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Chapter 13: TBE as a matter of public health

received by 27% and 15% of respondents, The vaccination rate against TBE in the general
respectively. population is 82%, which is the highest
worldwide. A high awareness of TBE among
• Strongest motivators for vaccination were the Austrian population was achieved through
fear of TBE (38%) and residence/spending an annual social marketing program, and the
time in high-risk areas (31–35%). Main widespread use of effective and well-tolerated
reasons for not receiving vaccinations were vaccines has led to a successful containment
the belief that vaccination was un- of the disease. The vaccination coverage
necessary (33%) and that there was no risk increased from 6% in 1980 to 82% in 2013 and
of contracting TBE (23%). exceeds 90% in some high-risk areas. This has
led to a steady decline in the number of TBE
One of the main aspects in issuing recom-
cases from several hundred cases to 50–100
mendations and creating awareness is the 13
cases per year (see Figure 1).
definition of a ‘risk area.’ The Robert Koch-
Institute in Germany, for example, defines and The risk of acquiring TBE in an endemic area
recommends vaccination for a ‘high-risk area’ like Austria equals 1:10,000, and this is
as follows: wherever the TBE incidence over a comparable to the risk of acquiring typhoid
floating 5-year period is significantly higher fever for an unvaccinated tourist in a highly
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than 1/100,000 population. Austria, on the endemic area like India (1:3,000 to
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contrary, does not restrict vaccination recom- 1:25,000). In fact, for an unvaccinated tourist
mendation to a numeric incidence. Any person staying in a highly endemic area in Austria for
living in or traveling to an endemic area is ‘at 4 weeks, the estimated risk of acquiring TBE is
risk’ and should be vaccinated. For details on about 1 per 830 person-years of exposure.
vaccination recommendations in European Based on the number of tourist overnight
countries, see Chapter 12a. stays in Austria, this would equal 60 travel-
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associated TBE cases each summer.

The Austrian example: Residents of and travelers to TBE endemic
areas who are at risk of tick bites are advised
A success story to receive TBE vaccination. 18,19

Austria is the only European country that
implemented as early as 1980 an annual, Summary and recommendations
national TBE awareness and vaccination for public health
campaign that targets the whole population;
this has led to a substantial decline in the
In summary and to adequately address public
number of TBE cases in Austria. The Austrian health issues related to TBE moving forward,
example shows that containment of TBE is the authors recommend the following:
feasible by mass vaccination. In the pre-
vaccination era, Austria had a very high 1. Public health officials should make TBE a
recorded morbidity of TBE – probably the notifiable disease and establish appro-
highest in Europe at the time, even despite priate tools for detection and reporting of
some shortfalls in the notification system. In human cases in their countries.
high-risk areas, the average annual incidence
in the population exposed to ticks in their 2. Maps indicating TBE risks should not solely
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working environment was 0.9 per 1,000. be based on incidences, since these are
biased due to underdiagnosis, temporal

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