Geeraedts et al.
Defining a risk area for tick-borne encephalitis (TBE) in a country where TBE is emerging, the Netherlands, July 2016-October 2020
Ticks Tick Borne Dis. 2022; 13(2):101898. doi: 10.1016/j.ttbdis.2022.101898

Autochthonous TBE cases have been reported for the first time in the Netherlands in 2016. Since then, additional cases occurred, mostly in the Twente region, which is in the eastern part of the Netherlands adjacent to Germany.

Here, the epidemiology and clinical symptoms of seven TBE cases from the Twente region are described in detail. Six of the seven cases had no travel history during the incubation time and thus are likely contracted in the Twente region. Five of the seven patients were older than 50 years of age, and a biphasic course was seen in four patients.

In the Netherlands, TBE is not a notifiable disease, but the cases are generally reported to the local Public Health Service, of which 25 exist across the country. In the Twente region, the incidence for TBE in the past four years was 1.27 per 100,000 in the rural part of the Twente region (Enschede, the largest city in this region not included). The authors discussed the usefulness of defining a risk area similar to Germany where the calculation is based on the number of TBE cases reported in counties.

Consequently, the Twente region may be considered a risk area based on the criteria of traditional risk areas in Germany, and a corresponding vaccination advice could be considered for people with risk of exposure to ticks.

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