{"version":"1.0","provider_name":"TBE Book","provider_url":"https:\/\/tbenews.com\/tbe","author_name":"IT","author_url":"https:\/\/tbenews.com\/tbe\/author\/brianong\/","title":"Croatia - TBE Book","type":"rich","width":600,"height":338,"html":"<blockquote class=\"wp-embedded-content\" data-secret=\"XIWcatLLQc\"><a href=\"https:\/\/tbenews.com\/tbe\/13-7-9\/\">Croatia<\/a><\/blockquote><iframe sandbox=\"allow-scripts\" security=\"restricted\" src=\"https:\/\/tbenews.com\/tbe\/13-7-9\/embed\/#?secret=XIWcatLLQc\" width=\"600\" height=\"338\" title=\"&#8220;Croatia&#8221; &#8212; TBE Book\" data-secret=\"XIWcatLLQc\" 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\/08\/Croatia.jpg","thumbnail_width":1180,"thumbnail_height":250,"description":"TBE in Croatia Tatjana Vilibi\u0107-\u010cavlek, Maja Bogdani\u0107, Vladimir Savi\u0107, Ljubo Barbi\u0107, Vladimir Stevanovi\u0107 and Bernard Kai\u0107 E-CDC risk status: endemic (last edited in June 2026, update for 2024: 24 reported cases; update for 2025: 8 reported cases) History and current situation In Croatia, TBE was reported for the first time in 1953 near Kri\u017eevci (Stara Ves, northwestern region).1 In addition to this first focus, several continental foci (Bjelovar, Pakrac, Koprivnica, Karlovac, Vara\u017edin) have been recorded since 1961. Moreover, TBEV antibodies were detected in residents of the Croatian littoral near the islands of Zadar, Pula, and Brac.2 In 1991, TBEV emerged in the mountainous area of Gorski Kotar.3 The disease is also endemic in northwestern and eastern regions between the Sava and Drava rivers. Endemicity is highest in northwestern counties, with average incidence rates ranging from 3.61 to 6.78 per 100,000 inhabitants.4,5 In 2015 and 2019, two TBE clusters after consumption of raw goat milk were observed.6,7 TBE in Croatia shows a bimodal seasonality with a larger peak during the spring and summer months (April\u2013August) and a smaller one in October\u2013November. A recent study showed that the majority of TBE patients are in the age group of 40\u201369 years (58.3%) with a male predominance (70.2%). Males predominate in all age groups with male-to-female ratios ranging from 1.3:1 (for those under 20 years) to 5:1 (for those between 50 and 59 years). Meningitis (54.8%) and encephalitis (30.9%) are the main clinical presentations in hospitalized patients with TBE. The abortive form (&#8220;febrile headache&#8221;) was reported in 13.1% of patients, and meningoencephalomyelitis in 1.2% of patients.8 In addition to human cases, 2.1% of TBEV asymptomatic seropositive individuals were detected in the same study (2017\u20132023). In contrast to acute cases, there is only a comparatively small difference in the seroprevalence between males (2.6%) and females (3.6%) as well as between age groups (2.5\u20133.7%). Recent serosurveys showed the presence of TBEV antibodies in animals as well. Seropositive horses were detected in continental Croatian counties in the period from 2017 to 2020. The overall seroprevalence rate was 12.1%, ranging from 7.3% to 17.1%. In 2022, 9.7% of sheep from the easternmost Vukovar-Srijem county tested positive for TBEV IgG antibodies.8 Ixodes ricinus ticks are the main vector of TBEV in Croatia. From 2017 to 2023, hard ticks were sampled using the dragging\u2013flagging method and hand-picked from both dead wild and live domestic animals. Ticks were collected in the Medvednica and Papuk mountain areas, and in the area between the Drava, Sava, and Danube Rivers. In the Alpine biogeographic region, ticks were mostly collected in the Gorski Kotar area. The seasonal tick dynamic was similar to the reported human cases.8 A study on the TBEV detection in ticks removed from red fox (Vulpes vulpes) carcasses hunted in endemic areas in northern Croatia was performed during two hunting seasons (2010-2011 and 2011-2012). TBEV was detected in adult Ixodes ricinus and Ixodes hexagonus ticks showing a prevalence of 1.6%. Furthermore, two spleen samples (1.1%) from 182 red deer (Cervus elaphus) were found positive for TBEV.9 Phylogenetic analysis of one TBEV strain detected in a urine sample from a patient with severe meningoencephalitis (2017) and strains from ticks and deer spleen showed that all clustered the TBEV European subtype.4,9 Overview of TBE in Croatia Table 1: TBE in Croatia Viral subtypes isolated TBEV European subtype4,8 Reservoir animals Rodents Infected tick species (%) 1.6% in one study Dairy product transmission 2015 \u2013 7 cases of TBEV (Bjelovar region) after consuming fresh goat milk and cheese62019 \u2013 5 cases of TBEV (Gorski Kotar region) after consuming raw goat milk from the same farm7 Case definition used by authorities ECDC case definition10 Type of reporting Mandatory11 Other TBE-surveillance Occasionally serosurveys8\u00a0 Special clinical features The majority of cases are in the age group 40\u201369 years. Meningitis (54.8%) and encephalitis (30.9%) are the most common clinical presentations in hospitalized patients. An abortive form \u201cfebrile headache\u201d was detected in 13.1% of patients.8 Licensed vaccines FSME-IMMUN Vaccination recommendations Risk groups (forestry workers, hunters, people who reside in endemic areas\/visit endemic areas) Vaccine uptake No data National Reference center for TBE National Reference Laboratory for Arboviruses, Reference Center for Diagnosis and Surveillance of Viral Zoonoses of the Croatian Ministry of Health, Department of Virology, Croatian Institute of Public Health Figure 1: TBE cases notified over time, 1987\u20132023. Update for 2025: 8 reported cases. Click the image above to enlarge Preliminary data for 2023, reporting is still ongoing until April 2024 Source: Reference Center for Epidemiology Croatian Ministry of Health; Croatian Institute of Public Health Figure 2: Age and gender distribution of notified TBE cases in Croatia, 2000\u20132020 Click the image above to enlarge Source: Reference Center for Epidemiology Croatian Ministry of Health; Croatian Institute of Public Health Figure 3: Sites of TBEV detection in Croatia, 2016\u20132023 Click the image above to enlarge Red shadowed areas: counties with reported cases; Red circles: Cumulative infection sites of TBE patients for the period from 2016 to 2023 Source: Vilibic-Cavlek T, et al. Microorganisms. 2024; 12(2):386. Figure 4: Seasonal dynamic of Ixodes ricinus ticks in Croatia, 2016\u20132023 Source: Vilibic-Cavlek T, et al. Microorganisms. 2024; 12(2):386. Acknowledgments TBE surveillance was supported by the projects: Croatian Science Foundation, project IP 2016-06-7456: Prevalence and molecular epidemiology of emerging and re-emerging neuroinvasive arboviral infections in Croatia; CRONEUROARBO (2017-2021), and the Next Generation EU project supported by Ministry of Science and Education of the Republic of Croatia, grant number NPOO 1 of the Croatian Veterinary Institute: Epidemiology of avian flaviviruses in the &#8220;One Health&#8221; context, FLAVIR. Contact Tatjana Vilibi\u0107-\u010cavlektatjana.vilibic-cavlek@hzjz.hr Authors Tatjana Vilibi\u0107-\u010cavlek, Maja Bogdani\u0107, Vladimir Savi\u0107, Ljubo Barbi\u0107, Vladimir Stevanovi\u0107 and Bernard Kai\u0107 Citation Vilibi\u0107-\u010cavlek T, Bogdani\u0107 M, Savi\u0107 V, Barbi\u0107 L, Stevanovi\u0107 V and Kai\u0107 B. TBE in Croatia. Chapter 13. In: Dobler G, Erber W, Br\u00f6ker M, Chitimia-Dobler L, Schmitt HJ, eds. The TBE Book. 9th ed. Singapore: Global Health Press; 2026. doi:10.33442\/26613980_13-7-9 References Vesenjak-Hirjan J. Tick-Borne Encephalitis in Croatia. Rad JAZU, Book 372; Croatian Publisher RAD JAZU: Zagreb, Croatia, 1976; pp. 1\u201310. Vesenjak-Hirjan J, Galinovi\u0107-Weisglass"}