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Velay A, Baquer F, Brunet J, Denis J, Parfut A, Talagrand-Reboul E, Hansmann Y. Infectious risks associated with outdoor sports activities. Infect Dis Now 2024; 54:104862. [PMID: 38845331 DOI: 10.1016/j.idnow.2024.104862] [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: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 06/15/2024]
Abstract
In France, outdoor sports and activities account for 36% of sports engagement, making outdoor venues the most popular settings for sports participation. Discussing the links between sports and health almost always highlights the beneficial impact of engaging in sports. However, due to a lack of specific notifications, infectious risks are not subject to epidemiological monitoring, and need to be better understood. Since the practice of outdoor sports has become part and parcel of many individuals' daily routines, it is essential to more accurately characterize the knowledge we have gained about the risks associated with exposure. However, directly associating the practice of a sport with an elevated risk of infectious diseases is a challenging endeavor. Sociological factors based on risk awareness and adoption of protective behaviors in response to the risk are crucial to the orientation of prevention efforts. This review deals with several (bacteriological, viral, parasitic, and mycological) infectious risks related to outdoor activities practiced in a natural field via contamination routes such as tick-bite, enteric pathogen, skin, and aerosol transmission. We have also detailed a number of preventive measures taking into account the outdoor setting (e.g., vaccination).
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Affiliation(s)
- Aurélie Velay
- Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
| | - Florian Baquer
- Laboratoire de Bactériologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julie Brunet
- Laboratoire de Parasitologie et Mycologie Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julie Denis
- Laboratoire de Parasitologie et Mycologie Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Assilina Parfut
- Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Yves Hansmann
- Service des Maladies Infectieuses et Tropicales, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Nygren TM, Pilic A, Böhmer MM, Wagner-Wiening C, Wichmann O, Harder T, Hellenbrand W. Correction: Nygren et al. Tick-Borne Encephalitis Risk Increases with Dog Ownership, Frequent Walks, and Gardening: A Case-Control Study in Germany 2018-2020. Microorganisms 2022, 10, 690. Microorganisms 2024; 12:958. [PMID: 38792862 PMCID: PMC11124476 DOI: 10.3390/microorganisms12050958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
In the original publication [...].
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Affiliation(s)
- Teresa Marie Nygren
- Immunization Unit, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany
- Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Antonia Pilic
- Immunization Unit, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany
| | - Merle Margarete Böhmer
- Bavarian Health and Food Safety Authority (LGL), Veterinärstraße 2, 85764 Oberschleißheim, Germany
- Faculty of Medicine, Institute of Social Medicine and Health Systems Research, Otto-von-Guericke-University Magdeburg, 39120 Magdeburg, Germany
| | | | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany
| | - Thomas Harder
- Immunization Unit, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany
| | - Wiebke Hellenbrand
- Immunization Unit, Robert Koch Institute, Seestraße 10, 13353 Berlin, Germany
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Kim P, Maxwell S, Parijat N, Kim D, McNeely CL. Targeted Tick-Borne Disease Recognition: Assessing Risk for Improved Public Health. Healthcare (Basel) 2024; 12:984. [PMID: 38786395 PMCID: PMC11121250 DOI: 10.3390/healthcare12100984] [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: 04/23/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Tick-borne diseases (TBDs) pose a rapidly growing threat to public health. The incidence of TBDs is on the rise, necessitating a comprehensive understanding of the risk factors beyond demographic considerations. This brief report combines a preliminary review of the literature with geographical case mapping to identify the various factors influencing TBD risk. The report highlights the vulnerability of outdoor workers, the importance of outdoor activities, and the role of education in adopting preventive behaviors. Pet ownership and interactions with animals are also associated with an increased risk. The state of Illinois is used as a case study for this report, revealing regional variations in TBD incidence, and linking them to agricultural practices, forested areas, and park accessibility. These findings inform recommendations for targeted prevention strategies, emphasizing the need for detailed geographical data to enhance public health efforts in curbing TBD incidence and risk.
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Affiliation(s)
- Pyung Kim
- School of Economic, Political and Policy Sciences, University of Texas at Dallas, Richardson, TX 75080, USA; (P.K.); (N.P.); (D.K.)
| | - Sarah Maxwell
- School of Economic, Political and Policy Sciences, University of Texas at Dallas, Richardson, TX 75080, USA; (P.K.); (N.P.); (D.K.)
| | - Nabila Parijat
- School of Economic, Political and Policy Sciences, University of Texas at Dallas, Richardson, TX 75080, USA; (P.K.); (N.P.); (D.K.)
| | - Dohyeong Kim
- School of Economic, Political and Policy Sciences, University of Texas at Dallas, Richardson, TX 75080, USA; (P.K.); (N.P.); (D.K.)
| | - Connie L. McNeely
- Schar School of Policy and Government, George Mason University, Fairfax, VA 22030, USA
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Gonzalo-Nadal V, Kohl A, Rocchi M, Brennan B, Hughes J, Nichols J, Da Silva Filipe A, Dunlop JI, Fares M, Clark JJ, Tandavanitj R, Patel AH, Cloquell-Miro A, Bongers J, Deacon J, Kaczmarska A, Stalin C, Liatis T, Irving J, Gutierrez-Quintana R. Suspected tick-borne flavivirus meningoencephalomyelitis in dogs from the UK: six cases (2021). J Small Anim Pract 2024; 65:132-143. [PMID: 37956993 DOI: 10.1111/jsap.13682] [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: 02/20/2023] [Revised: 06/30/2023] [Accepted: 10/01/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Tick-borne encephalitis virus and louping ill virus are neurotropic flaviviruses transmitted by ticks. Epidemiologically, tick-borne encephalitis is endemic in Europe whereas louping ill's predominant geographical distribution is the UK. Rarely, these flaviviruses affect dogs causing neurological signs. This case series aimed to describe the clinical, clinicopathological, and imaging findings, as well as the outcomes in six dogs with meningoencephalitis and/or meningomyelitis caused by a flavivirus in the UK in 2021. MATERIALS AND METHODS Observational retrospective case-series study. Clinical data were retrieved from medical records of dogs with positive serological or immunohistochemical results from three different institutions from spring to winter 2021. RESULTS Six dogs were included in the study. All dogs presented an initial phase of pyrexia and/or lethargy followed by progressive signs of spinal cord and/or intracranial disease. Magnetic resonance imaging showed bilateral and symmetrical lesions affecting the grey matter of the thalamus, pons, medulla oblongata, and thoracic or lumbar intumescences with none or mild parenchymal and meningeal contrast enhancement. Serology for tick-borne encephalitis virus was positive in five dogs with the presence of seroconversion in two dogs. The viral distinction between flaviviruses was not achieved. One dog with negative serology presented positive immunohistochemistry at post-mortem examination. Three dogs survived but presented neurological sequelae. Three dogs were euthanased due to the rapid progression of the clinical signs or static neurological signs. CLINICAL SIGNIFICANCE These cases raise awareness of the presence of tick-borne encephalitis as an emergent disease or the increased prevalence of louping ill virus affecting dogs in the UK.
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Affiliation(s)
- V Gonzalo-Nadal
- Division of Small Animal Clinical Sciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - A Kohl
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - M Rocchi
- Moredun Research Institute, Midlothian, UK
| | - B Brennan
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - J Hughes
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - J Nichols
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | | | - J I Dunlop
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - M Fares
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - J J Clark
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - R Tandavanitj
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - A H Patel
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - A Cloquell-Miro
- Division of Small Animal Clinical Sciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - J Bongers
- Division of Small Animal Clinical Sciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Moorview Vets, Cramlington, UK
| | | | - A Kaczmarska
- Division of Small Animal Clinical Sciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - C Stalin
- Division of Small Animal Clinical Sciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
- Moorview Vets, Cramlington, UK
| | - T Liatis
- Queen Mother Hospital for Animals, Royal Veterinary College, University of London, London, UK
| | - J Irving
- Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, Hertfordshire, UK
- Harper & Keele Veterinary School, Newport, Shropshire, UK
| | - R Gutierrez-Quintana
- Division of Small Animal Clinical Sciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Steininger P, Ensser A, Knöll A, Korn K. Results of Tick-Borne Encephalitis Virus (TBEV) Diagnostics in an Endemic Area in Southern Germany, 2007 to 2022. Viruses 2023; 15:2357. [PMID: 38140598 PMCID: PMC10748111 DOI: 10.3390/v15122357] [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: 11/10/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Tick-borne encephalitis virus (TBEV) is the most important tick-transmitted neurotropic flavivirus in Europe and Asia. Our analysis aimed to investigate the contribution of TBEV-specific antibody detection by serological assays and TBEV RNA detection by real-time PCR to the diagnosis of tick-borne encephalitis (TBE). We analyzed data from 3713 patients from 16 years of laboratory TBEV diagnostics in an endemic area in Southern Germany. During this period, 126 cases of TBE were diagnosed. TBEV-specific IgM ELISA tests showed a high clinical sensitivity (96.8%) and a very high clinical specificity (99.7%). In immunocompetent patients, TBE was reliably diagnosed by detection of TBEV IgM antibodies in serum. Intrathecal TBEV IgG antibody synthesis was detected in 46 of 84 (55%) cases by analysis of paired serum and cerebrospinal fluid (CSF) samples. None of the 87 immunocompetent TBE patients tested had detectable TBEV RNA in serum or CSF. In contrast, in two TBE patients without TBEV-specific antibodies, diagnosis could only be made by the detection of TBEV RNA in CSF. Both patients had previously been treated with the B cell-depleting antibody rituximab. Therefore, in patients with CNS infection and humoral immunodeficiency, it is necessary to include TBEV PCR in the diagnostic approach.
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Affiliation(s)
- Philipp Steininger
- Institute of Clinical and Molecular Virology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (A.E.); (A.K.); (K.K.)
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Nygren TM, Pilic A, Böhmer MM, Wagner-Wiening C, Wichmann O, Hellenbrand W. Recovery and sequelae in 523 adults and children with tick-borne encephalitis in Germany. Infection 2023; 51:1503-1511. [PMID: 37022643 PMCID: PMC10078068 DOI: 10.1007/s15010-023-02023-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 03/13/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE Despite being vaccine-preventable, tick-borne encephalitis (TBE) continues to cause considerable morbidity in Germany. Limited insight into potentially debilitating consequences of TBE may partially underly low (~ 20%) TBE vaccine uptake. We aimed to systematically assess TBE sequelae and other consequences. METHODS Routinely notified TBE patients from 2018 to 2020 from Southern Germany were invited to telephone interviews acutely and again after 18 months. Duration of acute symptoms was prospectively assessed. Recovery was defined as score 0 on the modified RANKIN scale. Determinants of time to recovery were analysed with cox regression, adjusted for covariates identified using directed acyclic graphs, yielding hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Of 558 cases, 523 (93.7%) completed follow-up. Full recovery was reported by 67.3% (children: 94.9%, adults: 63.8%). Sequelae included fatigue (17.0%), weakness (13.4%), concentration deficit (13.0%), and impaired balance (12.0%). Compared with 18-39-year-olds, recovery rates were 44% lower in ≥ 50-year-olds (HR: 0.56, 95%CI 0.42-0.75) and 79% higher in children (HR: 1.79, 95%CI 1.25-2.56). The recovery rate was 64% lower after severe TBE (compared to mild; HR: 0.36, 95%CI 0.25-0.52) and 22% lower with comorbidities (HR: 0.78, 95%CI 0.62-0.99). Substantial health-care use was reported (90.1% hospitalisation, 39.8% rehabilitation). Of employed cases, 88.4% required sick leave; 10.3% planned/reported premature retirement due to sequelae. CONCLUSION Half the adult and 5% of paediatric patients reported persisting sequelae after 18 months. Improved prevention could alleviate both individual (morbidity) and societal TBE burden (health-care costs, productivity losses). Insights into sequelae can help guide at-risk populations towards tick-avoidant strategies and encourage TBE vaccination.
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Affiliation(s)
| | - Antonia Pilic
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - Merle M Böhmer
- Bavarian Health and Food Safety Authority (LGL), Munich, Germany
- Institute of Social Medicine and Health Systems Research, Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
| | | | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Berlin, Germany
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Van Heuverswyn J, Hallmaier-Wacker LK, Beauté J, Gomes Dias J, Haussig JM, Busch K, Kerlik J, Markowicz M, Mäkelä H, Nygren TM, Orlíková H, Socan M, Zbrzeźniak J, Žygutiene M, Gossner CM. Spatiotemporal spread of tick-borne encephalitis in the EU/EEA, 2012 to 2020. Euro Surveill 2023; 28:2200543. [PMID: 36927718 PMCID: PMC10021474 DOI: 10.2807/1560-7917.es.2023.28.11.2200543] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
BackgroundTick-borne encephalitis (TBE) is a vaccine-preventable disease involving the central nervous system. TBE became a notifiable disease on the EU/EEA level in 2012.AimWe aimed to provide an updated epidemiological assessment of TBE in the EU/EEA, focusing on spatiotemporal changes.MethodsWe performed a descriptive analysis of case characteristics, time and location using data of human TBE cases reported by EU/EEA countries to the European Centre for Disease Prevention and Control with disease onset in 2012-2020. We analysed data at EU/EEA, national, and subnational levels and calculated notification rates using Eurostat population data. Regression models were used for temporal analysis.ResultsFrom 2012 to 2020, 19 countries reported 29,974 TBE cases, of which 24,629 (98.6%) were autochthonous. Czechia, Germany and Lithuania reported 52.9% of all cases. The highest notification rates were recorded in Lithuania, Latvia, and Estonia (16.2, 9.5 and 7.5 cases/100,000 population, respectively). Fifty regions from 10 countries, had a notification rate ≥ 5/100,000. There was an increasing trend in number of cases during the study period with an estimated 0.053 additional TBE cases every week. In 2020, 11.5% more TBE cases were reported than predicted based on data from 2016 to 2019. A geographical spread of cases was observed, particularly in regions situated north-west of known endemic regions.ConclusionA close monitoring of ongoing changes to the TBE epidemiological situation in Europe can support the timely adaption of vaccination recommendations. Further analyses to identify populations and geographical areas where vaccination programmes can be of benefit are needed.
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Affiliation(s)
| | | | - Julien Beauté
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Joana Gomes Dias
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Joana M Haussig
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Jana Kerlik
- Regional Authority of Public Health in Banská Bystrica, Banská Bystrica, Slovakia
| | | | - Henna Mäkelä
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Hana Orlíková
- National Institute of Public Health, Prague, Czechia
| | - Maja Socan
- National Institute of Public Health, Ljubljana, Slovenia
| | - Jakub Zbrzeźniak
- National Institute of Public Health - NIH - National Research Institute, Warsaw, Poland
| | - Milda Žygutiene
- National Public Health Center under the Ministry of Health, Vilnius, Lithuania
| | - Céline M Gossner
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Nygren TM, Pilic A, Böhmer MM, Wagner-Wiening C, Wichmann O, Harder T, Hellenbrand W. Tick-borne encephalitis vaccine effectiveness and barriers to vaccination in Germany. Sci Rep 2022; 12:11706. [PMID: 35810184 PMCID: PMC9271034 DOI: 10.1038/s41598-022-15447-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022] Open
Abstract
Tick-borne encephalitis (TBE) vaccination coverage remains low in Germany. Our case-control study (2018-2020) aimed to examine reasons for low vaccine uptake, vaccine effectiveness (VE), and vaccine breakthrough infections (VBIs). Telephone interviews (581 cases, 975 matched controls) covered vaccinations, vaccination barriers, and confounders identified with directed acyclic graphs. Multivariable logistic regression determined VE as 1-odds ratio with 95% confidence intervals (CI). We additionally calculated VE with the Screening method using routine surveillance and vaccination coverage data. Main vaccination barriers were poor risk perception and fear of adverse events. VE was 96.6% (95% CI 93.7-98.2) for ≥ 3 doses and manufacturer-recommended dosing intervals. Without boosters, VE after ≥ 3 doses at ≤ 10 years was 91.2% (95% CI 82.7-95.6). VE was similar for homologous/heterologous vaccination. Utilising routine surveillance data, VE was comparable (≥ 3 doses: 92.8%). VBIs (n = 17, 2.9% of cases) were older, had more comorbidities and higher severity than unvaccinated cases. However, only few VBIs were diagnostically confirmed; 57% of re-tested vaccinated cases (≥ 1 dose, n = 54) proved false positive. To increase TBE vaccine uptake, communication efforts should address complacency and increase confidence in the vaccines' safety. The observed duration of high VE may inform decision-makers to consider extending booster intervals to 10 years.
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Affiliation(s)
- Teresa M Nygren
- Immunisation Unit, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Antonia Pilic
- Immunisation Unit, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Merle M Böhmer
- Bavarian Health and Food Safety Authority (LGL), Oberschleißheim, Germany
- Institute of Social Medicine and Health Systems Research, Otto-Von-Guericke-University Magdeburg, Magdeburg, Germany
| | | | - Ole Wichmann
- Immunisation Unit, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Thomas Harder
- Immunisation Unit, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Wiebke Hellenbrand
- Immunisation Unit, Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
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