and Prevention recommended vaccination only for those who will be extensively exposed in high risk areas.
  • #1 Chapter 12a: Epidemiology by country – an overview – TBE Book
    https://tbenews.com/tbe/tbe12a/
    TBE is a flavivirus infection of the central nervous system (CNS), transmitted by ticks and in some instances by ingestion of unpasteurized milk. […] About 10,000 cases of TBE are reported annually, likely a significant underestimate as serological testing is more sporadic than complete and, in some countries, (like Japan) not even available. […] The European Centre for Disease Prevention and Control (ECDC) have put TBE on their list of notifiable diseases. […] Surveillance of TBE and the TBEV is incomplete. Reported incidences do not reflect actual risk since this fluctuates annually as a result of changes in exposure, vaccine uptake, intensity of case finding and reporting, climate factors, reservoir animals and ticks just to mention the most relevant factors. […] For largely unknown reasons (including human behavior, improved diagnostics, or climate change) TBEV appears to be spreading north, east, west, even south and to higher altitudes to areas that were previously believed to be free of the virus.
  • #1 Tick-Borne Encephalitis | Yellow Book | CDC
    https://www.cdc.gov/yellow-book/hcp/travel-associated-infections-diseases/tick-borne-encephalitis.html
    Tick-borne encephalitis (TBE) is focally endemic in a geographic region spreading from western and northern Europe to northern and eastern Asia. Approximately 5,000-10,000 TBE cases are reported from endemic countries each year. […] The highest disease incidence in recent years has been reported from the Baltic states (Estonia, Latvia, and Lithuania), Czech Republic, and Slovenia. […] During the past 30 years, the range of TBE virus transmission has expanded to new geographic areas and to higher altitudes. […] The main TBE virus transmission season is April-November when ticks are most active because of warmer weather in the Northern Hemisphere. […] The risk for TBE for an individual traveler is greatly affected by their planned itinerary and activities. […] During 2000-2023, 12 cases of TBE were reported among U.S. civilian travelers. […] Travelers at risk for TBE virus infection might also be at risk for other tick-borne diseases because the same ticks that transmit TBE virus also can transmit other pathogens.
  • #1 Tick-borne encephalitis vaccine uptake, effectiveness, and impact in Sweden from 2018 to 2022 | Scientific Reports
    https://www.nature.com/articles/s41598-025-86968-y
    TBE is a nationally notifiable disease in Sweden and 75-86% of surveillance-reported TBE cases are hospitalized. […] In 2022, thirty countries reported 3,516 TBE cases to the European Centre for Disease Prevention and Control (ECDC), resulting in an incidence 0.8/100,000 population per year (PPY). Of the reported cases, 465 (13.2%) were from Sweden; the number of reported TBE cases in Sweden in 2022 was 29% higher than the 359 cases reported in 2018. […] Despite this increase in reported TBE cases, the disease burden of TBEV infections in Sweden is under-recognized. […] Vaccination offers the most effective protection against TBE. […] In Sweden, the recommended vaccine schedule includes a three-dose primary series (at months 0, 13, and 5) in persons <50 years-of-age and a four-dose primary series (at months 0, 1, 3, and 5) in persons ≥50 years-of-age.
  • #1 Epidemiology of tick-borne encephalitis in China, 2007- 2018 | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0226712
    Tick-borne encephalitis (TBE) is endemic to Europe and some Asian countries and is prevalent in northeast China. We analyzed the epidemiology of TBE in China from 2007 to 2018. A total of 3,364 TBE cases were reported in mainland China from 2007 to 2018, for an annual incidence of 0.09 to 0.44/100,000. Among the TBE cases, 89.92% were reported in forest areas (41.94% in DaXingAnLing, 8.70% in XiaoXingAnLing, and 39.21% in ChangBaiShan) in northeast China. The TBE cases were primarily male with a proportion of 67.15% (2,259/3,364 cases) and in 40-49-year age group with a proportion of 31.89% (1,073/3,364 cases). The epidemiology of TBE differed slightly among the three forest regions. Domestic workers and forestry workers accounted for the most of the TBE cases in DaXingAnLing, and domestic workers and farmers in XiaoXingAnLing and ChangBaiShan, respectively. The TBE cases mainly occurred from April to August with a peak in June. The TBE laboratory confirmed rate in DaXingAnLing (84.14%, 1,189/1,413 cases) was highest, compared with XiaoXingAnLing and ChangBaiShan (13.99% and 11.37%, respectively). Moreover, the hospital with the highest laboratory confirmed rate (88.01%, 1,336/1,518 cases) was Inner Mongolia Forestry General Hospital of DaXingAnling region. Systematic enhanced TBE surveillance and a vaccination program are needed to improve the laboratory confirmed rate and reduce the incidence of TBE in northeast China.
  • #1 Recommendations to Improve Tick-Borne Encephalitis Surveillance and Vaccine Uptake in Europe
    https://www.mdpi.com/2076-2607/10/7/1283
    In Europe, TBE is generally diagnosed in forested belts ranging from Norway, Southeastern UK, Eastern France, and the Netherlands, down to Northern Italy through Central and Eastern Europe. […] The incidence of TBE is rising across Europe, including those at higher altitudes in Central Europe and further north and west in Scandinavian countries, as well as regions previously believed to be free of the virus. […] Cumulative reported TBE cases across Europe in 2020 were twice those in 2015. […] An increase in reported TBE case numbers was observed in 76% (13/17) of countries over this period. […] The causes for this increase are unclear but are likely to include various factors, such as changing human behavior, improved diagnosis of TBE, and changes in tick habitats and periods of activity due to climate change.
  • #1 Chapter 12: Epidemiology of TBE – TBE Book
    https://tbenews.com/tbe/chapter-12-epidemiology-of-tbe/
    The long-term trend, however, shows an increase in Germany, Austria, Slovakia, Switzerland and Poland, a constant trend the last 22 years in the Czech Republic and decreasing in Slovenia. […] Disease numbers in Sweden, Finland, Norway and even Italy have shown a substantial and continuous increase in the last couple of years. […] But also new countries, until recently regarded TBE-virus free, have been identified in the last decade as areas where TBEV circulates. […] Since 2016, the Netherland, Belgium and the United Kingdom have reported autochthonous human cases. […] These findings illustrate that increased awareness and forced investigations to detect TBEV can lead to identification of new TBEV endemic areas and artificially increase cases numbers. […] In recent years, new TBE foci have been reported from altitudes up to 2100 meters above sea level.
  • #1
    https://www.gov.uk/guidance/tick-borne-encephalitis-epidemiology-diagnosis-and-prevention
    The European subtype is associated with milder disease. […] TBEV is a notifiable organism, and you should notify your local health protection team if detected. […] In 2019, TBEV (European subtype) was detected in a small number of ticks in Thetford Forest and an area on the border between Hampshire and Dorset. […] To date, all other cases of TBEV infection reported in the UK have been acquired through travel to high-risk areas abroad. […] The risk from TBEV is currently assessed as very low for the general public, and low for high-risk groups (such as those living, working or visiting affected areas).
  • #1 Tick-Borne Encephalitis Virus (TBEV): Epidemiology, Diagnosis, Therapeutic Approaches and Some Molecular Aspects—An Updated Review
    https://www.mdpi.com/2036-7481/15/4/174
    The study of TBEV RNA in rodents and tick pools in the Netherlands revealed three different variants of the TBEV-Eu subtype. […] The TBEV is endemic in Slovakia, with increasing incidence over the past 50 years. […] The presence of antibodies against TBEV was revealed in several rodent species caught in various countries. […] In 2024, TBEV-Sib was confirmed by molecular analysis in the Caucasus region for the first time. […] The TBE cases were reported in Georgia, and a hospital-based acute febrile illness surveillance in six hospitals in Georgia revealed 36 TBE cases and indicated tick bites and the consumption of raw dairy products as the major transmission routes. […] New endemic TBEV foci have been documented in Armenia and Azerbaijan recently. […] There is a clear discrepancy between the statement that TBE cases were not reported in Turkey and the available data.
  • #1 Chapter 12: Epidemiology of TBE – TBE Book
    https://tbenews.com/tbe/chapter-12-epidemiology-of-tbe/
    New endemic zones in previously unaffected alpine regions in western Austria and in Switzerland were established, and a first report of TBEV being detected at locations in Norway up to more than 65N latitude was published 2018. […] Various factors may explain all these findings, at least in part: social factors (socio-political changes with changes in human behavior, duration, and type of leisure-time activities), ecological factors (e.g., effects of climate changes on the tick population and change in availability of tick host species, new flight routes of migrating birds which may lead to importation of TBE virus infected ticks into areas which have so far been free of TBE virus), and/or technological factors (advanced diagnostics, increased medical awareness). […] In the end, all factors mentioned above play an interactive role resulting in complex interactions that may explain the observed changes in TBE epidemiology. […] But still, TBE surveillance in Europe is in many countries more sporadic than systematic, and TBE cases are likely underreported.
  • #1 Chapter 12a: Epidemiology by country – an overview – TBE Book
    https://tbenews.com/tbe/tbe12a/
    Overall, TBE surveillance in Europe is more sporadic than systematic, and TBE cases are likely underreported. […] In the end, the real burden of disease from TBE remains unknown and the identification of TBEV endemic areas is far from being complete. […] With only inconsistent and incomplete scientific databases available, it is fair to conclude that the true TBEV disease burden is significantly underestimated. […] The epidemiology of TBE is the result of a complex interaction between reservoir animals, birds, ticks, plants, climate, weather, and human behavior (including vaccine uptake). […] Current changes include an increase in geographical distribution of TBE-risk areas as well as an overall increase of reported TBE cases. […] It appears that areas with TBEV endemicity as well as the total number of reported TBE cases have increased over the last several decades.
  • #1 Publicly available surveillance data on tick-borne encephalitis in Europe, 2023 – PubMed
    https://pubmed.ncbi.nlm.nih.gov/39137541/
    The European Centre for Disease Prevention and Control (ECDC) defines a case of tick-borne encephalitis (TBE) as an infection by the TBE virus (TBEV) with clinical manifestations of central nervous system inflammation (e.g., meningitis, encephalitis). […] To better understand the TBE surveillance landscape, online searches were conducted to determine if cases of TBE, TBEV infection, acute meningitis or encephalitis, or viral meningitis or encephalitis were subject to statutory reporting in European countries in 2023. […] Of 44 countries of the Europe Region of the United Nations, 37 (84 %) mandated statutory reporting of cases of TBE, TBEV infection, or acute/viral meningitis/encephalitis. […] Twenty-four countries reported on TBE cases to ECDC in 2020; however, surveillance for TBE in Europe is heterogeneous. […] Standardization of TBE surveillance would enhance the understanding of TBE disease burden in Europe.
  • #1 Recommendations to Improve Tick-Borne Encephalitis Surveillance and Vaccine Uptake in Europe
    https://www.mdpi.com/2076-2607/10/7/1283
    The identification of TBE-endemic areas is essential to inform national and international programs of TBE risk management. […] Since 2012, the European Centre for Disease Prevention and Control (ECDC) requires all European Union (EU) member states, plus Iceland and Norway, to annually report their TBE data to the European Surveillance System (TESSy). […] However, comparison between regions and countries is dependent on the accuracy and consistency of national/regional surveillance systems. […] Common TBE case definitions, officially introduced by the ECDC in 2012 and updated in 2018, aimed to increase and standardize TBE identification within surveillance programs across the EU. […] However, TBE case definitions and reporting have been implemented inconsistently throughout Europe. […] TBE underreporting may be exacerbated by clinicians who do not test for TBEV infection because they do not recognize the possibility of CNS inflammation.
  • #1 Epidemiology of tick-borne encephalitis in China, 2007- 2018 | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0226712
    Since it is not a notifiable infectious disease in China, surveillance of TBE has been lacking. Therefore, we carried out an epidemiological analysis of TBE in China using cases reported from China Information System for Diseases Control and Prevention over the past decade. […] The annual incidence of TBE in 2007 to 2018 was from 0.09 to 0.44/100,000. TBE cases were mainly distributed in northeast China, in DaXingAnLing and ChangBaiShan. TBE occurred from April to August, with a peak in May or June. TBE cases were predominantly found in men, 40-49 years of age, who worked as farmers, domestic workers, and forestry workers. The laboratory confirmed rate of TBE cases in all regions were less than 14% in 2007 and 2008 and sharply increased after 2009, mainly due to the increase in DaXingAnLing, 45.42% (1,518/3,364) of the TBE cases in all regions and 84.14% (1,189/1,413) of the DaXingAnLing TBE cases were reported in Inner Mongolia Forestry General Hospital. […] Enhanced vector-based and hospital-based sentinel TBE surveillance, and a vaccination program are needed to improve the laboratory confirmed rate and reduce the incidence and disease burden of TBE in China.
  • #1 Tick-borne encephalitis virus seroprevalence and infection incidence in Switzerland, 2020–2021 | Scientific Reports
    https://www.nature.com/articles/s41598-025-92560-1
    Although TBE is widely recognized as a major public health problem in Europe, surveillance is generally sporadic rather than systematic, and the true burden of disease is potentially underestimated. […] Our estimate of the annual incidence of infection (symptomatic or abortive, i.e., asymptomatic or presenting as a mild febrile illness without developing a neurological form) in unvaccinated individuals was 735/100,000, which is approximately 150-250 times higher than the incidence of clinically manifest, reported TBE cases in Switzerland. […] This study contributes to our understanding of the burden of TBE in Switzerland. Undiagnosed infections are common, and the incidence of TBEV infection is substantially higher than the number of reported clinical cases of TBE.
  • #1 Tick-Borne Encephalitis Virus (TBEV): Epidemiology, Diagnosis, Therapeutic Approaches and Some Molecular Aspects—An Updated Review
    https://www.mdpi.com/2036-7481/15/4/174
    The necessary precondition for TBEV transmission is a level of viremia that is equal to or higher than the threshold required for infection, which occurs in such mammals as sheep, goats, horses, dogs, and rodents. […] Data on the burden of TBE in different countries and the geographical distribution of viral subtypes are presented. […] In Europe, twenty EU/EEA countries reported 3650 TBE cases in 2022, of which 3516 (96.3%) were confirmed. […] The TBEV cases were also not revealed in Albania, Kosovo, Macedonia, and Montenegro. […] The number of confirmed cases for 2022 was also high in Lithuania and Poland. […] Based on TBE incidence, Czechia, Estonia, Latvia, Lithuania, and Slovenia are countries with a high incidence rate among European countries. […] The high number of TBEV cases in Czechia and the trend for the continuous increase in this indicator were associated with the gradual infiltration of TBEV into montane biocenosis due to climate warming.
  • #1 Epidemiology of Tick-Borne Encephalitis and the Impact of Vaccination on the Incidence of Disease | SpringerLink
    https://link.springer.com/chapter/10.1007/978-3-642-79896-2_13
    Tick-borne encephalitis (TBE) virus is one of the most important flavi- viruses causing severe disease in man. […] Based on agar gel diffusion and antibody adsorption experiments, two different subtypes of TBE virus have been described: a European subtype, which is mainly transmitted by Ixodes ricinus, and a Far Eastern subtype with Ixodes persulcatus as the principal vector. […] Studies on the molecular epidemiology of TBE virus showed that strains of both the Western and the Far Eastern subtype can be found in the European and Asian regions of the former Soviet Union. […] In addition, the authors also reported that no statistically significant difference in the degree of protection was detected when mice were immunized with the Austrian vaccine (strain Neudrfl) and challenged with Asian isolates of TBE virus.
  • #1 Chapter 12: Epidemiology of TBE – TBE Book
    https://tbenews.com/tbe/chapter-12-epidemiology-of-tbe/
    Severe long-term sequelae of TBE are well described both in children and in adults. […] TBE vaccination against TBE is on the World Health Organizations List of Essential Medicines, the safest and most effective medicines needed in a healthcare system. […] In addition, in 2012 the European Center for Disease Prevention and Control (ECDC) decided to add TBE to the list of mandatory notifiable diseases and provided for the first time ever a uniform disease case definition. […] As ECDC case definition and reporting have not been universally implemented around the globe or even throughout Europe, data on the burden of disease from different countries are difficult to compare. […] Finally, vaccine uptake substantially modifies the number of cases in a TBE risk area, as exemplified again by Austria, where in the last decade fewer than 100 cases are reported annually while this number, however, had been up to 700 cases annually before the introduction of a vaccination program.
  • #1 Tick-borne encephalitis vaccine uptake, effectiveness, and impact in Sweden from 2018 to 2022 | Scientific Reports
    https://www.nature.com/articles/s41598-025-86968-y
    Tick-borne encephalitis (TBE) is an increasing health threat in Sweden and elsewhere in Europe. TBE vaccination is commonly recommended in Sweden, but limited data are available on uptake, effectiveness, and impact of TBE vaccination. General population surveys conducted in 2019-2022 were used to estimate TBE vaccine uptake. TBE vaccine effectiveness (VE) was estimated using the screening method utilizing the surveys and public health TBE surveillance data, which predominately includes hospitalized TBE cases, from 2018 to 2022. Impact of TBE vaccination was calculated based on disease incidence and observed VE. In 2018-2022, 2,015 TBE cases were reported in Sweden; 82.8% (1,564/1,890) of cases with known TBE vaccination history were unvaccinated. Among persons surveyed from the general population with known vaccination history, 52.0% (11,562/22,247) were unvaccinated. Three dose VE against TBE was 89.0% (95% confidence interval 84.3-92.4). In a conservative estimate, despite suboptimal compliance with TBE vaccination recommendations, vaccination averted an estimated thousand TBE cases, most resulting in hospitalization, in Sweden from 2018 to 2022. To prevent additional TBE cases in Sweden, enhanced efforts to increase TBE vaccine uptake and compliance to the TBE vaccination schedule are needed.
  • #1 Recommendations to Improve Tick-Borne Encephalitis Surveillance and Vaccine Uptake in Europe
    https://www.mdpi.com/2076-2607/10/7/1283
    In addition, underreporting of TBE may occur in countries where TBEV and West Nile virus (WNV) infections are endemic. […] The choice of direct or indirect assay to detect TBEV is dependent on the phase of disease. […] The tendency for TBE to be restricted to geographical regions provides the opportunity to focus TBE surveillance on defined risk areas. […] In Romania, TBE surveillance is limited to high-TBE-risk areas in the northwest of the country. […] Incomplete surveillance can lead to a poor understanding of TBE endemic areas and potentially inadequate vaccine recommendations. […] Surveillance of TBE in Europe is currently incomplete, meaning that reported incidences likely only partially reflect actual risk. […] Improving TBE surveillance across Europe could be achieved by: The use of a single TBE case definition across Europe to ensure that data are comparable; Testing all cases of aseptic meningitis/encephalitis of unknown etiology for TBEV infection; Rapidly expanding testing to all patients with either a fever without a known source or CNS symptoms; Improved financing for and access to diagnostic tests and testing facilities; Employing nationwide surveillance systems in countries where these systems are lacking by implementing active surveillance systems.
  • #1 Recommendations to Improve Tick-Borne Encephalitis Surveillance and Vaccine Uptake in Europe
    https://www.mdpi.com/2076-2607/10/7/1283
    Vaccination remains the most effective method of protection against TBE, with available TBE vaccines demonstrating high seroconversion rates. […] TBE vaccine recommendations vary widely across Europe. […] Currently, only Austria and Switzerland have national universal vaccination programs. […] Vaccine uptake is low in many countries and does not appear to correlate with vaccine awareness. […] The complexity of the TBE vaccination schedule, accessibility, and reimbursement of the TBE vaccine, and the low awareness of potential consequences of TBE each contribute to the low uptake rates of vaccination across most of Europe. […] To improve access to vaccination, especially in rural areas, several novel approaches could be employed. […] It is important to raise TBE awareness across Europe, where it is evident that the risks posed by TBE are underestimated.
  • #1
    https://www.who.int/health-topics/tick-borne-encephalitis
    Tick-borne encephalitis (TBE) is an important cause of viral infections of the central nervous system in eastern, central, northern and increasingly western European countries, and in northern China, Mongolia, and the Russian Federation. […] Approximately 10 00012 000 clinical cases of tick-borne encephalitis are reported each year, but this figure is believed to be significantly lower than the actual total number of clinical cases. […] In areas where the disease is highly endemic, WHO recommends that vaccination be offered to all age groups, including children. […] Immunization is the best protection against tick-borne encephalitis.
  • #1 Tick-borne encephalitis vaccine uptake, effectiveness, and impact in Sweden from 2018 to 2022 | Scientific Reports
    https://www.nature.com/articles/s41598-025-86968-y
    Although a 2020 survey reported that 47% of the Swedish population had received at least one dose of a TBE vaccine, there are limited TBE vaccine uptake estimates available at the subnational level in Sweden. […] Factors contributing to the suboptimal TBE vaccine uptake in Sweden include limited awareness of the risk for acquiring TBEV infection or the severity of TBE, price of vaccination, lack of time or opportunity for vaccination, and aversion to receipt of vaccines. […] The objectives of the present study were to estimate TBE vaccine uptake, vaccine effectiveness, and public health impact at the national and subnational level in Sweden, a country where TBE is endemic. […] During the five-year study period, receipt of three doses of a TBE vaccine may have averted approximately one thousand, predominately hospitalized, TBE cases.
  • #1 Recommendations to Improve Tick-Borne Encephalitis Surveillance and Vaccine Uptake in Europe
    https://www.mdpi.com/2076-2607/10/7/1283
    Awareness campaigns to educate the public on the risk of TBE have already been shown to be effective. […] TBE is rapidly expanding to new areas in many parts of Europe, including those at higher altitudes. […] TBE surveillance varies across Europe, with countries having varying diagnostic criteria, access to diagnostic tests beyond ELISAs, and approaches to national/regional surveillance. […] Underreporting of TBE is particularly likely in children, in whom disease symptoms are often mild and may be nonspecific and, hence, may often not be correctly diagnosed.
  • #1
    https://www.gov.uk/government/publications/hairs-risk-assessment-tick-borne-encephalitis/hairs-risk-assessment-tick-borne-encephalitis
    Update the national encephalitis guidance to raise awareness among NHS staff and increase testing for TBE in clinically compatible UK-acquired encephalitis or neurological symptoms following a febrile illness. […] Testing should be considered where epidemiological risk exists (forest exposure or tick bite(s)), or there is no clear alternative diagnosis but compatible illness. […] Testing is carried out using a serological assay at the Rare and Imported Pathogens Laboratory (RIPL) in the first instance. […] Consideration of whether vaccination of high-risk groups such as forestry workers is warranted at this stage, while further studies looking for evidence of human exposure or infection are undertaken. […] Consideration of regionally appropriate follow-up to investigate evidence of historic and ongoing human TBEV exposure against a background of geographically varying presence of Louping ill.
  • #1 Tick-borne encephalitis surveillance in U.S. military service members and beneficiaries, 2006–2018 | Health.mil
    https://www.health.mil/News/Articles/2019/11/01/Tickborne-encephalitis-surveillance
    The risk of tick-borne encephalitis (TBE) among U.S. military service members and beneficiaries residing in or traveling to Europe has not been assessed since the 1990s. […] The primary objective of this study was to assess the current risk of TBE in this population. […] The risk of TBE among U.S. military service members and beneficiaries is low but may have increased in recent years. […] Additionally, there may be locations or activities that place certain individuals or units at increased risk for TBE, thus warranting additional control measures such as active surveillance, enhanced personal protective measures, and vaccination. […] The risk of TBE among U.S. military service members and beneficiaries is low but not negligible. […] There were 8 cases of TBE among U.S. military service members and beneficiaries between 2006 and 2018, 7 of which occurred in 2017 or 2018.
  • #1 Tick-borne encephalitis surveillance in U.S. military service members and beneficiaries, 2006–2018 | Health.mil
    https://www.health.mil/News/Articles/2019/11/01/Tickborne-encephalitis-surveillance
    The number of confirmed or probable TBE cases among U.S. military service members and beneficiaries is low but not negligible and has increased in recent years. […] Commanders and U.S. military public health personnel in Europe should be familiar with and anticipate high-risk areas and activities U.S. personnel are likely to encounter. […] Furthermore, they should ensure that TBE control measures include accurate and timely surveillance, proper personal protective measures (PPMs), tick avoidance, and risk-based vaccination.
  • #1 The epidemiology, clinical presentation, and predictors of severe Tick-borne encephalitis in Lithuania, a highly endemic country: A retrospective study of 1040 patients | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241587
    The incidence of Tick-borne encephalitis (TBE) has been increasing and posing a growing health problem because of the high costs to the healthcare system and society. […] The aim of this study was to analyze the epidemiology and clinical presentation of severe TBE, to identify the predictors for a severe disease course, and also predictors for meningoencephalomyelitic and severe meningoencephalitic/encephalitic forms. […] A total of 1040 patients were included in the study. A total of 152/1040 (14.6%) patients had a severe course. […] The highest proportion of severe cases, reaching 41.2%, was reported in the 70-79 year-old age group. […] The prognostic factors associated with a severe disease course and severe meningoencephalitic form are: older age, comorbidities, a monophasic course, a fever of 40C and above, CRP more than 30 mg/l, CSF protein more than 1 g/l, delayed immune response of TBEV IgG, pathological findings in CT.
  • #1 The epidemiology, clinical presentation, and predictors of severe Tick-borne encephalitis in Lithuania, a highly endemic country: A retrospective study of 1040 patients | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241587
    The proportion of severe cases (14.6%) in our study was comparable with the data from neighboring Latvia (14.1%) […] The risk of severe ME/E increases with age, and the risk of extremely severe myelitis is aggravated by the age of 60. […] The lethality in our study was 0.7%, which is similar to some Latvian, Polish, and German studies. […] Our data from a very endemic region in eastern Lithuania show that although the proportion of severe cases is not associated with annual and seasonal increases in morbidity, Tick-borne encephalitis poses a growing health issue in Lithuania.
  • #1 The current state of the problem of tick-borne encephalitis in Russia and the world | Kolyasnikova | Epidemiology and Vaccinal Prevention
    https://www.epidemvac.ru/jour/article/view/1741?locale=en_US
    Relevance. Despite the successes achieved over the 85-year history of the study of tick-borne encephalitis (TBE), there are still many controversial and unresolved issues. […] It is obvious that in the second decade of the XXI century, this natural focal neuroinfection, as before, poses a great threat to public health not only in Russia, but also in endemic countries of the world. […] Aim. To present modern aspects of etiology, epidemiology, diagnosis, specific prevention of TBE in Russia and endemic countries of the world. […] Currently, there are 4 genotypes of the TBE virus: Far Eastern, European, Siberian and Baikal, each of which has its own area, pathogenic potential for humans. […] Nosoareal of TBE covers most of the territory of Russia, 29 European countries. […] Cases of TBE disease or viral activity are registered in six Asian countries.
  • #1 The current state of the problem of tick-borne encephalitis in Russia and the world | Kolyasnikova | Epidemiology and Vaccinal Prevention
    https://www.epidemvac.ru/jour/article/view/1741?locale=en_US
    Since highly effective etiotropic drugs for the treatment of TBE have not yet been developed, the only strategy for reducing the incidence of TBE is mass vaccination of the population of endemic regions. […] Due to the increase in the rate of vaccination in Russia and European countries, in order to improve epidemiological surveillance of TBE, standards for specific laboratory diagnosis of the disease among vaccinated persons, clarification of the causes of the incidence of vaccinated, as well as deaths among them, need to be clarified. […] In conditions of combination of natural foci of TBE and other tick-borne infections, it is important to develop diagnostic algorithms, including differential diagnosis of this disease with other infections transmitted by Ixodic ticks.
  • #1 Tick-borne encephalitis: from tick surveillance to the first confirmed human cases, the United Kingdom, 2015 to 2023
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11803743/
    Testing for TBE in the UK is indicated only when a patient has compatible clinical illness and relevant exposure (usually including travel to an endemic country), although since 2023, TBE testing is now done on all referred undiagnosed encephalitis cases even if no known exposure to ticks or travel. […] This paper describes all cases of TBE diagnosed in the UK between 2022 and 2023 following the enhanced testing approach, including two cases of PCR-positive TBEV in patients without compatible travel history for imported infection, representing the first confirmed autochthonous cases of human TBE in the UK. […] This study demonstrates an exemplar relationship between international and national surveillance programmes, clinical diagnosis and awareness raising among clinicians.
  • #2 Recommendations to Improve Tick-Borne Encephalitis Surveillance and Vaccine Uptake in Europe
    https://www.mdpi.com/2076-2607/10/7/1283
    There has been an increase in reported TBE cases in Europe since 2015, reaching a peak in some countries in 2020, highlighting the need for better management of TBE risk in Europe. […] TBE surveillance is currently limited, in part, due to varying diagnostic guidelines, access to testing, and awareness of TBE. […] Consequently, TBE prevalence is underestimated and vaccination recommendations inadequate. […] TBE vaccine uptake is unsatisfactory in many TBE-endemic European countries. […] This review summarizes the findings of a scientific workshop of experts to improve TBE surveillance and vaccine uptake in Europe. […] Strategies to improve TBE surveillance and vaccine uptake should focus on: aligning diagnostic criteria and testing across Europe; expanding current vaccine recommendations and reducing their complexity; and increasing public education of the potential risks posed by TBEV infection.
  • #2
    https://www.who.int/health-topics/tick-borne-encephalitis
    Tick-borne encephalitis (TBE) is an important cause of viral infections of the central nervous system in eastern, central, northern and increasingly western European countries, and in northern China, Mongolia, and the Russian Federation. […] Approximately 10 00012 000 clinical cases of tick-borne encephalitis are reported each year, but this figure is believed to be significantly lower than the actual total number of clinical cases. […] In areas where the disease is highly endemic, WHO recommends that vaccination be offered to all age groups, including children. […] Immunization is the best protection against tick-borne encephalitis.
  • #2 Tick-borne encephalitis – Annual Epidemiological Report for 2022
    https://www.ecdc.europa.eu/en/publications-data/tick-borne-encephalitis-annual-epidemiological-report-2022
    For 2022, 20 European Union/European Economic Area (EU/EEA) countries reported 3 650 cases of tick-borne encephalitis (TBE), 3 516 (96.3%) of which were confirmed. […] The EU/EEA notification rate for 2022 was 0.81 per 100 000 population, which is a 14% increase compared to the results from 2021. […] Cases were more frequently reported among men (male-to-female ratio: 1.5:1) and most cases were reported in the age group 45-64 years. […] TBE presented a seasonal pattern. […] For 2022, 90% of confirmed cases in EU/EEA occurred between June and November, with July having the highest number of reported cases (n=800).
  • #2 Epidemiology of Tick-Borne Encephalitis (TBE) in – ProQuest
    https://www.proquest.com/scholarly-journals/epidemiology-tick-borne-encephalitis-tbe-germany/docview/2548988450/se-2
    Surveillance provides the basis for public health recommendationsforemost vaccinationfor TBE prevention. Thus, we aim to review TBE surveillance and epidemiology in Germany from 2001 to 2018, including the definition of TBE risk areas and their distribution over time as of 2007. […] The majority of the 6,063 notified TBE cases from 20012018 originated in Baden-Wurttemberg (BW) and Bavaria (BY) (89.0% of cases with a reported place of infection (PoI) in Germany), followed by Hesse, Saxony, Thuringia, and Rhineland-Palatinate. All current risk areas but two (in Saarland and Lower Saxony) are located in these states. The annual number of reported cases ranged from 195 to 583, the incidence in the two most affected states of BW and BY ranging from 0.7 to 2.0 cases/100,000 inhabitants (mean 1.2), with peaks in 20052006, 2011, 2013 and 20172018. Increases in incidence did not follow a uniform pattern. For instance, the increase in 2005 was more marked in BY, while the further increase in 2006 occurred almost entirely in BW and Hesse with case numbers in BY decreasing slightly, although remaining markedly above average. The peaks in 2011, 2013 and 2017 were due to increases in both BW and BY, while the peak in 2018 again occurred due to a further increase in BW, despite a slight decrease in case numbers in BY, as in 2006. Of the 222 cases reported with the PoI exclusively outside of Germany, 177 (79.7%) were from 6 countries (Austria (94), Czech Republic (20), Poland (17), Switzerland (16), Sweden (16) and Italy (14)).
  • #2 Tick-borne encephalitis: from tick surveillance to the first confirmed human cases, the United Kingdom, 2015 to 2023
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11803743/
    Tick-borne encephalitis virus (TBEV) is a flavivirus spread by ticks and can cause tick-borne encephalitis (TBE) in humans. Previously, TBE has been reported in returning travellers in the United Kingdom (UK), but in 2019 and 2020, two probable cases of TBE acquired in the UK were identified. […] The aim of this study was to investigate TBE cases in the UK between 2015 and 2023, describing the incidence, place and mode of acquisition and diagnostic process. […] We identified 21 cases: three possible, seven probable and 11 confirmed cases. Of these, 12 were between January 2022 and December 2023: three possible, three probable and six confirmed cases. Two confirmed TBE cases had definite or highly probable acquisition in the UK, in June and August 2022, respectively. […] Between 2015 and 2023, 21 TBE cases with a clinical disease were diagnosed in the UK. Of these, 12 were diagnosed 20222023. Three cases acquired the infection in the UK which further demonstrates how important it is to have surveillance programmes.
  • #2 Chapter 12: Epidemiology of TBE – TBE Book
    https://tbenews.com/tbe/chapter-12-epidemiology-of-tbe/
    New endemic zones in previously unaffected alpine regions in western Austria and in Switzerland were established, and a first report of TBEV being detected at locations in Norway up to more than 65N latitude was published 2018. […] Various factors may explain all these findings, at least in part: social factors (socio-political changes with changes in human behavior, duration, and type of leisure-time activities), ecological factors (e.g., effects of climate changes on the tick population and change in availability of tick host species, new flight routes of migrating birds which may lead to importation of TBE virus infected ticks into areas which have so far been free of TBE virus), and/or technological factors (advanced diagnostics, increased medical awareness). […] In the end, all factors mentioned above play an interactive role resulting in complex interactions that may explain the observed changes in TBE epidemiology. […] But still, TBE surveillance in Europe is in many countries more sporadic than systematic, and TBE cases are likely underreported.
  • #2 Recommendations to Improve Tick-Borne Encephalitis Surveillance and Vaccine Uptake in Europe
    https://www.mdpi.com/2076-2607/10/7/1283
    The identification of TBE-endemic areas is essential to inform national and international programs of TBE risk management. […] Since 2012, the European Centre for Disease Prevention and Control (ECDC) requires all European Union (EU) member states, plus Iceland and Norway, to annually report their TBE data to the European Surveillance System (TESSy). […] However, comparison between regions and countries is dependent on the accuracy and consistency of national/regional surveillance systems. […] Common TBE case definitions, officially introduced by the ECDC in 2012 and updated in 2018, aimed to increase and standardize TBE identification within surveillance programs across the EU. […] However, TBE case definitions and reporting have been implemented inconsistently throughout Europe. […] TBE underreporting may be exacerbated by clinicians who do not test for TBEV infection because they do not recognize the possibility of CNS inflammation.
  • #2 Evaluation of under-testing and under-diagnosis of tick-borne encephalitis in Germany | BMC Infectious Diseases | Full Text
    https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-023-08101-6
    Tick-borne encephalitis (TBE), a viral infectious disease affecting the central nervous system, potentially resulting in prolonged neurological symptoms and other long-term sequelae. […] This study assessed real-world TBE laboratory testing rates across Germany. […] TBE testing rates ranged from 54.0% (non-specific neurological symptoms only) to 65.6% (encephalitis symptoms only); the percentage of TBE positive results ranged from 5.3% (non-specific neurological symptoms only) to 36.9% (meningitis symptoms only). […] The findings of this study suggest that patients with typical TBE symptoms are likely under-tested, thus likely leading to under-diagnosis in Germany. […] Inadequate TBE testing and diagnosis impacts TBE surveillance, which is interlinked with low awareness and under-testing, leading to a vicious cycle of continued under-ascertainment of TBE cases.
  • #2 Tick-borne encephalitis vaccine uptake, effectiveness, and impact in Sweden from 2018 to 2022 | Scientific Reports
    https://www.nature.com/articles/s41598-025-86968-y
    Although a 2020 survey reported that 47% of the Swedish population had received at least one dose of a TBE vaccine, there are limited TBE vaccine uptake estimates available at the subnational level in Sweden. […] Factors contributing to the suboptimal TBE vaccine uptake in Sweden include limited awareness of the risk for acquiring TBEV infection or the severity of TBE, price of vaccination, lack of time or opportunity for vaccination, and aversion to receipt of vaccines. […] The objectives of the present study were to estimate TBE vaccine uptake, vaccine effectiveness, and public health impact at the national and subnational level in Sweden, a country where TBE is endemic. […] During the five-year study period, receipt of three doses of a TBE vaccine may have averted approximately one thousand, predominately hospitalized, TBE cases.
  • #2
    https://www.gov.uk/government/publications/hairs-risk-assessment-tick-borne-encephalitis/hairs-risk-assessment-tick-borne-encephalitis
    This work should include evidence from veterinary surveillance and research activities which have focussed principally on sheep and grouse. […] In addition: further seroprevalence studies of deer and subsequent tick testing to identify additional potential foci of TBEV, research into the titre of infectious virus in fresh unpasteurised milk from an infected animal, research into the effects of cheese production processes on the quantity of infectious virus present. […] In 2020 (latest full year data available), 3,817 cases (3,734 confirmed) were reported in Europe, including 16 associated fatalities. […] The highest incidence rates were reported in: Lithuania, Slovenia, the Czech Republic. […] Comparison of trends over a 5-year period shows that notification rates fluctuated annually and only Slovenia and Germany have seen a steady increase.
  • #2 Tick-borne encephalitis surveillance in U.S. military service members and beneficiaries, 2006–2018 | Health.mil
    https://www.health.mil/News/Articles/2019/11/01/Tickborne-encephalitis-surveillance
    U.S. military public health activities in Europe should ensure the implementation of TBE control measures, including accurate and timely surveillance, proper personal protective and tick avoidance measures, and risk-based vaccination. […] The primary objective of this study was to determine the number of TBE cases among all U.S. military service members and other beneficiaries worldwide between 2006 and 2018, with a special focus on the risk of TBE in Europe, in order to inform current public health risk assessment and force health protection posture. […] The current study found a very similar overall number of 8 cases over a 13-year period, with all but 1 case identified during the past 2 years. […] The findings of this study support the current recommendations to vaccinate only those U.S. military service members and beneficiaries at higher risk for TBE acquisition because of residence in an area of high endemicity or participation in extensive outdoor activities.
  • #2 The epidemiology, clinical presentation, and predictors of severe Tick-borne encephalitis in Lithuania, a highly endemic country: A retrospective study of 1040 patients | PLOS One
    https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241587
    The proportion of severe cases (14.6%) in our study was comparable with the data from neighboring Latvia (14.1%) […] The risk of severe ME/E increases with age, and the risk of extremely severe myelitis is aggravated by the age of 60. […] The lethality in our study was 0.7%, which is similar to some Latvian, Polish, and German studies. […] Our data from a very endemic region in eastern Lithuania show that although the proportion of severe cases is not associated with annual and seasonal increases in morbidity, Tick-borne encephalitis poses a growing health issue in Lithuania.

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