{"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":"Chapter 14: Public health aspects of TBE - TBE Book","type":"rich","width":600,"height":338,"html":"<blockquote class=\"wp-embedded-content\" data-secret=\"gpgG0fbDd4\"><a href=\"https:\/\/tbenews.com\/tbe\/chapter-14-public-health-aspects-of-tbe\/\">Chapter 14: Public health aspects of TBE<\/a><\/blockquote><iframe sandbox=\"allow-scripts\" security=\"restricted\" src=\"https:\/\/tbenews.com\/tbe\/chapter-14-public-health-aspects-of-tbe\/embed\/#?secret=gpgG0fbDd4\" width=\"600\" height=\"338\" title=\"&#8220;Chapter 14: Public health aspects of TBE&#8221; &#8212; TBE Book\" data-secret=\"gpgG0fbDd4\" 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\/2024\/06\/Chapter-14-PUBLIC-HEALTH-scaled.jpg","thumbnail_width":2560,"thumbnail_height":1709,"description":"Chapter 14:Public health aspects of TBE Phung Lang, Rahel Ackermann-G\u00e4umann Key points Introduction Public health measures are a key strategy for reducing the transmission of pathogens with epidemic potential. These measures encompass vaccination programs and non-pharmaceutical interventions that can be implemented by individuals, institutions, communities, local and national governments, and international bodies to slow or stop the spread of an infectious disease. TBE requires significant public health attention due to its potential to harm individuals residing in or traveling to TBE endemic areas. The disease can lead to long-term disability and even death. It is important to inform the public about the risks associated with TBE and provide an appropriate public health response. Reporting and surveillance TBEV is found in natural foci, which are areas where the virus circulates among ticks and reservoir hosts. As a result, TBE is limited to specific geographical regions, resulting in TBE endemic areas.1\u20133 More than 25 countries in Northern, Central, and Eastern Europe have one or more areas where TBE is endemic,4 with the highest reporting rates in the Baltic States, Slovenia, and the Czech Republic.5 Together with Russia and part of eastern Asia, these countries form what is known as the \u201cTBE belt\u201d.6 The incidence of TBE has increased over the past 25 years,7,8 with a northwestward spread in continental Europe, including to regions and altitudes previously believed to be free of the virus.1,9\u201311 The number of reported TBE cases in Europe in 2020 was twice that of 2015;9 nearly 30,000 cases were reported in the EU\/EEA countries between 2012 and 2020.11 However, annual case reporting fluctuates widely due to various factors.1 Since 2012, the European Centre for Disease Prevention and Control (ECDC) has required all European Union member states, as well as Iceland and Norway, to report their TBE data annually to the European Surveillance System (TESSy).12 In 2022, 43% of European countries13 used the latest diagnostic criteria introduced by the ECDC in 2018.14 In some countries that do not use the ECDC criteria, such as Italy, national diagnostic criteria are largely similar to the ECDC criteria. Therefore, reported TBE case numbers may not differ significantly.1,14 However, this may not be the case in countries that have key differences in requirements for the confirmation of a TBE case, such as in Germany, where clinical signs may be limited to non-specific symptoms (i.e., without CNS symptoms).1,15\u201317 Country data on TBE prevalence is difficult to compare due to differences in case definitions between countries, resulting in varying degrees of accuracy.1,9 TBE is typically an acute disease, and progression may terminate after the first phase, which is called the \u201cabortive\u201d clinical pattern. This form of TBE may be asymptomatic or manifest as a mild febrile illness, including symptoms such as headache, fever, fatigue, myalgia, anorexia, nausea, and vomiting, without progression to any form of encephalitis.18,19 However, only a few countries, namely Austria, Latvia, Germany, and Slovenia, collect data on nonspecific non-CNS symptoms.1,15,20\u201323 Additionally, mild CNS symptoms may go unreported since they do not fulfill the ECDC criteria, leading to underreporting of TBE. This is particularly noteworthy in pediatric patients, where symptoms are often mild and can be misdiagnosed.1 are very likely to be underreported compared to adults, as up to two-thirds of pediatric TBE cases are missed.9,24,25 Clinicians who do not test for TBEV infection due to a lack of recognition of the possibility of CNS inflammation may impact the number of reported TBE cases. Furthermore, if they suspect CNS inflammation, they may be less inclined to perform a CSF examination that supports a TBE diagnosis.1 Access to diagnostic tests for TBE is limited, as is knowledge on their appropriate use.1 Serological assays are the preferred method for TBE diagnosis.26 However, interpreting serologic test results is challenging due to the high cross-reactivity of the antigenic structure among orthoflaviviruses, particularly in areas where other orthoflaviviruses co-circulate or where vaccination against other orthoflaviviruses is common.27 Improved laboratory capacities and implementation of neutralization assays in these countries could improve identification of TBE by distinguishing it from other orthoflaviviral infections.1,28 Due to strict biosafety regulations in a number of Western countries, the performance of neutralization assays is restricted to laboratories equipped with a biosafety level 3 facility (biosafety level 4 in the United States). Therefore, alternative assays not requiring the work with infectious viruses could also be of value.29,30 Accurately determining the tick populations infected with TBEV and the number of human TBE cases is crucial for defining TBE risk areas. Endemic areas, which are risk areas where recurrent transmission of TBEV to humans occurs over several seasonal cycles,31 must be documented in most countries to make targeted vaccination recommendations.1,32,33 The geographic restriction of TBE allows for targeted surveillance in high-risk areas. However, incomplete surveillance can lead to a poor understanding of TBE endemic areas and potentially inadequate vaccine recommendations.1 This was demonstrated in Poland, where numerous new endemic districts were identified, including foci far away from previously known endemic districts, during an enhanced surveillance project.34 Restricted surveillance may hinder the early identification of new TBE endemic areas, thereby increasing the risk of TBEV infection for the public. Moreover, designating areas as endemic or high-risk may limit awareness and diagnosis of TBE in non-endemic areas, despite a national obligation to report TBE cases. This may lead to a decrease in the ability to detect cases of TBE in areas where the disease was not previously present, as well as in the diagnosis of imported cases of TBE.1 Overall, the identification of TBE endemic areas is crucial to inform national and international TBE risk management programs.1 However, identification of TBE endemic areas remains incomplete, and TBE surveillance in Europe is generally sporadic rather than systematic.9 TBE cases are likely to be underreported, and the true burden of TBE disease is significantly underestimated.9 Impact of climate change on tick-borne encephalitis Infection transmission occurs when the activities of reservoirs, vectors, and humans overlap, with variations depending on the pathogen and location. Climate change has the potential to affect all of these"}