Abstract
Italy is considered at low incidence of tick-borne encephalitis (TBE), and the occurrence of human cases of TBE appears to be geographically restricted to the north east of the country. However, most information to date derives from case series, with no systematic data collection. To estimate incidence rates (IR) and spatial distribution of TBE cases, we conducted a retrospective study in north-eastern Italy. Data were collected through the infectious disease units and public health districts of three regions (Friuli Venezia Giulia, Trentino Alto Adige and Veneto) between 2000 and 2013. Overall, 367 cases were identified (IR: 0.38/100,000). The cases' median age was 56 years and 257 (70%) were male. Central nervous system involvement was reported in 307 cases (84%). Annual fluctuations in case numbers occurred, with peaks in 2006 and in 2013, when 44 and 42 cases were respectively observed. A strong seasonality effect was noted, with the highest number of cases in July. In terms of geographical location, three main endemic foci with high TBE IR (>10/100,000) were identified in three provinces, namely Belluno (Veneto region), Udine (Friuli Venezia Giulia) and Trento (Trentino Alto-Adige). When investigating the whole study area in terms of altitude, the IR between 400 and 600 m was greater (2.41/100,000) than at other altitudes (p<0.01). In conclusion, the incidence of TBE in Italy is relatively low, even considering only the three known affected regions. However, three endemic foci at high risk were identified. In these areas, where the risk of TBEV infection is likely high, more active offer of TBE vaccination could be considered.
Highlights
Tick-borne encephalitis (TBE) is considered a disease of the central nervous system (CNS) caused by infection with the TBE virus (TBEV), a flavivirus discovered in 1937, during an expedition in Far-East Russia [1].There are three TBEV subtypes: the European, the Siberian, and the Far Eastern subtype
The neurological manifestation defining the syndromic picture of TBE underrepresent the overall clinical burden of disease related to TBEV infection
23 developed tiredness, 19 paresis, 11 tremor, seven headache, six memory and/or concentration disturbances, three pain in the extremities; insomnia, anxiety, or nausea were reported by two patients, respectively, whereas hearing disturbance, dizziness, or electroencephalography anomalies only by one
Summary
Tick-borne encephalitis (TBE) is considered a disease of the central nervous system (CNS) caused by infection with the TBE virus (TBEV), a flavivirus discovered in 1937, during an expedition in Far-East Russia [1].There are three TBEV subtypes: the European, the Siberian, and the Far Eastern subtype. Tick-borne encephalitis (TBE) is considered a disease of the central nervous system (CNS) caused by infection with the TBE virus (TBEV), a flavivirus discovered in 1937, during an expedition in Far-East Russia [1]. The main hosts and reservoirs of TBEV are small rodent species, whereas ticks (Ixodes persulcatus and I. ricinus) act as the vector [2]. The principal vector of the European TBEV subtype is I. ricinus. The clinical manifestations of TBE usually start with a febrile illness, but ca 20 to 30% of the patients subsequently develop CNS disease, such as meningitis or encephalitis [2,3,4]. The neurological manifestation defining the syndromic picture of TBE underrepresent the overall clinical burden of disease related to TBEV infection
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