Highlights
- •Comprehensive description of clinical TBE manifestations and symptom persistence.
- •Evidence against the assumption that TBE is usually mild in children (50% of the pediatric cases were moderate/severe).
- •Uncovering underreporting of CNS symptoms in routine TBE data (>80% vs. ∼50%).
- •Novel factors associated with acute severity: hypertension, monophasic course.
- •Documenting current diagnostic and treatment practices and potential deficits.
Summary
Objectives
Tick-borne encephalitis (TBE) is a growing public health problem with an average of
361 cases notified annually to Germany’s passive surveillance system since 2001. We
aimed to assess clinical manifestations and identify covariates associated with severity.
Methods
We included cases notified 2018–2020 in a prospective cohort study and collected data
with telephone interviews, questionnaires to general practitioners, and hospital discharge
summaries. Covariates’ causal associations with severity were evaluated with multivariable
logistic regression, adjusted for variables identified via directed acyclic graphs.
Results
Of 1220 eligible cases, 581 (48%) participated. Of these, 97.1% were not (fully) vaccinated.
TBE was severe in 20.3% of cases (children: 9.1%, ≥70-year-olds: 48.6%). Routine surveillance
data underreported the proportion of cases with central nervous system involvement
(56% vs. 84%). Ninety percent required hospitalization, 13.8% intensive care, and
33.4% rehabilitation. Severity was most notably associated with age (odds ratio (OR):
1.04, 95% confidence interval (CI): 1.02–1.05), hypertension (OR: 2.27, 95%CI: 1.37–3.75),
and monophasic disease course (OR: 1.67, 95%CI: 1.08–2.58).
Conclusions
We observed substantial TBE burden and health service utilization, suggesting that
awareness of TBE severity and vaccine preventability should be increased. Knowledge
of severity-associated factors may help inform patients’ decision to get vaccinated.
Keywords
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Article info
Publication history
Published online: February 14, 2023
Accepted:
February 12,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
