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Vilibic-Cavlek T, Krcmar S, Bogdanic M, Tomljenovic M, Barbic L, Roncevic D, Sabadi D, Vucelja M, Santini M, Hunjak B, Stevanovic V, Boljfetic M, Bjedov L, Masovic V, Potocnik-Hunjadi T, Lakoseljac D, Al-Mufleh M, Savic V. An Overview of Tick-Borne Encephalitis Epidemiology in Endemic Regions of Continental Croatia, 2017-2023. Microorganisms 2024; 12:386. [PMID: 38399790 PMCID: PMC10891638 DOI: 10.3390/microorganisms12020386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Tick-borne encephalitis (TBE) represents an important public health problem in Europe. We analyzed the epidemiology of TBE based on data from humans, animals, and Ixodes ricinus ticks in endemic regions of continental Croatia. In the period from 2017 to 2023, cerebrospinal fluid (CSF) and serum samples of 684 patients with neuroinvasive diseases, 2240 horse serum samples, and 300 sheep serum samples were tested for TBEV. In addition, 8751 I. ricinus ticks were collected. CSF samples were tested using RT-PCR. Serological tests (serum, CSF) were performed using commercial ELISA, with confirmation of cross-reactive samples by a virus neutralization test. Eighty-four autochthonous human TBEV cases were confirmed. The majority of patients were in the age group of 40-69 years (58.3%) with a male predominance (70.2%). TBE showed a bimodal seasonality with a large peak in April-August and a small one in October-November. In addition to humans, TBEV IgG antibodies were found in 12.2% of horses and 9.7% of sheep. Seasonal tick abundance corresponds to the reported number of human infections. Continental Croatia is still an active natural focus of TBE. Continuous monitoring of infections in humans, sentinel animals, and ticks is needed for the implementation of preventive measures.
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Affiliation(s)
- Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Stjepan Krcmar
- Department of Biology, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
| | - Morana Tomljenovic
- Department of Epidemiology, Teaching Institute of Public Health of the Primorje-Gorski Kotar County, 51000 Rijeka, Croatia; (M.T.); (D.R.); (D.L.)
- Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (V.S.); (V.M.)
| | - Dobrica Roncevic
- Department of Epidemiology, Teaching Institute of Public Health of the Primorje-Gorski Kotar County, 51000 Rijeka, Croatia; (M.T.); (D.R.); (D.L.)
- Department of Public Health, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
| | - Dario Sabadi
- Department of Infectious Diseases, Clinical Hospital Center Osijek, 31000 Osijek, Croatia;
- Medical Faculty, University of Osijek, 31000 Osijek, Croatia
| | - Marko Vucelja
- Department of Forest Protection and Wildlife Management, Faculty of Forestry and Wood Technology, University of Zagreb, 10000 Zagreb, Croatia; (M.V.); (M.B.); (L.B.)
| | - Marija Santini
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia
| | - Blazenka Hunjak
- Department of Bacteriology, Croatian Institute of Public Health, 10000 Zagreb, Croatia;
- Department of Microbiology, University of Applied Health Sciences, 10000 Zagreb, Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (V.S.); (V.M.)
| | - Marko Boljfetic
- Department of Forest Protection and Wildlife Management, Faculty of Forestry and Wood Technology, University of Zagreb, 10000 Zagreb, Croatia; (M.V.); (M.B.); (L.B.)
| | - Linda Bjedov
- Department of Forest Protection and Wildlife Management, Faculty of Forestry and Wood Technology, University of Zagreb, 10000 Zagreb, Croatia; (M.V.); (M.B.); (L.B.)
| | - Viktor Masovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (V.S.); (V.M.)
| | | | - Danijela Lakoseljac
- Department of Epidemiology, Teaching Institute of Public Health of the Primorje-Gorski Kotar County, 51000 Rijeka, Croatia; (M.T.); (D.R.); (D.L.)
- Department of Public Health, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
| | - Mahmoud Al-Mufleh
- Department of Infectious Diseases, County Hospital Cakovec, 40000 Cakovec, Croatia;
| | - Vladimir Savic
- Poultry Center, Croatian Veterinary Institute, 10000 Zagreb, Croatia
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Christoph R, Giovanni A, Arne S, Sebastian V, Gerhard D, Angelika M, Marc S, Sonja H, Marie S, Lydia J, Michael F, Gerhardt H, Frank D, Martin A, Sonnleitner S, Walder G, Martin F, Martina P. Immunogenicity of tick-borne-encephalitis-virus-(TBEV)-vaccination and impact of age on humoral and cellular TBEV-specific immune responses in patients with rheumatoid arthritis. Vaccine 2024; 42:745-752. [PMID: 38242736 DOI: 10.1016/j.vaccine.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/31/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024]
Abstract
Inactivated vaccines, such as tick-borne-encephalitis-virus-(TBEV) vaccine, have been discussed as less immunogenic in elderly and in immunocompromised patients. In this controlled cross-sectional cohort study, the antibody and cellular responses after TBEV-vaccination were investigated in 36 rheumatoid arthritis (RA) patients and 112 healthy controls (HC) by evaluating IgG-anti-TBEV concentration, neutralization and relative avidity index (RAI). Cellular reactivity was assessed by IFNgamma-producing spot-forming-units (SFU) by ELISPOT assay and flow cytometry. RA patients showed lower IgG-anti-TBEV compared to HC, which were influenced by age at and time since last TBEV vaccination and disease duration. High-responders regarding cellular immunity and avidity were less frequent in RA compared to HC. RA patients who had received booster vaccinations were more likely to demonstrate higher IgG-anti-TBEV responses compared to those who had not. In conclusion, RA patients showed a negative effect of age on anti-TBEV-IgG and immunological benefits of timely booster vaccination are suggested.
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Affiliation(s)
- Rack Christoph
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Almanzar Giovanni
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Schäfer Arne
- Department of Internal Medicine II, Department of Rheumatology/Clinical Immunology, University of Würzburg, 97080 Würzburg, Germany; Diabetes Zentrum Mergengtheim, Bad Mergentheim, Germany
| | - Völkl Sebastian
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Dobler Gerhard
- Institut für Mikrobiologie der Bundeswehr, 80937 Munich, Germany
| | - Mutterer Angelika
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Schmalzing Marc
- Department of Internal Medicine II, Department of Rheumatology/Clinical Immunology, University of Würzburg, 97080 Würzburg, Germany
| | - Hick Sonja
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Steimer Marie
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Jahn Lydia
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Fladerer Michael
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany
| | - Hartmann Gerhardt
- General Medical Practice Dr. Hartmann, Hauptstraße 34, 97204 Höchberg, Germany
| | - Deininger Frank
- Rheumatology Practice Dr. Deininger, Haugerpfarrgasse 7, 97070 Würzburg, Germany
| | - Arbogast Martin
- Center of Rheumatology and Orthopedics, Hubertusstraße 40, 82487 Oberammergau, Germany
| | - Sissy Sonnleitner
- Laboratory for Hygiene and Microbiology, 9931 Außervillgraten, Austria
| | - Gernot Walder
- Laboratory for Hygiene and Microbiology, 9931 Außervillgraten, Austria
| | - Feuchtenberger Martin
- Department of Internal Medicine II, Department of Rheumatology/Clinical Immunology, University of Würzburg, 97080 Würzburg, Germany; Department of Rheumatology, MED|BAYERN OST Medical Center Altötting Burghausen, Rheumatologie Krankenhausstraße 1, 84489 Burghausen, Germany
| | - Prelog Martina
- Department of Pediatrics, Pediatric Rheumatology/Special Immunology, University Hospital Würzburg, 97080 Würzburg, Germany.
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Ackermann-Gäumann R, Lang P, Zens KD. Defining the "Correlate(s) of Protection" to tick-borne encephalitis vaccination and infection - key points and outstanding questions. Front Immunol 2024; 15:1352720. [PMID: 38318179 PMCID: PMC10840404 DOI: 10.3389/fimmu.2024.1352720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
Tick-borne Encephalitis (TBE) is a severe disease of the Central Nervous System (CNS) caused by the tick-borne encephalitis virus (TBEV). The generation of protective immunity after TBEV infection or TBE vaccination relies on the integrated responses of many distinct cell types at distinct physical locations. While long-lasting memory immune responses, in particular, form the basis for the correlates of protection against many diseases, these correlates of protection have not yet been clearly defined for TBE. This review addresses the immune control of TBEV infection and responses to TBE vaccination. Potential correlates of protection and the durability of protection against disease are discussed, along with outstanding questions in the field and possible areas for future research.
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Affiliation(s)
- Rahel Ackermann-Gäumann
- Microbiologie, ADMED Analyses et Diagnostics Médicaux, La Chaux-de-Fonds, Switzerland
- Swiss National Reference Center for Tick-transmitted Diseases, La Chaux-de-Fonds, Switzerland
| | - Phung Lang
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Kyra D. Zens
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Institute for Experimental Immunology, University of Zurich, Zurich, Switzerland
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Carlströmer Berthén N, Tompa E, Olausson S, Nyberg C, Nyman D, Ringbom M, Perander L, Svärd J, Lindgren PE, Forsberg P, Wilhelmsson P, Sjöwall J, Nordberg M. The AxBioTick Study: Borrelia Species and Tick-Borne Encephalitis Virus in Ticks, and Clinical Responses in Tick-Bitten Individuals on the Aland Islands, Finland. Microorganisms 2023; 11:1100. [PMID: 37317075 DOI: 10.3390/microorganisms11051100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 06/16/2023] Open
Abstract
The AxBioTick study was initiated to investigate the prevalence of ticks and tick-borne pathogens and their impact on antibody and clinical responses in tick-bitten individuals on the Aland Islands. This geographical area is hyperendemic for both Lyme borreliosis (LB) and Tick-borne encephalitis (TBE). Blood samples and ticks were collected from 100 tick-bitten volunteers. A total of 425 ticks was collected, all determined to Ixodes ricinus using molecular tools. Of them 20% contained Borrelia species, of which B. garinii and B. afzelii were most common. None contained the TBE virus (TBEV). Blood samples were drawn in conjunction with the tick bite, and eight weeks later. Sera were analyzed for Borrelia- and TBEV-specific antibodies using an ELISA and a semiquantitative antibody assay. In total 14% seroconverted in Borrelia C6IgG1, 3% in TBEV IgG, and 2% in TBEV IgM. Five participants developed clinical manifestations of LB. The high seroprevalence of both Borrelia (57%) and TBEV (52%) antibodies are likely attributed to the endemic status of the corresponding infections as well as the TBE vaccination program. Despite the similar prevalence of Borrelia spp. detected in ticks in other parts of Europe, the infection rate in this population is high. The AxBioTick study is continuing to investigate more participants and ticks for co-infections, and to characterize the dermal immune response following a tick bite.
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Affiliation(s)
- Nellie Carlströmer Berthén
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- Bimelix AB, 22100 Mariehamn, The Aland Islands, Finland
| | - Eszter Tompa
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
| | - Susanne Olausson
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- Bimelix AB, 22100 Mariehamn, The Aland Islands, Finland
| | - Clara Nyberg
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
| | - Dag Nyman
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- Bimelix AB, 22100 Mariehamn, The Aland Islands, Finland
| | - Malin Ringbom
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- The Aland Islands Healthcare Services, 22100 Mariehamn, The Aland Islands, Finland
| | - Linda Perander
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- The Aland Islands Healthcare Services, 22100 Mariehamn, The Aland Islands, Finland
| | - Joel Svärd
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
| | - Per-Eric Lindgren
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
- Clinical Microbiology, Laboratory Medicine, County Hospital Ryhov, 551 85 Jonkoping, Sweden
| | - Pia Forsberg
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
| | - Peter Wilhelmsson
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
- Clinical Microbiology, Laboratory Medicine, County Hospital Ryhov, 551 85 Jonkoping, Sweden
| | - Johanna Sjöwall
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection, Linkoping University, 581 83 Linkoping, Sweden
- Department of Infectious Diseases, Vrinnevi Hospital, 603 79 Norrkoping, Sweden
| | - Marika Nordberg
- Borrelia Research Group of the Aland Islands, 22100 Mariehamn, The Aland Islands, Finland
- The Aland Islands Healthcare Services, 22100 Mariehamn, The Aland Islands, Finland
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5
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Santonja I, Stiasny K, Essl A, Heinz FX, Kundi M, Holzmann H. Tick-Borne Encephalitis in Vaccinated Patients: A Retrospective Case-Control Study and Analysis of Vaccination Field Effectiveness in Austria From 2000 to 2018. J Infect Dis 2023; 227:512-521. [PMID: 35235953 DOI: 10.1093/infdis/jiac075] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/01/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There are discrepant observations on the severity of tick-borne encephalitis (TBE) in vaccinated persons. We, therefore, analyzed the occurrence of severe and mild disease in hospitalized vaccinated and nonvaccinated patients with TBE and determined the field effectiveness (FE) of vaccination against these forms of disease. METHODS The study covered all patients hospitalized with TBE in Austria from 2000 to 2018. Clinical diagnoses in vaccinated and age- and sex-matched nonvaccinated patients were compared in a nested case-control study. FE was calculated based on vaccination coverage and incidences in the nonvaccinated and vaccinated population. RESULTS Of 1545 patients hospitalized with TBE, 206 were vaccinated. In those, a higher proportion of severe TBE was observed, especially in children. FE was high in all age groups and against all forms of disease. The higher proportion of severe TBE can be explained by a lower FE against severe than against mild disease, a difference especially pronounced in children (FE, 82.7% for severe vs 94.7% for mild disease). CONCLUSIONS The FE of TBE vaccination is excellent. The observed higher proportion of severe disease in vaccinated persons with TBE does not reflect a higher risk associated with vaccination but is rather due to a somewhat lower FE against severe TBE. Because this effect was more pronounced in children, we recommend adapting the immunization schedule.
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Affiliation(s)
- Isabel Santonja
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Karin Stiasny
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Astrid Essl
- Astrid Essl Consulting-Gesundheitsforschung, Wiener Neustadt, Austria
| | - Franz X Heinz
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Michael Kundi
- Center for Public Health, Medical University of Vienna, Vienna, Austria
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The Prevalence of Asymptomatic Infections with Tick-Borne Encephalitis Virus and Attitude towards Tick-Borne Encephalitis Vaccine in the Endemic Area of Northeastern Poland. Vaccines (Basel) 2022; 10:vaccines10081294. [PMID: 36016182 PMCID: PMC9412675 DOI: 10.3390/vaccines10081294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 12/02/2022] Open
Abstract
In Poland, tick-borne encephalitis (TBE) vaccination rate is low despite high incidence of severe infections with TBE virus (TBEV). However, infection with TBEV can be asymptomatic or mild, which makes the total number of cases difficult to assess. We aimed at assessing asymptomatic TBEV infections and describing attitudes towards the TBE vaccine. We studied 298 healthy adult blood donors and 180 children from the TBE endemic area of northeastern Poland for the presence of anti-TBEV IgG antibodies. We also surveyed a separate cohort of 444 adults. Thirty-eight blood donors (13%) and 38 survey respondents (9%) reported a history of a prior anti-TBEV vaccination. Forty respondents (9%) reported vaccinating their child in the past. Fourteen unvaccinated blood donors (5%) and four children (2%) were seropositive for specific anti-TBEV antibodies, suggesting a history of an undiagnosed TBEV infection. In the surveyed cohort, 130 (32%) expressed their intention to be vaccinated and 144 (36%) expressed their intention to vaccinate their child. This intention was significantly higher in respondents with a recent tick-bite, a diagnosis of tick-borne disease in a close relative, and in males. Our study shows that asymptomatic TBEV infections are common. The acceptance of TBE vaccine is low, but might be increased by communicating risks associated with tick bites.
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Wondim MA, Czupryna P, Pancewicz S, Kruszewska E, Groth M, Moniuszko-Malinowska A. Epidemiological Trends of Trans-Boundary Tick-Borne Encephalitis in Europe, 2000-2019. Pathogens 2022; 11:pathogens11060704. [PMID: 35745558 PMCID: PMC9228375 DOI: 10.3390/pathogens11060704] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/01/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023] Open
Abstract
Tick-borne encephalitis is a neuroinfection widely distributed in the Euro-Asia region. Primarily, the virus is transmitted by the bite of infected ticks. From 2000-2019, the total number of confirmed cases in Europe reported to the European Centre for Disease Prevention and Control was 51,519. The number of cases decreased in 2014 and 2015; however, since 2015, a growing number of cases have been observed, with the involvement of countries in which TBE has not been previously reported. The determinant factors for the spread of TBE are host population size, weather conditions, movement of hosts, and local regulations on the socioeconomic dynamics of the local and travelling people around the foci areas. The mean incidence rate of tick-borne encephalitis from 2000-2019 in Europe was 3.27, while the age-adjusted mean incidence rate was 2.19 per 100,000 population size. This review used several articles and data sources from the European Centre for Diseases Prevention and Control.
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Kantele A, Rombo L, Vene S, Kundi M, Lindquist L, Erra EO. Three-dose versus four-dose primary schedules for tick-borne encephalitis (TBE) vaccine FSME-immun for those aged 50 years or older: A single-centre, open-label, randomized controlled trial. Vaccine 2022; 40:1299-1305. [PMID: 35101266 DOI: 10.1016/j.vaccine.2022.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/26/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND TBE vaccination failures among those past middle age have raised concern about immune response declining with age. We investigated immunogenicity of the TBE-vaccine FSME-Immun among those aged 50+ years using the standard three-dose primary series and alternative four-dose schedules. METHODS In this single-centre, open-label, randomized controlled trial, 200 TBE-naive Swedish adults were given primary TBE vaccination with FSME-Immun. Those aged 50+ years (n = 150) were randomized to receive the standard three-dose (days 0-30-360) or one of two four-dose series (0-7-21-360; 0-30-90-360). For participants < 50 years (n = 50) the standard three-dose schedule was used. Titres of neutralizing antibodies were determined on days 0, 60, 120, 360, and 400. The main outcome was the log titre of TBE virus-specific neutralizing antibodies on day 400. RESULTS The three-dose schedule yielded lower antibody titres among those aged 50+ years than the younger participants on day 400 (geometric mean titre 41 versus 74, p < 0.05). The older group showed higher titres for the four-dose 0-7-21-360 than the standard three-dose schedule both on day 400 (103 versus 41, p < 0.01; primary end point) and at the other testing points (days 60, 120, 360). Using the other four-dose schedule (0-30-90-360), no such difference was observed on day 400 (63 versus 41, NS). CONCLUSION Immune response to the TBE vaccine declined with age. A four-dose schedule (0-7-21-360) may benefit those aged 50 years or older. This study is registered at ClinicalTrials.gov, NCT01361776.
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Affiliation(s)
- Anu Kantele
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Human Microbiome Research Program, Faculty of Medicine, University, University of Helsinki, Helsinki, Finland.
| | - Lars Rombo
- Clinical Research Centre, Sormland County Council Eskilstuna, and University of Uppsala, Uppsala, Sweden; Department of Medical Biochemistry and Microbiology, Zoonosis Science Center, Uppsala University, Uppsala, Sweden
| | - Sirkka Vene
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
| | - Michael Kundi
- Medical University of Vienna, Center for Public Health, Vienna, Austria
| | - Lars Lindquist
- Division of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Elina O Erra
- Meilahti Vaccine Research Center, MeVac, Department of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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Prelog M, Almanzar G, Stern R, Robrade K, Holzer MT, Winzig C, Kleines M, Stiasny K, Meyer T, Speth F, Haas JP. Humoral and cellular immune response to tick-borne-encephalitis (TBE) vaccination depends on booster doses in patients with Juvenile Idiopathic Arthritis (JIA). Vaccine 2021; 39:5918-5927. [PMID: 34462165 DOI: 10.1016/j.vaccine.2021.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/29/2021] [Accepted: 08/06/2021] [Indexed: 11/15/2022]
Abstract
Juvenile Idiopathic Arthritis (JIA) patients living in areas with high prevalence of tick-borne-encephalitis-virus-(TBEV)-infection are recommended for administration of inactivated TBE-vaccination. However, there are serious concerns regarding protective vaccine-induced immune responses against TBEV in immunocompromised patients. The present study aimed to analyze the humoral and cellular immune response to TBE-vaccination in previously TBE-vaccinated JIA patients compared to healthy controls (HC) including investigation of IgG-anti-TBEV avidity, neutralization capacity, cellular reactivity by IFNgamma-ELISPOT and cytokine secretion assays. Similar IgG-anti-TBEV antibody concentrations, neutralization titers and cellular reactivity were found between JIA and HC. The number and the early timing of booster vaccinations after primary vaccination had the most prominent effect on neutralizing antibodies in JIA and on IgG-anti-TBEV concentrations in both JIA and HC. Administration of booster vaccinations made it more likely for JIA patients to have IgG-anti-TBEV concentrations ≥165 VIEU/ml and avidities >60%. TNF-alpha inhibitors had a positive and MTX administration a negative effect on humoral immune responses. In conclusion, irrespective of having JIA or not, vaccinated children showed similar humoral and cellular immunity against TBEV several years after primary TBE-vaccination. However, in JIA, booster vaccinations mounted a significantly higher humoral immune response than in JIA without boosters. Our results highlight the need for timely administration of boosters particularly in JIA. Although immunosuppressive treatment at vaccinations in diagnosed JIA had a negative effect mainly on TBEV-specific cellular immunity, most JIA patients mounted a favorable humoral immune response which was maintained over time. Thus, successful TBE-vaccination seems highly feasible in JIA patients with immunosuppressive regimens.
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Affiliation(s)
- M Prelog
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany.
| | - G Almanzar
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - R Stern
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - K Robrade
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - M T Holzer
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - C Winzig
- Department of Pediatrics, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - M Kleines
- Department of Medical Microbiology, RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - K Stiasny
- Department of Virology, Medical University Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - T Meyer
- Pediatric Surgery Unit, Department of Surgery, University Hospital Wuerzburg, Josef-Schneider-Straße 2, 97080 Wuerzburg, Germany
| | - F Speth
- German Center of Pediatric and Adolescent Rheumatology, Gehfeldstraße 24, 82467 Garmisch-Partenkirchen, Germany
| | - J P Haas
- German Center of Pediatric and Adolescent Rheumatology, Gehfeldstraße 24, 82467 Garmisch-Partenkirchen, Germany
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Steffen R, Erber W, Schmitt HJ. Can the booster interval for the tick-borne encephalitis (TBE) vaccine 'FSME-IMMUN' be prolonged? - A systematic review. Ticks Tick Borne Dis 2021; 12:101779. [PMID: 34298356 DOI: 10.1016/j.ttbdis.2021.101779] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 05/24/2021] [Accepted: 06/14/2021] [Indexed: 12/30/2022]
Abstract
Tick-borne encephalitis (TBE) vaccines are effective and well tolerated. However, their acceptance and use by the public in endemic areas are suboptimal. To some extent this is due to the complicated dosing schedule requiring frequent boosters at variable intervals that even change with age. Simplification of the dosing schedule has failed so far as it is debated if the persistence of TBE virus (TBEV) antibodies is the only relevant factor for protection or if immune memory plays a decisive role as well. The objective here is to present the available evidence to determine the need for boosters and their interval after a primary series of three doses of FSME-IMMUN. A systematic literature review was conducted with a focus on serology, particularly seropersistence, immune memory, effectiveness, and vaccine breakthroughs (VB) of FSME-IMMUN. While after a 3-dose primary series seropositivity persisted for more than 10 years in >90% of younger subjects, it dropped to 37.5% in those 60 years or older. In contrast, field effectiveness of FSME-IMMUN remains high in irregularly vaccinated subjects and thus does not correlate well with the percentage of subjects achieving an arbitrarily defined threshold of persisting antibodies. FSME-IMMUN booster doses led to increases in antibody responses within 7 days. VB are rare and remain poorly understood. VB did not increase, and vaccine effectiveness did not significantly decrease with time since completion of the primary vaccination series or with the time since administration of the last vaccine dose. For all these reasons, data identified from this systematic review suggest that seropersistence alone does not explain the high effectiveness of FSME-IMMUN irrespective of the time since the last vaccine dose was administered. Induction of immunological memory characterized by a rapid and sustained secondary immune response is proving to be an alternative mechanism of action for protection against TBE. In this context Switzerland and Finland have adopted a longer booster interval (i.e., 10 years) following the three-dose primary immunization schedule without any evidence of harm at a population level. Longer booster intervals will likely drive up vaccine uptake. There is a lack of data to base an interval recommendation beyond 10 years.
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Affiliation(s)
- R Steffen
- Epidemiology, Biostatistics and Prevention Institute, Department of Public and Global Health, Division of Infectious Diseases, World Health Organization Collaborating Centre for Travelers' Health, University of Zurich, Switzerland; Division of Epidemiology, Human Genetics & Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA.
| | - W Erber
- Pfizer Inc., Vienna, Austria
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11
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Marvik Å, Tveten Y, Pedersen AB, Stiasny K, Andreassen ÅK, Grude N. Low prevalence of tick-borne encephalitis virus antibodies in Norwegian blood donors. Infect Dis (Lond) 2020; 53:44-51. [PMID: 32924695 DOI: 10.1080/23744235.2020.1819561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Tick-borne encephalitis (TBE) constitutes a public health concern in Europe. Certain coastal municipalities in southern Norway are considered TBE risk areas and in the last two years, there have been increasing numbers of TBE cases. Since the majority of infections are claimed to be asymptomatic, the aim of the current study was to assess the seroprevalence of antibodies to tick-borne encephalitis virus (TBEV) among unvaccinated adults living in a TBE endemic area in Norway. METHODS One thousand one hundred and twenty-three blood donors living in Vestfold and Telemark county were included and associated sera were analysed for TBEV IgG antibodies. Information regarding tick bites, previous flavivirus exposure and knowledge regarding TBE and TBE prevention were obtained through a questionnaire. RESULTS Fifty-eight samples were reactive by ELISA, of which 21 (36.2%) were confirmed by a TBEV-specific serum neutralization test. Of the 21 blood donors with neutralizing TBEV antibodies detected, 17 reported previous TBE vaccination. Thus, only four blood donors (0.4%) had TBEV neutralizing antibodies consistent with previously undergone TBEV infection. Regarding TBE awareness, half of the blood donors were familiar with TBE, but only 35% were aware of a preventive TBE vaccine. CONCLUSIONS Our study indicates low prevalence of subclinical TBEV infections among blood donors living in Vestfold and Telemark county and there is a lack of awareness among general public.
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Affiliation(s)
- Åshild Marvik
- Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Yngvar Tveten
- Department of Medical Biochemistry, Telemark Hospital Trust, Skien, Norway
| | | | - Karin Stiasny
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Åshild Kristine Andreassen
- Department of Virology, Division for Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Natural Sciences and Environmental Health, Faculty of Technology, Natural Sciences and Maritime Sciences, University of South-eastern Norway, Bø, Norway
| | - Nils Grude
- Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Norway.,The Antibiotic Centre of Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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12
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Immunogenicity and safety of the tick-borne encephalitis vaccination (2009–2019): A systematic review. Travel Med Infect Dis 2020; 37:101876. [DOI: 10.1016/j.tmaid.2020.101876] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 12/20/2022]
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13
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Analysis of Multiple Risk Factors for Seronegative Rate of Anti-Tick-Borne Encephalitis Virus Immunization in Human Serum. ACTA ACUST UNITED AC 2020; 56:medicina56050244. [PMID: 32443896 PMCID: PMC7279439 DOI: 10.3390/medicina56050244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/04/2020] [Accepted: 05/15/2020] [Indexed: 11/25/2022]
Abstract
Background and objectives: Tick-borne encephalitis virus (TBEV) infections have been the cause of threatening outbreaks for many years. Apart from several physical and chemical methods to prevent tick bites, active vaccination of people highly exposed to infection is still the most important strategy of prevention. However, in some subjects, the lack of or low response to TBEV antigens is observed. The aim of the current study was to assess the prevalence of seronegative rate for anti-TBEV antibodies and the risk factors for waning immunity. Materials and Methods: 2315 at least primary vaccinated subjects from the high risk group for TBEV infections participated in this study. A commercial enzyme-linked immunosorbent assay (ELISA) test was used for the assessment of anti-TBEV IgG serum level. Results: Data showed that 86.2% of subjects who underwent vaccination were positive for anti-TBEV antibodies within 5 years. As much as 13.8% of subjects that underwent primary or primary and booster vaccination were barely protected after vaccination. Women and subjects under 60 years underwent more effective protection but sex and older age was not a risk factor for being a subject of waning immunity. A logistic regression showed that both a longer time since the vaccination and a lower number of booster doses constantly increased the chance of lost anti-TBEV antibodies. Conclusions: This study demonstrates that the vaccination schedule should be reevaluated. The extension of the interval of booster immunization is risky and all subjects should be surrounded by care consisting of more frequent monitoring of serum antibodies by personalized schedule to adjust the frequency of subsequent doses of booster vaccination.
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14
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Vikse R, Paulsen KM, Edgar KS, H-O Pettersson J, Ottesen PS, Okbaldet YB, Kiran N, Lamsal A, Lindstedt HEH, Pedersen BN, Soleng A, Andreassen ÅK. Geographical distribution and prevalence of tick-borne encephalitis virus in questing Ixodes ricinus ticks and phylogeographic structure of the Ixodes ricinus vector in Norway. Zoonoses Public Health 2020; 67:370-381. [PMID: 32112526 DOI: 10.1111/zph.12696] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 01/24/2020] [Accepted: 02/10/2020] [Indexed: 12/30/2022]
Abstract
The tick-borne encephalitis virus (TBEV), a zoonotic flaviviral infection, is endemic in large parts of Norway and Eurasia. Humans are mainly infected with TBEV via bites from infected ticks. In Norway, the main geographical distribution of ticks is along the Norwegian coastline from southeast (~59°N) and up to the southern parts of Nordland County (~65°N). In this study, we collected ticks by flagging along the coast from Østfold County to Nordland County. By whole-genome sequencing of the mitochondrial genome of Ixodes ricinus, the phylogenetic tree suggests that there is limited phylogeographic structure both in Norway and in Europe. The overall TBEV prevalence is 0.3% for nymphs and 4.3% for adults. The highest estimated TBEV prevalence in adult ticks was detected in Rogaland and Vestfold County, while for nymphs it is highest in Vestfold, Vest-Agder and Rogaland. The present work is one of the largest studies on distribution and prevalence of TBEV in ticks in Scandinavia, showing that the virus is wider distributed in Norway than previously anticipated.
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Affiliation(s)
- Rose Vikse
- Division for Infection Control and Environmental Health, Department of Virology, Norwegian Institute of Public Health, Oslo, Norway
| | - Katrine M Paulsen
- Division for Infection Control and Environmental Health, Department of Virology, Norwegian Institute of Public Health, Oslo, Norway.,Department of Production Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Oslo, Norway
| | - Kristin Skarsfjord Edgar
- Division for Infection Control and Environmental Health, Department of Pest Control, Norwegian Institute of Public Health, Oslo, Norway
| | - John H-O Pettersson
- Division for Infection Control and Environmental Health, Department of Infectious Diseases Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway.,Department of Medical Biochemistry and Microbiology/Zoonosis Science Center, Uppsala University, Uppsala, Sweden.,Marie Bashir Institute for Infectious Diseases and Biosecurity, Charles Perkins Centre, School of Life and Environmental Sciences and Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Preben Skrede Ottesen
- Division for Infection Control and Environmental Health, Department of Pest Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Yohannes Bein Okbaldet
- Division for Infection Control and Environmental Health, Department of Virology, Norwegian Institute of Public Health, Oslo, Norway
| | - Nosheen Kiran
- Division for Infection Control and Environmental Health, Department of Virology, Norwegian Institute of Public Health, Oslo, Norway
| | - Alaka Lamsal
- Division for Infection Control and Environmental Health, Department of Virology, Norwegian Institute of Public Health, Oslo, Norway.,University of South East Norway, Bø i Telemark, Norway
| | - Heidi Elisabeth H Lindstedt
- Division for Infection Control and Environmental Health, Department of Pest Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Benedikte Nevjen Pedersen
- Division for Infection Control and Environmental Health, Department of Virology, Norwegian Institute of Public Health, Oslo, Norway.,University of South East Norway, Bø i Telemark, Norway
| | - Arnulf Soleng
- Division for Infection Control and Environmental Health, Department of Pest Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Åshild K Andreassen
- Division for Infection Control and Environmental Health, Department of Virology, Norwegian Institute of Public Health, Oslo, Norway.,University of South East Norway, Bø i Telemark, Norway
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15
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Hansson KE, Rosdahl A, Insulander M, Vene S, Lindquist L, Gredmark-Russ S, Askling HH. Tick-borne Encephalitis Vaccine Failures: A 10-year Retrospective Study Supporting the Rationale for Adding an Extra Priming Dose in Individuals Starting at Age 50 Years. Clin Infect Dis 2020; 70:245-251. [PMID: 30843030 PMCID: PMC6938976 DOI: 10.1093/cid/ciz176] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/26/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Southern Sweden is endemic for tick-borne encephalitis (TBE), with Stockholm County as one of the high-risk areas. Our aim in this study was to describe cases of vaccine failures and to optimize future vaccination recommendations. METHODS Patients with TBE were identified in the notification database at the Department of Communicable Disease Control and Prevention in Stockholm County during 2006-2015. Vaccine failure was defined as TBE despite adherence to the recommended vaccination schedule with at least 2 doses. Clinical data were extracted from medical records. RESULTS A total of 1004 TBE cases were identified, 53 (5%) were defined as vaccine failures. In this latter group, the median age was 62 years (6-83). Forty-three (81%) patients were aged >50 years and 2 were children. Approximately half of the patients had comorbidities, with diseases affecting the immune system accounting for 26% of all cases. Vaccine failures following the third or fourth vaccine dose accounted for 36 (68%) of the patients. Severe and moderate TBE disease affected 81% of the cases. CONCLUSIONS To our knowledge, this is the largest documented cohort of TBE vaccine failures. Vaccine failure after 5 TBE vaccine doses is rare. Our data provide rationale for adding an extra priming dose to those aged ≥50 years.
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Affiliation(s)
- Karin E Hansson
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Infectious Diseases, Södersjukhuset, Stockholm, Sweden
| | - Anja Rosdahl
- School of Medical Sciences, Örebro University, Sweden
- Department of Infectious Diseases, Örebro University Hospital, Sweden
| | - Mona Insulander
- Department of Communicable Disease Control and Prevention, Stockholm County, Sweden
| | - Sirkka Vene
- Public Health Agency of Sweden, Solna, Sweden
| | - Lars Lindquist
- Department of Medicine, Karolinska Institutet, Huddinge, Sweden
- Department of Infectious diseases, Karolinska University Hospital, Sweden
| | - Sara Gredmark-Russ
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Infectious diseases, Karolinska University Hospital, Sweden
| | - Helena H Askling
- Division of Infectious Diseases, Unit for Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
- Department of Communicable Disease Control and Prevention, Sörmland County, Sweden
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16
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Bühler T, Boos N, Leuppi-Taegtmeyer AB, Berger CT. Febrile illness and bicytopenia within hours after tick-borne encephalitis booster vaccination. NPJ Vaccines 2019; 4:52. [PMID: 31871772 PMCID: PMC6917779 DOI: 10.1038/s41541-019-0152-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/22/2019] [Indexed: 12/23/2022] Open
Abstract
We report the case of a 20-year-old male complaining of sudden-onset, severe headaches, fever, chills, and generalized arthralgia. He had no symptoms of a respiratory tract infection. Blood examination revealed severe leukopenia and mild to moderate thrombocytopenia. Onset of symptoms was rapid, intense, and occurred only a few hours after routine tick-borne encephalitis (TBE) booster vaccine. The question of a relationship between booster vaccine administration and the febrile illness with bicytopenia was raised. A broad range of diagnostics excluded infections and other causes for bicytopenia. Symptoms resolved within a few days, and blood counts normalized within two weeks. Due to the close temporal relationship, a transient benign bicytopenia and febrile illness as a systemic reaction to TBE vaccination was assumed. Review of the literature and adverse event reporting systems suggest that this is a very rare reaction.
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Affiliation(s)
- Tim Bühler
- 1Department of Clinical Pharmacology & Toxicology, University and University Hospital Basel, Basel, Switzerland.,2Regional Center of Pharmacovigilance, University Hospital Basel, Basel, Switzerland
| | - Noemi Boos
- 3Medical Outpatient Clinic, University Hospital Basel, Basel, Switzerland
| | - Anne B Leuppi-Taegtmeyer
- 1Department of Clinical Pharmacology & Toxicology, University and University Hospital Basel, Basel, Switzerland
| | - Christoph T Berger
- 4Translational Immunology, Department of Biomedicine, University Basel, Basel, Switzerland.,5Vaccination Clinic, Medical Outpatient Unit, University Hospital Basel, Basel, Switzerland
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17
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Dorko E, Bušová A, Rimárová K, Drabiščák E, Kizek P, Popaďák P, Popaďáková J, Jenčová J, Jenča A, Petrášová A. Effectiveness of primary vaccination against tick-borne encephalitis in employees of the armed forces. Cent Eur J Public Health 2019; 26 Suppl:S42-S46. [PMID: 30817872 DOI: 10.21101/cejph.a5271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 11/15/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of our study is to evaluate immune response after receiving the primary vaccination against tick-borne encephalitis (TBE), and to establish a link between seropositivity and selected factors in soldiers. METHODS Blood samples, questionnaires and vaccination records were obtained. TBE antibodies were detected using both ELISA and a neutralization test (NT). We used logistic regression for statistical analysis. RESULTS Overall, seropositivity (presence of IgG) was detected in 88% of participants. The proportion of seropositive subjects in relation to the number of doses of vaccine was 69% (2 doses) and 91% (3 doses). A statistically significant relationship was found between seropositivity and the number of vaccine doses. No statistical significance was identified in relation to age and sex. There was no statistical significance of seropositivity, depending on the time of the last dose of the vaccine. CONCLUSIONS TBE immunisation should be targeted at individuals in the most affected locations and those at highest risk of exposure according to lifestyle and occupation.
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Affiliation(s)
- Erik Dorko
- Department of Public Health and Hygiene, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovak Republic
| | - Andrea Bušová
- Department of Public Health and Hygiene, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovak Republic
| | - Kvetoslava Rimárová
- Department of Public Health and Hygiene, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovak Republic
| | - Erik Drabiščák
- Department of Public Health and Hygiene, Faculty of Medicine, Pavol Jozef Safarik University in Kosice, Kosice, Slovak Republic
| | - Peter Kizek
- 1st Department of Stomatology, Faculty of Medicine, Pavol Jozef Safarik University in Kosice and Louis Pasteur University Hospital, Kosice, Slovak Republic
| | - Peter Popaďák
- Department of Forensic Medicine and Pathological Anatomy, Health Care Surveillance Authority, Kosice, Slovak Republic
| | - Jana Popaďáková
- Department of Neurology, Hospital Vranov nad Toplou, Vranov nad Toplou, Slovak Republic
| | - Janka Jenčová
- Department of Stomatology and Maxilofacial Surgery, Faculty of Medicine, Pavol Jozef Safarik University in Kosice and Louis Pasteur University Hospital, Kosice, Slovak Republic
| | - Andrej Jenča
- Department of Stomatology and Maxilofacial Surgery, Faculty of Medicine, Pavol Jozef Safarik University in Kosice and Louis Pasteur University Hospital, Kosice, Slovak Republic
| | - Adriána Petrášová
- Department of Stomatology and Maxilofacial Surgery, Faculty of Medicine, Pavol Jozef Safarik University in Kosice and Louis Pasteur University Hospital, Kosice, Slovak Republic
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18
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Abstract
Since 2012, tick-borne encephalitis (TBE) is a notifiable in the European Union. The European Centre for Disease Prevention and Control annually collects data from 28 countries plus Iceland and Norway, based on the EU case definition. Between 2012 and 2016, 23 countries reported 12,500 TBE cases (Ireland and Spain reported none), of which 11,623 (93.0%) were confirmed cases and 878 (7.0%) probable cases. Two countries (Czech Republic and Lithuania) accounted for 38.6% of all reported cases, although their combined population represented only 2.7% of the population under surveillance. The annual notification rate fluctuated between 0.41 cases per 100,000 population in 2015 and 0.65 in 2013 with no significant trend over the period. Lithuania, Latvia and Estonia had the highest notification rates with 15.6, 9.5 and 8.7 cases per 100,000 population, respectively. At the subnational level, six regions had mean annual notification rates above 15 cases per 100,000 population, of which five were in the Baltic countries. Approximately 95% of cases were hospitalised and the overall case fatality ratio was 0.5%. Of the 11,663 cases reported with information on importation status, 156 (1.3%) were reported as imported. Less than 2% of cases had received two or more doses of TBE vaccine.
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Affiliation(s)
- Julien Beauté
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Gianfranco Spiteri
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Eva Warns-Petit
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden (affiliation when the work was performed),Direction Départementale de la Cohésion Sociale et de la Protection des Populations d’Ille-et-Vilaine, Rennes, France (current affiliation)
| | - Hervé Zeller
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden (affiliation when the work was performed)
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19
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Shedrawy J, Henriksson M, Hergens MP, Askling HH. Estimating costs and health outcomes of publicly funded tick-born encephalitis vaccination: A cost-effectiveness analysis. Vaccine 2018; 36:7659-7665. [PMID: 30385058 DOI: 10.1016/j.vaccine.2018.10.086] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/20/2018] [Accepted: 10/25/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The number of notified cases of Tick-Borne Encephalitis (TBE) in Sweden has been increasing the past years despite the increased use of TBE-vaccine not subsidized by the healthcare system. Stockholm County is a high endemic area and an earlier study has shown that low-income households have lower vaccination coverage even when they are at high risk. This paper aims to determine the cost-effectiveness of a publicly funded TBE vaccination program in Stockholm. METHODS In three different cohorts with individuals aged 3, 40 or 50 years, long-term costs and health outcomes of an out-of-pocket strategy (53% of the cohort is vaccinated on their own expenses) and a structured vaccination program (full cohort is vaccinated covered by the publicly funded health care system), were estimated using a Markov model. The Markov model predicts the costs and effects in term of Quality-adjusted Life Years (QALYs) over a lifetime horizon using a third-party healthcare payer perspective. The primary results are presented as an incremental cost effectiveness ratio (ICER) indicating the additional cost required to achieve one additional QALY with the structured vaccination program. RESULTS The results show that the structured vaccination program is associated with a gain in QALYs and increased costs compared with an out-of-pocket strategy. The calculated ICERs were 27 761, 99 527 and 160 827 SEK/QALY in cohorts of age 3, 40 and 50, respectively. The sensitivity analyses showed that the results are robust when varying different parameters. CONCLUSION Given the setting of Stockholm county, this analysis shows a cost per QALY of a free vaccinations program, especially for children of 3 years old, below generally acceptable cost-effectiveness thresholds in Sweden.
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Affiliation(s)
- Jad Shedrawy
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Martin Henriksson
- Department of Medical and Health Sciences/Division of Health Care Analysis, Linköping University, Sweden
| | - Maria-Pia Hergens
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Medicine/Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Communicable Disease Control and Prevention, Stockholm County, Sweden
| | - H Helena Askling
- Department of Medicine/Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden; Department of Communicable Disease Control and Prevention, Sörmland County, Sweden
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20
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Maikova GB, Chernokhaeva LL, Rogova YV, Kozlovskaya LI, Kholodilov IS, Romanenko VV, Esyunina MS, Ankudinova AA, Kilyachina AS, Vorovitch MF, Karganova GG. Ability of inactivated vaccines based on far‐eastern tick‐borne encephalitis virus strains to induce humoral immune response in originally seropositive and seronegative recipients. J Med Virol 2018; 91:190-200. [DOI: 10.1002/jmv.25316] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 09/02/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Galina B. Maikova
- Chumakov Institute of Poliomyelitis and Viral Encephalitides, FSBSI “Chumakov FSC IBP RAS,”Moscow Russia
| | - Liubov L. Chernokhaeva
- Chumakov Institute of Poliomyelitis and Viral Encephalitides, FSBSI “Chumakov FSC IBP RAS,”Moscow Russia
| | - Yulia V. Rogova
- Chumakov Institute of Poliomyelitis and Viral Encephalitides, FSBSI “Chumakov FSC IBP RAS,”Moscow Russia
| | - Liubov I. Kozlovskaya
- Chumakov Institute of Poliomyelitis and Viral Encephalitides, FSBSI “Chumakov FSC IBP RAS,”Moscow Russia
- Institute for Translational Medecine and Biotechnology, Sechenov First Moscow State Medical UniversityMoscow Russia
| | - Ivan S. Kholodilov
- Chumakov Institute of Poliomyelitis and Viral Encephalitides, FSBSI “Chumakov FSC IBP RAS,”Moscow Russia
| | - Victor V. Romanenko
- Hygienic and Epidemiological Center of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing in Sverdlovsk RegionEkaterinburg Russia
| | - Mariya S. Esyunina
- Office of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing in Sverdlovsk RegionEkaterinburg Russia
| | - Anna A. Ankudinova
- Ekaterinburg Scientific Research Institute of Virus Infections, Federal Service for Surveillance on Consumer Rights Protection and Human WellbeingEkaterinburg Russia
| | - Anna S. Kilyachina
- Ekaterinburg Scientific Research Institute of Virus Infections, Federal Service for Surveillance on Consumer Rights Protection and Human WellbeingEkaterinburg Russia
| | - Mikhail F. Vorovitch
- Chumakov Institute of Poliomyelitis and Viral Encephalitides, FSBSI “Chumakov FSC IBP RAS,”Moscow Russia
- Institute for Translational Medecine and Biotechnology, Sechenov First Moscow State Medical UniversityMoscow Russia
| | - Galina G. Karganova
- Chumakov Institute of Poliomyelitis and Viral Encephalitides, FSBSI “Chumakov FSC IBP RAS,”Moscow Russia
- Institute for Translational Medecine and Biotechnology, Sechenov First Moscow State Medical UniversityMoscow Russia
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21
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Taba P, Schmutzhard E, Forsberg P, Lutsar I, Ljøstad U, Mygland Å, Levchenko I, Strle F, Steiner I. EAN consensus review on prevention, diagnosis and management of tick‐borne encephalitis. Eur J Neurol 2017; 24:1214-e61. [DOI: 10.1111/ene.13356] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 06/01/2017] [Indexed: 12/30/2022]
Affiliation(s)
- P. Taba
- Department of Neurology and Neurosurgery University of Tartu Tartu Estonia
| | - E. Schmutzhard
- Department of Neurology Medical University Innsbruck Innsbruck Austria
| | - P. Forsberg
- Department of Clinical and Experimental Medicine and Department of Infectious Diseases Linköping University Linköping Sweden
| | - I. Lutsar
- Department of Microbiology University of Tartu Tartu Estonia
| | - U. Ljøstad
- Department of Neurology Sørlandet Hospital Kristiansand Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - Å. Mygland
- Department of Neurology Sørlandet Hospital Kristiansand Norway
- Department of Clinical Medicine University of Bergen Bergen Norway
| | - I. Levchenko
- Institute of Neurology Psychiatry and Narcology of the National Academy of Medical Sciences of Ukraine Kharkiv Ukraine
| | - F. Strle
- Department of Infectious Diseases University Medical Centre Ljubljana Ljubljana Slovenia
| | - I. Steiner
- Department of Neurology Rabin Medical Center Petach Tikva Israel
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Lotrič-Furlan S, Bogovič P, Avšič-Županc T, Jelovšek M, Lusa L, Strle F. Tick-borne encephalitis in patients vaccinated against this disease. J Intern Med 2017; 282:142-155. [PMID: 28440879 DOI: 10.1111/joim.12625] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Information on tick-borne encephalitis (TBE) in patients already vaccinated against the disease is limited. OBJECTIVES To compare the course and outcome in patients with vaccination breakthrough TBE with findings in patients who developed TBE without previous vaccination. METHODS All adult patients diagnosed with TBE at a single medical centre during a 16-year period and who had received at least two doses of TBE vaccine before the onset of illness qualified for the study. For each patient with breakthrough TBE, two unvaccinated sex- and age-matched patients, diagnosed with TBE in the same year, were included for comparison. RESULTS Amongst 2332 patients diagnosed with TBE in the period 2000-2015, 39 (1.7%) had been vaccinated against the disease. Their median age was 59 (20-83) years; 22 of 39 (56.4%) were male. In comparison with unvaccinated patients with TBE, those with breakthrough disease more often experienced a monophasic course of illness (P = 0.006), had a higher CSF leucocyte count (P = 0.005), more often had urine retention (P = 0.012), more often needed ICU treatment (P = 0.009), were hospitalized for longer (P = 0.002) and had more severe acute illness (P = 0.004 for simple clinical assessment, P = 0.001 for severity score). CONCLUSION In addition to several findings corroborating previous results in patients with vaccination breakthrough TBE, such as older age and the presence of a particular specific serum antibody pattern indicating anamnestic response, findings in this study indicate that the acute illness in patients with breakthrough TBE is more severe than in unvaccinated sex- and age-matched patients who develop the disease.
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Affiliation(s)
- S Lotrič-Furlan
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - P Bogovič
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - T Avšič-Županc
- Medical Faculty, Institute for Microbiology and Immunology, Ljubljana, Slovenia
| | - M Jelovšek
- Medical Faculty, Institute for Microbiology and Immunology, Ljubljana, Slovenia
| | - L Lusa
- Faculty of Medicine, Institute for Biostatistics and Medical Informatics, University of Ljubljana, Ljubljana, Slovenia
| | - F Strle
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Vorovitch MF, Maikova GB, Chernokhaeva LL, Romanenko VV, Ankudinova AV, Khapchaev YK, Karganova GG, Ishmukhametov AA, Drozdov SG. Immunogenicity and safety of the adult tbe vaccine «tick-e-vac». Vopr Virusol 2017; 62:73-80. [PMID: 36494931 DOI: 10.18821/0507-4088-2017-62-2-73-80] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Indexed: 12/13/2022]
Abstract
About 3,000 cases of TBE are registered annually in the Russian Federation. Vaccination is the main way to prevent the tick-borne encephalitis disease. Comparative study of the reactogenicity and immunogenicity of a new vaccine «Tick-E-Vac» was held. Volunteers aged from 16 years old were twice immunized with the vaccines «Tick-E-Vac» or «Encevir» derived from strains of Far East subtype of TBE virus, according to standard and emergency schemes. The clinical study was randomized, comparative, blind, and controlled. The frequency, intensity, time of occurrence, and duration of local and general reactions had been recorded. The titers of antiviral antibodies in ELISA had been determined to assess the immunological efficacy of vaccination. According to the results of the clinical study, the severity of local and general reactions in initial seronegative recipients was weak or moderate. The symptoms were usually manifested within 1-2 days after injection and persisted for not more than 4 days, after which time the symptoms disappeared. There was no statistically significant difference in the reactogenicity of the vaccines after the first and after the second injection. The reactogenicity also did not depend on the gender of recipients. After the first immunization, the level of seroprotection was not less than 43%; the average geometric titer of antibodies (GTA), not less than 1:200. After the second injection, the level of seroprotection reached 90-100%; GTA, not less than 1:500. The data on the reactogenicity and immunogenicity to the original seropositive recipients is not significantly different from the data for the initial seronegative recipients. The data indicate weak reactogenicity of the vaccines «Tick-E-Vac» and «Encevir». Double vaccination with an interval of 14 or 30 days leads to the formation of expressed immune response. Thus, differences in the level of seroprotection and in antiviral titers in the cases of the standard and emergency vaccination schedules are not statistically significant. The correlation between the development in recipients of local and general symptoms and the immunological efficacy of the vaccines has not been identified.
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Affiliation(s)
- M F Vorovitch
- Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Products of Russian Academy of Sciences
| | - G B Maikova
- Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Products of Russian Academy of Sciences
| | - L L Chernokhaeva
- Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Products of Russian Academy of Sciences
| | - V V Romanenko
- Center for Hygiene and Epidemiology in the Sverdlovsk Region
| | - A V Ankudinova
- Center for Hygiene and Epidemiology in the Sverdlovsk Region
| | - Y K Khapchaev
- Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Products of Russian Academy of Sciences
| | - G G Karganova
- Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Products of Russian Academy of Sciences
| | - A A Ishmukhametov
- Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Products of Russian Academy of Sciences
| | - S G Drozdov
- Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Products of Russian Academy of Sciences
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Tonteri E, Kurkela S, Timonen S, Manni T, Vuorinen T, Kuusi M, Vapalahti O. Surveillance of endemic foci of tick-borne encephalitis in Finland 1995-2013: evidence of emergence of new foci. ACTA ACUST UNITED AC 2016; 20:30020. [PMID: 26535471 DOI: 10.2807/1560-7917.es.2015.20.37.30020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 04/23/2015] [Indexed: 12/30/2022]
Abstract
The geographical risk areas for tick-borne encephalitis (TBE) in Finland remained the same until the beginning of the 21st century, but a considerable geographical expansion has been observed in the past 10 years. In order to support public health measures, the present study describes the number of laboratory-confirmed TBE cases and laboratory tests conducted and the associated trends by hospital district, with a particular emphasis on the suspected geographical risk areas. An additional investigation was conducted on 1,957 clinical serum samples throughout the country taken from patients with neurological symptoms to screen for undiagnosed TBE cases. This study identified new TBE foci in Finland, reflecting the spread of the disease into new areas. Even in the most endemic municipalities, transmission of TBE to humans occurred in very specific and often small foci. The number of antibody tests for TBE virus more than doubled (an increase by 105%) between 2007 and 2013. Analysis of the number of tests also revealed areas in which the awareness of clinicians may be suboptimal at present. However, it appears that underdiagnosis of neuroinvasive TBE is not common.
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Affiliation(s)
- Elina Tonteri
- Departments of Virology and Veterinary Biosciences, University of Helsinki, Helsinki, Finland
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25
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Hertzell KB, Pauksens K, Rombo L, Knight A, Vene S, Askling HH. Tick-borne encephalitis (TBE) vaccine to medically immunosuppressed patients with rheumatoid arthritis: A prospective, open-label, multi-centre study. Vaccine 2016; 34:650-655. [DOI: 10.1016/j.vaccine.2015.12.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/04/2015] [Accepted: 12/07/2015] [Indexed: 12/30/2022]
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Comparison of Two Commercial Tick-Borne Encephalitis Virus IgG Enzyme-Linked Immunosorbent Assays. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2015; 22:754-60. [PMID: 25924768 DOI: 10.1128/cvi.00096-15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/23/2015] [Indexed: 12/30/2022]
Abstract
Despite the availability of protective vaccines, tick-borne encephalitis virus (TBEV) infections have been increasingly reported to the European Centre for Disease Prevention and Control in the past 2 decades. Since the diagnosis of TBEV exposure relies on serological testing, we compared two commercial enzyme-linked immunosorbent assays (ELISAs), i.e., Immunozym FSME IgG assay (ELISA-1) and Euroimmun FSME Vienna IgG assay (ELISA-2). Both assays use whole TBEV antigens, but they differ in viral strains (Neudoerfl for ELISA-1 and K23 for ELISA-2) and cutoff values. In testing of samples from 398 healthy blood donors, ELISA-1 showed higher reactivity levels than ELISA-2 (P < 0.001), suggesting different assay properties. This finding was supported by Bland-Altman analysis of the optical density at 450 nm (OD450) (mean bias, +0.32 [95% limits of agreement, -0.31 to +0.95]) and persisted after transformation into Vienna units. Concordant results were observed for 276 sera (69%) (44 positive and 232 negative results). Discordant results were observed for 122 sera (31%); 15 were fully discordant, all being ELISA-1 positive and ELISA-2 negative, and 107 were partially discordant (101 being ELISA-1 indeterminate and ELISA-2 negative and 6 having positive or indeterminate reactivity in both ELISAs). Neutralization testing at a 1:10 dilution yielded positive results for 33 of 44 concordant positive sera, 1 of 15 fully discordant sera, and 1 of 33 partially discordant sera. Indirect immunofluorescence testing revealed high antibody titers of ≥100 for yellow fever virus in 18 cases and for dengue virus in one case, suggesting that cross-reactivity contributed to the ELISA-1 results. We conclude that (i) cross-reactivity among flaviviruses remains a limitation of TBEV serological testing, (ii) ELISA-2 revealed reasonable sensitivity and specificity for anti-TBEV IgG population screening of human sera, and (iii) neutralization testing is most specific and should be reserved for selective questions.
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