Abstract
We reviewed tick-borne encephalitis (TBE) surveillance and epidemiology in Germany, as these underlie public health recommendations, foremost vaccination. We performed descriptive analyses of notification data (2001–2018, n = 6063) according to region, demographics and clinical manifestations and calculated incidence trends using negative binomial regression. Risk areas were defined based on incidence in administrative districts. Most cases (89%) occurred in the federal states of Baden-Wurttemberg and Bavaria, where annual TBE incidence fluctuated markedly between 0.7–2.0 cases/100,000 inhabitants. A slight but significantly increasing temporal trend was observed from 2001–2018 (age-adjusted incidence rate ratio (IRR) 1.02 (95% confidence interval (CI): 1.01–1.04)), primarily driven by high case numbers in 2017–2018. Mean incidence was highest in 40–69-year-olds and in males. More males (23.7%) than females (18.0%, p = 0.02) had severe disease (encephalitis or myelitis), which increased with age, as did case-fatality (0.4% overall; 2.1% among ≥70-year-olds). Risk areas increased from 129 districts in 2007 to 161 in 2019. Expansion occurred mainly within existent southern endemic areas, with slower contiguous north-eastern and patchy north-western spread. Median vaccination coverage at school entry in risk areas in 2016–2017 ranged from 20%–41% in 4 states. Increasing TBE vaccine uptake is an urgent priority, particularly in high-incidence risk areas.
Highlights
In Germany, infection with tick-borne encephalitis (TBE) virus (TBEV) is transmitted mainly by the tick Ixodes ricinus
The majority of the 6,063 notified TBE cases from 2001–2018 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 (Figure 1)
Fulfilment of the TBE case definition requires (either non-specific symptoms or signs of central nervous system (CNS) infection) and [laboratory confirmation by means of either simultaneously elevated IgM and IgG TBE-specific antibodies in serum or cerebrospinal fluid (CSF) or an increase in TBE-specific IgG antibodies in serum or the detection of intrathecal antibody synthesis] [69]
Summary
In Germany, infection with tick-borne encephalitis (TBE) virus (TBEV) is transmitted mainly by the tick Ixodes ricinus. TBEV infection is asymptomatic or presents with non-specific symptoms, including fever and malaise, in 70%–95% of cases [1,2]. Serological evidence for TBE in humans and mice in Germany was first reported by Sinneker in various regions of Eastern Germany in 1959 [7], followed by serologic diagnosis of symptomatic TBE. Süss et al [10,11] later reviewed TBE cases in Eastern Germany, reporting 1200 cases ascertained from 1960 to 1970, many occurring during outbreaks related to the consumption of raw milk. From 1960 to 1970, TBE incidence in Eastern Germany decreased from 0.7 to
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