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The probability of infection in the UK population is considered very low. Question 8. Will there be human exposure? Yes (high-risk groups) In addition, PHE’s Rare and Imported Pathogens Laboratory is also evaluating different diagnostic tests and will be developing a specific set of guidance for the investigation and management of Lyme disease in the UK. Prevention of Lyme disease is one of the most effective ways of managing this infection. PHE is also working towards raising awareness of the signs and symptoms of Lyme disease among GPs and other healthcare professionals. There were 998 provisional cases of Lyme disease reported to PHE in England and Wales in 2012 – a similar number of cases as was reported in 2011. However, not all cases of Lyme disease are confirmed by laboratory testing and, as in previous years, the overall number of Lyme disease cases in England and Wales is estimated at between 2,000 and 3,000 cases a year. Incidence of Lyme disease acquired in England and Wales remains low compared to some other European countries or in North America.
Following an asymptomatic interval of around 7 days, there is a second clinical phase involving the CNS with presentations such as meningitis, meningoencephalitis, myelitis, paralysis and radiculitis ( 4). In the UK, a licensed TBE vaccine is available and is currently recommended only for those ‘at high risk of exposure to the virus’, through travel to endemic areas or employment ( 41 to 43). The Joint Committee on Vaccination and Immunisation ( JCVI) has been asked to consider whether vaccination of high-risk groups such as forestry workers is warranted at this stage, while further studies looking for evidence of human exposure or infection are undertaken. Outcome of probability assessment
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note 1] This question has been added to differentiate between those infections causing severe disease in a handful of people and those causing severe disease in larger numbers of people. ‘Significant’ is not quantified in the algorithm but has been left open for discussion and definition within the context of the risk being assessed. Question 9. Are effective interventions available? Yes Approximately two-thirds of human TBEV infections are subclinical, but the clinical spectrum ranges from mild disease (non-specific febrile illness) to CNS involvement (for example, meningitis, severe meningoencephalitis with or without paralysis). Symptomatic infection can occur in all age groups, and is often more severe in adults, especially the elderly. The TBEV-Eur subtype is associated with milder disease compared to the other 2 virus subtypes.
Recent evidence of TBEV transmission in the Netherlands highlights that climatic and other environmental factors may have an impact on changing viral distribution to parts of western Europe. Is the disease endemic in the UK? Outcome Some people with severe symptoms will be referred to a specialist in hospital so antibiotics can be given directly into a vein.
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Climate change models also suggested a northern spread of TBEV in Europe ( 37). Will there be human exposure? Outcome Wow! There is some VERY bad information in these comments. It’s almost so bad, if I was the author of this article, I’d turn the comments off. Here’s some TRUTH for those that care to learn: The probability of infection in the UK population is considered very low. Question 6. Are effective measures in place to mitigate against these? Yes A third case, positive by PCR, was reported in England in September 2022, with infection likely to have been acquired in Scotland in June 2022. A fourth case, also positive by PCR, was reported in England in October 2022, with a likely exposure while visiting the North Yorkshire Moors. The FSA has assessed the risk of infection with TBEV to consumers in these areas ( 51), as follows:
It is not ubiquitous across the UK. Go to question 5. (Outcome) Question 5. Are there routes of introduction into animals in the UK? Yes The scale of harm caused by the infectious threat in terms of morbidity and mortality depends on spread, severity, availability of interventions and context. The disease is caused by corkscrew-shaped bacteria, called spirochaetes, belonging to the genus Borrelia - hence the other name of the disease, Lyme borreliosis. Some human cases have been associated with consumption of unpasteurised milk or milk products from infected animals ( 13 to 15). TBEV is rarely transmitted from human to human via transplant ( 16), blood transfusion or breastfeeding ( 17). Animal studies have shown the potential for vertical transmission from an infected mother to the foetus ( 18). Infection has also been acquired accidentally in laboratories ( 19). Low for high risk groups (defined risk areas only). Step 2. Assessment of the impact on human healthEuropean Food Safety Authority. Scientific Opinion on the public health risks related to the consumption of raw drinking milk. EFSA Journal. 2015; 13(1):3940. TBE typically follows a biphasic course; a viraemic phase with flu-like symptoms, followed by a period of quiescence, then the second phase with CNS involvement. Ixodes ricinus can take up to six years to complete its life cycle, although more typically two or three. It spends much of this time on the ground between feeds.
Travel-related TBE cases are occasionally diagnosed in the UK – 7 confirmed cases were reported between 2014 and 2018 ( 28).A few people who are diagnosed and treated for Lyme disease continue to have symptoms, like tiredness, aches and loss of energy, that can last for years. I. ricinus is the primary vector for the TBEV-Eur transmission to humans, although foodborne transmission (mainly through contaminated unpasteurised milk) is occasionally reported ( 13 to 15). For zoonoses or vector-borne disease, is the animal host or vector present in the UK? Outcome
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