TBE incidence versus virus prevalence and increased prevalence of the TBE virus in Ixodes ricinus removed from humans.

Traditionally, the classification of risk areas of tick-borne encephalitis (TBE) is based on the recording of autochthonous cases of the disease. In Germany, an extension of these areas over the years and an increasing virus prevalence in ticks have been observed in recent years. Registration of foci with autochthonous TBE cases, recording of disease incidence and virus prevalence in ticks are all proven epidemiological methods to characterize TBE risk areas. These data are necessary for a scientifically proven recommendation of TBE vaccines, and they need to be updated regularly. These epidemiological methods have advantages and disadvantages with respect to the risk assessment of TBE areas. Despite the fact that these methods are suitable for risk assessment in practice, disease incidence (new cases per year/100,000 inhabitants) and virus prevalence in questing ticks did not correlate. Using nested RT-PCR we were able to demonstrate that the prevalence of TBE virus (TBEV) in ticks removed from humans was significantly higher than in unfed, free-living Ixodes ricinus of the same area. The 561 ticks collected from humans in doctors' surgeries in Bavaria in 2002 were examined by nRT-PCR. The estimated overall virus prevalence in tested ticks was 8.8% (95% CI: 6.45-11.57%). The removed ticks examined were classified according to the sites of exposure of the patients in the individual districts. Peak values were measured in the district of Regen with 20.6% and in the district of Freyung-Grafenau with 18.3%. In recent studies on unfed I. ricinus (nymphs, adults), the average TBEV prevalence in ticks in Bavarian risk areas was between 0.5% and 2%.