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Open AccessArticle

Epidemiology of Tick-Borne Encephalitis (TBE) in Germany, 2001–2018

1
Immunization Unit, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany
2
Department for Infectious Disease Epidemiology, Bavarian Health and Food Safety Authority, Veterinaerstr. 2, 85764 Oberschleissheim, Germany
3
State Health Office Baden-Wuerttemberg, Nordbahnhofstr. 135, 70191 Stuttgart, Germany
4
Bundeswehr Institute of Microbiology, Neuherbergstrasse 11, 80937 Munich, Germany
5
Infectious Disease Data Science Unit, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany
*
Author to whom correspondence should be addressed.
Pathogens 2019, 8(2), 42; https://doi.org/10.3390/pathogens8020042
Received: 28 February 2019 / Revised: 18 March 2019 / Accepted: 22 March 2019 / Published: 29 March 2019
(This article belongs to the Special Issue Ticks and Tick Borne Diseases Surveillance)
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. View Full-Text
Keywords: Tick-borne encephalitis (TBE); epidemiology; incidence; risk areas; clinical manifestations; temporospatial distribution; vaccination; Germany Tick-borne encephalitis (TBE); epidemiology; incidence; risk areas; clinical manifestations; temporospatial distribution; vaccination; Germany
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Hellenbrand, W.; Kreusch, T.; Böhmer, M.M.; Wagner-Wiening, C.; Dobler, G.; Wichmann, O.; Altmann, D. Epidemiology of Tick-Borne Encephalitis (TBE) in Germany, 2001–2018. Pathogens 2019, 8, 42.

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