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Geeraedts F, Wertenbroek A, de Klerk J, Prick JJ, Reichman LJA, Hess D, Bosma F, Reimerink J, Skidmore B, Laverman GD. Defining a risk area for tick-borne encephalitis (TBE) in a country where TBE is emerging, the Netherlands, July 2016-October 2020. Ticks Tick Borne Dis 2022; 13:101898. [PMID: 35042080 DOI: 10.1016/j.ttbdis.2022.101898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
Abstract
TBE is an emerging infectious disease in the Netherlands since July 2016, and risk areas have not been defined yet. Until October 2020 twelve autochthonous cases of TBE have been identified. In six of these cases transmission of TBE virus likely occurred in the Twente region, which therefore is the region with the highest case number and risk of contracting the disease. Here we summarize the Twente cases so far and discuss if the Twente region should be considered a risk-area using criteria of traditional TBE endemic countries, and the public health measures that may accompany such designation.
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Affiliation(s)
- Felix Geeraedts
- Laboratory for Medical Microbiology and Public Health, Hengelo, the Netherlands.
| | - Agnes Wertenbroek
- Department of Neurology, Ziekenhuis Groep Twente, Almelo/Hengelo, the Netherlands
| | - Jabke de Klerk
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Jan J Prick
- Department of Neurology, Ziekenhuis Groep Twente, Almelo/Hengelo, the Netherlands
| | - Loes J A Reichman
- Department of Neurology, Ziekenhuis Groep Twente, Almelo/Hengelo, the Netherlands
| | - Dorine Hess
- Laboratory for Medical Microbiology and Public Health, Hengelo, the Netherlands
| | - Froukje Bosma
- Laboratory for Medical Microbiology and Public Health, Hengelo, the Netherlands; Public Health Service, Twente, the Netherlands
| | - Johan Reimerink
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | - Gozewijn D Laverman
- Department of Internal Medicine, Ziekenhuis Groep Twente, Almelo/Hengelo, the Netherlands
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Frimmel S, Löbermann M, Feldhusen F, Seelmann M, Stiasny K, Süss J, Reisinger EC. Detection of tick-borne encephalitis virus antibodies in sera of sheep and goats in Mecklenburg-Western Pomerania (north-eastern Germany). Ticks Tick Borne Dis 2019; 10:901-904. [PMID: 31003897 DOI: 10.1016/j.ttbdis.2019.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/03/2019] [Accepted: 04/10/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Silvius Frimmel
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University of Rostock Medical School, 18055 Rostock, Germany.
| | - Micha Löbermann
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University of Rostock Medical School, 18055 Rostock, Germany
| | - Frerk Feldhusen
- State Institute for Agriculture, Food Safety and Fisheries Mecklenburg-Western Pomerania, D-18059 Rostock, Germany
| | - Matthias Seelmann
- State Institute for Agriculture, Food Safety and Fisheries Mecklenburg-Western Pomerania, D-18059 Rostock, Germany
| | - Karin Stiasny
- Center for Virology, Medical University of Vienna, A-1090 Vienna, Austria
| | - Jochen Süss
- Brehm Memorial Center Renthendorf, 07646 Renthendorf, Germany
| | - Emil Christian Reisinger
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University of Rostock Medical School, 18055 Rostock, Germany
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Hellenbrand W, Kreusch T, Böhmer MM, Wagner-Wiening C, Dobler G, Wichmann O, Altmann D. Epidemiology of Tick-Borne Encephalitis (TBE) in Germany, 2001⁻2018. Pathogens 2019; 8:E42. [PMID: 30934855 PMCID: PMC6630332 DOI: 10.3390/pathogens8020042] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 12/21/2022] Open
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.
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Affiliation(s)
- Wiebke Hellenbrand
- Immunization Unit, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany.
| | - Teresa Kreusch
- Immunization Unit, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany.
| | - Merle M Böhmer
- Department for Infectious Disease Epidemiology, Bavarian Health and Food Safety Authority, Veterinaerstr. 2, 85764 Oberschleissheim, Germany.
| | | | - Gerhard Dobler
- Bundeswehr Institute of Microbiology, Neuherbergstrasse 11, 80937 Munich, Germany.
| | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany.
| | - Doris Altmann
- Infectious Disease Data Science Unit, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany.
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Seroprevalence of tick-borne-encephalitis virus in wild game in Mecklenburg-Western Pomerania (north-eastern Germany). Ticks Tick Borne Dis 2016; 7:1151-1154. [PMID: 27527383 DOI: 10.1016/j.ttbdis.2016.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/05/2016] [Accepted: 08/10/2016] [Indexed: 12/30/2022]
Abstract
Mecklenburg-Western Pomerania, a federal state in the north east of Germany, has never been a risk area for TBEV infection, but a few autochthonous cases, along with TBEV-RNA detection in ticks, have shown a low level of activity in natural foci of the virus in the past. As wild game and domestic animals have been shown to be useful sentinels for TBEV we examined sera from wild game shot in Mecklenburg-Western Pomerania for the prevalence of TBEV antibodies. A total of 359 sera from wild game were investigated. All animals were shot in Mecklenburg-Western Pomerania in 2012. Thirteen of 359 sera tested positive or borderline for anti-TBEV-IgG with ELISA and four samples tested positive using NT. The four TBEV-positive sera confirmed by NT constitute the first detection of TBEV-antibodies in sera of wild game in Mecklenburg-Western Pomerania since 1986-1989. This underlines that the serological examination of wild game can be a useful tool in defining areas of possible TBEV infection, especially in areas of low TBEV-endemicity.
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Mehlhorn H, Mehlhorn T, Müller M, Vogt M, Rissland J. Tick survey for prevalent pathogens in peri-urban recreation sites in Saarland and Rhineland-Palatinate (Germany). Parasitol Res 2015; 115:1167-72. [PMID: 26646396 DOI: 10.1007/s00436-015-4852-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 11/24/2015] [Indexed: 02/02/2023]
Abstract
Ixodid ticks are important vectors of human pathogens in Central Europe. Despite this fact, prevalence studies are scarce, especially with regard to much-frequented peri-urban recreation sites. In this pilot study, 4.014 larvae, nymphs and adult ticks sampled monthly during the active seasons in 2011 and 2012 from 14 distinct collection sites in two German states (Saarland and Rhineland-Palatinate) were screened for Borrelia spp., Anaplasma spp. and tick-borne encephalitis virus. Mean prevalence rates were 19.8 % for Borrelia spp., 1.9 % for Anaplasma spp. and 0.1 % for tick-borne encephalitis virus (TBEV), which are in accordance with those reported from other regions in Germany and neighbouring countries. Nevertheless, the detection of TBEV-infected ticks is the first positive result after several unsuccessful efforts over the previous years in official "TBE-risk" zones of Saarland and Rhineland-Palatinate which supports the presumption of the origin of observed local infection. Besides ixodid ticks a non-engorged adult female tick of the invading species Dermacentor reticulatus has been found reflecting the appearance of another vector eventually jeopardising the health of host animals as well as humans.
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Affiliation(s)
- Heinz Mehlhorn
- Institute for Parasitology, Heinrich Heine University, D-40225, Düsseldorf, Germany.
| | - Tim Mehlhorn
- Institute for Clinical Microbiology and Hospital Hygiene, Heinrich Heine University, D-40225, Düsseldorf, Germany
| | - Melanie Müller
- Institute of Virology, Saarland University Medical Centre, Homburg, Germany
| | - Manfred Vogt
- Landesuntersuchungsamt Rheinland-Pfalz, Abteilung Humanmedizin, Koblenz, Germany
| | - Jürgen Rissland
- Institute of Virology, Saarland University Medical Centre, Homburg, Germany
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Imhoff M, Hagedorn P, Schulze Y, Hellenbrand W, Pfeffer M, Niedrig M. Review: Sentinels of tick-borne encephalitis risk. Ticks Tick Borne Dis 2015; 6:592-600. [PMID: 26005107 DOI: 10.1016/j.ttbdis.2015.05.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/15/2015] [Accepted: 05/01/2015] [Indexed: 12/28/2022]
Abstract
Tick-borne encephalitis (TBE) is a viral zoonotic disease endemic in many regions of Eurasia. The definition of TBE risk areas is complicated by the focal nature of the TBE virus transmission. Furthermore, vaccination may reduce case numbers and thus mask infection risk to unvaccinated persons. Therefore, additional risk indicators are sought to complement the current risk assessment solely based on human incidence. We reviewed studies published over the past ten years investigating potential new sentinels of TBE risk to understand the advantages and disadvantages of the various sentinel animal surveys and surrogate indicator methods. Virus prevalence in questing ticks is an unsuitable indicator of TBE infection risk as viral RNA is rarely detected even in large sample sizes collected at known TBE endemic areas. Seroprevalence in domestic animals, on the other hand, showed good spatial correlation with TBE incidence in humans and might also uncover presently unknown TBEV foci.
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Affiliation(s)
- Maren Imhoff
- Centre for Biological Threats and Special Pathogens: Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany.
| | - Peter Hagedorn
- Centre for Biological Threats and Special Pathogens: Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany.
| | - Yesica Schulze
- Centre for Biological Threats and Special Pathogens: Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany.
| | - Wiebke Hellenbrand
- Centre for Biological Threats and Special Pathogens: Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany.
| | - Martin Pfeffer
- Institute of Animal Hygiene & Veterinary Public Health, Centre of Veterinary Public Health, University of Leipzig, An den Tierkliniken 1, 04103 Leipzig, Germany.
| | - Matthias Niedrig
- Centre for Biological Threats and Special Pathogens: Highly Pathogenic Viruses (ZBS 1), Robert Koch Institute, Nordufer 20, 13353 Berlin, Germany.
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Frimmel S, Krienke A, Riebold D, Loebermann M, Littmann M, Fiedler K, Klaus C, Süss J, Reisinger EC. Tick-borne encephalitis virus habitats in North East Germany: reemergence of TBEV in ticks after 15 years of inactivity. BIOMED RESEARCH INTERNATIONAL 2014; 2014:308371. [PMID: 25110671 PMCID: PMC4109299 DOI: 10.1155/2014/308371] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 06/06/2014] [Indexed: 12/30/2022]
Abstract
The incidence of tick-borne encephalitis has risen in Europe since 1990 and the tick-borne encephalitis virus (TBEV) has been documented to be spreading into regions where it was not previously endemic. In Mecklenburg-West Pomerania, a federal state in Northern Germany, TBEV was not detectable in over 16,000 collected ticks between 1992 and 2004. Until 2004, the last human case of TBE in the region was reported in 1985. Following the occurrence of three autochthonous human cases of TBE after 2004, however, we collected ticks from the areas in which the infections were contracted. To increase the chance of detecting TBEV-RNA, some of the ticks were fed on mice. Using nested RT-PCR, we were able to confirm the presence of TBEV in ticks for the first time after 15 years. A phylogenetic analysis revealed a close relationship between the sequences we obtained and a TBEV sequence from Mecklenburg-East Pomerania published in 1992 and pointed to the reemergence of a natural focus of TBEV after years of low activity. Our results imply that natural foci of TBEV may either persist at low levels of activity for years or reemerge through the agency of migrating birds.
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Affiliation(s)
- Silvius Frimmel
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University of Rostock Medical School, Ernst-Heydemann-Straße 6, 18057 Rostock, Germany
| | - Anja Krienke
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University of Rostock Medical School, Ernst-Heydemann-Straße 6, 18057 Rostock, Germany
| | - Diana Riebold
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University of Rostock Medical School, Ernst-Heydemann-Straße 6, 18057 Rostock, Germany
| | - Micha Loebermann
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University of Rostock Medical School, Ernst-Heydemann-Straße 6, 18057 Rostock, Germany
| | - Martina Littmann
- Health Department of the State of Mecklenburg-West Pomerania, 18055 Rostock, Germany
| | - Karin Fiedler
- Health Department of the State of Mecklenburg-West Pomerania, 18055 Rostock, Germany
| | - Christine Klaus
- Friedrich-Loeffler-Institute Jena, National Reference Laboratory for Tick-Borne Diseases, 07743 Jena, Germany
| | - Jochen Süss
- Tick Information Center, 07646 Lippersdorf, Germany
| | - Emil Christian Reisinger
- Department of Tropical Medicine, Infectious Diseases and Nephrology, University of Rostock Medical School, Ernst-Heydemann-Straße 6, 18057 Rostock, Germany
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Stefanoff P, Pfeffer M, Hellenbrand W, Rogalska J, Rühe F, Makówka A, Michalik J, Wodecka B, Rymaszewska A, Kiewra D, Baumann-Popczyk A, Dobler G. Virus detection in questing ticks is not a sensitive indicator for risk assessment of tick-borne encephalitis in humans. Zoonoses Public Health 2012; 60:215-26. [PMID: 22765504 DOI: 10.1111/j.1863-2378.2012.01517.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Tick-borne encephalitis virus (TBEV) is the most important tick-transmitted arbovirus causing human disease in Europe, but information on its endemic occurrence varies between countries because of differences in surveillance systems. Objective data are necessary to ascertain the disease risk for vaccination recommendations and other public health interventions. In two independent, separately planned projects, we used real-time RT-PCR to detect TBE virus in questing ticks. In Poland, 32 sampling sites were selected in 10 administrative districts located in regions where sporadic TBE cases were reported. In Germany, 18 sampling sites were selected in two districts located in a region with high TBE incidence. Altogether, >16,000 ticks were tested by real-time RT-PCR, with no sample testing positive for TBEV. A systematic search for published studies on TBEV prevalence in ticks in Poland and Germany also suggested that testing large numbers of collected ticks could not consistently assure virus detection in known endemic foci. Although assignment of results to administrative regions is essential for TBE risk mapping, this was possible in only 10 (investigating 22,417 ticks) of 15 published studies (>50,000 ticks) identified. We conclude that the collection and screening of ticks by real-time RT-PCR cannot be recommended for assessment of human TBE risk. Alternative methods of environmental TBEV monitoring should be considered, such as serological monitoring of rodents or other wildlife.
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Affiliation(s)
- P Stefanoff
- Department of Epidemiology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland.
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