Schley et al.
Evaluation of under-testing and under-diagnosis of tick-borne encephalitis in Germany
BMC Infect Dis. 2023;23:139. doi:10.1186/s12879-023-08101-6

Various studies have shown that knowledge about TBE and the risk of acquiring a TBE virus infection may be insufficient not only among lay people but also among physicians. This may lead to underdiagnosis of TBE virus infections with long-term consequences for the patients, the healthcare provider, and payers. Therefore, a study has been carried out to learn more about the pathway of TBE testing and diagnosis among patients presenting with typical TBE-consistent symptoms in Germany.

The retrospective cross-sectional study was initially carried out with interviews among 12 hospital-based physicians in July/August 2020. The study continued with a quantitative phase whereby 500 physicians were given web-based surveys including at least 2–3 retrospective case report forms for patients who had presented with meningitis or encephalitis from October 2020 to March 2021.

The results showed critical gaps in the routine testing and diagnosis of TBE. For example, more than one-third of patients with typical symptoms of TBE were not tested for TBE in spite of the recommendations of the European Academy of Neurology, which may result in an under-ascertainment of TBE cases. TBE testing rates were higher in patients presenting with tick bite (72.8%) compared to those with no tick bite (57.6%) or “don’t know” (55.4%). Patients with high fever were more often tested for TBE (71.9%) than those with fever (61.9%) or no fever (44.6%). The authors found that TBE testing procedures are not standardized across hospitals in Germany.

Insufficient awareness of the disease and lack of routine screening (especially in officially non-risk areas) may contribute to the underdiagnosis of TBE cases in Germany.

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