{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:53:39Z","timestamp":1791910419559,"version":"4.3.4"},"reference-count":72,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2019,3,29]],"date-time":"2019-03-29T00:00:00Z","timestamp":1553817600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>We reviewed tick-borne encephalitis (TBE) surveillance and epidemiology in Germany, as these underlie public health recommendations, foremost vaccination. We performed descriptive analyses of notification data (2001\u20132018, n = 6063) according to region, demographics and clinical manifestations and calculated incidence trends using negative binomial regression. Risk areas were defined based on incidence in administrative districts. Most cases (89%) occurred in the federal states of Baden-Wurttemberg and Bavaria, where annual TBE incidence fluctuated markedly between 0.7\u20132.0 cases\/100,000 inhabitants. A slight but significantly increasing temporal trend was observed from 2001\u20132018 (age-adjusted incidence rate ratio (IRR) 1.02 (95% confidence interval (CI): 1.01\u20131.04)), primarily driven by high case numbers in 2017\u20132018. Mean incidence was highest in 40\u201369-year-olds and in males. More males (23.7%) than females (18.0%, p = 0.02) had severe disease (encephalitis or myelitis), which increased with age, as did case-fatality (0.4% overall; 2.1% among \u226570-year-olds). Risk areas increased from 129 districts in 2007 to 161 in 2019. Expansion occurred mainly within existent southern endemic areas, with slower contiguous north-eastern and patchy north-western spread. Median vaccination coverage at school entry in risk areas in 2016\u20132017 ranged from 20%\u201341% in 4 states. Increasing TBE vaccine uptake is an urgent priority, particularly in high-incidence risk areas.<\/jats:p>","DOI":"10.3390\/pathogens8020042","type":"journal-article","created":{"date-parts":[[2019,3,29]],"date-time":"2019-03-29T13:09:58Z","timestamp":1553864998000},"page":"42","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":68,"title":["Epidemiology of Tick-Borne Encephalitis (TBE) in Germany, 2001\u20132018"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8563-3629","authenticated-orcid":false,"given":"Wiebke","family":"Hellenbrand","sequence":"first","affiliation":[{"name":"Immunization Unit, Robert Koch Institute, Seestra\u00dfe 10, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2930-8095","authenticated-orcid":false,"given":"Teresa","family":"Kreusch","sequence":"additional","affiliation":[{"name":"Immunization Unit, Robert Koch Institute, Seestra\u00dfe 10, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merle","family":"B\u00f6hmer","sequence":"additional","affiliation":[{"name":"Department for Infectious Disease Epidemiology, Bavarian Health and Food Safety Authority, Veterinaerstr. 2, 85764 Oberschleissheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiane","family":"Wagner-Wiening","sequence":"additional","affiliation":[{"name":"State Health Office Baden-Wuerttemberg, Nordbahnhofstr. 135, 70191 Stuttgart, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard","family":"Dobler","sequence":"additional","affiliation":[{"name":"Bundeswehr Institute of Microbiology, Neuherbergstrasse 11, 80937 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2353-7188","authenticated-orcid":false,"given":"Ole","family":"Wichmann","sequence":"additional","affiliation":[{"name":"Immunization Unit, Robert Koch Institute, Seestra\u00dfe 10, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doris","family":"Altmann","sequence":"additional","affiliation":[{"name":"Infectious Disease Data Science Unit, Robert Koch Institute, Seestra\u00dfe 10, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,3,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.1016\/S0140-6736(08)60800-4","article-title":"Tick-borne encephalitis","volume":"371","author":"Lindquist","year":"2008","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.tmaid.2010.06.004","article-title":"Tick-borne encephalitis: Pathogenesis and clinical implications","volume":"8","author":"Dobler","year":"2010","journal-title":"Travel Med. 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