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Angulo FJ, Halsby K, Davidson A, Ravikumar S, Pilz A, Stark JH, Moïsi JC. Publicly available surveillance data on tick-borne encephalitis in Europe, 2023. Ticks Tick Borne Dis 2024; 15:102388. [PMID: 39137541 DOI: 10.1016/j.ttbdis.2024.102388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 07/15/2024] [Accepted: 07/31/2024] [Indexed: 08/15/2024]
Abstract
The European Centre for Disease Prevention and Control (ECDC) defines a case of tick-borne encephalitis (TBE) as an infection by the TBE virus (TBEV) with clinical manifestations of central nervous system inflammation (e.g., meningitis, encephalitis). To better understand the TBE surveillance landscape, online searches were conducted to determine if cases of TBE, TBEV infection, acute meningitis or encephalitis, or viral meningitis or encephalitis were subject to statutory reporting in European countries in 2023. In countries with statutory reporting, notification responsibility and available information on surveillance-reported cases were determined. The number of TBE cases reported to ECDC were compared with the number of cases recorded in national surveillance reports. Of 44 countries of the Europe Region of the United Nations, 37 (84 %) mandated statutory reporting of cases of TBE, TBEV infection, or acute/viral meningitis/encephalitis. Twenty-six (87 %) of 30 countries with identified surveillance reports recorded TBE cases in 2020-2023. Of these countries, 17 (65 %) required TBE reporting by clinicians and laboratories, 5 (19 %) by clinicians only, and 4 (15 %) by laboratories only. Twenty-four countries reported on TBE cases to ECDC in 2020; however, surveillance for TBE in Europe is heterogeneous. Standardization of TBE surveillance would enhance the understanding of TBE disease burden in Europe.
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Affiliation(s)
- Frederick J Angulo
- Vaccines and Antivirals Medical Affairs, Pfizer Vaccines, 500 Arcola Rd, Collegeville, PA 19426, USA.
| | - Kate Halsby
- Vaccines and Antivirals Medical Affairs, Pfizer Vaccines, London, United Kingdom
| | - Alexander Davidson
- Vaccines and Antivirals Medical Affairs, Pfizer Vaccines, New York, NY, USA
| | - Saiganesh Ravikumar
- Vaccines and Antivirals Medical Affairs, Pfizer Vaccines, 500 Arcola Rd, Collegeville, PA 19426, USA; Department of Anesthesiology, Northwell Health, New Hyde Park, NY 11040, USA
| | - Andreas Pilz
- Vaccines and Antivirals Medical Affairs, Pfizer Vaccines, Vienna, Austria
| | - James H Stark
- Vaccines and Antivirals Medical Affairs, Pfizer Vaccines, Cambridge, MA, USA
| | - Jennifer C Moïsi
- Vaccines and Antivirals Medical Affairs, Pfizer Vaccines, Paris, France
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Bjellvi J, Idegård A, Zelano J. Risk factors for status epilepticus after brain disorders in adults: A multi-cohort national register study. Epilepsy Behav 2024; 156:109840. [PMID: 38788662 DOI: 10.1016/j.yebeh.2024.109840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/10/2024] [Accepted: 05/12/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE We aimed to describe risks of status epilepticus (SE) after different brain disorders in adults using population-wide register data. Our hypothesis was that SE would be more common in disorders with widespread pathology and that the risk would increase with disorder severity. METHODS We analyzed five large datasets created from the Swedish National Patient Register, the Cause of Death Register, and national quality registers with adults in Sweden with brain infections, dementia, multiple sclerosis (MS), stroke, and traumatic brain injury (TBI). Risk factors were assessed using Cox regression. RESULTS In adults with TBI, stroke, dementia, MS, or brain infections, the incidence rate of SE was highest in survivors of brain infections (64/100,000 person years) and stroke (64/100,000), followed by TBI (37/100,000), dementia (36/100,000), and MS (26/100,000). SE was considerably more common in patients with epilepsy after their brain disorder. Across all datasets severe disorder increased SE-risk. Herpes simplex encephalitis (HR 5.5 95 % CI: 2.6-12), progressive MS (HR 2.3, 95 % CI: 1.1-4.7), structural TBI (2.0, 95 % CI: 1.6-2.6), and intracerebral hemorrhage (HR 1.5, 95 % CI: 1.2-2.0) were the subtypes of brain disorders with the highest relative risk of SE. Having another CNS disorder increased SE-risk in TBI (HR 2.9, 95 % CI: 2.3-3.7), brain infections (HR 2.8, 95 % CI: 1.7-4.5), and dementia (HR 2.5, 95 % CI: 1.5-4.2). CONCLUSION SE-risk increases with disorder severity and number of CNS comorbidities. These findings can guide treatment strategy by allowing identification of high-risk patients. Pathophysiological studies are needed to better understand remote symptomatic SE.
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Affiliation(s)
- Johan Bjellvi
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 7 413 45, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Blå Stråket 7 413 45, Gothenburg, Sweden.
| | - André Idegård
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 7 413 45, Gothenburg, Sweden; Wallenberg Center of Molecular and Translational Medicine, University of Gothenburg, Box 100 405 30, Gothenburg, Sweden.
| | - Johan Zelano
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Blå Stråket 7 413 45, Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Member of the ERN EpiCARE, Blå Stråket 7 413 45, Gothenburg, Sweden; Wallenberg Center of Molecular and Translational Medicine, University of Gothenburg, Box 100 405 30, Gothenburg, Sweden.
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Freimane Z, Karelis G, Zolovs M, Zavadska D. Tick-borne encephalitis infections without CNS involvement: An observational study in Latvia, 2007-2022. PLoS One 2024; 19:e0305120. [PMID: 38848332 PMCID: PMC11161013 DOI: 10.1371/journal.pone.0305120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 05/23/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Tick-borne encephalitis (TBE) is a human viral infectious disease involving the central nervous system (CNS). It is caused by the tick-borne encephalitis virus (TBEV). At present, there is very limited information regarding the clinical importance and health burden of TBE infections without signs of CNS inflammation. Moreover, such cases are omitted from official TBE surveillances and there are no reports of population-based studies. METHODS AND FINDINGS A nationwide population-based study was conducted in Latvia by intensively searching for symptomatic TBEV infections recorded in outpatient and hospital settings between 2007 and 2022. In total, 4,124 symptomatic TBEV infections were identified, of which 823 (20.0%) had no CNS involvement. Despite the lack of neurological symptoms, non-CNS TBE patients still experienced severe health conditions that required management in a hospital setting for a median duration of 7 days. Furthermore, lumbar puncture information was available for 708 of these patients, with 100 (14.1%) undergoing the procedure, suggesting a high suspicion of CNS involvement. CONCLUSIONS Clearly, non-CNS TBE has the potential to negatively impact the health of patients. The actual burden of non-CNS TBEV cases may be higher than we think as these cases are omitted from official TBE surveillances and are challenging to recognize.
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Affiliation(s)
- Zane Freimane
- Department of Paediatrics, Children’s Clinical University Hospital, Riga Stradiņš University, Riga, Latvia
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Riga East University Hospital, Riga, Latvia
- Department of Infectology, Riga Stradiņš University, Riga, Latvia
| | - Maksims Zolovs
- Statistics Unit, Riga Stradiņš University, Riga, Latvia
- Institute of Life Sciences and Technology, Daugavpils University, Daugavpils, Latvia
| | - Dace Zavadska
- Department of Paediatrics, Children’s Clinical University Hospital, Riga Stradiņš University, Riga, Latvia
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Hills SL, Poehling KA, Chen WH, Staples JE. Tick-Borne Encephalitis Vaccine: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023. MMWR Recomm Rep 2023; 72:1-29. [PMID: 37943707 PMCID: PMC10651317 DOI: 10.15585/mmwr.rr7205a1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
Tick-borne encephalitis (TBE) virus is focally endemic in parts of Europe and Asia. The virus is primarily transmitted to humans by the bites of infected Ixodes species ticks but can also be acquired less frequently by alimentary transmission. Other rare modes of transmission include through breastfeeding, blood transfusion, solid organ transplantation, and slaughtering of viremic animals. TBE virus can cause acute neurologic disease, which usually results in hospitalization, often permanent neurologic or cognitive sequelae, and sometimes death. TBE virus infection is a risk for certain travelers and for laboratory workers who work with the virus. In August 2021, the Food and Drug Administration approved Ticovac TBE vaccine for use among persons aged ≥1 year. This report summarizes the epidemiology of and risks for infection with TBE virus, provides information on the immunogenicity and safety of TBE vaccine, and summarizes the recommendations of the Advisory Committee on Immunization Practices (ACIP) for use of TBE vaccine among U.S. travelers and laboratory workers. The risk for TBE for most U.S. travelers to areas where the disease is endemic is very low. The risk for exposure to infected ticks is highest for persons who are in areas where TBE is endemic during the main TBE virus transmission season of April–November and who are planning to engage in recreational activities in woodland habitats or who might be occupationally exposed. All persons who travel to areas where TBE is endemic should be advised to take precautions to avoid tick bites and to avoid the consumption of unpasteurized dairy products because alimentary transmission of TBE virus can occur. TBE vaccine can further reduce infection risk and might be indicated for certain persons who are at higher risk for TBE. The key factors in the risk-benefit assessment for vaccination are likelihood of exposure to ticks based on activities and itinerary (e.g., location, rurality, season, and duration of travel or residence). Other risk-benefit considerations should include 1) the rare occurrence of TBE but its potentially high morbidity and mortality, 2) the higher risk for severe disease among certain persons (e.g., older persons aged ≥60 years), 3) the availability of an effective vaccine, 4) the possibility but low probability of serious adverse events after vaccination, 5) the likelihood of future travel to areas where TBE is endemic, and 6) personal perception and tolerance of risk ACIP recommends TBE vaccine for U.S. persons who are moving or traveling to an area where the disease is endemic and will have extensive exposure to ticks based on their planned outdoor activities and itinerary. Extensive exposure can be considered based on the duration of travel and frequency of exposure and might include shorter-term (e.g., <1 month) travelers with daily or frequent exposure or longer-term travelers with regular (e.g., a few times a month) exposure to environments that might harbor infected ticks. In addition, TBE vaccine may be considered for persons who might engage in outdoor activities in areas where ticks are likely to be found, with a decision to vaccinate made on the basis of an assessment of their planned activities and itinerary, risk factors for a poor medical outcome, and personal perception and tolerance of risk. In the laboratory setting, ACIP recommends TBE vaccine for laboratory workers with a potential for exposure to TBE virus
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Zavadska D, Freimane Z, Karelis G, Ermina I, Harper LR, Bender C, Zhang P, Angulo FJ, Erber W, Bormane A, Gutmane E, Litauniece ZA, Tihonovs J, Griskevica A, Madhava H, Jodar L. Effectiveness of tick-borne encephalitis vaccination in Latvia, 2018-2020: an observational study. Clin Microbiol Infect 2023; 29:1443-1448. [PMID: 37422077 DOI: 10.1016/j.cmi.2023.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES Tick-borne encephalitis (TBE) is an infection by the tick-borne encephalitis virus (TBEV) that results in symptoms of central nervous system inflammation. TBE is endemic in Latvia and other European countries. TBE vaccines are commonly used in Latvia, but vaccine effectiveness estimates are limited. METHODS Study staff at Rīga Stradinš University conducted nationwide active surveillance for TBEV infections. Serum and cerebrospinal fluid were ELISA-tested for TBEV-specific IgG and IgM antibodies. Vaccination history was collected by interview and medical record review. Utilizing data from surveillance and population surveys, vaccine effectiveness (with 95% CIs) and cases averted were estimated using the screening method. RESULTS There were 587 laboratory-identified TBE cases from 2018 to 2020; 98.1% (576/587) were unvaccinated, 1.5% (9/587) were unknown or partially vaccinated, and 0.3% (2/587) were fully vaccinated (three-dose primary series and appropriately timed boosters). TBE resulted in the death of 1.7% (10/587) of TBE cases. TBE vaccine history was ascertained from 92.0% (13 247/14 399) people from the general population: 38.6% (5113/13 247) were unvaccinated, 26.3% (3484/13 247) were fully vaccinated, and 35.1% (4650/13 247) were partially vaccinated. TBE vaccine effectiveness was 99.5% (98.0-99.9) against TBE, 99.5% (97.9-99.9) against TBE hospitalization, 99.3% (94.8-99.9) against moderate/severe TBE, and 99.2% (94.4-99.9) against TBE hospitalization >12 days. From 2018 to 2020, vaccination averted 906 TBE cases, including 20 deaths. DISCUSSION TBE vaccine was highly effective in preventing TBE, moderate and severe disease, and prolonged hospitalization. To prevent life-threatening TBE, TBE vaccine uptake and compliance should be increased in Latvia and other European regions where TBE is endemic.
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Affiliation(s)
- Dace Zavadska
- Department of Pediatrics, Children's Clinical University Hospital, Rīga Stradinš University, Riga, Latvia
| | - Zane Freimane
- Department of Pediatrics, Children's Clinical University Hospital, Rīga Stradinš University, Riga, Latvia
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Riga East University Hospital, Rīga Stradinš University, Riga, Latvia
| | - Ineta Ermina
- Research Department, Rīga Stradinš University, Riga, Latvia
| | - Lisa R Harper
- Vaccines/Antivirals & Evidence Generation, Pfizer Vaccines, Collegeville, PA, USA
| | - Cody Bender
- Vaccines/Antivirals & Evidence Generation, Pfizer Vaccines, Collegeville, PA, USA
| | - Pingping Zhang
- Vaccines/Antivirals & Evidence Generation, Pfizer Vaccines, Collegeville, PA, USA
| | - Frederick J Angulo
- Vaccines/Antivirals & Evidence Generation, Pfizer Vaccines, Collegeville, PA, USA.
| | - Wilhelm Erber
- Vaccines/Antivirals & Evidence Generation, Pfizer Vaccines, Vienna, Austria
| | - Antra Bormane
- Infectious Disease Surveillance and Immunization Unit, Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Evija Gutmane
- Department of Neurology and Neurosurgery, Riga East University Hospital, Rīga Stradinš University, Riga, Latvia
| | - Zane A Litauniece
- Department of Neurology and Neurosurgery, Riga East University Hospital, Rīga Stradinš University, Riga, Latvia
| | - Jevgenijs Tihonovs
- Department of Neurology and Neurosurgery, Rezekne Regional Hospital, Rezekne, Latvia
| | - Aija Griskevica
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Riga, Latvia
| | - Harish Madhava
- Vaccines/Antivirals & Evidence Generation, Pfizer Vaccines, London, UK
| | - Luis Jodar
- Vaccines/Antivirals & Evidence Generation, Pfizer Vaccines, Collegeville, PA, USA
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Zavadska D, Freimane Z, Karelis G, Ermina I, Harper LR, Bender C, Zhang P, Angulo FJ, Erber W, Bormane A, Griskevica A, Moïsi JC, Jodar L. Effectiveness of Tick-borne Encephalitis Vaccines in Children, Latvia, 2018-2020. Pediatr Infect Dis J 2023; 42:927-931. [PMID: 37406220 DOI: 10.1097/inf.0000000000004034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Tick-borne encephalitis (TBE) is an infection by the tick-borne encephalitis virus (TBEV) with symptoms of central nervous system inflammation. TBE is endemic in Latvia and other parts of Europe. TBE vaccination is recommended for children in Latvia. TBE vaccine effectiveness (VE) was estimated in Latvia, a country with high TBE incidence, providing the first VE estimates against a range of TBEV infection outcomes in children 1-15 years-of-age. METHODS Rīga Stradinš University conducted nationwide surveillance for suspected TBE cases. Serum and cerebrospinal fluid were ELISA tested for TBEV-specific IgG and IgM antibodies. A fully vaccinated child was an individual who had received the 3-dose primary series and appropriately timed boosters. The proportion of laboratory-confirmed TBE cases fully vaccinated (PCV) was determined from interviews and medical records. The proportion of the general population fully vaccinated (PPV) was determined from national surveys conducted in 2019 and 2020. TBE VE in children 1-15 years-of-age was estimated using the screening method: VE = 1 - [PCV/(1 - PCV)/PPV/(1 - PPV)]. RESULTS From 2018 to 2020, surveillance identified 36 TBE cases in children 1-15 years-of-age; all were hospitalized, 5 (13.9%) for >12 days. Of the TBE cases, 94.4% (34/36) were unvaccinated compared with 43.8% of children in the general population. VE against TBE hospitalization in children 1-15 years-of-age was 94.9% (95% confidence interval 63.1-99.3). In 2018-2020, vaccination in children 1-15 years-of-age averted 39 hospitalized TBE cases. CONCLUSION Pediatric TBE vaccines were highly effective in preventing TBE in children. Increasing TBE vaccine uptake in children is essential to maximize the public health impact of TBE vaccination.
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Affiliation(s)
- Dace Zavadska
- From the Department of Pediatrics, Children's Clinical University Hospital, Rīga Stradinš University, Riga, Latvia
| | - Zane Freimane
- From the Department of Pediatrics, Children's Clinical University Hospital, Rīga Stradinš University, Riga, Latvia
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Riga East University Hospital, Rīga Stradinš University, Riga, Latvia
| | - Ineta Ermina
- From the Department of Pediatrics, Children's Clinical University Hospital, Rīga Stradinš University, Riga, Latvia
| | - Lisa R Harper
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Pfizer Vaccines, Collegeville, Pennslyvania
| | - Cody Bender
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Pfizer Vaccines, Collegeville, Pennslyvania
| | - Pingping Zhang
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Pfizer Vaccines, Collegeville, Pennslyvania
| | - Frederick J Angulo
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Pfizer Vaccines, Collegeville, Pennslyvania
| | - Wilhelm Erber
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Vienna, Austria
| | - Antra Bormane
- Infectious Disease Surveillance and Immunization Unit, Centre for Disease Prevention and Control of Latvia
| | | | - Jennifer C Moïsi
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Paris, France
| | - Luis Jodar
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Pfizer Vaccines, Collegeville, Pennslyvania
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Miazga W, Wnuk K, Tatara T, Świtalski J, Matera A, Religioni U, Gujski M. The long-term efficacy of tick-borne encephalitis vaccines available in Europe - a systematic review. BMC Infect Dis 2023; 23:621. [PMID: 37735357 PMCID: PMC10515056 DOI: 10.1186/s12879-023-08562-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/24/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Despite the availability of vaccination, TBE (tick-borne encephalitis) remains a global public health problem. Therefore, the aim of our study was to assess the long-term efficacy of vaccinations against tick-borne encephalitis using vaccines available on the European market. METHODS The analysis was conducted on the results of a systematic review conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. The search was performed in three databases, namely Medline (via PubMed), EMBASE (via Ovid), and the Cochrane Library database. The authors followed the PRISMA method and the selection of the articles was performed with two independent researchers. RESULTS From a total of 199 citations, 9 studies were included in this review. According to the primary studies identified in the search, the efficacy of available anti-TBE vaccines ranges from 90.1% to 98.9%; however, in individuals above the age of 60, the protection wanes as early as one year after vaccination. Administration of a booster dose 3 years after completion of the basic vaccination schedule significantly extended the period of protection against TBE. CONCLUSIONS Anti-TBE vaccines available in Europe have a high level of efficacy. However, the level of protection against TBE is decreasing after vaccination. Therefore, in addition to the conventional schedule, booster vaccines should be administered every 5 years in individuals before the age of 60 and more frequently, e.g. every 3 years, in individuals aged 60 and beyond.
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Affiliation(s)
- Wojciech Miazga
- Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, 00032, Warsaw, Poland
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, 01826, Warsaw, Poland
| | - Katarzyna Wnuk
- Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, 00032, Warsaw, Poland
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, 01826, Warsaw, Poland
| | - Tomasz Tatara
- Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, 00032, Warsaw, Poland.
- Department of Public Health, Faculty of Health Sciences, Medical University of Warsaw, 02091, Warsaw, Poland.
| | - Jakub Świtalski
- Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, 00032, Warsaw, Poland
- Department of Health Economics and Medical Law, Faculty of Health Sciences, Medical University of Warsaw, 01445, Warsaw, Poland
| | - Adrian Matera
- Department of Health Policy Programs, Department of Health Technology Assessment, Agency for Health Technology Assessment and Tariff System, 00032, Warsaw, Poland
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, Kleczewska 61/63, 01826, Warsaw, Poland.
| | - Mariusz Gujski
- Department of Public Health, Faculty of Health Sciences, Medical University of Warsaw, 02091, Warsaw, Poland
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Parfut A, Laugel E, Baer S, Gonzalez G, Hansmann Y, Wendling MJ, Fafi-Kremer S, Velay A. Tick-borne encephalitis in pediatrics: An often overlooked diagnosis. Infect Dis Now 2023; 53:104645. [PMID: 36642097 DOI: 10.1016/j.idnow.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
Tick-borne encephalitis (TBE) is a vector-borne disease caused by a flavivirus, the tick-borne encephalitis virus (TBEV), and transmitted by the bite of infected Ixodes ricinus ticks. The European subtype (TBEV-Eu) is endemic in 27 European countries. During the last decade, increased TBE incidence was observed in many countries, including some of those believed to be of low endemicity/devoid of TBEV circulation. However, data dealing with TBE in children are far less profuse than with adults. Historically, children are known to have mild TBEV infection with favorable outcomes. That said, recent case reports and observational studies on pediatric cohorts have challenged this point of view. Like adults, children may present severe forms and fail to completely recover following TBE infection, at times leading to long-term cognitive impairment. In this review, we comprehensively describe the incidence, exposure factors, and transmission routes of TBEV in children, as well as the clinical and biological manifestations of TBE and imaging findings in this population. We also harness new data on long-term outcomes and sequelae in pediatric cohorts. Finally, we provide an overview of vaccination recommendations for children in European countries.
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Affiliation(s)
- Assilina Parfut
- Virology Laboratory, University Hospital of Strasbourg, Strasbourg, F-67000, France
| | - Elodie Laugel
- Virology Laboratory, University Hospital of Strasbourg, Strasbourg, F-67000, France; INSERM, UMR_S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Sarah Baer
- CHU de Strasbourg, Service de Pédiatrie Spécialisée et Générale, Unité de Neurologie Pédiatrique, Strasbourg, France
| | - Gaëlle Gonzalez
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR VIROLOGIE, Laboratoire de Santé Animale, Maisons-Alfort, France
| | - Yves Hansmann
- CHU de Strasbourg, Service des maladies infectieuses et tropicales, Strasbourg, France
| | - Marie-Josée Wendling
- Virology Laboratory, University Hospital of Strasbourg, Strasbourg, F-67000, France
| | - Samira Fafi-Kremer
- Virology Laboratory, University Hospital of Strasbourg, Strasbourg, F-67000, France; INSERM, UMR_S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Aurélie Velay
- Virology Laboratory, University Hospital of Strasbourg, Strasbourg, F-67000, France; INSERM, UMR_S1109, LabEx Transplantex, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
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Martello E, Gillingham EL, Phalkey R, Vardavas C, Nikitara K, Bakonyi T, Gossner CM, Leonardi-Bee J. Systematic review on the non-vectorial transmission of Tick-borne encephalitis virus (TBEv). Ticks Tick Borne Dis 2022; 13:102028. [PMID: 36030646 DOI: 10.1016/j.ttbdis.2022.102028] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/15/2022] [Accepted: 08/10/2022] [Indexed: 12/30/2022]
Abstract
Tick-borne encephalitis (TBE) is an infection caused by the Tick-borne encephalitis virus (TBEv) and it is common in Europe. The virus is predominantly transmitted by ticks, but other non-vectorial modes of transmission are possible. This systematic review synthesises the epidemiological impact of non-vectorial modes of TBEv transmission in Europe. 41 studies were included comprising of 1308 TBE cases. Alimentary (36 studies), handling infected material (3 studies), blood-borne (1 study), solid organ transplant (1 study) were identified as potential routes of TBEv transmission; however, no evidence of vertical transmission from mother to offspring was reported (2 studies). Consumption of unpasteurised milk/milk products was the most common vehicle of transmission and significantly increased the risk of TBE by three-fold (pooled RR 3.05, 95% CI 1.53 to 6.11; 4 studies). This review also confirms handling infected material, blood-borne and solid organ transplant as potential routes of TBEv transmission. It is important to tracing back to find the vehicle of the viral infection and to promote vaccination as it remains a mainstay for the prevention of TBE.
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Affiliation(s)
- Elisa Martello
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK.
| | | | - Revati Phalkey
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK; Climate Change and Health Group, UK Health Security Agency, UK
| | - Constantine Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece; Department of Oral Health Policy and Epidemiology Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | | | - Tamas Bakonyi
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Céline M Gossner
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
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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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11
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Kunze M, Banović P, Bogovič P, Briciu V, Čivljak R, Dobler G, Hristea A, Kerlik J, Kuivanen S, Kynčl J, Lebech AM, Lindquist L, Paradowska-Stankiewicz I, Roglić S, Smíšková D, Strle F, Vapalahti O, Vranješ N, Vynograd N, Zajkowska JM, Pilz A, Palmborg A, Erber W. Recommendations to Improve Tick-Borne Encephalitis Surveillance and Vaccine Uptake in Europe. Microorganisms 2022; 10:1283. [PMID: 35889002 PMCID: PMC9322045 DOI: 10.3390/microorganisms10071283] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 01/18/2023] Open
Abstract
There has been an increase in reported TBE cases in Europe since 2015, reaching a peak in some countries in 2020, highlighting the need for better management of TBE risk in Europe. TBE surveillance is currently limited, in part, due to varying diagnostic guidelines, access to testing, and awareness of TBE. Consequently, TBE prevalence is underestimated and vaccination recommendations inadequate. TBE vaccine uptake is unsatisfactory in many TBE-endemic European countries. This review summarizes the findings of a scientific workshop of experts to improve TBE surveillance and vaccine uptake in Europe. Strategies to improve TBE surveillance and vaccine uptake should focus on: aligning diagnostic criteria and testing across Europe; expanding current vaccine recommendations and reducing their complexity; and increasing public education of the potential risks posed by TBEV infection.
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Affiliation(s)
- Michael Kunze
- Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria;
| | - Pavle Banović
- Ambulance for Lyme Borreliosis and Other Tick-Borne Diseases, Department of Prevention of Rabies and Other Infectious Diseases, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia;
- Department of Microbiology with Parasitology and Immunology, Faculty of Medicine in Novi Sad, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Petra Bogovič
- Department of Infectious Diseases, University Medical Centre Ljubljana, Japljeva 2, 1525 Ljubljana, Slovenia; (P.B.); (F.S.)
| | - Violeta Briciu
- Department of Infectious Diseases, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400348 Cluj-Napoca, Romania;
| | - Rok Čivljak
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, Mirogojska 8, 10000 Zagreb, Croatia; (R.Č.); (S.R.)
- Department for Infectious Diseases, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Gerhard Dobler
- National Reference Laboratory for TBEV, Bundeswehr Institute of Microbiology, 80937 Munich, Germany;
| | - Adriana Hristea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020022 Bucharest, Romania;
| | - Jana Kerlik
- Department of Epidemiology, Regional Authority of Public Health in Banská Bystrica, 97556 Banská Bystrica, Slovakia;
| | - Suvi Kuivanen
- Department of Virology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (S.K.); (O.V.)
| | - Jan Kynčl
- Department of Infectious Diseases Epidemiology, National Institute of Public Health, Vinohrady, 10000 Prague, Czech Republic;
- Department of Epidemiology and Biostatistics, Third Faculty of Medicine, Charles University, 10000 Prague, Czech Republic
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Lars Lindquist
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institute, 14186 Stockholm, Sweden;
| | - Iwona Paradowska-Stankiewicz
- Department of Epidemiology of Infectious Diseases and Surveillance, National Institute of Public Health, National Institute of Hygiene—National Research Institute, 00791 Warsaw, Poland;
| | - Srđan Roglić
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, Mirogojska 8, 10000 Zagreb, Croatia; (R.Č.); (S.R.)
- Department for Infectious Diseases, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Dita Smíšková
- Department of Infectious Diseases, Second Faculty of Medicine, Charles University, 18081 Prague, Czech Republic;
| | - Franc Strle
- Department of Infectious Diseases, University Medical Centre Ljubljana, Japljeva 2, 1525 Ljubljana, Slovenia; (P.B.); (F.S.)
| | - Olli Vapalahti
- Department of Virology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (S.K.); (O.V.)
- Department of Veterinary Biosciences, University of Helsinki, 00014 Helsinki, Finland
- Virology and Immunology, HUSLAB, Helsinki University Hospital, 00260 Helsinki, Finland
| | - Nenad Vranješ
- Department for Research & Monitoring of Rabies & Other Zoonoses, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia;
| | - Nataliya Vynograd
- Department of Epidemiology, Danylo Halytsky Lviv National Medical University, 79010 Lviv, Ukraine;
| | - Joanna Maria Zajkowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, 15-540 Białystok, Poland;
| | - Andreas Pilz
- Medical and Scientific Affairs, Pfizer Vaccines, 1210 Vienna, Austria;
| | - Andreas Palmborg
- Medical and Scientific Affairs, Pfizer Vaccines, 19138 Stockholm, Sweden;
| | - Wilhelm Erber
- Medical and Scientific Affairs, Pfizer Vaccines, 1210 Vienna, Austria;
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12
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Zens KD, Haile SR, Schmidt AJ, Altpeter ES, Fehr JS, Lang P. Retrospective, matched case-control analysis of tickborne encephalitis vaccine effectiveness by booster interval, Switzerland 2006-2020. BMJ Open 2022; 12:e061228. [PMID: 35459683 PMCID: PMC9036433 DOI: 10.1136/bmjopen-2022-061228] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To estimate effectiveness of tickborne encephalitis (TBE) vaccination by time interval (<5, 5-10 and 10+years) postvaccination. DESIGN A retrospective, matched case-control study PARTICIPANTS: Cases-all adult (age 18-79) TBE cases in Switzerland reported via the national mandatory disease reporting surveillance system from 2006 to 2020 (final n=1868). Controls-community controls from a database of randomly selected adults (age 18-79) participating in a 2018 cross-sectional study of TBE vaccination in Switzerland (final n=4625). PRIMARY OUTCOME MEASURES For cases and controls, the number of TBE vaccine doses received and the time since last vaccination were determined. Individuals were classified as being 'unvaccinated' (0 doses), 'incomplete' (1-2 doses) or 'complete' (3+ doses). Individuals with 'complete' vaccination were further classified by time since the last dose was received (<5 years, 5-10 years or 10+ years). A conditional logistic regression model was used to calculate vaccine effectiveness (VE: 100 × [1-OR]) for each vaccination status category. RESULTS VE for incomplete vaccination was 76.8% (95% CI 69.0% to 82.6%). For complete vaccination, overall VE was 95.0% (95% CI 93.5% to 96.1%). When the most recent dose was received <5 years prior VE was 91.6% (95% CI 88.4% to 94.0%), 95.2% (95% CI 92.4% to 97.0%) when the most recent dose was received 5-10 years prior, and 98.5% (95% CI 96.8% to 99.2%) when the most recent dose was received 10+ years prior. CONCLUSIONS That VE does not decrease among completely vaccinated individuals over 10+ years since last vaccination supports the longevity of the protective response following complete TBE vaccination. Our findings support the effectiveness of 10-year TBE booster intervals currently used in Switzerland.
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Affiliation(s)
- Kyra D Zens
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Institute for Experimental Immunology, University of Zurich, Zurich, Switzerland
| | - Sarah R Haile
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Axel J Schmidt
- Communicable Diseases Division, Swiss Federal Office of Public Health, Bern, Switzerland
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Ekkehardt S Altpeter
- Communicable Diseases Division, Swiss Federal Office of Public Health, Bern, Switzerland
| | - Jan S Fehr
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Phung Lang
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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13
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Incidence of Tick-Borne Encephalitis during the COVID-19 Pandemic in Selected European Countries. J Clin Med 2022; 11:jcm11030803. [PMID: 35160255 PMCID: PMC8836726 DOI: 10.3390/jcm11030803] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 02/06/2023] Open
Abstract
Ixodes ricinus ticks are one of the most important vectors and reservoirs of infectious diseases in Europe, and tick-borne encephalitis (TBE) is one of the most dangerous human diseases transmitted by these vectors. The aim of the present study was to investigate the TBE incidence in some European countries during the COVID-19 pandemic. To this end, we analyzed the data published by the European Center for Disease Prevention and Control (ECDC) and Eurostat on the number of reported TBE and COVID-19 cases in 2020 and TBE cases in 2015–2019 (reference period). Significant differences in the TBE incidence were found between the analyzed countries. The highest TBE incidence was found in Lithuania (25.45/100,000 inhabitants). A high TBE incidence was also observed in Central European countries. In 12 of the 23 analyzed countries, there was significant increase in TBE incidence during the COVID-19 pandemic during 2020 compared to 2015–2019. There was no correlation between the incidence of COVID-19 and TBE and between the availability of medical personnel and TBE incidence in the studied countries. In conclusion, Central Europe and the Baltic countries are areas with a high risk of TBE infection. Despite the COVID-19 pandemic and imposed restrictions, the incidence of TBE is increasing in more than half of the analyzed countries.
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14
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Abstract
In recent decades, the incidence of tick-borne encephalitis (TBE) in Sweden has increased. To calculate the burden of disease over a 17-year period, we analyzed data from the Swedish National Health Data Register for TBE cases diagnosed during 1998–2014. We compared healthcare use and sick leave associated with 2,429 persons with TBE with a referent cohort of 7,287 persons without TBE. Patients with TBE were hospitalized for significantly more days during the first year after disease onset (11.5 vs. 1.1 days), logged more specialist outpatient visits (3.6 vs. 1.2 visits), and logged more sick leave days (66 vs. 10.7 days). These differences generally increased over time. The case-fatality rate for TBE was 1.1%. Our calculated cost of TBE to society provides a baseline for decisions on immunization programs. Analyzing register data, our study adds to clinical studies of smaller cohorts and model-based studies that calculate disease burden.
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15
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Erber W, Khan F, Zavadska D, Freimane Z, Dobler G, Böhmer MM, Jodar L, Schmitt HJ. Effectiveness of TBE vaccination in southern Germany and Latvia. Vaccine 2021; 40:819-825. [PMID: 34952753 DOI: 10.1016/j.vaccine.2021.12.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/21/2021] [Accepted: 12/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Tick-borne encephalitis (TBE) is a vaccine-preventable disease which may cause long-term sequelae and even death. The data on the long-term effectiveness of TBE vaccines are limited. Additionally, the vaccination schedule is complex which in part contributes towards sub-optimal uptake in TBE-endemic areas. The current ecological study measures vaccine effectiveness (VE) in two European countries. METHODS TBE VE was measured from 2007 to 2018 in Latvia and Southern German states by age group, vaccination history, and schedule compliance. TBE cases and vaccination history were obtained from the public health agencies for Latvia and the southern German federal states of Bavaria and Baden-Wuerttemberg. Cases were "within schedule" if a TBE infection was diagnosed within the time interval preceding the next scheduled dose and "outside schedule" if the diagnosis occurred after the next scheduled dose. Vaccine uptake was estimated via representative nationwide surveys. RESULTS VE after 2, 3, and ≥4 doses was high in both countries at 97.2%, 95.0%, and 95.4% for southern Germany, and 98.1%, 99.4%, and 98.8% for Latvia while within- schedule, and only showed marginal differences outside schedule at 90.6%, 89.9%, and 95.6% for southern Germany, and 97.4%, 98.4%, and 99.0% for Latvia regardless of age groups. CONCLUSIONS In both countries, VE after two and three primary doses within-schedule was very high in all age groups. Once receiving booster doses, high VE continued to be observed even in persons with extended intervals since the last dose received, suggesting that longer and more flexible booster intervals may be considered for sustainable long-term protection.
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Affiliation(s)
| | | | - Dace Zavadska
- Department of Paediatrics, Riga Stradiņš University, Children's Clinical University Hospital, Riga, Latvia
| | - Zane Freimane
- Department of Paediatrics, Riga Stradiņš University, Children's Clinical University Hospital, Riga, Latvia
| | | | - Merle M Böhmer
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany; Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
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16
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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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17
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Wagner JN, Sonnberger M, Troescher A, Krehan I, Hauser A, Panholzer J, von Oertzen TJ. Reply to Schmitt HJ et al.: 'Response to: "Patients with breakthrough tick-borne encephalitis suffer a more severe clinical course and display extensive magnetic resonance imaging changes"'. Eur J Neurol 2021; 28:e30-e31. [PMID: 33501726 DOI: 10.1111/ene.14755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Judith N Wagner
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Michael Sonnberger
- Department of Neuroradiology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Anna Troescher
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Ingomar Krehan
- Department of Neurology 2, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Amadeus Hauser
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Juergen Panholzer
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Tim J von Oertzen
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
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18
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Wald M, Merisor S, Zachary P, Augereau O, Gravier S, Jaulhac B, De Briel D, Velay A, Gregorowicz G, Martinot M. Microbiological Outcomes Associated With Low Leukocyte Counts in Cerebrospinal Fluid. Open Forum Infect Dis 2020; 8:ofaa597. [PMID: 33575417 PMCID: PMC7863864 DOI: 10.1093/ofid/ofaa597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/03/2020] [Indexed: 11/17/2022] Open
Abstract
The significance of low leukocyte counts in cerebrospinal fluid (CSF) remains unclear. We performed a 2-year retrospective study to examine microbiological outcomes associated with CSF leukocytes at 6–10/mm3. Of the 178 samples examined, we detected positive results for 11 samples, including 5 cases of tick-borne encephalitis virus infection.
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Affiliation(s)
- Mathieu Wald
- Infectious Diseases Department, Hôpitaux Civils de Colmar, France
| | - Simona Merisor
- Infectious Diseases Department, Hôpitaux Civils de Colmar, France
| | - Pierre Zachary
- Microbiology Department, Hôpitaux Universitaires de Strasbourg, France
| | | | - Simon Gravier
- Infectious Diseases Department, Hôpitaux Civils de Colmar, France
| | - Benoit Jaulhac
- Microbiology Department, Hôpitaux Universitaires de Strasbourg, France
| | | | - Aurélie Velay
- Virology Department, Hôpitaux Universitaires de Strasbourg
| | | | - Martin Martinot
- Infectious Diseases Department, Hôpitaux Civils de Colmar, France
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19
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Zelano J, Westman G. Epilepsy after brain infection in adults: A register-based population-wide study. Neurology 2020; 95:e3213-e3220. [PMID: 32989110 DOI: 10.1212/wnl.0000000000010954] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/03/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe risk and risk factors of epilepsy after hospitalization for brain infection in adults in Sweden. METHODS This was a matched retrospective cohort study based on the comprehensive National Patient and Cause of Death Registers. All individuals age >18 without prior epilepsy who received inpatient care in 2000-2010 for a brain infection were included, with 3 age- and sex-matched unexposed controls per exposed individual (n = 12,101 exposed and 36,228 controls). Kaplan-Meier risks of epilepsy after different brain infections were calculated and risk factors identified by Cox regression. Patients were followed until the end of 2017. RESULTS The 10-year risk of epilepsy was 5.9% (95% confidence interval [CI] 5.5-6.3) in cases and 1.2% (95% CI 1.0-1.4) in controls: 1.7% (95% CI 0.7-2.7) after tick-borne encephalitis, 4.1% (95% CI 3.3-4.9) after bacterial meningitis, 26.0% (95% CI 21.5-30.5) after herpes simplex virus encephalitis, and 30.2% (95% CI 27.1-33.3) after brain abscess. In Cox regression, seizure during the index admission and mechanical ventilation were epilepsy risk factors. CONCLUSIONS Epilepsy is common after several types of brain infections in adults. The type of infection, its severity, and propensity to cause seizures in the acute phase influence the risk of subsequent epilepsy. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in adults, brain infection is associated with an increased risk of subsequent epilepsy.
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Affiliation(s)
- Johan Zelano
- From the Institute of Neuroscience and Physiology, Department of Clinical Neuroscience (J.Z.), and Department of Neurology (J.Z.), Sahlgrenska Academy, and Wallenberg Center of Molecular and Translational Medicine (J.Z.), Gothenburg University; and Department of Medical Sciences (G.W.), Section of Infectious Diseases, Uppsala University, Sweden.
| | - Gabriel Westman
- From the Institute of Neuroscience and Physiology, Department of Clinical Neuroscience (J.Z.), and Department of Neurology (J.Z.), Sahlgrenska Academy, and Wallenberg Center of Molecular and Translational Medicine (J.Z.), Gothenburg University; and Department of Medical Sciences (G.W.), Section of Infectious Diseases, Uppsala University, Sweden
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20
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Schmitt H, Erber W, Khan F. Response to: ‘Patients with breakthrough tick‐borne encephalitis suffer a more severe clinical course and display extensive MRI changes’. Eur J Neurol 2020; 27:e86-e87. [DOI: 10.1111/ene.14449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - F. Khan
- Pfizer Vaccines Collegeville PA USA
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21
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Capligina V, Seleznova M, Akopjana S, Freimane L, Lazovska M, Krumins R, Kivrane A, Namina A, Aleinikova D, Kimsis J, Kazarina A, Igumnova V, Bormane A, Ranka R. Large-scale countrywide screening for tick-borne pathogens in field-collected ticks in Latvia during 2017-2019. Parasit Vectors 2020; 13:351. [PMID: 32665019 PMCID: PMC7362577 DOI: 10.1186/s13071-020-04219-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Tick-borne diseases are of substantial concern worldwide in both humans and animals. Several hard tick species are of medical and veterinary interest in Europe, and changes in the range of tick species can affect the spread of zoonotic pathogens. The aim of the present study was to map the current prevalence and distribution pattern of ticks and related tick-borne pathogens in Latvia, a Baltic state in northern Europe. Methods Nearly 4600 Ixodes ricinus, I. persulcatus and Dermacentor reticulatus tick samples were collected in all regions of Latvia during 2017–2019 and were screened by molecular methods to reveal the prevalence and distribution pattern of a wide spectrum of tick-borne pathogens. Results New localities of D. reticulatus occurrence were found in western and central Latvia, including the Riga region, indicating that the northern border of D. reticulatus in Europe has moved farther to the north. Among the analyzed ticks, 33.42% carried at least one tick-borne pathogen, and 5.55% of tick samples were positive for two or three pathogens. A higher overall prevalence of tick-borne pathogens was observed in I. ricinus (34.92%) and I. persulcatus (31.65%) than in D. reticulatus (24.2%). The molecular analysis revealed the presence of tick-borne encephalitis virus, Babesia spp., Borrelia spp., Anaplasma phagocytophilum and Rickettsia spp. Overall, 15 and 7 tick-borne pathogen species were detected in Ixodes spp. and D. reticulatus ticks, respectively. This is the first report of Borrelia miyamotoi in Latvian field-collected ticks. Conclusions This large-scale countrywide study provides a snapshot of the current distribution patterns of Ixodes and Dermacentor ticks in Latvia and gives us a reliable overview of tick-borne pathogens in Latvian field-collected ticks.![]()
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Affiliation(s)
- Valentina Capligina
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, Latvia
| | - Maija Seleznova
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, Latvia
| | - Sarmite Akopjana
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, Latvia
| | - Lauma Freimane
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, Latvia
| | - Marija Lazovska
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, Latvia
| | - Rudolfs Krumins
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, Latvia
| | - Agnija Kivrane
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, Latvia
| | - Agne Namina
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, Latvia
| | - Darja Aleinikova
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, Latvia
| | - Janis Kimsis
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, Latvia
| | - Alisa Kazarina
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, Latvia
| | - Viktorija Igumnova
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, Latvia
| | - Antra Bormane
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, Latvia
| | - Renate Ranka
- Latvian Biomedical Research and Study Centre, Ratsupites Street 1, Riga, Latvia.
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Wagner JN, Sonnberger M, Troescher A, Krehan I, Hauser A, Panholzer J, von Oertzen TJ. Patients with breakthrough tick-borne encephalitis suffer a more severe clinical course and display extensive magnetic resonance imaging changes. Eur J Neurol 2020; 27:1201-1209. [PMID: 32324925 PMCID: PMC7383477 DOI: 10.1111/ene.14276] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 12/25/2022]
Abstract
Background and purpose Tick‐borne encephalitis (TBE) is a common viral disease in central Europe and Asia. Severe or even lethal neurological symptoms may ensue. With limited therapeutic options, active vaccination against the TBE virus (TBEV) is strongly recommended in endemic areas. A systematic analysis of the clinical picture and cerebral imaging findings associated with TBE was conducted with particular focus on patients who acquired TBE despite previous vaccination. Methods A cohort of 52 patients with serologically proven TBE treated at our centre in a 10‐year period who received at least one cerebral magnetic resonance imaging (MRI) was retrospectively described. Extension of MRI changes was systematically assessed by an experienced neuroradiologist. Standard statistical procedures were performed. Results Fifty‐two patients with a definite serological diagnosis of TBE were included. The most common presentation was encephalitis (67%). MRI showed TBE‐associated parenchymal lesions in 33% of all patients. Sites of predilection included the periaqueductal grey, the thalamus and the brainstem. Ten patients had received at least one prior active or passive TBEV immunization. All of these had a maximal Rankin Scale score of at least 4. The median number of affected anatomical regions on MRI was significantly higher than in the non‐vaccinated cohort. Conclusions To our knowledge, this is the first study systematically describing the peculiarities of MRI in patients vaccinated against TBE. In addition to a severe clinical course, they exhibit more extensive MRI lesions than a non‐vaccinated cohort. Possible reasons for these findings include incomplete seroconversion, more virulent TBEV strains or antibody‐dependent enhancement.
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Affiliation(s)
- J N Wagner
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - M Sonnberger
- Department of Neuroradiology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - A Troescher
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - I Krehan
- Department of Neurology 2, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - A Hauser
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - J Panholzer
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - T J von Oertzen
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
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23
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Hart CE, Ribeiro JM, Kazimirova M, Thangamani S. Tick-Borne Encephalitis Virus Infection Alters the Sialome of Ixodes ricinus Ticks During the Earliest Stages of Feeding. Front Cell Infect Microbiol 2020; 10:41. [PMID: 32133301 PMCID: PMC7041427 DOI: 10.3389/fcimb.2020.00041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/21/2020] [Indexed: 01/14/2023] Open
Abstract
Ticks are hematophagous arthropods that transmit a number of pathogens while feeding. Among these is tick-borne encephalitis virus (TBEV), a flavivirus transmitted by Ixodes ricinus ticks in the temperate zone of Europe. The infection results in febrile illness progressing to encephalitis and meningitis with a possibility of fatality or long-term neurological sequelae. The composition of tick saliva plays an essential role in the initial virus transmission during tick feeding. Ticks secrete a diverse range of salivary proteins to modulate the host response, such as lipocalins to control the itch and inflammatory response, and both proteases and protease inhibitors to prevent blood coagulation. Here, the effect of viral infection of adult females of Ixodes ricinus was studied with the goal of determining how the virus alters the tick sialome to modulate host tissue response at the site of infection. Uninfected ticks or those infected with TBEV were fed on mice and removed and dissected one- and 3-h post-attachment. RNA from the salivary glands of these ticks, as well as from unfed ticks, was extracted and subjected to next-generation sequencing to determine the expression of key secreted proteins at each timepoint. Genes showing statistically significant up- or down-regulation between infected and control ticks were selected and compared to published literature to ascertain their function. From this, the effect of tick viral infection on the modulation of the tick-host interface was determined. Infected ticks were found to differentially express a number of uncategorized genes, proteases, Kunitz-type serine protease inhibitors, cytotoxins, and lipocalins at different timepoints. These virus-induced changes to the tick sialome may play a significant role in facilitating virus transmission during the early stages of tick feeding.
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Affiliation(s)
- Charles E. Hart
- SUNY Center for Environmental Health and Medicine, SUNY Upstate Medical University, Syracuse, NY, United States
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, United States
- The Institute for Translational Science, University of Texas Medical Branch, Galveston, TX, United States
| | - Jose M. Ribeiro
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, United States
| | - Maria Kazimirova
- Institute of Zoology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Saravanan Thangamani
- SUNY Center for Environmental Health and Medicine, SUNY Upstate Medical University, Syracuse, NY, United States
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, United States
- Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, United States
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24
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Dobler G, Kaier K, Hehn P, Böhmer MM, Kreusch TM, Borde JP. Tick-borne encephalitis virus vaccination breakthrough infections in Germany: a retrospective analysis from 2001 to 2018. Clin Microbiol Infect 2019; 26:1090.e7-1090.e13. [PMID: 31843655 DOI: 10.1016/j.cmi.2019.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 11/24/2019] [Accepted: 12/02/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES There are few data available regarding the clinical course of tick-borne encephalitis virus (TBEV) vaccination breakthrough infections. The published studies suggest that vaccination breakthrough infections may have a more severe course than native TBEV infection in unvaccinated individuals-potentially due to antibody-dependent enhancement. Here we report a large analysis of vaccination breakthrough infections. METHODS This retrospective analysis was based on a national surveillance dataset spanning the years 2001-2018. Variables reflecting disease severity, such as 'CNS symptoms', 'myelitis', 'fatal outcome' and 'hospitalization' were analysed as well as general epidemiological variables. Cases were categorized as 'unvaccinated' or 'ever vaccinated', the latter category including cases with at least one dose of a TBEV vaccine. RESULTS A total of 6073 notified TBEV infection cases were included in our analysis. Sufficient data on vaccination status were available for 95.1% of patients (5777/6073); of these, 5298 presented with a native infection. A total of (334/5777) cases developed an infection despite having been vaccinated at least once. Comparing unvaccinated patients with those with at least one vaccination, we find an odds ratio (OR) 2.73, (95% confidence interval (CI) 0.79-9.50) regarding the variable fatal outcome that did not reach statistical significance. Analysing the clinical variables 'CNS symptoms' and 'myelitis', there is no difference between these groups (OR 0.86, 95% CI 0.68-1.08; and OR 1.30, 95% CI 0.74-2.27 respectively). Patients who were vaccinated and had an assumed protection at symptom onset (n = 100) had a higher risk for the development of myelitic symptoms (OR 2.21, 95% CI 1.01-4.86]) than unvaccinated patients. CONCLUSION Our findings could neither verify that vaccination breakthrough infections might cause a more severe disease than native infections nor prove a clear antibody-dependent enhancement phenomenon. It remains unclear whether the increased myelitis risk in a subgroup of vaccinated patients is a true effect or confounded.
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Affiliation(s)
- G Dobler
- Bundeswehr Institute of Microbiology, German National Reference Laboratory for TBEV, Munich, Germany
| | - K Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Centre - University of Freiburg, Freiburg, Germany
| | - P Hehn
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Centre - University of Freiburg, Freiburg, Germany
| | - M M Böhmer
- Bavarian Health and Food Safety Authority, Department of Infectious Disease Epidemiology & Taskforce Infectiology/Airport, Oberschleissheim, Germany
| | - T M Kreusch
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Immunization Unit, Berlin, Germany
| | - J P Borde
- Division of Infectious Diseases, Department of Medicine II, University of Freiburg Medical Centre and Faculty of Medicine, Freiburg, Germany; Praxis Dr. J. Borde/Gesundheitszentrum Oberkirch, Oberkirch, Germany.
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25
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Poellabauer E, Angermayr R, Behre U, Zhang P, Harper L, Schmitt HJ, Erber W. Seropersistence and booster response following vaccination with FSME-IMMUN in children, adolescents, and young adults. Vaccine 2019; 37:3241-3250. [PMID: 30928173 DOI: 10.1016/j.vaccine.2019.03.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/15/2019] [Accepted: 03/16/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Tick-borne encephalitis (TBE) is a viral disease that can have a severe clinical course and considerable long-term morbidity. As no curative treatment exists, vaccination is the primary means of prevention. Long-term antibody seropersistence 2-5 years after the 3-dose primary immunization and 3-10 years after first booster was evaluated, as well as booster responses in children, adolescents and young adults. METHODS Subjects who participated in these phase 4 prospective, open-label follow-up studies received all vaccinations with FSME-IMMUN. After 3-dose primary immunization, subjects were followed for 2-5 years. Overall, 205 out of 358 subjects (57%) received the first booster and 179 of these subjects (87%) enrolled in a further 10-year follow-up. Antibody seropersistence was assessed annually. Subjects with a TBE antibody titer below a pre-specified cut-off at the yearly blood draw received a booster. Seropositivity rates and geometric mean fold rises (GMFRs) were assessed. RESULTS In children who received their 3-dose primary immunization between 1 and 15 years of age, the seropositivity rate 5 years after the 3rd dose was 84.9% by NT and 72.0% by ELISA. One month post-first booster, all subjects were seropositive by NT and 98.5% by ELISA. Response to first booster by GMFR ranged from 3.7 to 11.4. At 5 years post-first booster, seropositivity was 99.4% by NT and 97.5% by ELISA, and at 10 years, was 90.3% by NT and 87.7% by ELISA. Although seropositivity rates differed between age groups, all subjects (100%) who received a second booster responded with a robust increase of TBEV antibodies. DISCUSSION Long-lasting seropersistence of TBEV antibodies after the 3-dose primary immunization and first booster was demonstrated as well as a competent immune memory response in those who received a first or second booster at any time during the 15-year follow-up. Therefore, an extension of FSME-IMMUN booster interval up to 10 years after the 3-dose primary immunization seems warranted. ClinicalTrials.gov Identifier: NCT00894686.
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Affiliation(s)
- E Poellabauer
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Austria
| | | | - U Behre
- Private Practice, Kehl, Germany
| | - P Zhang
- Pfizer Inc., Collegeville, PA, USA
| | - L Harper
- Pfizer Inc., Collegeville, PA, USA
| | | | - W Erber
- Pfizer Inc., Vienna, Austria.
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