{"id":5726,"date":"2017-09-04T00:08:45","date_gmt":"2017-09-03T16:08:45","guid":{"rendered":"https:\/\/id-ea.org\/tbe\/?p=5726"},"modified":"2023-05-12T12:10:56","modified_gmt":"2023-05-12T04:10:56","slug":"tbe12b10","status":"publish","type":"post","link":"https:\/\/tbenews.com\/tbe\/tbe12b10\/","title":{"rendered":"Estonia"},"content":{"rendered":"\n
<\/a><\/span>
\n

TBE in Estonia<\/strong><\/h1>\n

Kuulo Kutsar<\/strong><\/p>\n<\/div>\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<\/strong><\/h3>\n\n\n\n

The first cases of tick-borne encephalitis (TBE) in Estonia were identified in 1949. Today, Estonia is a TBE-endemic country. A TBE-endemic area in Estonia is defined as an area with circulation of the TBEV between ticks and vertebrate hosts as determined by detection of the TBEV or the demonstration of autochthonous infections in humans or animals within the last 20 years.<\/p>\n\n\n\n

Euro-Asian genotypes of TBEV \u2013 the Western or European (TBEV-EU), Siberian (TBEV-Sib), and Far-Eastern (TBEV-FE) subtypes are co-circulating in Estonia. Vectors of TBEV, the tick species Ixodes ricinus<\/em> and Ixodes persulcatus<\/em>, are distributed throughout the country. The high-risk season for infection coincides with the period of biological activity of ticks and lasts for 7 months from April to November, peaking in June to August. Most TBE cases are diagnosed in persons \u226560 years of age and the incidence among the rural population is 1.8 times higher than among the urban population.<\/p>\n\n\n\n

Overview of TBE in Estonia<\/strong><\/h3>\n\n\n\n
\n\n\n\n\n\n\n\n
Table 1: Virus, vector, transmission of TBE in Estonia<\/th>\n<\/tr>\n
Viral subtypes, distribution<\/strong><\/td>\nCo-circulation of European (TBEV-EU), Far-Eastern (TBEV-FE), and Siberian (TBEV-Sib) subtypes<\/td>\n<\/tr>\n
Reservoir animals<\/strong><\/td>\nRodents, ruminants, game<\/td>\n<\/tr>\n
Infected tick species (%)<\/strong><\/td>\n2011: I. persulcatus<\/em> 8%, I. ricinus <\/em>on mainland 0.6%\u20130.8% and on Saaremaa island 3.0%.
2013 whole country: I. persulcatus<\/em> 4.23%, I. ricinus <\/em>0.42%.<\/td>\n<\/tr>\n
Dairy product transmission<\/strong><\/td>\nDocumented but rare<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>
\n\n\n\n
\n\n\n\n\n\n\n\n
Table 2: TBE reporting and vaccine prevention in Estonia<\/th>\n<\/tr>\n
Mandatory TBE reporting<\/strong><\/td>\nReporting<\/strong>: neurologists, infectious disease specialist. Case definition<\/strong>\n

 <\/p>\n

Clinical criteria: a person with symptoms of the central nervous system (meningitis, meningoencephalitis, encephalomyelitis, encephaloradiculitis)<\/p>\n

Laboratory criteria for case confirmation<\/strong>:<\/p>\n

At least 1 of the following:<\/p>\n

    \n
  • TBE-specific IgM and IgG antibodies in blood<\/li>\n
  • TBE-specific IgM antibodies in CSF<\/li>\n
  • Seroconversion of 4-fold increase of TBE-specific antibodies in paired serum samples<\/li>\n
  • Detection of TBE viral nucleic acid in a clinical specimen<\/li>\n
  • Isolation of TBEV from clinical specimens. Probable case: detection of TBE-specific IgM antibodies in a unique serum sample.<\/li>\n<\/ul>\n

    Epidemiological criteria<\/strong><\/p>\n

    Exposure to a common source (unpasteurized dairy product). Case classification:<\/p>\n

      \n
    • Possible case: Not applicable<\/li>\n
    • Probable case: a person meeting the clinical criteria and the laboratory criteria for a probable case OR a person meeting the clinical criteria and with an epidemiological link.<\/li>\n<\/ul>\n

      Confirmed case: a person meeting the clinical and laboratory criteria for case confirmation.<\/p>\n<\/td>\n<\/tr>\n

Other TBE surveillance<\/strong><\/td>\nLaboratory and epidemiological surveillance<\/td>\n<\/tr>\n
Special clinical features<\/strong><\/td>\nBiphasic disease: meningitis, meningoencephalitis, or meningoencephalomyelitis. Risk groups: people who often spend time outdoors (in nature).<\/td>\n<\/tr>\n
Available vaccines<\/strong><\/td>\nTBE vaccination by age groups in Estonia, 2018-2019\n

Vaccines available: ENCEPUR CHILDREN and ENCEPUR ADULTS, FSME-IMMUN and FSME-IMMUN junior<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Age<\/td>\n\n

2018<\/p>\n<\/td>\n

\n

2019<\/p>\n<\/td>\n<\/tr>\n

Vaccination<\/td>\nRevaccination<\/td>\nVaccination<\/td>\nRevaccination<\/td>\n<\/tr>\n
1 – 4<\/td>\n5717<\/td>\n4374<\/td>\n8253<\/td>\n4181<\/td>\n<\/tr>\n
15 -17<\/td>\n1123<\/td>\n1618<\/td>\n897<\/td>\n1324<\/td>\n<\/tr>\n
Adults<\/td>\n10 567<\/td>\n17 997<\/td>\n16 817<\/td>\n17 856<\/td>\n<\/tr>\n
Population\n

(Estonia)<\/p>\n<\/td>\n

1 319 133<\/td>\n1 324 820<\/td>\n<\/tr>\n
Age<\/td>\n\n

2020<\/p>\n<\/td>\n<\/tr>\n

Vaccination<\/td>\nRevaccination<\/td>\nVaccination<\/td>\nRevaccination<\/td>\n<\/tr>\n
1 – 4<\/td>\n8,344<\/td>\n3,716<\/td>\n5,409<\/td>\n2,962<\/td>\n<\/tr>\n
15 – 17<\/td>\n845<\/td>\n1,295<\/td>\n630<\/td>\n875<\/td>\n<\/tr>\n
Adults<\/td>\n16,033<\/td>\n14,767<\/td>\n11,024<\/td>\n13,308<\/td>\n<\/tr>\n
Population\n

(Estonia)<\/p>\n<\/td>\n

1 328 889<\/td>\n1 330 068<\/td>\n<\/tbody>\n<\/table>\n<\/td>\n<\/tr>\n
Vaccination recommendations and reimbursement<\/strong><\/td>\nVaccination recommendations 1998. No reimbursement; self-paid.<\/td>\n<\/tr>\n
Vaccine uptake by age group\/risk group\/general population<\/strong><\/td>\nVaccine uptake by general population (vaccinated and revaccinated): 2018 \u2013 3.1%; 2019 \u2013 3.7%; 2020 \u2013 3.4%; 2021 \u2013 2.6%<\/td>\n<\/tr>\n
Name, address\/website of TBE National Reference Center<\/strong><\/td>\nInstitute for Health Development, Lab for Virology http:\/\/www.tai.ee\/en\/about-us\/national-institute-for-health-development<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>
\n\n\n\n
\n
\n

Figure 1:<\/span> Burden of TBE in Estonia over time<\/h3>\n

<\/a><\/p>\n<\/div>\n

\"\"<\/a><\/figure>
<\/div>\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\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\n\t\n\t\n\t\n\t\n\t\n\t\n\t\n\t
Years<\/th>Number of Cases<\/th>Incidence \/ 105<\/sup><\/th>\n<\/tr>\n<\/thead>\n
1950<\/td>0.3<\/td>0.3<\/td>\n<\/tr>\n
1951<\/td>0<\/td>0<\/td>\n<\/tr>\n
1952<\/td>10<\/td>0.9<\/td>\n<\/tr>\n
1953<\/td>1<\/td>0.1<\/td>\n<\/tr>\n
1954<\/td>7<\/td>0.6<\/td>\n<\/tr>\n
1955<\/td>3<\/td>0.3<\/td>\n<\/tr>\n
1957<\/td>1<\/td>0.1<\/td>\n<\/tr>\n
1958<\/td>1<\/td>0.1<\/td>\n<\/tr>\n
1959<\/td>0<\/td>0<\/td>\n<\/tr>\n
1960<\/td>3<\/td>0.2<\/td>\n<\/tr>\n
1961<\/td>0<\/td>0<\/td>\n<\/tr>\n
1962<\/td>0<\/td>0<\/td>\n<\/tr>\n
1963<\/td>0<\/td>0<\/td>\n<\/tr>\n
1964<\/td>2<\/td>0.2<\/td>\n<\/tr>\n
1965<\/td>1<\/td>0.1<\/td>\n<\/tr>\n
1966<\/td>0<\/td>0<\/td>\n<\/tr>\n
1967<\/td>0<\/td>0<\/td>\n<\/tr>\n
1968<\/td>2<\/td>0.2<\/td>\n<\/tr>\n
1969<\/td>0<\/td>0<\/td>\n<\/tr>\n
1970<\/td>2<\/td>0.2<\/td>\n<\/tr>\n
1971<\/td>9<\/td>0.7<\/td>\n<\/tr>\n
1972<\/td>10<\/td>0.7<\/td>\n<\/tr>\n
1973<\/td>9<\/td>0.7<\/td>\n<\/tr>\n
1974<\/td>12<\/td>0.8<\/td>\n<\/tr>\n
1975<\/td>19<\/td>1.3<\/td>\n<\/tr>\n
1976<\/td>63<\/td>4.4<\/td>\n<\/tr>\n
1977<\/td>38<\/td>2.6<\/td>\n<\/tr>\n
1978<\/td>28<\/td>1.9<\/td>\n<\/tr>\n
1979<\/td>35<\/td>2.4<\/td>\n<\/tr>\n
1980<\/td>46<\/td>3.1<\/td>\n<\/tr>\n
1981<\/td>43<\/td>2.9<\/td>\n<\/tr>\n
1982<\/td>16<\/td>1.1<\/td>\n<\/tr>\n
1983<\/td>46<\/td>3.0<\/td>\n<\/tr>\n
1984<\/td>69<\/td>4.5<\/td>\n<\/tr>\n
1985<\/td>37<\/td>2.4<\/td>\n<\/tr>\n
1986<\/td>64<\/td>4.1<\/td>\n<\/tr>\n
1987<\/td>89<\/td>5.7<\/td>\n<\/tr>\n
1988<\/td>67<\/td>4.3<\/td>\n<\/tr>\n
1989<\/td>58<\/td>3.7<\/td>\n<\/tr>\n
1990<\/td>37<\/td>2.3<\/td>\n<\/tr>\n
1991<\/td>68<\/td>4.4<\/td>\n<\/tr>\n
1992<\/td>99<\/td>6.5<\/td>\n<\/tr>\n
1993<\/td>163<\/td>10.8<\/td>\n<\/tr>\n
1994<\/td>177<\/td>11.8<\/td>\n<\/tr>\n
1995<\/td>175<\/td>11.8<\/td>\n<\/tr>\n
1996<\/td>178<\/td>12.1<\/td>\n<\/tr>\n
1997<\/td>404<\/td>27.8<\/td>\n<\/tr>\n
1998<\/td>387<\/td>27.0<\/td>\n<\/tr>\n
1999<\/td>185<\/td>12.8<\/td>\n<\/tr>\n
2000<\/td>272<\/td>19.8<\/td>\n<\/tr>\n
2001<\/td>215<\/td>15.8<\/td>\n<\/tr>\n
2002<\/td>90<\/td>6.6<\/td>\n<\/tr>\n
2003<\/td>237<\/td>17.5<\/td>\n<\/tr>\n
2004<\/td>182<\/td>13.5<\/td>\n<\/tr>\n
2005<\/td>164<\/td>12.2<\/td>\n<\/tr>\n
2006<\/td>171<\/td>12.7<\/td>\n<\/tr>\n
2007<\/td>140<\/td>10.4<\/td>\n<\/tr>\n
2008<\/td>90<\/td>6.7<\/td>\n<\/tr>\n
2009<\/td>179<\/td>13.3<\/td>\n<\/tr>\n
2010<\/td>201<\/td>15.0<\/td>\n<\/tr>\n
2011<\/td>250<\/td>18.7<\/td>\n<\/tr>\n
2012<\/td>178<\/td>13.3<\/td>\n<\/tr>\n
2013<\/td>113<\/td>8.5<\/td>\n<\/tr>\n
2014<\/td>84<\/td>6.5<\/td>\n<\/tr>\n
2015<\/td>116<\/td>8.8<\/td>\n<\/tr>\n
2016<\/td>81<\/td>6.2<\/td>\n<\/tr>\n
2017<\/td>87<\/td>6.6<\/td>\n<\/tr>\n
2018<\/td>85<\/td>6.5<\/td>\n<\/tr>\n
2019<\/td>83<\/td>6.3<\/td>\n<\/tr>\n
2020<\/td>70<\/td>5.3<\/td>\n<\/tr>\n
2021<\/td>80<\/td>6.0<\/td>\n<\/tr>\n
2022<\/td>138<\/td>10.4<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/a><\/div>\n<\/div>
\n\n\n\n
\n
\n

Figure 2:<\/span> Age distribution of TBE in Estonia, 2005\u20132022<\/h3>\n

<\/a><\/p>\n<\/div>\n

\"\"<\/a><\/figure>
<\/div>\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
Year<\/th>0-9<\/th>10-19<\/th>20-29<\/th>30-39<\/th>40-49<\/th>50-59<\/th>60\u2265<\/th>\n<\/tr>\n<\/thead>\n
2005<\/td>17<\/td>22<\/td>20<\/td>26<\/td>23<\/td>21<\/td>35<\/td>\n<\/tr>\n
2006<\/td>14<\/td>22<\/td>22<\/td>15<\/td>25<\/td>31<\/td>42<\/td>\n<\/tr>\n
2007<\/td>10<\/td>15<\/td>14<\/td>25<\/td>21<\/td>18<\/td>37<\/td>\n<\/tr>\n
2008<\/td>6<\/td>10<\/td>11<\/td>14<\/td>13<\/td>14<\/td>22<\/td>\n<\/tr>\n
2009<\/td>17<\/td>23<\/td>20<\/td>22<\/td>32<\/td>24<\/td>41<\/td>\n<\/tr>\n
2010<\/td>18<\/td>24<\/td>22<\/td>19<\/td>33<\/td>34<\/td>51<\/td>\n<\/tr>\n
2011<\/td>12<\/td>20<\/td>28<\/td>28<\/td>31<\/td>47<\/td>84<\/td>\n<\/tr>\n
2012<\/td>12<\/td>28<\/td>12<\/td>27<\/td>24<\/td>21<\/td>54<\/td>\n<\/tr>\n
2013<\/td>8<\/td>11<\/td>12<\/td>12<\/td>14<\/td>19<\/td>37<\/td>\n<\/tr>\n
2014<\/td>7<\/td>11<\/td>7<\/td>10<\/td>16<\/td>11<\/td>22<\/td>\n<\/tr>\n
2015<\/td>10<\/td>11<\/td>7<\/td>19<\/td>17<\/td>15<\/td>37<\/td>\n<\/tr>\n
2016<\/td>8<\/td>8<\/td>5<\/td>8<\/td>18<\/td>11<\/td>23<\/td>\n<\/tr>\n
2017<\/td>16<\/td>6<\/td>10<\/td>13<\/td>10<\/td>11<\/td>21<\/td>\n<\/tr>\n
2018<\/td>6<\/td>12<\/td>3<\/td>13<\/td>15<\/td>7<\/td>29<\/td>\n<\/tr>\n
2019<\/td>7<\/td>11<\/td>5<\/td>12<\/td>12<\/td>10<\/td>26<\/td>\n<\/tr>\n
2020<\/td>2<\/td>8<\/td>7<\/td>9<\/td>10<\/td>10<\/td>24<\/td>\n<\/tr>\n
2021<\/td>9<\/td>9<\/td>7<\/td>5<\/td>13<\/td>14<\/td>23<\/td>\n<\/tr>\n
2022<\/td>15<\/td>8<\/td>6<\/td>15<\/td>24<\/td>23<\/td>47<\/td>\n<\/tr>\n
2023<\/td>24<\/td>20<\/td>9<\/td>26<\/td>17<\/td>37<\/td>76<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div>
\n\n\n\n
\n
\n

Figure 3:<\/span> Gender distribution of TBE in Estonia, 2005\u20132022<\/h3>\n

<\/a><\/p>\n<\/div>\n

\"\"<\/a><\/figure>
<\/div>\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
<\/td>Men<\/th>Women<\/th>\n<\/tr>\n<\/thead>\n
2005<\/td>82<\/td>82<\/td>\n<\/tr>\n
2006<\/td>87<\/td>84<\/td>\n<\/tr>\n
2007<\/td>76<\/td>64<\/td>\n<\/tr>\n
2008<\/td>52<\/td>38<\/td>\n<\/tr>\n
2009<\/td>89<\/td>90<\/td>\n<\/tr>\n
2010<\/td>105<\/td>96<\/td>\n<\/tr>\n
2011<\/td>118<\/td>132<\/td>\n<\/tr>\n
2012<\/td>98<\/td>80<\/td>\n<\/tr>\n
2013<\/td>56<\/td>57<\/td>\n<\/tr>\n
2014<\/td>45<\/td>39<\/td>\n<\/tr>\n
2015<\/td>56<\/td>60<\/td>\n<\/tr>\n
2016<\/td>38<\/td>43<\/td>\n<\/tr>\n
2017<\/td>41<\/td>46<\/td>\n<\/tr>\n
2018<\/td>42<\/td>41<\/td>\n<\/tr>\n
2019<\/td>41<\/td>44<\/td>\n<\/tr>\n
2020<\/td>31<\/td>39<\/td>\n<\/tr>\n
2021<\/td>38<\/td>42<\/td>\n<\/tr>\n
2022<\/td>67<\/td>71<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/a><\/div>\n<\/div>
\n\n\n\n
\n
\n

Figure 4:<\/span> TBEV-isolation and TBE cases, 2018<\/h3>\n

TBEV-isolation and TBE cases 2018<\/p>\n

<\/a><\/p>\n<\/div>\n

\"\"<\/a><\/figure>
<\/div>\n<\/div>\n\n\n\n

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

kkutsar@hotmail.com<\/p>\n\n\n\n

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

Kutsar K. TBE in Estonia. Chapter 12b. In: Dobler G, Erber W, Br\u00f6ker M, Schmitt HJS, eds. The TBE Book<\/em>. 6th ed. Singapore: Global Health Press;2023. doi:10.33442\/26613980_12b10-6<\/p>\n\n\n\n

References<\/h3>\n\n\n\n
    \n
  1. Health Board. [website] https:\/\/www.vaktsineeri.ee\/. Immunoprophylaxis of communicable diseases, 2020 report form for vaccinators<\/i>. Available at https:\/\/www.vaktsineeri.ee\/et\/tervishoiutootajatele-vaktsineerimine. Accessed February 21, 2020.<\/li>\n\n\n\n
  2. Katargina O, Russakova S, Geller J et al. Detection and characterization of tick-borne encephalitis virus in Baltic countries and Eastern Poland. PLoS One. <\/i>2013:8(5):e61375<\/li>\n<\/ol>\n<\/span>","protected":false},"excerpt":{"rendered":"

    TBE in Estonia Kuulo Kutsar E-CDC risk status: endemic (data as of end 2022) History and current situation The first cases of tick-borne encephalitis (TBE) in Estonia were identified in 1949. Today, Estonia is a TBE-endemic country. A TBE-endemic area in Estonia is defined as an area with circulation of the TBEV between ticks and vertebrate hosts as determined by detection of the TBEV or the demonstration of autochthonous infections in humans or animals within the last 20 years. Euro-Asian genotypes of TBEV \u2013 the Western or European (TBEV-EU), Siberian (TBEV-Sib), and Far-Eastern (TBEV-FE) subtypes are co-circulating in Estonia. Vectors of TBEV, the tick species Ixodes ricinus and Ixodes persulcatus, are distributed throughout the country. The high-risk season for infection coincides with the period of biological activity of ticks and lasts for 7 months from April to November, peaking in June to August. Most TBE cases are diagnosed in persons \u226560 years of age and the incidence among the rural population is 1.8 times higher than among the urban population. Overview of TBE in Estonia Table 1: Virus, vector, transmission of TBE in Estonia Viral subtypes, distribution Co-circulation of European (TBEV-EU), Far-Eastern (TBEV-FE), and Siberian (TBEV-Sib) subtypes Reservoir animals Rodents, ruminants, game Infected tick species (%) 2011: I. persulcatus 8%, I. ricinus on mainland 0.6%\u20130.8% and on Saaremaa island 3.0%.2013 whole country: I. persulcatus 4.23%, I. ricinus 0.42%. Dairy product transmission Documented but rare Table 2: TBE reporting and vaccine prevention in Estonia Mandatory TBE reporting Reporting: neurologists, infectious disease specialist. Case definition   Clinical criteria: a person with symptoms of the central nervous system (meningitis, meningoencephalitis, encephalomyelitis, encephaloradiculitis) Laboratory criteria for case confirmation: At least 1 of the following: TBE-specific IgM and IgG antibodies in blood TBE-specific IgM antibodies in CSF Seroconversion of 4-fold increase of TBE-specific antibodies in paired serum samples Detection of TBE viral nucleic acid in a clinical specimen Isolation of TBEV from clinical specimens. Probable case: detection of TBE-specific IgM antibodies in a unique serum sample. Epidemiological criteria Exposure to a common source (unpasteurized dairy product). Case classification: Possible case: Not applicable Probable case: a person meeting the clinical criteria and the laboratory criteria for a probable case OR a person meeting the clinical criteria and with an epidemiological link. Confirmed case: a person meeting the clinical and laboratory criteria for case confirmation. Other TBE surveillance Laboratory and epidemiological surveillance Special clinical features Biphasic disease: meningitis, meningoencephalitis, or meningoencephalomyelitis. Risk groups: people who often spend time outdoors (in nature). Available vaccines TBE vaccination by age groups in Estonia, 2018-2019 Vaccines available: ENCEPUR CHILDREN and ENCEPUR ADULTS, FSME-IMMUN and FSME-IMMUN junior Age 2018 2019 Vaccination Revaccination Vaccination Revaccination 1 – 4 5717 4374 8253 4181 15 -17 1123 1618 897 1324 Adults 10 567 17 997 16 817 17 856 Population (Estonia) 1 319 133 1 324 820 Age 2020 Vaccination Revaccination Vaccination Revaccination 1 – 4 8,344 3,716 5,409 2,962 15 – 17 845 1,295 630 875 Adults 16,033 14,767 11,024 13,308 Population (Estonia) 1 328 889 1 330 068 Vaccination recommendations and reimbursement Vaccination recommendations 1998. No reimbursement; self-paid. Vaccine uptake by age group\/risk group\/general population Vaccine uptake by general population (vaccinated and revaccinated): 2018 \u2013 3.1%; 2019 \u2013 3.7%; 2020 \u2013 3.4%; 2021 \u2013 2.6% Name, address\/website of TBE National Reference Center Institute for Health Development, Lab for Virology http:\/\/www.tai.ee\/en\/about-us\/national-institute-for-health-development Figure 1: Burden of TBE in Estonia over time Source data Figure 2: Age distribution of TBE in Estonia, 2005\u20132022 Source data Figure 3: Gender distribution of TBE in Estonia, 2005\u20132022 Source data Figure 4: TBEV-isolation and TBE cases, 2018 TBEV-isolation and TBE cases 2018 Contact: kkutsar@hotmail.com Citation: Kutsar K. TBE in Estonia. Chapter 12b. In: Dobler G, Erber W, Br\u00f6ker M, Schmitt HJS, eds. The TBE Book. 6th ed. Singapore: Global Health Press;2023. doi:10.33442\/26613980_12b10-6 References<\/p>\n","protected":false},"author":3,"featured_media":12828,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[45],"tags":[],"coauthors":[65],"class_list":["post-5726","post","type-post","status-publish","format-standard","has-post-thumbnail","category-tbe-countries-estonia"],"yoast_head":"\nEstonia - 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\/tbe12b10\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Estonia - TBE Book\" \/>\n<meta property=\"og:description\" content=\"TBE in Estonia Kuulo Kutsar E-CDC risk status: endemic (data as of end 2022) History and current situation The first cases of tick-borne encephalitis (TBE) in Estonia were identified in 1949. Today, Estonia is a TBE-endemic country. A TBE-endemic area in Estonia is defined as an area with circulation of the TBEV between ticks and vertebrate hosts as determined by detection of the TBEV or the demonstration of autochthonous infections in humans or animals within the last 20 years. Euro-Asian genotypes of TBEV \u2013 the Western or European (TBEV-EU), Siberian (TBEV-Sib), and Far-Eastern (TBEV-FE) subtypes are co-circulating in Estonia. Vectors of TBEV, the tick species Ixodes ricinus and Ixodes persulcatus, are distributed throughout the country. The high-risk season for infection coincides with the period of biological activity of ticks and lasts for 7 months from April to November, peaking in June to August. Most TBE cases are diagnosed in persons \u226560 years of age and the incidence among the rural population is 1.8 times higher than among the urban population. Overview of TBE in Estonia Table 1: Virus, vector, transmission of TBE in Estonia Viral subtypes, distribution Co-circulation of European (TBEV-EU), Far-Eastern (TBEV-FE), and Siberian (TBEV-Sib) subtypes Reservoir animals Rodents, ruminants, game Infected tick species (%) 2011: I. persulcatus 8%, I. ricinus on mainland 0.6%\u20130.8% and on Saaremaa island 3.0%.2013 whole country: I. persulcatus 4.23%, I. ricinus 0.42%. Dairy product transmission Documented but rare Table 2: TBE reporting and vaccine prevention in Estonia Mandatory TBE reporting Reporting: neurologists, infectious disease specialist. Case definition   Clinical criteria: a person with symptoms of the central nervous system (meningitis, meningoencephalitis, encephalomyelitis, encephaloradiculitis) Laboratory criteria for case confirmation: At least 1 of the following: TBE-specific IgM and IgG antibodies in blood TBE-specific IgM antibodies in CSF Seroconversion of 4-fold increase of TBE-specific antibodies in paired serum samples Detection of TBE viral nucleic acid in a clinical specimen Isolation of TBEV from clinical specimens. Probable case: detection of TBE-specific IgM antibodies in a unique serum sample. Epidemiological criteria Exposure to a common source (unpasteurized dairy product). Case classification: Possible case: Not applicable Probable case: a person meeting the clinical criteria and the laboratory criteria for a probable case OR a person meeting the clinical criteria and with an epidemiological link. Confirmed case: a person meeting the clinical and laboratory criteria for case confirmation. Other TBE surveillance Laboratory and epidemiological surveillance Special clinical features Biphasic disease: meningitis, meningoencephalitis, or meningoencephalomyelitis. Risk groups: people who often spend time outdoors (in nature). Available vaccines TBE vaccination by age groups in Estonia, 2018-2019 Vaccines available: ENCEPUR CHILDREN and ENCEPUR ADULTS, FSME-IMMUN and FSME-IMMUN junior Age 2018 2019 Vaccination Revaccination Vaccination Revaccination 1 – 4 5717 4374 8253 4181 15 -17 1123 1618 897 1324 Adults 10 567 17 997 16 817 17 856 Population (Estonia) 1 319 133 1 324 820 Age 2020 Vaccination Revaccination Vaccination Revaccination 1 – 4 8,344 3,716 5,409 2,962 15 – 17 845 1,295 630 875 Adults 16,033 14,767 11,024 13,308 Population (Estonia) 1 328 889 1 330 068 Vaccination recommendations and reimbursement Vaccination recommendations 1998. No reimbursement; self-paid. Vaccine uptake by age group\/risk group\/general population Vaccine uptake by general population (vaccinated and revaccinated): 2018 \u2013 3.1%; 2019 \u2013 3.7%; 2020 \u2013 3.4%; 2021 \u2013 2.6% Name, address\/website of TBE National Reference Center Institute for Health Development, Lab for Virology http:\/\/www.tai.ee\/en\/about-us\/national-institute-for-health-development Figure 1: Burden of TBE in Estonia over time Source data Figure 2: Age distribution of TBE in Estonia, 2005\u20132022 Source data Figure 3: Gender distribution of TBE in Estonia, 2005\u20132022 Source data Figure 4: TBEV-isolation and TBE cases, 2018 TBEV-isolation and TBE cases 2018 Contact: kkutsar@hotmail.com Citation: Kutsar K. TBE in Estonia. Chapter 12b. In: Dobler G, Erber W, Br\u00f6ker M, Schmitt HJS, eds. The TBE Book. 6th ed. Singapore: Global Health Press;2023. doi:10.33442\/26613980_12b10-6 References\" \/>\n<meta property=\"og:url\" content=\"https:\/\/tbenews.com\/tbe\/tbe12b10\/\" \/>\n<meta property=\"og:site_name\" content=\"TBE Book\" \/>\n<meta property=\"article:published_time\" content=\"2017-09-03T16:08:45+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-05-12T04:10:56+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/tbenews.com\/tbe\/wp-content\/uploads\/2017\/09\/Estonia.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=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b10\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b10\\\/\"},\"author\":{\"name\":\"Administrator admin\",\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/#\\\/schema\\\/person\\\/dd436937ad52c89f92315a6488c1d2c7\"},\"headline\":\"Estonia\",\"datePublished\":\"2017-09-03T16:08:45+00:00\",\"dateModified\":\"2023-05-12T04:10:56+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b10\\\/\"},\"wordCount\":618,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b10\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/wp-content\\\/uploads\\\/2017\\\/09\\\/Estonia.jpg\",\"articleSection\":[\"Estonia\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b10\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b10\\\/\",\"url\":\"https:\\\/\\\/tbenews.com\\\/tbe\\\/tbe12b10\\\/\",\"name\":\"Estonia - 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Today, Estonia is a TBE-endemic country. A TBE-endemic area in Estonia is defined as an area with circulation of the TBEV between ticks and vertebrate hosts as determined by detection of the TBEV or the demonstration of autochthonous infections in humans or animals within the last 20 years. Euro-Asian genotypes of TBEV \u2013 the Western or European (TBEV-EU), Siberian (TBEV-Sib), and Far-Eastern (TBEV-FE) subtypes are co-circulating in Estonia. Vectors of TBEV, the tick species Ixodes ricinus and Ixodes persulcatus, are distributed throughout the country. The high-risk season for infection coincides with the period of biological activity of ticks and lasts for 7 months from April to November, peaking in June to August. Most TBE cases are diagnosed in persons \u226560 years of age and the incidence among the rural population is 1.8 times higher than among the urban population. Overview of TBE in Estonia Table 1: Virus, vector, transmission of TBE in Estonia Viral subtypes, distribution Co-circulation of European (TBEV-EU), Far-Eastern (TBEV-FE), and Siberian (TBEV-Sib) subtypes Reservoir animals Rodents, ruminants, game Infected tick species (%) 2011: I. persulcatus 8%, I. ricinus on mainland 0.6%\u20130.8% and on Saaremaa island 3.0%.2013 whole country: I. persulcatus 4.23%, I. ricinus 0.42%. Dairy product transmission Documented but rare Table 2: TBE reporting and vaccine prevention in Estonia Mandatory TBE reporting Reporting: neurologists, infectious disease specialist. Case definition   Clinical criteria: a person with symptoms of the central nervous system (meningitis, meningoencephalitis, encephalomyelitis, encephaloradiculitis) Laboratory criteria for case confirmation: At least 1 of the following: TBE-specific IgM and IgG antibodies in blood TBE-specific IgM antibodies in CSF Seroconversion of 4-fold increase of TBE-specific antibodies in paired serum samples Detection of TBE viral nucleic acid in a clinical specimen Isolation of TBEV from clinical specimens. Probable case: detection of TBE-specific IgM antibodies in a unique serum sample. Epidemiological criteria Exposure to a common source (unpasteurized dairy product). Case classification: Possible case: Not applicable Probable case: a person meeting the clinical criteria and the laboratory criteria for a probable case OR a person meeting the clinical criteria and with an epidemiological link. Confirmed case: a person meeting the clinical and laboratory criteria for case confirmation. Other TBE surveillance Laboratory and epidemiological surveillance Special clinical features Biphasic disease: meningitis, meningoencephalitis, or meningoencephalomyelitis. Risk groups: people who often spend time outdoors (in nature). Available vaccines TBE vaccination by age groups in Estonia, 2018-2019 Vaccines available: ENCEPUR CHILDREN and ENCEPUR ADULTS, FSME-IMMUN and FSME-IMMUN junior Age 2018 2019 Vaccination Revaccination Vaccination Revaccination 1 – 4 5717 4374 8253 4181 15 -17 1123 1618 897 1324 Adults 10 567 17 997 16 817 17 856 Population (Estonia) 1 319 133 1 324 820 Age 2020 Vaccination Revaccination Vaccination Revaccination 1 – 4 8,344 3,716 5,409 2,962 15 – 17 845 1,295 630 875 Adults 16,033 14,767 11,024 13,308 Population (Estonia) 1 328 889 1 330 068 Vaccination recommendations and reimbursement Vaccination recommendations 1998. No reimbursement; self-paid. Vaccine uptake by age group\/risk group\/general population Vaccine uptake by general population (vaccinated and revaccinated): 2018 \u2013 3.1%; 2019 \u2013 3.7%; 2020 \u2013 3.4%; 2021 \u2013 2.6% Name, address\/website of TBE National Reference Center Institute for Health Development, Lab for Virology http:\/\/www.tai.ee\/en\/about-us\/national-institute-for-health-development Figure 1: Burden of TBE in Estonia over time Source data Figure 2: Age distribution of TBE in Estonia, 2005\u20132022 Source data Figure 3: Gender distribution of TBE in Estonia, 2005\u20132022 Source data Figure 4: TBEV-isolation and TBE cases, 2018 TBEV-isolation and TBE cases 2018 Contact: kkutsar@hotmail.com Citation: Kutsar K. TBE in Estonia. Chapter 12b. In: Dobler G, Erber W, Br\u00f6ker M, Schmitt HJS, eds. The TBE Book. 6th ed. Singapore: Global Health Press;2023. doi:10.33442\/26613980_12b10-6 References","og_url":"https:\/\/tbenews.com\/tbe\/tbe12b10\/","og_site_name":"TBE Book","article_published_time":"2017-09-03T16:08:45+00:00","article_modified_time":"2023-05-12T04:10:56+00:00","og_image":[{"width":1180,"height":250,"url":"https:\/\/tbenews.com\/tbe\/wp-content\/uploads\/2017\/09\/Estonia.jpg","type":"image\/jpeg"}],"author":"Administrator admin","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Administrator admin","Est. reading time":"4 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/tbenews.com\/tbe\/tbe12b10\/#article","isPartOf":{"@id":"https:\/\/tbenews.com\/tbe\/tbe12b10\/"},"author":{"name":"Administrator admin","@id":"https:\/\/tbenews.com\/tbe\/#\/schema\/person\/dd436937ad52c89f92315a6488c1d2c7"},"headline":"Estonia","datePublished":"2017-09-03T16:08:45+00:00","dateModified":"2023-05-12T04:10:56+00:00","mainEntityOfPage":{"@id":"https:\/\/tbenews.com\/tbe\/tbe12b10\/"},"wordCount":618,"commentCount":0,"publisher":{"@id":"https:\/\/tbenews.com\/tbe\/#organization"},"image":{"@id":"https:\/\/tbenews.com\/tbe\/tbe12b10\/#primaryimage"},"thumbnailUrl":"https:\/\/tbenews.com\/tbe\/wp-content\/uploads\/2017\/09\/Estonia.jpg","articleSection":["Estonia"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/tbenews.com\/tbe\/tbe12b10\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/tbenews.com\/tbe\/tbe12b10\/","url":"https:\/\/tbenews.com\/tbe\/tbe12b10\/","name":"Estonia - 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