{"id":5570,"date":"2017-08-31T22:27:49","date_gmt":"2017-08-31T14:27:49","guid":{"rendered":"https:\/\/id-ea.org\/tbe\/?p=5570"},"modified":"2023-05-12T11:01:15","modified_gmt":"2023-05-12T03:01:15","slug":"tbe12b7","status":"publish","type":"post","link":"https:\/\/tbenews.com\/tbe\/tbe12b7\/","title":{"rendered":"Croatia"},"content":{"rendered":"\n
<\/a><\/span>
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TBE in Croatia<\/strong><\/h1>\n<\/div>\n\n\n\n

Wilhelm Erber and Tamara Vukovi\u0107-Jankovi\u0107<\/strong><\/p>\n\n\n\n

E-CDC risk status: endemic<\/strong><\/h3>\n\n\n\n

(data as of end 2022)<\/em><\/p>\n\n\n\n

History and current situation<\/h3>\n\n\n\n

Even though tick-borne encephalitis (TBE) has been a notifiable disease in Croatia since 2007, there are no or only limited data available on the occurring tick species in the endemic areas, on the prevalence of TBE virus (TBEV) in ticks, its distribution in Croatia, and its genetic characteristics. Reporting of human cases also is very scarce. The Central European subtype of virus (TBEV-EU) appears to be present in Croatia.<\/p>\n\n\n\n

Natural foci of TBE have been found so far in the continental area in the northwestern region (between the Sava River and the Drava River, near Zagreb, Vara\u017edin, Bjelovar, Koprivnica, Kri\u017eevci, and Vinkovci \u2013 with an area around Slavonski Brod) and in the northeastern region (across a small area on the western outskirts of Osijek city). Recently, 2 new natural foci have emerged in the central mountainous region, south of the Sava River. Cases are reported only sporadically in the Adriatic coastal region.1<\/sup><\/a><\/p>\n\n\n\n

A recent study found a prevalence of TBEV similar to other European countries (0.1%\u20135%) in ticks removed from red foxes in Varazdin County and Zagreb County (in the vicinity of Medvednica mountain), both well known as TBE areas. Furthermore, a viral prevalence of 1.1% (95% CI: 0.3%\u20133.0%) has been found in red deer (Cervus elaphus<\/em>) from 2 areas in northeastern Croatia (Vukovar-Srijem County and Osijek-Baranja County). The latest human TBE cases from these 2 counties were recorded in 2009 (1 case) and 2010 (1 case), respectively.2<\/sup><\/a><\/p>\n\n\n\n

An average of 20 human cases of TBE is reported each year (minimum 11, maximum 45)3<\/sup><\/a>,<\/sup><\/a>4<\/sup><\/a> i.e., 0.26\u20131.05 cases\/100,000 persons. The majority of cases were registered in the Koprivnica-Kri\u017eevci County (average annual incidence 5.2\/100,000), Me\u0111imurska County (5\/100,000), and Bjelovar-Bilogora County (4.3\/100,000). The average incidence rate in the city of Zagreb, within the observed period, was 0.2\/100,000 (16 cases registered). In 2015, the first outbreak of TBE after consumption of raw goat milk was reported in 7 out of 10 exposed persons.5<\/sup><\/a><\/p>\n\n\n\n
\n

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Figure 1:<\/span> Geographical distribution of TBE by counties of the Republic of Croatia (1999\u20132008)3<\/sup><\/a><\/h3>\n<\/div>\n
\"\"<\/a><\/figure>
<\/div>\n

Click the image above to enlarge<\/p>\n<\/div>\n\n\n\n

Overview of TBE in Croatia<\/span><\/h3>\n\n\n\n
\n\n\n\n\n\n\n\n
Table 1: Virus, vector, transmission of TBE in Croatia<\/th>\n<\/tr>\n
Viral subtypes, distribution<\/td>\nEuropean subtype (TBEV-EU)2,3<\/sup><\/a><\/td>\n<\/tr>\n
Reservoir animals<\/td>\nRodents<\/td>\n<\/tr>\n
Infected tick species (%)<\/td>\nInformation not available<\/td>\n<\/tr>\n
Dairy product transmission<\/td>\nIn 2015 a small outbreak of TBE affecting 7 people from the region of Bjelovar after consuming fresh goat’s milk and cheeses.5<\/sup><\/a> In 2019, 5 patients were reported to have consumed raw goat milk from the same farm in the Gorski Kotar region.6<\/sup><\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n\n\n\n
\n
\n\n\n\n\n\n\n\n\n\n\n
Table 2: TBE-reporting and vaccine prevention in Croatia<\/th>\n<\/tr>\n
Mandatory TBE reporting<\/td>\nTBE has been an obligatory reportable disease in Croatia since 20071<\/sup><\/a><\/td>\n<\/tr>\n
Other TBE-surveillance<\/td>\nNot applicable<\/td>\n<\/tr>\n
Special clinical features<\/td>\nInformation not available<\/td>\n<\/tr>\n
Available vaccines<\/td>\nFSME IMMUN7<\/sup><\/a><\/td>\n<\/tr>\n
Vaccination recommendations and reimbursement<\/td>\nOnly recommended for residents in endemic areas and those visiting endemic areas (for recreation), as well as forestry workers in the Koprivnica-Kri\u017eevci region1<\/sup><\/a><\/td>\n<\/tr>\n
Vaccine uptake by age group\/ risk group\/ general population<\/td>\nYear \/ Number of vaccinated individuals in Zagreb8<\/sup><\/a>\n

2010 \/ 670<\/p>\n

2011 \/ 678<\/p>\n

2012 \/ 781<\/p>\n

2013 \/ 577<\/p>\n

2014 \/ 415<\/p>\n<\/td>\n<\/tr>\n

Name, address\/website of TBE National Reference Center<\/td>\nNational Institute of Public Health of Croatia\n

https:\/\/www.hzjz.hr\/en\/<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n\n\n\n
\n

\n
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Figure 2:<\/span> Burden of TBE in Croatia over time8-9<\/sup><\/a><\/h3>\n<\/div>\n
\"\"<\/a><\/figure>
<\/div>\n

Click the image above to enlarge<\/p>\n

Source data \n\n\n\n\t\n\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t
Year<\/th>Number of Cases <\/th>Incidence \/ 105<\/sup><\/th>\n<\/tr>\n<\/thead>\n
1991<\/td>60<\/td>1.4<\/td>\n<\/tr>\n
1992<\/td>27<\/td>0.6<\/td>\n<\/tr>\n
1993<\/td>76<\/td>1.8<\/td>\n<\/tr>\n
1994<\/td>87<\/td>2.1<\/td>\n<\/tr>\n
1995<\/td>59<\/td>1.4<\/td>\n<\/tr>\n
1996<\/td>57<\/td>1.4<\/td>\n<\/tr>\n
1997<\/td>25<\/td>0.6<\/td>\n<\/tr>\n
1998<\/td>24<\/td>0.6<\/td>\n<\/tr>\n
1999<\/td>26<\/td>0.6<\/td>\n<\/tr>\n
2000<\/td>18<\/td>0.4<\/td>\n<\/tr>\n
2001<\/td>27<\/td>0.6<\/td>\n<\/tr>\n
2002<\/td>30<\/td>0.7<\/td>\n<\/tr>\n
2003<\/td>36<\/td>0.9<\/td>\n<\/tr>\n
2004<\/td>38<\/td>0.9<\/td>\n<\/tr>\n
2005<\/td>28<\/td>0.7<\/td>\n<\/tr>\n
2006<\/td>20<\/td>0.5<\/td>\n<\/tr>\n
2007<\/td>11<\/td>0.3<\/td>\n<\/tr>\n
2008<\/td>20<\/td>0.5<\/td>\n<\/tr>\n
2009<\/td>44<\/td>1.1<\/td>\n<\/tr>\n
2010<\/td>36<\/td>0.9<\/td>\n<\/tr>\n
2011<\/td>26<\/td>0.6<\/td>\n<\/tr>\n
2012<\/td>45<\/td>1.1<\/td>\n<\/tr>\n
2013<\/td>44<\/td>1.1<\/td>\n<\/tr>\n
2014<\/td>22<\/td>0.5<\/td>\n<\/tr>\n
2015<\/td>25<\/td>0.6<\/td>\n<\/tr>\n
2016<\/td>6<\/td>0.1<\/td>\n<\/tr>\n
2017<\/td>10<\/td>0.2<\/td>\n<\/tr>\n
2018<\/td>24<\/td>0.6<\/td>\n<\/tr>\n
2019<\/td>14<\/td>0.3<\/td>\n<\/tr>\n
2020<\/td>15<\/td>0.4<\/td>\n<\/tr>\n
2021<\/td>4<\/td>0.1<\/td>\n<\/tr>\n
2022<\/td>23<\/td>0.6<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>\n\n\n\n
\n

Age and gender distribution of TBE in Croatia<\/span><\/h3> No available data\n<\/div>\n\n\n\n

Acknowledgments<\/strong><\/h3>\n\n\n\n

2021 and 2022 TBE case numbers were kindly provided by Assoc. Prof. Rok \u010civljak, University of Zagreb School of Medicine, Dr. Fran Mihaljevi\u0107 University Hospital for Infectious Diseases, Zagreb, Croatia.<\/p>\n\n\n\n

Contact:<\/strong><\/h3>\n\n\n\n

wilhelm.erber@pfizer.com<\/p>\n\n\n\n

Citation:<\/h3>\n\n\n\n

Erber W, Vukovi\u0107-Jankovi\u0107 T. TBE in Croatia. Chapter 12b. In: Dobler G, Erber W, Br\u00f6ker M, Schmitt HJ, eds. The TBE Book<\/em>. 6th ed. Singapore: Global Health Press;2023. doi:10.33442\/26613980_12b7-6<\/p>\n\n\n\n

References<\/strong><\/h3>\n\n\n\n
    \n
  1. <\/a>Zavadska D, et al. Recommendations for tick-borne encephalitis vaccination from the Central European Vaccination Awareness Group (CEVAG). Hum Vaccin Immunother<\/em>. 2013;9(2):362-74.<\/li>\n\n\n\n
  2. <\/a><\/a>Jemersic L, et al. Detection and genetic characterization of tick-borne encephalitis virus (TBEV) derived from ticks removed from red foxes (Vulpes vulpes) and isolated from spleen samples of red deer (Cervus elaphus<\/em>) in Croatia. Ticks Tick Borne Dis<\/em>. 2014;5(1):7-13.<\/li>\n\n\n\n
  3. <\/a><\/a>Mulic R, et al. Tick-borne diseases in the Republic of Croatia. Lijec Vjesn. 2011;133(3-4):89-95.<\/li>\n\n\n\n
  4. <\/a><\/a>Suss J. Tick-borne encephalitis 2010: epidemiology, risk areas, and virus strains in Europe and Asia-an overview. Ticks Tick-Borne Dis<\/em>. 2011;2(1):2-15.<\/li>\n\n\n\n
  5. <\/a><\/a>Markovinovic L, et al. An outbreak of tick-borne encephalitis associated with raw goat milk and cheese consumption, Croatia, 2015. Infection<\/em>. 2016;44:661\u20135.<\/li>\n\n\n\n
  6. <\/a>Vilibic-Cavlek T, et al. Emerging and Neglected Viruses of Zoonotic Importance in Croatia. Pathogens.<\/em> 2021; 10(1):73. https:\/\/doi.org\/10.3390\/pathogens10010073<\/li>\n\n\n\n
  7. <\/a><\/a>Agency for Medicines and Medical Devices of Croatia. Database available at: http:\/\/www.halmed.hr\/Lijekovi\/Baza-lijekova\/#rezultati<\/a> [Accessed July 2017]<\/li>\n\n\n\n
  8. <\/a><\/a>Dr. Andrija \u0160tampar Teaching Institute of Public Health. Data available at: http:\/\/www.stampar.hr\/en<\/a> [Accessed June, 2017]<\/li>\n\n\n\n
  9. <\/a><\/a>Amicizia D, et al. Epidemiology of tick-borne encephalitis (TBE) in Europe and its prevention by available vaccines. Hum Vaccin Immunother.<\/em> 2013;9(5):1163\u201371.<\/li>\n<\/ol>\n<\/span>","protected":false},"excerpt":{"rendered":"

    TBE in Croatia Wilhelm Erber and Tamara Vukovi\u0107-Jankovi\u0107 E-CDC risk status: endemic (data as of end 2022) History and current situation Even though tick-borne encephalitis (TBE) has been a notifiable disease in Croatia since 2007, there are no or only limited data available on the occurring tick species in the endemic areas, on the prevalence of TBE virus (TBEV) in ticks, its distribution in Croatia, and its genetic characteristics. Reporting of human cases also is very scarce. The Central European subtype of virus (TBEV-EU) appears to be present in Croatia. Natural foci of TBE have been found so far in the continental area in the northwestern region (between the Sava River and the Drava River, near Zagreb, Vara\u017edin, Bjelovar, Koprivnica, Kri\u017eevci, and Vinkovci \u2013 with an area around Slavonski Brod) and in the northeastern region (across a small area on the western outskirts of Osijek city). Recently, 2 new natural foci have emerged in the central mountainous region, south of the Sava River. Cases are reported only sporadically in the Adriatic coastal region.1 A recent study found a prevalence of TBEV similar to other European countries (0.1%\u20135%) in ticks removed from red foxes in Varazdin County and Zagreb County (in the vicinity of Medvednica mountain), both well known as TBE areas. Furthermore, a viral prevalence of 1.1% (95% CI: 0.3%\u20133.0%) has been found in red deer (Cervus elaphus) from 2 areas in northeastern Croatia (Vukovar-Srijem County and Osijek-Baranja County). The latest human TBE cases from these 2 counties were recorded in 2009 (1 case) and 2010 (1 case), respectively.2 An average of 20 human cases of TBE is reported each year (minimum 11, maximum 45)3,4 i.e., 0.26\u20131.05 cases\/100,000 persons. The majority of cases were registered in the Koprivnica-Kri\u017eevci County (average annual incidence 5.2\/100,000), Me\u0111imurska County (5\/100,000), and Bjelovar-Bilogora County (4.3\/100,000). The average incidence rate in the city of Zagreb, within the observed period, was 0.2\/100,000 (16 cases registered). In 2015, the first outbreak of TBE after consumption of raw goat milk was reported in 7 out of 10 exposed persons.5 Figure 1: Geographical distribution of TBE by counties of the Republic of Croatia (1999\u20132008)3 Click the image above to enlarge Overview of TBE in Croatia Table 1: Virus, vector, transmission of TBE in Croatia Viral subtypes, distribution European subtype (TBEV-EU)2,3 Reservoir animals Rodents Infected tick species (%) Information not available Dairy product transmission In 2015 a small outbreak of TBE affecting 7 people from the region of Bjelovar after consuming fresh goat’s milk and cheeses.5 In 2019, 5 patients were reported to have consumed raw goat milk from the same farm in the Gorski Kotar region.6 Table 2: TBE-reporting and vaccine prevention in Croatia Mandatory TBE reporting TBE has been an obligatory reportable disease in Croatia since 20071 Other TBE-surveillance Not applicable Special clinical features Information not available Available vaccines FSME IMMUN7 Vaccination recommendations and reimbursement Only recommended for residents in endemic areas and those visiting endemic areas (for recreation), as well as forestry workers in the Koprivnica-Kri\u017eevci region1 Vaccine uptake by age group\/ risk group\/ general population Year \/ Number of vaccinated individuals in Zagreb8 2010 \/ 670 2011 \/ 678 2012 \/ 781 2013 \/ 577 2014 \/ 415 Name, address\/website of TBE National Reference Center National Institute of Public Health of Croatia https:\/\/www.hzjz.hr\/en\/ Figure 2: Burden of TBE in Croatia over time8-9 Click the image above to enlarge Source data Age and gender distribution of TBE in Croatia No available data Acknowledgments 2021 and 2022 TBE case numbers were kindly provided by Assoc. Prof. Rok \u010civljak, University of Zagreb School of Medicine, Dr. Fran Mihaljevi\u0107 University Hospital for Infectious Diseases, Zagreb, Croatia. Contact: wilhelm.erber@pfizer.com Citation: Erber W, Vukovi\u0107-Jankovi\u0107 T. TBE in Croatia. Chapter 12b. In: Dobler G, Erber W, Br\u00f6ker M, Schmitt HJ, eds. The TBE Book. 6th ed. Singapore: Global Health Press;2023. doi:10.33442\/26613980_12b7-6 References<\/p>\n","protected":false},"author":3,"featured_media":12831,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[42],"tags":[],"coauthors":[65],"class_list":["post-5570","post","type-post","status-publish","format-standard","has-post-thumbnail","category-tbe-countries-croatia"],"yoast_head":"\nCroatia - TBE Book<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/tbenews.com\/tbe\/tbe12b7\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Croatia - TBE Book\" \/>\n<meta property=\"og:description\" content=\"TBE in Croatia Wilhelm Erber and Tamara Vukovi\u0107-Jankovi\u0107 E-CDC risk status: endemic (data as of end 2022) History and current situation Even though tick-borne encephalitis (TBE) has been a notifiable disease in Croatia since 2007, there are no or only limited data available on the occurring tick species in the endemic areas, on the prevalence of TBE virus (TBEV) in ticks, its distribution in Croatia, and its genetic characteristics. Reporting of human cases also is very scarce. The Central European subtype of virus (TBEV-EU) appears to be present in Croatia. Natural foci of TBE have been found so far in the continental area in the northwestern region (between the Sava River and the Drava River, near Zagreb, Vara\u017edin, Bjelovar, Koprivnica, Kri\u017eevci, and Vinkovci \u2013 with an area around Slavonski Brod) and in the northeastern region (across a small area on the western outskirts of Osijek city). Recently, 2 new natural foci have emerged in the central mountainous region, south of the Sava River. Cases are reported only sporadically in the Adriatic coastal region.1 A recent study found a prevalence of TBEV similar to other European countries (0.1%\u20135%) in ticks removed from red foxes in Varazdin County and Zagreb County (in the vicinity of Medvednica mountain), both well known as TBE areas. Furthermore, a viral prevalence of 1.1% (95% CI: 0.3%\u20133.0%) has been found in red deer (Cervus elaphus) from 2 areas in northeastern Croatia (Vukovar-Srijem County and Osijek-Baranja County). The latest human TBE cases from these 2 counties were recorded in 2009 (1 case) and 2010 (1 case), respectively.2 An average of 20 human cases of TBE is reported each year (minimum 11, maximum 45)3,4 i.e., 0.26\u20131.05 cases\/100,000 persons. The majority of cases were registered in the Koprivnica-Kri\u017eevci County (average annual incidence 5.2\/100,000), Me\u0111imurska County (5\/100,000), and Bjelovar-Bilogora County (4.3\/100,000). The average incidence rate in the city of Zagreb, within the observed period, was 0.2\/100,000 (16 cases registered). In 2015, the first outbreak of TBE after consumption of raw goat milk was reported in 7 out of 10 exposed persons.5 Figure 1: Geographical distribution of TBE by counties of the Republic of Croatia (1999\u20132008)3 Click the image above to enlarge Overview of TBE in Croatia Table 1: Virus, vector, transmission of TBE in Croatia Viral subtypes, distribution European subtype (TBEV-EU)2,3 Reservoir animals Rodents Infected tick species (%) Information not available Dairy product transmission In 2015 a small outbreak of TBE affecting 7 people from the region of Bjelovar after consuming fresh goat’s milk and cheeses.5 In 2019, 5 patients were reported to have consumed raw goat milk from the same farm in the Gorski Kotar region.6 Table 2: TBE-reporting and vaccine prevention in Croatia Mandatory TBE reporting TBE has been an obligatory reportable disease in Croatia since 20071 Other TBE-surveillance Not applicable Special clinical features Information not available Available vaccines FSME IMMUN7 Vaccination recommendations and reimbursement Only recommended for residents in endemic areas and those visiting endemic areas (for recreation), as well as forestry workers in the Koprivnica-Kri\u017eevci region1 Vaccine uptake by age group\/ risk group\/ general population Year \/ Number of vaccinated individuals in Zagreb8 2010 \/ 670 2011 \/ 678 2012 \/ 781 2013 \/ 577 2014 \/ 415 Name, address\/website of TBE National Reference Center National Institute of Public Health of Croatia https:\/\/www.hzjz.hr\/en\/ Figure 2: Burden of TBE in Croatia over time8-9 Click the image above to enlarge Source data Age and gender distribution of TBE in Croatia No available data Acknowledgments 2021 and 2022 TBE case numbers were kindly provided by Assoc. Prof. Rok \u010civljak, University of Zagreb School of Medicine, Dr. Fran Mihaljevi\u0107 University Hospital for Infectious Diseases, Zagreb, Croatia. Contact: wilhelm.erber@pfizer.com Citation: Erber W, Vukovi\u0107-Jankovi\u0107 T. TBE in Croatia. Chapter 12b. In: Dobler G, Erber W, Br\u00f6ker M, Schmitt HJ, eds. The TBE Book. 6th ed. Singapore: Global Health Press;2023. doi:10.33442\/26613980_12b7-6 References\" \/>\n<meta property=\"og:url\" content=\"https:\/\/tbenews.com\/tbe\/tbe12b7\/\" \/>\n<meta property=\"og:site_name\" content=\"TBE Book\" \/>\n<meta property=\"article:published_time\" content=\"2017-08-31T14:27:49+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-05-12T03:01:15+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/tbenews.com\/tbe\/wp-content\/uploads\/2017\/08\/Croatia.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1180\" \/>\n\t<meta property=\"og:image:height\" content=\"250\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Administrator admin\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Administrator admin\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b7\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b7\\\/\"},\"author\":{\"name\":\"Administrator admin\",\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/#\\\/schema\\\/person\\\/dd436937ad52c89f92315a6488c1d2c7\"},\"headline\":\"Croatia\",\"datePublished\":\"2017-08-31T14:27:49+00:00\",\"dateModified\":\"2023-05-12T03:01:15+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b7\\\/\"},\"wordCount\":805,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b7\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/wp-content\\\/uploads\\\/2017\\\/08\\\/Croatia.jpg\",\"articleSection\":[\"Croatia\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b7\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b7\\\/\",\"url\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b7\\\/\",\"name\":\"Croatia - 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TBE Book","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/tbenews.com\/tbe\/tbe12b7\/","og_locale":"en_US","og_type":"article","og_title":"Croatia - TBE Book","og_description":"TBE in Croatia Wilhelm Erber and Tamara Vukovi\u0107-Jankovi\u0107 E-CDC risk status: endemic (data as of end 2022) History and current situation Even though tick-borne encephalitis (TBE) has been a notifiable disease in Croatia since 2007, there are no or only limited data available on the occurring tick species in the endemic areas, on the prevalence of TBE virus (TBEV) in ticks, its distribution in Croatia, and its genetic characteristics. Reporting of human cases also is very scarce. The Central European subtype of virus (TBEV-EU) appears to be present in Croatia. Natural foci of TBE have been found so far in the continental area in the northwestern region (between the Sava River and the Drava River, near Zagreb, Vara\u017edin, Bjelovar, Koprivnica, Kri\u017eevci, and Vinkovci \u2013 with an area around Slavonski Brod) and in the northeastern region (across a small area on the western outskirts of Osijek city). Recently, 2 new natural foci have emerged in the central mountainous region, south of the Sava River. Cases are reported only sporadically in the Adriatic coastal region.1 A recent study found a prevalence of TBEV similar to other European countries (0.1%\u20135%) in ticks removed from red foxes in Varazdin County and Zagreb County (in the vicinity of Medvednica mountain), both well known as TBE areas. Furthermore, a viral prevalence of 1.1% (95% CI: 0.3%\u20133.0%) has been found in red deer (Cervus elaphus) from 2 areas in northeastern Croatia (Vukovar-Srijem County and Osijek-Baranja County). The latest human TBE cases from these 2 counties were recorded in 2009 (1 case) and 2010 (1 case), respectively.2 An average of 20 human cases of TBE is reported each year (minimum 11, maximum 45)3,4 i.e., 0.26\u20131.05 cases\/100,000 persons. The majority of cases were registered in the Koprivnica-Kri\u017eevci County (average annual incidence 5.2\/100,000), Me\u0111imurska County (5\/100,000), and Bjelovar-Bilogora County (4.3\/100,000). The average incidence rate in the city of Zagreb, within the observed period, was 0.2\/100,000 (16 cases registered). In 2015, the first outbreak of TBE after consumption of raw goat milk was reported in 7 out of 10 exposed persons.5 Figure 1: Geographical distribution of TBE by counties of the Republic of Croatia (1999\u20132008)3 Click the image above to enlarge Overview of TBE in Croatia Table 1: Virus, vector, transmission of TBE in Croatia Viral subtypes, distribution European subtype (TBEV-EU)2,3 Reservoir animals Rodents Infected tick species (%) Information not available Dairy product transmission In 2015 a small outbreak of TBE affecting 7 people from the region of Bjelovar after consuming fresh goat’s milk and cheeses.5 In 2019, 5 patients were reported to have consumed raw goat milk from the same farm in the Gorski Kotar region.6 Table 2: TBE-reporting and vaccine prevention in Croatia Mandatory TBE reporting TBE has been an obligatory reportable disease in Croatia since 20071 Other TBE-surveillance Not applicable Special clinical features Information not available Available vaccines FSME IMMUN7 Vaccination recommendations and reimbursement Only recommended for residents in endemic areas and those visiting endemic areas (for recreation), as well as forestry workers in the Koprivnica-Kri\u017eevci region1 Vaccine uptake by age group\/ risk group\/ general population Year \/ Number of vaccinated individuals in Zagreb8 2010 \/ 670 2011 \/ 678 2012 \/ 781 2013 \/ 577 2014 \/ 415 Name, address\/website of TBE National Reference Center National Institute of Public Health of Croatia https:\/\/www.hzjz.hr\/en\/ Figure 2: Burden of TBE in Croatia over time8-9 Click the image above to enlarge Source data Age and gender distribution of TBE in Croatia No available data Acknowledgments 2021 and 2022 TBE case numbers were kindly provided by Assoc. Prof. Rok \u010civljak, University of Zagreb School of Medicine, Dr. Fran Mihaljevi\u0107 University Hospital for Infectious Diseases, Zagreb, Croatia. Contact: wilhelm.erber@pfizer.com Citation: Erber W, Vukovi\u0107-Jankovi\u0107 T. TBE in Croatia. Chapter 12b. In: Dobler G, Erber W, Br\u00f6ker M, Schmitt HJ, eds. The TBE Book. 6th ed. 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