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. 2013 Jan;19(1):69-76.
doi: 10.3201/eid1901.120458.

Vaccination and tick-borne encephalitis, central Europe

Franz X Heinz  1 , Karin Stiasny, Heidemarie Holzmann, Marta Grgic-Vitek, Bohumir Kriz, Astrid Essl, Michael Kundi
Affiliations

Vaccination and tick-borne encephalitis, central Europe

Franz X Heinz et al. Emerg Infect Dis. 2013 Jan.

Abstract

Tick-borne encephalitis (TBE) is a substantial public health problem in many parts of Europe and Asia. To assess the effect of increasing TBE vaccination coverage in Austria, we compared incidence rates over 40 years for highly TBE-endemic countries of central Europe (Czech Republic, Slovenia, and Austria). For all 3 countries we found extensive annual and longer range fluctuations and shifts in distribution of patient ages, suggesting major variations in the complex interplay of factors influencing risk for exposure to TBE virus. The most distinctive effect was found for Austria, where mass vaccination decreased incidence to ≈16% of that of the prevaccination era. Incidence rates remained high for the nonvaccinated population. The vaccine was effective for persons in all age groups. During 2000-2011 in Austria, ≈4,000 cases of TBE were prevented by vaccination.

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Figures

Figure 1
Figure 1
Tick-borne encephalitis (TBE) incidence rates, 1972–2011, central Europe. A) Total population (red dashed line) and nonvaccinated population (red solid line) in Austria. The black line represents the increasing coverage of vaccination, which started in 1978. B) Comparative representation of TBE incidences in Austria (red line), Czech Republic (green line), and Slovenia (blue line). The incidence scale for Slovenia (right y-axis) differs from that of Austria and the Czech Republic (left y-axis). C) Sliding-window representation of TBE incidence in Austria (red line), Czech Republic (green line), and Slovenia (blue line) in means of 5-year intervals. The incidence scale for Slovenia (right y-axis) differs from that of Austria and the Czech Republic (left y-axis).
Figure 2
Figure 2
Results of joinpoint analysis of annual incidence rates (no. cases/100,000 population) of tick-borne encephalitis (TBE) in A) Austria (total population), B) Austria (nonvaccinated population), C) Czech Republic, and D) Slovenia. The lines in each panel represent the piecewise log-linear relationship between year and incidence. Estimated joinpoints and their 95% CIs are shown.
Figure 3
Figure 3
Age distribution of tick-borne encephalitis (TBE) patients during 1990–1999 (dotted lines; open symbols) and 2000–2010 (solid lines; closed symbols) in Austria (red), Czech Republic (green), and Slovenia (blue). The incidence scale for Slovenia (right y-axis) differs from that of Austria and the Czech Republic (left y-axis).
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