1.0TBE Bookhttps://tbenews.com/tbeIThttps://tbenews.com/tbe/author/brianong/rich600338<blockquote class="wp-embedded-content" data-secret="KpenVL40sA"><a href="https://tbenews.com/tbe/13-3-9/">Belgium</a></blockquote><iframe sandbox="allow-scripts" security="restricted" src="https://tbenews.com/tbe/13-3-9/embed/#?secret=KpenVL40sA" width="600" height="338" title="“Belgium” — TBE Book" data-secret="KpenVL40sA" frameborder="0" marginwidth="0" marginheight="0" scrolling="no" class="wp-embedded-content"></iframe><script> /*! This file is auto-generated */ !function(d,l){"use strict";l.querySelector&&d.addEventListener&&"undefined"!=typeof URL&&(d.wp=d.wp||{},d.wp.receiveEmbedMessage||(d.wp.receiveEmbedMessage=function(e){var t=e.data;if((t||t.secret||t.message||t.value)&&!/[^a-zA-Z0-9]/.test(t.secret)){for(var s,r,n,a=l.querySelectorAll('iframe[data-secret="'+t.secret+'"]'),o=l.querySelectorAll('blockquote[data-secret="'+t.secret+'"]'),c=new RegExp("^https?:$","i"),i=0;i<o.length;i++)o[i].style.display="none";for(i=0;i<a.length;i++)s=a[i],e.source===s.contentWindow&&(s.removeAttribute("style"),"height"===t.message?(1e3<(r=parseInt(t.value,10))?r=1e3:~~r<200&&(r=200),s.height=r):"link"===t.message&&(r=new URL(s.getAttribute("src")),n=new URL(t.value),c.test(n.protocol))&&n.host===r.host&&l.activeElement===s&&(d.top.location.href=t.value))}},d.addEventListener("message",d.wp.receiveEmbedMessage,!1),l.addEventListener("DOMContentLoaded",function(){for(var e,t,s=l.querySelectorAll("iframe.wp-embedded-content"),r=0;r<s.length;r++)(t=(e=s[r]).getAttribute("data-secret"))||(t=Math.random().toString(36).substring(2,12),e.src+="#?secret="+t,e.setAttribute("data-secret",t)),e.contentWindow.postMessage({message:"ready",secret:t},"*")},!1)))}(window,document); //# sourceURL=https://tbenews.com/tbe/wp-includes/js/wp-embed.min.js </script> https://tbenews.com/tbe/wp-content/uploads/2017/02/Belgium.jpg1180250TBE in Belgium Marjan Van Esbroeck, Tinne Lernout and Steven Van Gucht ECDC risk status: Affected (last edited in June 2026, update for 2024: 2 reported cases; update for 2025: 3 reported cases) History and current situation Until 2018, only imported cases of TBE were detected in Belgium, mainly infected in other parts of Europe such as Estonia, Germany,1 Austria, Scandinavia, Slovenia2 and the Czech Republic, but also Kyrgyzstan, Russia and the USA. In the summer of 2020, the first three confirmed autochthonous cases were diagnosed at the National Reference Centre of arboviruses (the Institute of Tropical Medicine, Antwerp, Belgium).3  Already in 2018, two cases possibly/probably infected in Belgium were reported, but patients had also traveled during the incubation period. No autochthonous cases have been detected since 2020 (Figure 1). The distribution of reported cases by age and gender is comparable to what is observed in other European countries, with a higher number of cases in males, and more cases in the older age groups (45+). Based on the current epidemiological findings, Belgium is classified as an affected country for TBE, with possible presence of the virus spread over the territory (Figure 2). The finding of autochthonous cases was not surprising as several (sero)prevalence studies in sentinel animals suggested that the virus had been circulating at a low level for at least several years. Depending on the animal species, prevalence rates ranging from 0.11% in dogs in 2009 (Belgium) to 9.27% in wild boars in 2019/2020 (Flanders) have been reported.4-8 The results of the study on wild boars in 2020 suggest an increase in TBEV prevalence over the last decade.8 Two out of the three patients with an autochthonous infection, diagnosed in 2020, had been exposed in a geographical location adjacent to an area with known TBEV seropositivity in animals.3 Several screening programs set up to detect TBEV in ticks, have been undertaken since 2017. Screening for TBEV by PCR in 1,307 ticks collected through flagging in the surrounding nature of the autochthonous cases in 2018, 2019, 2022 and 2023 did not reveal the presence of TBEV (Van Esbroeck, personal communication). Using a citizen science approach based on an existing notification tool for tick bites, 1,599 and 928 ticks removed from humans, 99% of which belonged to Ixodes ricinus, were collected across Belgium in 2017 and 2021 respectively. None of the ticks tested positive for TBEV by PCR.8-10 In 2019, a seroprevalence study in Flanders among 195 forestry workers exposed to tick bites during professional activities, of which 85% with more than 10 years of exposure and 42% reporting at least one tick bite/month during the tick season, revealed that none had antibodies showing evidence of infection.11 Overview of TBE in Belgium Table 1: TBE in Belgium Viral subtypes isolated Update 2026: TBEV was first detected in ticks collected in 2024 at a location in the south of Belgium where a patient with an autochthonous TBE infection had been bitten by a tick in 2020. Sequencing revealed that the strain shared greater similarity with a strain found in Finland than with the Salland strain circulating in the Netherlands.13 Reservoir animals Seropositive cattle and sheep at national level  and roe deer and wild boars in Flanders have been identified4-8 Infected tick species (%) No positive ticks have been detected8-10 (Van Esbroeck personal communication) Diary product transmission No information available Case definition used by authorities ECDC case definitions Type of reporting Annual reporting to the ECDC Other TBE-surveillance 1. A national reference center (NRC) for TBE performs laboratory confirmation in suspected human cases2. Ad hoc seroprevalence monitoring in animals4-83. PCR testing of ticks collected from humans, from animals and by flagging8-10  (Van Esbroeck personal communication) Special clinical features No Licensed vaccines FSME-IMMUN (Pfizer) Vaccination recommendations In the current epidemiological setting, vaccination is only recommended for travelers to endemic regions doing outdoor activities in forested areas during the tick season and for people handling TBEV in a laboratory setting12 Vaccine uptake No data available National Reference center for TBE Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium, +32 3 247 64 45. www.itg.be   Figure 1: TBE case numbers over time, vaccination status unknown. Update for 2025: 3 reported cases. Click the image above to enlarge Source Data:   Figure 2: Cumulative sites of TBEV-infection in Belgium, 2018-2023 Click the image above to enlarge Acknowledgments The National Reference Center for TBE is partially supported by the Belgian Ministry of Social Affairs through a fund within the Health Insurance System. The Belgian Institute for Health, Sciensano is supported by the Belgian regional authorities (Department of Care and Agency for Nature and Forests (Flanders), and Agency for a qualitative life (Wallonia)). Contact Marjan Van Esbroeckmvesbroeck@itg.be Authors Marjan Van Esbroeck, Tinne Lernout, Steven Van Gucht Citation Van Esbroeck M, Lernout T, Van Gucht S. TBE in Belgium. Chapter 13. In: Dobler G, Erber W, Bröker M, Chitimia-Dobler L, Schmitt HJS, eds. The TBE Book. 9th ed. Singapore: Global Health Press; 2026. doi:10.33442/26613980_13-3-9 References Gils S, Frans J, Ho E, et al. Case report: tick-borne encephalitis (TBE) in a Belgian traveller returning from Germany. J Travel Med. 2018;25(1):10.1093/jtm/tay078. doi:10.1093/jtm/tay078 Du Four S, Mertens R, Wiels W, De Keyser J, Bissay V, Flamez A. Meningoencephaloradiculitis following infection with tick borne encephalitis virus: case report and review of the literature. Acta Neurol Belg. 2018;118(1):93-96. doi:10.1007/s13760-017-0873-9 Stoefs A, Heyndrickx L, De Winter J, et al. Autochthonous Cases of Tick-Borne Encephalitis, Belgium, 2020. Emerg Infect Dis. 2021;27(8):2179-2182. doi:10.3201/eid2708.211175 Roelandt S, Heyman P, De Filette M, et al. Tick-borne encephalitis virus seropositive dog detected in Belgium: screening of the canine population as sentinels for public health. Vector Borne Zoonotic Dis. 2011;11(10):1371-1376. doi:10.1089/vbz.2011.0647 Roelandt S*, Suin V*, Riocreux F, et al. Autochthonous tick- borne encephalitis virus-seropositive cattle in Belgium: a risk- based targeted serological survey. Vector Borne Zoonotic Dis. 2014;14:640-7. doi:10.1089/vbz.2014.1576. *Equal contribution. Tavernier P, Sys SU, De Clercq K, et al. Serologic screening for 13 infectious agents in roe deer (Capreolus capreolus) in Flanders. Infect Ecol Epidemiol. 2015;5:29862. Published 2015 Nov