{"version":"1.0","provider_name":"TBE Book","provider_url":"https:\/\/tbenews.com\/tbe","author_name":"Administrator admin","author_url":"https:\/\/tbenews.com\/tbe\/author\/administrator-admin\/","title":"Hungary - TBE Book","type":"rich","width":600,"height":338,"html":"<blockquote class=\"wp-embedded-content\" data-secret=\"5Hvp1O1jjc\"><a href=\"https:\/\/tbenews.com\/tbe\/13-14-9-2\/\">Hungary<\/a><\/blockquote><iframe sandbox=\"allow-scripts\" security=\"restricted\" src=\"https:\/\/tbenews.com\/tbe\/13-14-9-2\/embed\/#?secret=5Hvp1O1jjc\" width=\"600\" height=\"338\" title=\"&#8220;Hungary&#8221; &#8212; TBE Book\" data-secret=\"5Hvp1O1jjc\" frameborder=\"0\" marginwidth=\"0\" marginheight=\"0\" scrolling=\"no\" class=\"wp-embedded-content\"><\/iframe><script>\n\/*! This file is auto-generated *\/\n!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);\n\/\/# sourceURL=https:\/\/tbenews.com\/tbe\/wp-includes\/js\/wp-embed.min.js\n<\/script>\n","thumbnail_url":"https:\/\/tbenews.com\/tbe\/wp-content\/uploads\/2017\/07\/Hungary.jpg","thumbnail_width":1180,"thumbnail_height":250,"description":"TBE in Hungary Anna Nagy, Ferenc Schneider, Eszter Mezei and Andr\u00e1s Lakos E-CDC risk status: endemic (data as of end 2022) History and current situation Hungarian scientists were among the pioneers in Europe as the tick-borne encephalitis virus (TBEV) was isolated in 1952.1 However, most of their observations were published in the Hungarian language, and therefore cannot easily be accessed by the international medical community. Here the relevant Hungarian data are summarized. Before 1997, the average annual number of tick-borne encephalitis (TBE) cases reported to authorities was around 300, and as of that year it has decreased to fewer than 30 patients per year (Figures 1, 2). It has been speculated that the decrease is a result of underreporting of TBE, following a change in the reimbursement system for payments related to serologic TBE diagnosis.2-4 However, two main arguments contradict the &#8220;underreporting hypothesis&#8221;: Figure 1: Gender distribution of TBE cases and the sold number of doses of TBE vaccines The data of TBE cases in this graph originated from the National Reference Laboratory for Viral Zoonoses and from the Department of Epidemiological and Vaccination Surveillance of the National Public Health Center. The data for 1998 is missing, an estimation is plotted in the graph. No reliable information on the number of vaccine doses sold in 1995 could be found; estimated information was used. (The number of vaccine doses sold are not available from 2018.) Figure 2: Burden of TBE in Hungary from 1981 to 2022.24-25 Age distribution and the requested number of diagnostic tests. The data of TBE cases in this graph originated from the National Reference Laboratory for Viral Zoonoses and from the Department of Epidemiological and Vaccination Surveillance of the National Public Health Center. The number of TBE cases decreased dramatically after a mass vaccination campaign from 1992 to 1995. The Hungarian population is 10 million, so the incidence for 100 cases is 1\/100,000. A West Nile virus epidemic resulted in 225 infections in 2018 (https:\/\/www.eurosurveillance.org\/content\/10.2807\/1560-7917.ES.2019.24.28.1900038). That was the reason of striking elevation of the requested TBE serological tests. The elevated number of tests coincided with the elevated number of verified TBE cases. Overview of TBE in Hungary Table 1: Virus, vector, transmission of TBE in Hungary Viral subtypes, distribution TBEV-EU6 Reservoir animals Apodemus agrarius, Apodemus flavicollis,Microtus arvalis, Myodes glareolus6Apodemus flavicollis, Apodemus agrarius, Myodes glareolus, Microtus subterraneus7 Infected tick species (%) 2\/2485 = 0.08%16\/8310 \u2248 0.07%840\/51,746 \u2248 0.08%; the highest figure was 22\/6738 \u2248 0.3% in this study91\/17,500 \u2248 0.006%105\/2196 \u2248 0.23%, only with PCR113\/9616 \u2248 0.03%7 Dairy product transmission Out of the 81 food-borne TBE cases registered between 1992 and 2011, 55.1% were male. Also, 4.4% of the total number of TBE cases were milk-borne. On average, 24.5% of people who drank infected goat milk suffered from clinical symptoms of neurologic infection.Historically, only 2 TBE epidemics in Hungary were caused by cow milk.12 The largest epidemic came from a single goat (of the 75 tested animals) with 25 cases amongst 154 subjects who had consumed contaminated milk.13 In that year (2007), almost half of the total number (30\/63) of registered TBE cases were of alimentary origin. Table 2: TBE reporting and vaccine prevention in Hungary Mandatory TBE reporting Every physician who establishes a diagnosis of TBE must report it. Practically, these are hospital-based specialists for infectious diseases, pediatricians, internists, and neurologists.Case definition: clinical symptoms of central nervous infection + presence of TBE immunoglobulin M (IgM) antibodies in serum and cerebrospinal fluid (CSF) OR TBEV-specific IgM in CSF OR isolation of infectious virus from clinical samples OR detection of TBEV RNA in clinical samples OR seroconversion and\/or 4-fold specific IgG increase in a sample pair.14 Other TBE surveillance No Special clinical features \u2022 In one study, 21% of retrospectively collected patient cases were agrarian, 16% forestry workers.8 \u2022 Other work has shown 12% to 16% of patients with TBE were forestry workers.9,10 \u2022 Similarly, another report found 10.4% of 5196 cases were forestry, 11% other agrarian workers.15 \u2022 Also, 2% of the 1,670 forestry workers screened for Lyme borreliosis went through TBE (Lakos, unpublished data).\u2022 65% of hospitalized patients could recall a biphasic course of their TBE.16 &nbsp; In the same department of the Central Hospital for Infectious Diseases, during the years 1976\u20131980 (n=100), 27 patients showed paresis, 2 died. In 1987\u20131991 (n=93), only 5 patients had paresis, none of them died.17From 1985 to 2008, the death rate from TBE in Hungary was 29\/3,987 (0.73%).18 However, in an earlier period from 1977 to 1996, the fatality rate was higher \u2013 43\/5,196 (0.83%). Most of the fatal cases were male (85%), while the proportion of male patients in the total TBE population was 70%.15 Available vaccines FSME Immune Inject vaccine has been available for public use since 1992; another vaccine, Encepur, was launched in 1995. Previously, between 1977 and 1990, some 150,000 doses were distributed for the at-risk population. (Note: during 1979 to 1983, the FSME Immune Inject vaccine was considered to be ineffective both clinically and serologically.19 It has to be mentioned, that TBE vaccination in Austria at the same time showed a field effectiveness 79.4%-10% after the second dose and 97.3%-100% after the third dose.26) From 1990 to 2017, 6 million doses were sold.20 (The Hungarian population is 10 million.) Vaccination recommendations and reimbursement When FSME Immune Inject was first available in Hungary in the early 1990s, the reimbursement rate was 95%; the pharmacy price was 59 HUF (\u224820 euro cents). After a gradual decrease, the reimbursement was cancelled for the FSME Immune Inject and Encepur vaccines in 2008 and 2012, respectively. The present price is around 10,000 HUF (33 euros). For occupationally exposed workers, vaccination has been mandatory at the employers\u2019 expense since 1999.20 Vaccine uptake by age group\/risk group\/general population Not available. Name, address\/website of TBE NRC National Public Health Center, National Reference Laboratory for Viral Zoonoses, Budapest, Hungary [https:\/\/www.nnk.gov.hu\/] Figure 3: TBEV-isolation and TBE cases in Hungary Map of Hungary showing human TBE incidence (ECDC, 2017).22 TBEV isolation sites are marked by circles"}