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Chapter 13: TBE as a matter of public health

This is especially the case in affluent societies vaccinate risk groups only has no substantial
where economic resources and systems for impact on the annual TBE incidence This is
prevention are readily available. The Austrian exemplified by the Austrian experience, where
example shows that the population is willing an Austria-wide vaccination campaign was
to spend money on prevention – if aware of started in 1981 targeting the general
the problem and properly informed. This is population. Subsequently the vaccination
clearly the task of local governments. In coverage of the Austrian population increased
Austria, only certain highly exposed risk and the TBE disease numbers were drastically
groups are financially supported and receive reduced. (see Figure 1) This may be due to an
complete or partial coverage for TBE increase in outdoor leisure activities as well as
vaccination (mostly those with an the fact that an increasing proportion of the
occupational risk of exposure). The great population is more mobile and therefore
majority of vaccinees in Austria invests out of moves from non-risky to risky areas more
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their own pockets. frequently.

Recommendations for TBE TBE awareness and vaccination
vaccination rates

Recommendations for TBE vaccination vary Awareness promotion is the key element in
considerably across the countries in which TBE control, in combination with vaccination
TBEV foci are found (see also Chapter 12a). In among healthcare workers and among the
areas where TBEV is highly endemic and general public, starting with specific risk
where the average pre-vaccination incidence groups, e.g., forestry workers, hunters, and
of clinical disease is ≥5 cases/100,000 people military personal. The results from a cross-
per year, the World Health Organization sectional study involving 11 European
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(WHO) and the European Centre for Disease countries showed:
Prevention and Control (ECDC) both
recommend that vaccination be offered to all • Overall awareness of TBE (83%) was lower
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age groups, including children. than awareness of influenza (98%) or
measles (92%). Of all respondents, 68%
However, all these factors depend on an were aware of the TBE vaccine, and 25%
awareness-based recognition and notification had received ≥1 vaccination(s) against TBE.
system and do not reflect those major
changes occurring in the past few decades. • Vaccination rates for TBE were lowest in
The changing epidemiology of TBE includes Finland and Slovakia (–10%). Much higher
increasing TBE infection rates outside known vaccination rates were seen in Latvia and
endemic areas mostly north and south; case- Estonia with 53% and 31%, respectively,
based discoveries of new TBE foci (e.g. The and highest in Austria (85%). In Germany,
Netherlands) and new areas with TBEV vaccination rates varied widely with
identification in ticks; TBEV transmissions in highest rates (up to >80%) in a few regions
higher altitudes; and changed nutrition with many cases like the Odenwald, where
behavior resulting in an increase of risky vaccine uptake even approaches 100%.
eating habits (such as the consumption of raw
milk and other raw dairy products). • Compliance among respondents who
Furthermore, experience in several countries received ≥1 TBE vaccinations was 61%.
has shown that the recommendation to First and second booster injections were

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