Background
In Germany, TBE virus has been identified in many areas, and the number of yearly reported cases of TBE fluctuate between 200 and 700 during the last two decades with a trend to increasing number during the last years. The Standing Committee for Vaccination (STIKO) recommends vaccination for individuals living in or traveling to districts which have been designated TBE risk areas by the Robert Koch-Institute (RKI). Currently, about 33 million people (38.9% of the total German population) live in 183 of the 411 German administrative districts, and nearly 54 million people live in areas where at least one case of TBE has been notified. Nevertheless, vaccination rate in Germany remains low, even in definite risk areas.
An online survey has been carried out in 2023 to assess knowledge, attitudes and practices about TBE with 10,225 participants, 18 to 65 years of age, plus 17,169 household members. The sample included participants from all federal states of the German population.
Results.
TBE awareness among the survey participants over the last five years ranged from a minimum of 64% in 2019 to a maximum of 68% in 2022.
Within a list of other infectious diseases, TBE (together with Lyme borreliosis) ranks sixth of seven diseases after influenza, measles, tetanus, meningitis and pneumonia.
Disease awareness was highest in the Federal State of Saxony (81%, where the number of reported cases has strongly increased during the last years) and lowest (56%) in the Federal State of Hamburg (see also Snapshot 1&2/2026).
In 2023, a slightly lower percentage (63%) were aware of TBE vaccines with the highest rate in Bavaria (74%) and the lowest rate in Hamburg (51%).
An increasing trend was observed in the self-reported vaccination rates (40% in 2019 to 51% in 2023). In the general population, 56% reported to be vaccinated. The highest rate was found in Bavaria (70%) and Baden-Wuerttemberg (68%). In these two federal states, nearly all administrative districts were designated risk areas. The lowest vaccination rates were seen in Schleswig-Holstein and Mecklenburg-Western Pomerania (38% each). The two northern federal states are low-risk areas according to the RKI.
The percentage of subjects having received three vaccine doses (complete primary series) in the full German population was 38%, and 20% had received an additional booster dose. The percentage of individuals vaccinated “on schedule” according to the recommendations was 20%.
The strongest motivation factor for receiving TBE vaccination was recommendation by a physician (34%), followed by the perception of living in a risk area (21%). The main reasons provided for not being vaccinated was the belief of respondents that they do not live in (37%) or visit (35%) risk areas, or they believed not being at risk (22%)
Discussion
The survey demonstrated that the general awareness and knowledge about TBE and about existing vaccines is relatively high in Germany. There exists a north/south gradient regarding awareness and vaccination rates with highest rates in southern federal states where most of the TBE cases are reported.
Given the fact that nearly two-third of the German population live in either risk areas (defined by the RKI) or where autochthonous cases have occurred, it is important to increase TBE awareness across Germany. Notably, although many vaccinations are not carried out according to the recommended vaccination schedule, vaccine effectiveness is high as demonstrated by studies in various countries, including Germany (see Newsletter August 2022).
As TBE virus has been detected also outside of the risk areas and an underreporting TBE has been observed, the risk to acquire a TBE virus infection is nationwide and appropriate information and education is warranted. A large portion of the survey participants indicated that their motivation for being vaccinated was the education/clue by a physician. This demonstrates the importance of HCPs, mainly family doctors, in their role to support patient´s informed decisions to vaccinate against TBE (and other infectious diseases). The physician´s recommendation is one of the main drivers for most patients, regardless of the endemicity status of the area they live in.
Literature
Malerczyk et al.
Knowledge, attitudes, and practices on tick-borne encephalitis vaccination and prevention in Germany: Results of a nationwide household survey
Ticks Tick Borne Dis., SSRN, Preprint ssm.com/abstract=5374166, posted August 1, 2025
Author: Dr. Michael Bröker
Compiled: January 2026