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Review
. 2012 Aug 31:5:184.
doi: 10.1186/1756-3305-5-184.

Why is tick-borne encephalitis increasing? A review of the key factors causing the increasing incidence of human TBE in Sweden

Affiliations
Review

Why is tick-borne encephalitis increasing? A review of the key factors causing the increasing incidence of human TBE in Sweden

Thomas G T Jaenson et al. Parasit Vectors. .

Abstract

The highest annual incidence of human tick-borne encephalitis (TBE) in Sweden ever recorded by the Swedish Institute for Communicable Disease Control (SMI) occurred last year, 2011. The number of TBE cases recorded during 2012 up to 6th August 2012 indicates that the incidence for 2012 could exceed that of 2011. In this review of the ecology and epidemiology of TBE in Sweden our main aim is to analyse the possible reasons behind the gradually increasing incidence of human TBE during the last 20 years. The main TBE virus (TBEV) vector to humans in Sweden is the nymphal stage of the common tick Ixodes ricinus. The main mode of transmission and maintenance of TBEV in the tick population is considered to be when infective nymphs co-feed with uninfected but infectible larvae on rodents. In most locations the roe deer, Capreolus capreolus is the main host for the reproducing adult I. ricinus ticks. The high number of roe deer for more than three decades has resulted in a very large tick population. Deer numbers have, however, gradually declined from the early 1990s to the present. This decline in roe deer numbers most likely made the populations of small rodents, which are reservoir-competent for TBEV, gradually more important as hosts for the immature ticks. Consequently, the abundance of TBEV-infected ticks has increased. Two harsh winters in 2009-2011 caused a more abrupt decline in roe deer numbers. This likely forced a substantial proportion of the "host-seeking" ticks to feed on bank voles (Myodes glareolus), which at that time suddenly had become very numerous, rather than on roe deer. Thus, the bank vole population peak in 2010 most likely caused many tick larvae to feed on reservoir-competent rodents. This presumably resulted in increased transmission of TBEV among ticks and therefore increased the density of infected ticks the following year. The unusually warm, humid weather and the prolonged vegetation period in 2011 permitted nymphs and adult ticks to quest for hosts nearly all days of that year. These weather conditions stimulated many people to spend time outdoors in areas where they were at risk of being attacked by infective nymphs. This resulted in at least 284 human cases of overt TBE. The tick season of 2012 also started early with an exceptionally warm March. The abundance of TBEV-infective "hungry" ticks was presumably still relatively high. Precipitation during June and July was rich and will lead to a "good mushroom season". These factors together are likely to result in a TBE incidence of 2012 similar to or higher than that of 2011.

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Figures

Figure 1
Figure 1
Total numbers of reported human TBE cases in Sweden each year for the 30-year period 1982–2011.
Figure 2
Figure 2
Total numbers of roe deer shot each year during 1960–2010 in six counties (Stockholms, Uppsala, Södermanlands, Östergötlands, Skåne and Västra Götalands län) with relatively high incidences of human TBE. Hunting data from Dr Jonas Kindberg, Wildlife Monitoring Unit, Swedish Association for Hunting and Wildlife Management.
Figure 3
Figure 3
Each black dot on the maps represents a locality where one or more persons are presumed to have contracted the TBE virus infection. The left map (a) shows the probable places of infection of all domestic TBE cases (n = 236) recorded by SMI during the 5-year period 1987–1991. The central map (b) shows the corresponding data 20 years later, i.e. all domestic TBE cases (n = 940) recorded during 2007–2011. Each black dot on the right map (c) represents a locality where one or more persons (N = 2550 human TBE cases) are presumed to have contracted the TBE virus infection during the period 1986–2011.
Figure 4
Figure 4
Total number of reported TBE cases in Sweden during 2011 (N = 284 cases). The cases are grouped by month of appearance of the first symptoms compatible with TBE.

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