In reply to Anth.:
Everything you needed to know about the changing incidence of tickborne encephalitis in Europe - and then some...
The recorded incidence of tickborne encephalitis (TBE) in Europe and Russia has changed over the past two decades, but the geographical pattern of change is heterogeneous (1).
The most dramatic changes of all were the sudden increases in 1992-3 in Latvia, Lithuania, Poland and Belarus, and also in Estonia, Germany, the Czech Republic, and Slovakia (2).
TBE cases have increased steadily since the mid-1970s in Russia, and since the mid-1980s in Switzerland, Sweden, and Finland. Since 1997, the first cases have appeared in Norway. Along the southern edge of the virus's range, in Slovenia, Croatia and Hungary, incidence has fluctuated and shown no consistent trend apart from signs of decreasing over the past 4-5 years. In Austria, the only country with extensive systematic vaccination coverage, TBE incidence has decreased progressively since the early 1980s.
To understand the causes we must take a pan-European view of changing climate and other environmental factors, socio-political systems and public health services, and expect to identify combinations of biological and non-biological factors specific to each country. Continental scale multi-temporal data on environmental conditions, remotely sensed from meteorological satellites, have given us predictive risk maps and allowed insight into the climatic determinants of the rates of contact between humans and infected ticks (3). Most obviously, development and death rates that determine the distribution and abundance of ticks are sensitive to changes in climate, and also to habitat structure and the availability of hosts, particularly the larger species, commonly ungulates, upon which all three life stages of vector ticks feed. Climate is also critical in determining the seasonality of activity. Warmer weather in spring and autumn may permit longer activity seasons for both ticks and humans, likely to be most important in northern regions such as Scandinavia, where prolonged low temperatures are limiting factors for tick development and activity. This may have contributed to the spread of ticks and TBE to new parts of Sweden (1) and the recent appearance of cases of TBE in Norway.
The circulation of tickborne pathogens themselves depends on more subtle environmental variables. We now understand that the force of TBE virus transmission, and therefore the infection prevalence in tick populations, depends on the degree of seasonal overlap between larval and nymphal ticks (4). For persistent cycles, the relatively few infected nymphs must transmit the virus to the more numerous larvae as they feed together on rodents (5). This is associated with particular seasonal profiles of ground temperature, which explains the focal nature of TBE despite the wider distribution of competent ticks species, principally Ixodes ricinus and I. persulcatus. In some parts of Europe, climate change may disrupt the delicate balance between tick demographic patterns and the TBE virus transmission route, especially where increasingly warm and dry summers impose high mortality on ticks (6). This seems to account for the decline in TBE incidence along the southern boundary in Slovenia, Croatia and Hungary.
Superimposed on these biological phenomena are non-biological factors that can vary much more suddenly and are therefore likely to result in dramatic changes in disease incidence. Most striking is the coincidence of the abrupt 1992/93 increases in TBE with the end of the communist era in eastern Europe. This was accompanied by altered patterns in human behaviour involving agricultural practices, and the greater use of tick infested habitats for work, food harvest and leisure activities. Further complicating factors are various public health activities, including improved surveillance, diagnosis, vaccination, awareness and avoidance. The history of TBE incidence in Russia illustrates the interplay of non-biological factors well (7). High recorded incidence in the 1950s and 1960s is ascribed to expanding industries (for example, timber) in the forest zone, together with improved diagnostics. There followed a period of aggressive control of ticks by DDT spraying, achieving progressive decrease in incidence until the early 1970s. Vector control then ceased, and by 1990 TBE cases were back to their 1960s level. The final upsurge over the 1990s occurred as a greater proportion of city dwellers were exposed to ticks in their garden plots and dachas, and as laboratory diagnosis of TBE improved further.
Biologically, tickborne diseases are amongst the most complex of infectious disease systems and the observed epidemiological heterogeneity, in both space and time, should therefore come as no surprise. Many of the above factors are not defined by national borders, and so there have been regional shifts in the incidence of TBE within countries as well as differential changes between countries. Analysis on different spatial scales, local, regional, national and continental, will help us to disentangle the environmental from the sociological causes. Satellites offer us one vital truly international tool to help achieve this by revealing changing environmental conditions over the same spatial scales.
References:
1. International Scientific Working Group on Tick-Borne Encephalitis. TBE cases. 2000.Available from:
http://www.tbe-info.com/epidemiology/index.html
2. Skarpaas T, Sundøy A, Bruu AL, Vene S, Pedersen J, Eng PG, et al. Skogflattencefalitt i Norge. Tidsskr Nor Loegeforen 2002; 122: 30-2.
3. Hay SI, Randolph SE, Rogers DJ, eds. Remote sensing and geographical information systems in epidemiology. London: Academic Press, 2000.
4. Randolph SE, Green RM, Peacey MF, Rogers DJ. Seasonal synchrony: the key to tick-borne encephalitis foci identified by satellite data. Parasitology 2000; 121: 15-23.
5. Randolph SE, Miklisová D, Lysy J, Rogers DJ, Labuda M. Incidence from coincidence: patterns of tick infestations on rodents facilitate transmission of tick-borne encephalitis virus. Parasitology 1999; 118: 177-86.
6. Randolph SE, Rogers DJ. Fragile transmission cycles of tick-borne encephalitis virus may be disrupted by predicted climate change. Proc Roy Soc Lond B 2000; 267: 1741-44.
7. Korenberg EI, Kovaleskii YV. Main features of tick-borne encephalitis eco-epidemiology in Russia. Zentralbl Bakteriol 1999; 289: 525-39.
Reported by Sarah Randolph Department of Zoology, University of Oxford, England.