Caputo et al.
Implementation of preventive measures against tick-borne infections in a non-endemic area for tick-borne encephalitis – Results from a population-based survey in Lower Saxony, Germany
Ticks Tick Borne Dis 2019; 10: 614-620
Lyme borreliosis (LB) and tick-borne encephalitis (TBE) are the most common tick transmitted diseases in Germany. The Robert Koch-Institut defines TBE risk areas on county level. In 2018, 156 counties were classified as TBE risk areas and the number of TBE cases outside these risk areas have been very low (about 5% of all cases). The German Standing committee on Vaccination (STIKO) recommends TBE vaccination for individuals living in and travelling into risk areas.
A population-based longitudinal Hygiene and Behavior Infectious Disease –study has been carried out in Lower Saxony, a Federal State with about eight million inhabitants and 45 counties, of which until 2018 no county has been assessed as a TBE risk area. About 23% of the participants reported to be vaccinated against TBE at least once (for comparison: it is 40% in Bavaria, a TBE risk Federal State) and 75% named travelling to endemic areas as reason for vaccination. Only 33% of these vaccinees had received a complete primary vaccination consisting of three injections and of these only 34% had received a booster dose. 98% of participants knew that LB is caused by a tick bite, but only 81% stated this for TBE. 25% of the individuals erroneously assumed that TBE vaccination also protects against LB. Many participants were unsure how to remove a tick from their body. More than 96% rated „wearing long clothes“ and „checking body“ as non-specific prevention measure, but much less people practiced this (50% and 75% and even less people (30%) implemented „tucking pans in the socks“ or „using anti-tick agents“.
In early 2019, the first county in Lower Saxony has been assessed to be a TBE risk area. Clarification of facts about TBE and educational advertising is warranted.