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Tick-Borne Threats in Europe: From Epidemiology to the Impact of...
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Tick-Borne Threats in Europe: From Epidemiology to the Impact of Vaccination

A special issue of Pathogens (ISSN 2076-0817).

Deadline for manuscript submissions: 31 December 2026 | Viewed by 2940

Special Issue Editors

Dr. Frederick J. Angulo

E-Mail Website
Guest Editor
Global Vaccines and Anti-Infectives Medical Affairs, Pfizer, Collegeville, PA 19426, USA
Interests: vaccine-preventable diseases; infectious disease epidemiology; tick-borne diseases
Dr. Andreas Pilz

E-Mail Website
Guest Editor
Global Vaccines and Anti-Infectives Medical Affairs, Pfizer Corporation Austria GmbH, 1030 Vienna, Austria
Interests: immunology; tick-borne infections; vaccine implementation
Dr. Kyra Zens

E-Mail Website
Guest Editor
1. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland
2. Institute for Experimental Immunology, University of Zurich, 8001 Zurich, Switzerland
Interests: vaccinology; public health surveillance; infectious disease epidemiology

Special Issue Information

Dear Colleagues,

Tick-borne diseases, particularly Lyme borreliosis and tick-borne encephalitis (TBE), represent an increasing public health threat in Europe. In recent years, the geographic range of endemic areas for Lyme borreliosis and TBE has expanded and the number of surveillance-reported cases of Lyme borreliosis and TBE have increased in several European countries. Fortunately, vaccines are available or are under development for the prevention of Lyme borreliosis and TBE. Our aim in launching this Special Issue is to describe the epidemiology of Lyme borreliosis and TBE, particularly the public health burden of these diseases, and to report on efforts to prevent these tick-borne diseases, including addressing challenges in enhancing vaccine uptake and complying with national recommendations on vaccine use. 

Lyme borreliosis and tick-borne encephalitis (TBE) are growing public health concerns across Europe, with clear increases in disease burden documented in several countries. Both diseases are potentially preventable with vaccination. Safe and effective TBE vaccines have been available and widely used in Europe for many years, while candidate vaccines for the prevention of Lyme borreliosis are currently under development. Rigorous epidemiological data are essential in understanding the burden of these diseases, informing discussions on the potential use of vaccines, and supporting activities and overcome obstacles for disease prevention. Furthermore, such data are also vitally important in evaluating the public health impact of preventive measures, including vaccines, against these diseases.

This Special Issue will focus on the epidemiology of Lyme borreliosis and TBE, particularly on the public health burden of these diseases. It will also explore the impact of preventive measures, including vaccines, against Lyme disease and TBE and its current and future challenges for implementation. This Special Issue is open to all researchers involved in research on Lyme disease and TBE in Europe. Original research articles, reviews, and case reports are welcome.

We look forward to receiving your contributions.

Dr. Frederick J. Angulo
Dr. Andreas Pilz
Dr. Kyra Zens
Guest Editors

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • tick-borne diseases
  • epidemiology
  • prevention
  • vaccines
  • public health impact

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Published Papers (4 papers)

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Research

10 pages, 207 KB  
Article
Seroprevalence of Borrelia burgdorferi Antibodies in Patients with Ulcerative Colitis and Its Association with Disease Activity
by Gokhan Aydin and Taner Akyol
Pathogens 2026, 15(4), 408; https://doi.org/10.3390/pathogens15040408 - 9 Apr 2026
Viewed by 223
Abstract
Background and Aim: Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by immune dysregulation. Environmental factors, including infectious agents, have been proposed to influence disease activity in inflammatory bowel disease. Although Borrelia burgdorferi has been shown to exert complex immunomodulatory effects [...] Read more.
Background and Aim: Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by immune dysregulation. Environmental factors, including infectious agents, have been proposed to influence disease activity in inflammatory bowel disease. Although Borrelia burgdorferi has been shown to exert complex immunomodulatory effects on host immune responses, its seroprevalence and potential association with disease activity in patients with ulcerative colitis have not been systematically investigated. This study aimed to evaluate the seroprevalence of Borrelia burgdorferi IgG antibodies in patients with ulcerative colitis and to assess the relationship between seropositivity and laboratory markers of disease activity. Methods: In this retrospective observational study, 100 patients with ulcerative colitis (59 males, 41 females; mean age 48.5 ± 17 years) who underwent Borrelia burgdorferi IgG serological testing due to musculoskeletal or neurological symptoms suggestive of possible Lyme disease between October 2020 and October 2024 were included. Demographic characteristics, hematological and biochemical parameters, and inflammatory markers were compared between seropositive and seronegative groups. Due to the retrospective design, validated clinical disease activity indices were not consistently available; therefore, disease activity was indirectly assessed using laboratory inflammatory markers. Results: Among patients with ulcerative colitis, 22% were seropositive for Borrelia burgdorferi IgG. Seropositive patients had significantly lower uric acid, alkaline phosphatase, and C-reactive protein levels compared to seronegative patients (p = 0.001, p = 0.023, and p = 0.020, respectively). Free T4 levels were significantly higher in the seropositive group (p = 0.049). In terms of erythrocyte indices, mean corpuscular volume and mean corpuscular hemoglobin were significantly higher, while RDW-CV values were significantly lower in seropositive patients (all p < 0.05). Conclusion:Borrelia burgdorferi IgG seropositivity in patients with ulcerative colitis was associated with lower laboratory markers of systemic inflammation and a more stable hematological profile. Although causality cannot be established, these findings may suggest a potential association between prior Borrelia exposure and a distinct inflammatory phenotype in UC; however, this relationship should be interpreted with caution. Further prospective and mechanistic studies are warranted to clarify the potential immunological interactions between environmental microbial exposure and inflammatory bowel disease activity. Full article
(This article belongs to the Special Issue Tick-Borne Threats in Europe: From Epidemiology to the Impact of Vaccination)
22 pages, 1763 KB  
Article
Clinical Manifestations of Lyme Borreliosis in Europe: Burden of Lyme Disease Study (BOLD), 2021–2022
by Kate Halsby, Alexandra Loew-Baselli, Franc Strle, Anna Moniuszko-Malinowska, Johan Sanmartin Berglund, Viliam Cibik, Dagmar Zakova, Ye Tan, Frederick J. Angulo, Juanita Edwards, Andreas Pilz, Brad D. Gessner, Elizabeth Begier, James H. Stark and on behalf of the BOLD Study Group
Pathogens 2026, 15(3), 327; https://doi.org/10.3390/pathogens15030327 - 18 Mar 2026
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Abstract
Lyme borreliosis (LB), the most common European tick-borne disease, can manifest as an erythema migrans (EM) rash or as disseminated LB. The prospective Burden of Lyme Disease (BOLD) study evaluated the frequency of LB clinical manifestations, including signs, symptoms, and treatment patterns in [...] Read more.
Lyme borreliosis (LB), the most common European tick-borne disease, can manifest as an erythema migrans (EM) rash or as disseminated LB. The prospective Burden of Lyme Disease (BOLD) study evaluated the frequency of LB clinical manifestations, including signs, symptoms, and treatment patterns in 14 healthcare practices in endemic regions of six European countries: the Czech Republic, Germany, Poland, Slovakia, Slovenia, and Sweden. Between April 2021 and December 2022, patients with suspected LB were evaluated using predefined case definitions that were applied by investigators to identify medically attended LB cases. Enrolled cases were interviewed about their symptoms. Among the 797 LB cases, 615 (77.2%) had EM and 182 (22.8%) had disseminated disease; 154 of the disseminated cases had Lyme arthritis (LA), five had Lyme neuroborreliosis, and three had Lyme carditis. Geographically, the proportion of disseminated disease varied by country, from 1.1% in Slovenia to 78.0% in Slovakia. Overall, 76.3% of all LB cases in Slovakia were LA. Antibiotic use varied by country, although every country prescribed doxycycline. The frequency of LB manifestations varied substantially between countries. EM was the most common manifestation in all countries except Slovakia, where LA was most common. This study underscores the need for improved prevention strategies. Full article
(This article belongs to the Special Issue Tick-Borne Threats in Europe: From Epidemiology to the Impact of Vaccination)
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17 pages, 827 KB  
Article
Zoonotic Pathogens in Ixodes ricinus from an Urban Environment in Northern Slovakia
by Zuzana Cellengová, Blažena Hajdová, Andrea Schreiberová, Patrícia Petroušková, Maroš Kostičák and Alica Kočišová
Pathogens 2026, 15(3), 292; https://doi.org/10.3390/pathogens15030292 - 6 Mar 2026
Viewed by 541
Abstract
Ixodes ricinus is the most common and, epidemiologically speaking, the most important tick species in Slovakia, transmitting a wide range of zoonotic pathogens. The goal of the present study was to monitor selected tick-borne infectious agents in an urban environment in northern Slovakia [...] Read more.
Ixodes ricinus is the most common and, epidemiologically speaking, the most important tick species in Slovakia, transmitting a wide range of zoonotic pathogens. The goal of the present study was to monitor selected tick-borne infectious agents in an urban environment in northern Slovakia where the conditions for their occurrence and survival are typically unfavourable. Ticks were collected by the flagging method during the period from March to November 2024 in the city of Žilina in five urban locations characterized by high human activity and suitable conditions for tick–host interactions. A total of 264 ticks of Ixodes ricinus were collected (67 females, 85 males, and 112 nymphs). A molecular analysis confirmed the presence of Borrelia spp. in 34.5% of samples, while the most frequently detected species was Borrelia afzelii. The other detected species included zoonotic piroplasms Babesia microti and Babesia venatorum (1.5%), as well as the bacteria Anaplasma spp. (2.65%) and Rickettsia spp. (0.4%). In four ticks (1.5%), the presence of coinfection caused by multiple pathogens was detected. These results confirm that urban ecosystems located in the northern regions of Slovakia also provide significant reservoirs of zoonotic pathogens and impose a potential risk for public health. Full article
(This article belongs to the Special Issue Tick-Borne Threats in Europe: From Epidemiology to the Impact of Vaccination)
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13 pages, 393 KB  
Article
Seroprevalence of Tick-Borne Encephalitis Virus in Latvia Using Standard and Subtype-Specific NS1-Based ELISA Assays
by Zane Freimane, Gerhard Dobler, Guntis Karelis, Lidia Chitimia-Dobler, Oksana Savicka and Dace Zavadska
Pathogens 2025, 14(11), 1115; https://doi.org/10.3390/pathogens14111115 - 2 Nov 2025
Viewed by 953
Abstract
Background: Latvia is one of the most endemic tick-borne encephalitis (TBE) countries in Europe. However, assessing TBE seroprevalence and true infection rates has been challenging. Current diagnostics cannot reliably distinguish between immune responses induced by natural infection from those induced by vaccination, especially [...] Read more.
Background: Latvia is one of the most endemic tick-borne encephalitis (TBE) countries in Europe. However, assessing TBE seroprevalence and true infection rates has been challenging. Current diagnostics cannot reliably distinguish between immune responses induced by natural infection from those induced by vaccination, especially in TBE endemic countries with recommended immunisation programmes. A recently developed ELISA targeting antibodies against TBEV non-structural protein 1 (NS1) offers improved specificity for natural infection and can differentiate among three clinically relevant TBEV subtypes. Methods: We conducted a cross-sectional TBEV seroprevalence study in the Latvian population during 2019–2022, consisting of two pools: 1020 residents living in different regions of Latvia and 200 random Latvian Biobank blood samples. We used the standard anti-TBEV IgG ELISA (VIDITEST, VIDIA, Czech Republic) for the screening and detection of TBEV (whole virus) IgG antibodies and the newly established research-use anti-TBEV NS1 IgG ELISA for the detection of subtype-specific TBEV NS1 IgG antibodies against three virus subtypes: European, Siberian and Far Eastern. Results: The total TBEV seroprevalence among 1020 residents was 39.7%, representing all age cohorts of the population from all regions of Latvia. In total, 33.4% of the enrolled population were vaccinated against TBE with at least one dose of the TBE vaccine. Among the unvaccinated population, 16.3% had positive TBEV-specific IgG antibodies by standard ELISA. On the contrary, NS1-specific antibodies, indicating past natural infection, were detected in only 4.3% of the overall study population. Subtype differentiation revealed infections from all three major TBEV subtypes present in Latvia. Conclusions: In conclusion, this population-based study highlights a high risk of TBE in Latvia, with substantial seroprevalence even among unvaccinated individuals. The NS1-based ELISA enhances the accuracy of TBE surveillance and offers important clinical utility by facilitating more reliable diagnosis and case classification, regardless of vaccination status. Full article
(This article belongs to the Special Issue Tick-Borne Threats in Europe: From Epidemiology to the Impact of Vaccination)
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