High burden of tick-borne encephalitis in Slovenia-Challenge for vaccination policyArchived
Slovenia is one of the countries with the highest reported incidence rates of tick-borne encephalitis (TBE). Vaccination uptake is low, estimated to be 12.4%. TBE surveillance data for the last 20 years were analysed.
Grgič-Vitek M, Klavs I.National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia.Vaccine. 2011 May 25. [Epub ahead of print]
Slovenia is one of the countries with the highest reported incidence rates of tick-borne encephalitis (TBE). Vaccination uptake is low, estimated to be 12.4%. TBE surveillance data for the last 20 years were analysed. Though nearly all of Slovenia is endemic for TBE with national yearly incidence rates up to 26.7/100,000, we showed that two regions (Gorenjska and Koroška) were much more affected than other seven regions, with annual incidence rates up to 57.2/100,000 and 76.9/100,000 population, respectively. In the last decade, there was a shift in the age distribution of reported TBE cases to the older age groups, which resulted in the highest age-specific incidence rates nationally in 55-64 age group (up to 33.4/100,000 in 2006). To reduce this high burden of TBE, ideally the whole population of Slovenia should be offered free of charge vaccination against TBE. Alternatively, in view of limited resources available, sensible approach would be increasing vaccination coverage of the general population using social marketing and increasing TBE awareness, and in addition, offering free of charge vaccination to the most affected groups. The following priority target groups should be considered to be prospectively covered with free of charge vaccination: (1) 45-69 years old individuals in the two most affected regions (Gorenjska, Koroška), (2) the remaining age groups in the two most affected regions, (3) 45-69 years old individuals in the region with the next highest TBE incidence rates (Ljubljana), and (4) individuals 45-69 years old in all remaining Slovenian regions.
VBORNET comment, 30/9/2011: This article reports the current TBE situation in Slovenia. Slovenia is one of the most affected countries in Europe and the regions of Gorenjska and Koroška show the highest incidence rates. Given this alarming situation the authors propose government subsidized vaccination of the entire population. Since this is unlikely to be implemented for a variety of reasons, the authors propose a mixed approach combining the free vaccination of age groups at risk in the two most affected regions and the country wide information of the general public to raise awareness. This is a nice example where spatial risk-maps databases may contribute to a better information of the public.