{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T01:09:53Z","timestamp":1787792993319,"version":"build-2784847793"},"reference-count":16,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T00:00:00Z","timestamp":1717718400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","award":["#56910489"],"award-info":[{"award-number":["#56910489"]}],"id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0305120","type":"journal-article","created":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T17:54:02Z","timestamp":1717782842000},"page":"e0305120","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Tick-borne encephalitis infections without CNS involvement: An observational study in Latvia, 2007\u20132022"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3242-1630","authenticated-orcid":true,"given":"Zane","family":"Freimane","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9586-2775","authenticated-orcid":true,"given":"Guntis","family":"Karelis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maksims","family":"Zolovs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4892-3763","authenticated-orcid":true,"given":"Dace","family":"Zavadska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,6,7]]},"reference":[{"issue":"1","key":"pone.0305120.ref001","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.ttbdis.2010.10.007","article-title":"Tick-borne encephalitis 2010: epidemiology, risk areas, and virus strains in Europe and Asia-an overview","volume":"2","author":"J. S\u00fcss","year":"2011","journal-title":"Ticks Tick Borne Dis"},{"key":"pone.0305120.ref002","unstructured":"European Centre for Disease Prevention and Control (ECDC) Surveillance Report. Tick-borne encephalitis Annual Epidemiological Report for 2020. https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/Tick-borne-encephalitis-annual-epidemiological-report-2022.pdf"},{"key":"pone.0305120.ref003","doi-asserted-by":"crossref","unstructured":"Zavadska D, Freimane Z. TBE in Latvia. In: Dobler G, Erber W, Broker M, Schmitt HJ, editors. The TBE Book, 3rd ed. Singapore: Global Health Press Pte LTD, p. 248\u2013255, 2020.","DOI":"10.33442\/26613980_12b19-4"},{"issue":"2","key":"pone.0305120.ref004","doi-asserted-by":"crossref","first-page":"362","DOI":"10.4161\/hv.22766","article-title":"Recommendations for tick-borne encephalitis vaccination from the Central European Vaccination Awareness Group (CEVAG)","volume":"9","author":"D Zavadska","year":"2013","journal-title":"Hum Vaccin Immunother"},{"issue":"42","key":"pone.0305120.ref005","doi-asserted-by":"crossref","first-page":"20299","DOI":"10.2807\/ese.17.42.20299-en","article-title":"Tick-borne encephalitis joins the diseases under surveillance in the European Union","volume":"17","author":"A Amato-Gauci","year":"2012","journal-title":"Euro Surveill"},{"key":"pone.0305120.ref006","unstructured":"Dobler G, Erber W, Broker M, Schmitt HJ. The TBE Book, 2nd ed. Singapore: Global Health Press Pte LTD, 2019, p. 248\u2013255"},{"issue":"4","key":"pone.0305120.ref007","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1086\/515195","article-title":"Tick-borne encephalitis","volume":"28","author":"U Dumpis","year":"1999","journal-title":"Clin Infect Dis"},{"issue":"2","key":"pone.0305120.ref008","doi-asserted-by":"crossref","first-page":"291","DOI":"10.3201\/eid2802.211661","article-title":"Clinical and Laboratory Characteristics and Outcome of Illness Caused by Tick-Borne Encephalitis Virus without Central Nervous System Involvement","volume":"28","author":"P Bogovi\u010d","year":"2022","journal-title":"Emerg Infect Dis"},{"issue":"11","key":"pone.0305120.ref009","doi-asserted-by":"crossref","first-page":"e0204844","DOI":"10.1371\/journal.pone.0204844","article-title":"Tick-borne encephalitis: A 43-year summary of epidemiological and clinical data from Latvia (1973 to 2016)","volume":"13","author":"D Zavadska","year":"2018","journal-title":"PLoS One"},{"issue":"2","key":"pone.0305120.ref010","doi-asserted-by":"crossref","first-page":"314","DOI":"10.3201\/eid2802.204324","article-title":"Burden of Tick-Borne Encephalitis, Sweden","volume":"28","author":"D Slunge","year":"2022","journal-title":"Emerg Infect Dis"},{"key":"pone.0305120.ref011","unstructured":"The jamovi project (2022). jamovi. (Version 2.3) [Computer Software]. https:\/\/www.jamovi.org."},{"key":"pone.0305120.ref012","unstructured":"European Commission Decision 2002\/253\/EC of 19 March 2002. Laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119\/98\/EC of the European Parliament and of the Council. 2002. https:\/\/publications.europa.eu\/en\/publication-detail\/-\/publication\/ddee8c4e-4df7-4b41-b748-8dc6cb3b74b9\/language-en"},{"key":"pone.0305120.ref013","unstructured":"Central Statistical Bureau of Latvia. (http:\/\/data.csb.gov.lv\/pxweb\/lv\/Sociala\/Sociala__ikgad__iedz__iedzskaits\/IS0020.px\/table\/tableViewLayout2\/?rxid=09cbdccf-2334-4466-bdf7-0051bad1decd."},{"key":"pone.0305120.ref014","volume-title":"The TBE Book","author":"G Dobler","year":"2019","edition":"2"},{"key":"pone.0305120.ref015","unstructured":"Freimane Z, Zavadska D, Erber W, Schmitt HJ. Tick-borne encephalitis\u2013vaccination and disease severity: 12-year population based data of Latvia. Abstract from 38th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID), Netherlands (2020) p 220."},{"key":"pone.0305120.ref016","article-title":"Effectiveness of tick-borne encephalitis vaccination in Latvia, 2018\u20132020: an observational study","volume":"6","author":"D Zavadska","year":"2023","journal-title":"Clin Microbiol Infect"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0305120","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T17:54:11Z","timestamp":1717782851000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0305120"}},"subtitle":[],"editor":[{"given":"Md. 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