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Chapter 12b: TBE in the Netherlands

to the “Sallandse Heuvelrug’ and one patient performing TBEV diagnostics in the
acquired infection near the ‘Utrechtse Netherland to 4. As it is not mandatory to
8
Heuvelrug’. The third patient lived in the east report TBEV in the Netherlands, the exact
of the Netherlands, in the province of number of requests for TBEV diagnostics and
Overijssel, and most likely acquired infection confirmed cases per year is currently not avail-
near his residence (Figure 3). Additionally, 8 able.
more travel-associated TBEV infections were
diagnosed in the period from 2016-2018. In the Netherlands, only FSME-Immun® and
These patients were most probably infected in FSME-Immun® Junior are available for vaccin-
8
Germany (4), Austria (3) and Kazakhstan (1). ation against TBEV. Yet, as until 2015 TBEV
was thought to be non-endemic, vaccination
Due to the increased awareness for TBEV, the was only considered when traveling to TBEV-
number of diagnostic requests for TBEV at the endemic areas. Consequently, the current vac-
laboratory of the Netherlands Centre of cination uptake is very low.
Infectious Disease Control rose to 96 in 2016.
In 2017 (70 requests) and 2018 (92 requests), In summary, in 2016, the first au-
the number of diagnostic requests remained tochthonous TBE cases were reported in the
high compared to the period 2006-2015. Netherlands. To date, 5 autochthonous
Historically, next to the Netherlands Centre of cases have been recognized, adding the
Infectious Disease Control at the National Netherlands to the list of TBEV-endemic
Institute for Public Health and the Environ- countries. TBEV was likely already present in
ment, only the World Health Organization the Netherlands before 2010, and seems to
[WHO] Reference and Research Centre for be expanding. 2 different Western European
Arboviruses and Hemorrhagic Fever Viruses at TBEV strains have been detected in the
the Erasmus Medical Center performed TBEV Netherlands. Based on the fact that two
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diagnostics in the Netherlands. However, autochthonous cases got infected near
recently, the University Medical Center national park ‘Sallandse heuvelrug’, it is
Groningen (UMCG) and the Radboud Univer- highly likely that the divergent ‘Salland’
sity Medical Center (Radboud UMC) also strain can cause disease in humans, but this
implemented TBEV diagnostics in their labora- remains to be confirmed.
tories, bringing the number of laboratories

Overview of TBE in the Netherlands

Table 1: Virus, vector, transmission of TBE in the Netherlands

5,6
TBEV-EU (Utrechtse Heuvelrug)
Viral subtypes, distribution
TBEV-EU ‘Salland’ (Sallandse Heuvelrug) 3

Unknown
Reservoir animals
3
(Roe deer were found to be sentinels and are likely dead-end hosts)
Infected tick species (%) I. ricinus 3-5

Dairy product transmission No information available

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