{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:42:00Z","timestamp":1787164920038,"version":"build-2736575974"},"reference-count":38,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2023,9,25]],"date-time":"2023-09-25T00:00:00Z","timestamp":1695600000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Tick-borne diseases (TBD) are endemic in Europe. However, surveillance is currently incomplete. Alternative strategies need to be considered. The aim of this study was to test an Emergency Department Syndromic Surveillance (EDSyS) system as a complementary data source to describe the impact of tick bites and TBD using a small-area analysis approach and to monitor the risk of TBD to target prevention. ED databases in the Local Health Authority 8 District (Veneto, Italy) were queried for tick-bite and TBD-related visits between January 2017 and December 2022. Hospitalisations were also collected. Events involving the resident population were used to calculate incidence rates. A total of 4187 ED visits for tick-bite and 143 for TBD were recorded; in addition, 62 TBD-related hospitalisations (of which 72.6% in over 50 s and 22.6% in over 65 s). ED visits peaked in spring and in autumn, followed by a 4-week lag in the increase in hospital admissions. The small-area analysis identified two areas at higher risk of bites and TBD. The use of a EDSyS system allowed two natural foci to be identified. This approach proved useful in predicting temporal and geographic risk of TBD and in identifying local endemic areas, thus enabling an effective multidisciplinary prevention strategy.<\/jats:p>","DOI":"10.3390\/ijerph20196822","type":"journal-article","created":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T03:45:23Z","timestamp":1695699923000},"page":"6822","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Emergency Department Syndromic Surveillance to Monitor Tick-Borne Diseases: A 6-Year Small-Area Analysis in Northeastern Italy"],"prefix":"10.3390","volume":"20","author":[{"given":"Massimiliano","family":"Colucci","sequence":"first","affiliation":[{"name":"Hospital Direction, Local Health Authority 8 (Azienda ULSS Berica), Veneto Region, 36100 Vicenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9561-0711","authenticated-orcid":false,"given":"Marco","family":"Fonzo","sequence":"additional","affiliation":[{"name":"Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liana","family":"Miccolis","sequence":"additional","affiliation":[{"name":"Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4954-5848","authenticated-orcid":false,"given":"Irene","family":"Amoruso","sequence":"additional","affiliation":[{"name":"Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Mondino","sequence":"additional","affiliation":[{"name":"Hospital Direction, Local Health Authority 8 (Azienda ULSS Berica), Veneto Region, 36100 Vicenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0764-1084","authenticated-orcid":false,"given":"Andrea","family":"Trevisan","sequence":"additional","affiliation":[{"name":"Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romina","family":"Cazzaro","sequence":"additional","affiliation":[{"name":"Hospital Direction, Local Health Authority 8 (Azienda ULSS Berica), Veneto Region, 36100 Vicenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7375-9187","authenticated-orcid":false,"given":"Tatjana","family":"Baldovin","sequence":"additional","affiliation":[{"name":"Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4040-8601","authenticated-orcid":false,"given":"Chiara","family":"Bertoncello","sequence":"additional","affiliation":[{"name":"Hygiene and Public Health Unit, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1007\/s00436-022-07445-3","article-title":"The evolving story of Borrelia burgdorferi sensu lato transmission in Europe","volume":"121","author":"Steinbrink","year":"2022","journal-title":"Parasitol. Res."},{"key":"ref_2","first-page":"2200543","article-title":"Spatiotemporal spread of tick-borne encephalitis in the EU\/EEA, 2012 to 2020","volume":"28","author":"Dias","year":"2023","journal-title":"Eurosurveillance"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Kunze, M., Banovi\u0107, P., Bogovi\u010d, P., Briciu, V., \u010civljak, R., Dobler, G., Hristea, A., Kerlik, J., Kuivanen, S., and Kyn\u010dl, J. (2022). Recommendations to Improve Tick-Borne Encephalitis Surveillance and Vaccine Uptake in Europe. Microorganisms, 10.","DOI":"10.3390\/microorganisms10071283"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1089\/vbz.2022.0070","article-title":"Incidence of Lyme Borreliosis in Europe: A Systematic Review (2005\u20132020)","volume":"23","author":"Burn","year":"2023","journal-title":"Vector-Borne Zoonotic Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1089\/vbz.2022.0069","article-title":"Seroprevalence of Lyme Borreliosis in Europe: Results from a Systematic Literature Review (2005\u20132020)","volume":"23","author":"Burn","year":"2023","journal-title":"Vector-Borne Zoonotic Dis."},{"key":"ref_6","first-page":"74","article-title":"An estimate of Lyme borreliosis incidence in Western Europe","volume":"39","author":"Sykes","year":"2016","journal-title":"J. Public Health"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"H\u00f6nig, V., \u0160vec, P., Marek, L., Mrkvi\u010dka, T., Dana, Z., Wittmann, M., Masa\u0159, O., Szturcov\u00e1, D., R\u016f\u017eek, D., and Pfister, K. (2019). Model of Risk of Exposure to Lyme Borreliosis and Tick-Borne Encephalitis Virus-Infected Ticks in the Border Area of the Czech Republic (South Bohemia) and Germany (Lower Bavaria and Upper Palatinate). Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16071173"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e2470","DOI":"10.1002\/rmv.2470","article-title":"Tick-borne encephalitis: A comprehensive review of the epidemiology, virology, and clinical picture","volume":"33","author":"Chiffi","year":"2023","journal-title":"Rev. Med. Virol."},{"key":"ref_9","unstructured":"Erber, W., Schmitt, H.J., Vukovic, J.T., Dobler, G., and Broker, M. (2019). The TBE Book, Global Health Press."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1159\/000503236","article-title":"Do We Know the True Burden of Tick-Borne Encephalitis? A Cross-Sectional Study","volume":"54","author":"Cocchio","year":"2020","journal-title":"Neuroepidemiology"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Rossi, B., Barreca, F., Benvenuto, D., Braccialarghe, N., Campogiani, L., Lodi, A., Aguglia, C., Cavasio, R.A., Giacalone, M.L., and Kontogiannis, D. (2023). Human Arboviral Infections in Italy: Past, Current, and Future Challenges. Viruses, 15.","DOI":"10.3390\/v15020368"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1089\/vbz.2022.0051","article-title":"Estimated Number of Symptomatic Lyme Borreliosis Cases in Adults in Finland in 2021 Using Seroprevalence Data to Adjust the Number of Surveillance-Reported Cases: A General Framework for Accounting for Underascertainment by Public Health Surveillance","volume":"23","author":"Olsen","year":"2023","journal-title":"Vector-Borne Zoonotic Dis."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Blanchard, L., Jones-Diette, J., Lorenc, T., Sutcliffe, K., Sowden, A., and Thomas, J. (2022). Comparison of national surveillance systems for Lyme disease in humans in Europe and North America: A policy review. BMC Public Health, 22.","DOI":"10.1186\/s12889-022-13669-w"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Hussain, S., Hussain, A., Aziz, U., Song, B., Zeb, J., George, D., Li, J., and Sparagano, O. (2021). The Role of Ticks in the Emergence of Borrelia burgdorferi as a Zoonotic Pathogen and Its Vector Control: A Global Systemic Review. Microorganisms, 9.","DOI":"10.3390\/microorganisms9122412"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"102174","DOI":"10.1016\/j.tmaid.2021.102174","article-title":"Vector-borne and zoonotic infections and their relationships with regional and socioeconomic statuses: An ID-IRI survey in 24 countries of Europe, Africa and Asia","volume":"44","author":"Saydam","year":"2021","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s12942-018-0163-7","article-title":"An updated meta-analysis of the distribution and prevalence of Borrelia burgdorferi s.l. in ticks in Europe","volume":"17","author":"Cutler","year":"2018","journal-title":"Int. J. Health Geogr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"101972","DOI":"10.1016\/j.ttbdis.2022.101972","article-title":"The epidemiology of infectious diseases in Europe in 2020 versus 2017\u20132019 and the rise of tick-borne encephalitis (1995\u20132020)","volume":"13","author":"Jenkins","year":"2022","journal-title":"Ticks Tick-Borne Dis."},{"key":"ref_18","unstructured":"Della Salute, M. (2023, July 21). Piano Nazionale di Prevenzione, Sorveglianza e Risposta Alle Arbovirosi (PNA) 2020\u20132025. (Italian Ministry of Health. National Plan for Prevention, Surveillance and Response to Arboviruses 2020\u20132025), Available online: https:\/\/www.salute.gov.it\/portale\/documentazione\/p6_2_2_1.jsp?id=2947&lingua=italiano."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1111\/zph.12361","article-title":"Tick bite and Lyme disease-related emergency department encounters in New Hampshire, 2010\u20132014","volume":"64","author":"Daly","year":"2017","journal-title":"Zoonoses Public Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"102185","DOI":"10.1016\/j.ttbdis.2023.102185","article-title":"Tick-borne diseases under the radar in the North Sea Region","volume":"14","author":"Quarsten","year":"2023","journal-title":"Ticks Tick-Borne Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1089\/vbz.2022.0067","article-title":"The Landscape of Lyme Borreliosis Surveillance in Europe","volume":"23","author":"Nagarajan","year":"2023","journal-title":"Vector-Borne Zoonotic Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2200666","DOI":"10.2807\/1560-7917.ES.2023.28.26.2200666","article-title":"VectorNet: Collaborative mapping of arthropod disease vectors in Europe and surrounding areas since 2010","volume":"28","author":"Wint","year":"2023","journal-title":"Euro. Surveill."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"101486","DOI":"10.1016\/j.ttbdis.2020.101486","article-title":"Investigating novel approaches to tick-borne encephalitis surveillance in Sweden, 2010-2017","volume":"11","author":"Martin","year":"2020","journal-title":"Ticks Tick-Borne Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.ttbdis.2014.07.022","article-title":"Monitoring human tick-borne disease risk and tick bite exposure in Europe. Available tools and promising future methods","volume":"5","author":"Almeras","year":"2014","journal-title":"Ticks Tick-Borne Dis."},{"key":"ref_25","unstructured":"Ricc\u00f2, M. (2021). Epidemiology of Tick-borne encephalitis in North-Eastern Italy (2017\u20132020): International insights from national notification reports. Acta Biomed. Atenei. Parm., 92."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"101257","DOI":"10.1016\/j.ttbdis.2019.07.001","article-title":"Lyme borreliosis incidence in Lombardy, Italy (2000\u20132015): Spatiotemporal analysis and environmental risk factors","volume":"10","author":"Zanzani","year":"2019","journal-title":"Ticks Tick-Borne Dis."},{"key":"ref_27","unstructured":"European Centre for Disease Prevention and Control (2018). Synergies in Community and Institutional Public Health Emergency Preparedness for Tick-Borne Diseases in the Netherlands: A Case Study on Tick-Borne Encephalitis and Lyme Borreliosis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e101","DOI":"10.1017\/S0950268819000074","article-title":"Syndromic surveillance: Two decades experience of sustainable systems\u2014Its people not just data!","volume":"147","author":"Smith","year":"2019","journal-title":"Epidemiol. Infect."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3S","DOI":"10.1177\/0033354917708995","article-title":"Using Syndromic Surveillance for All-Hazards Public Health Surveillance, Successes, Challenges, and the Future","volume":"132","author":"Yoon","year":"2017","journal-title":"Public Health Rep."},{"key":"ref_30","unstructured":"ISTAT (2023, July 21). Principali Statistiche Geografiche Sui Comuni 2023. Available online: https:\/\/www.istat.it\/it\/archivio\/156224."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1111\/zph.12810","article-title":"Human-tick encounters as a measure of tickborne disease risk in lyme disease endemic areas","volume":"68","author":"Hook","year":"2021","journal-title":"Zoonoses Public Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"612","DOI":"10.15585\/mmwr.mm7017a2","article-title":"Emergency Department Visits for Tick Bites\u2014United States, January 2017\u2013December 2019","volume":"70","author":"Marx","year":"2021","journal-title":"MMWR. Morb. Mortal. Wkly. Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2251","DOI":"10.1017\/S0950268816000686","article-title":"The use of syndromic surveillance to monitor the incidence of arthropod bites requiring healthcare in England, 2000\u20132013: A retrospective ecological study","volume":"144","author":"Newitt","year":"2016","journal-title":"Epidemiol. Infect."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"101628","DOI":"10.1016\/j.ttbdis.2020.101628","article-title":"Emergence of Lyme borreliosis in the province of Verona, Northern Italy: Five-years of sentinel surveillance","volume":"12","author":"Beltrame","year":"2021","journal-title":"Ticks Tick-Borne Dis."},{"key":"ref_35","unstructured":"del Veneto, R. (2023, July 21). Bur n. 53 of 24 May 2019. Deliberation of the Regional Council no. 612 of 14 May 2019. Approval of the Technical Document \u201cVaccination against Tick Borne Encephalitis (TBE) in the Veneto Region\u201d and Amendment of the \u201cRegional Vaccination Tariff\u201d, Connected to the \u201cSingle Regional Tariff for Services Rendered by the Prevention Departments of the Veneto Local Health Units\u201d, in the Part Relating to the Offer of Tick-Borne Encephalitis (TBE) Vaccination. Available online: https:\/\/bur.regione.veneto.it\/BurvServices\/pubblica\/DettaglioDgr.aspx?id=394640."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Hansen, M.F., S\u00f8rensen, P.K., S\u00f8rensen, A.E., and Krogfelt, K.A. (2023). Can protection motivation theory predict protective behavior against ticks?. BMC Public Health, 23.","DOI":"10.1186\/s12889-023-16125-5"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1128142","DOI":"10.3389\/fphar.2023.1128142","article-title":"The history of Lyme disease in Italy and its spread in the Italian territory","volume":"14","author":"Trevisan","year":"2023","journal-title":"Front. Pharmacol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.pt.2023.02.005","article-title":"Biodiversity in the Lyme-light: Ecological restoration and tick-borne diseases in Europe","volume":"39","author":"Holding","year":"2023","journal-title":"Trends Parasitol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/19\/6822\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:57:47Z","timestamp":1760129867000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/19\/6822"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,25]]},"references-count":38,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["ijerph20196822"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20196822","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,25]]}}}