Systematic review on the non-vectorial transmission of Tick-borne encephalitis virus (TBEv)

Elisa Martello*, Emma L. Gillingham, Revati Phalkey, Constantine Vardavas, Katerina Nikitara, Tamas Bakonyi, Céline M. Gossner, Jo Leonardi-Bee

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Tick-borne encephalitis (TBE) is an infection caused by the Tick-borne encephalitis virus (TBEv) and it is common in Europe. The virus is predominantly transmitted by ticks, but other non-vectorial modes of transmission are possible. This systematic review synthesises the epidemiological impact of non-vectorial modes of TBEv transmission in Europe. 41 studies were included comprising of 1308 TBE cases. Alimentary (36 studies), handling infected material (3 studies), blood-borne (1 study), solid organ transplant (1 study) were identified as potential routes of TBEv transmission; however, no evidence of vertical transmission from mother to offspring was reported (2 studies). Consumption of unpasteurised milk/milk products was the most common vehicle of transmission and significantly increased the risk of TBE by three-fold (pooled RR 3.05, 95% CI 1.53 to 6.11; 4 studies). This review also confirms handling infected material, blood-borne and solid organ transplant as potential routes of TBEv transmission. It is important to tracing back to find the vehicle of the viral infection and to promote vaccination as it remains a mainstay for the prevention of TBE.

Original languageEnglish
Article number102028
JournalTicks and Tick-borne Diseases
Issue number6
Publication statusPublished - Nov 2022

Bibliographical note

Funding Information:
The authors thank the following colleagues from the ECDC for their help with translations of full text papers: Grazina Mirinaviciute, Boguslaw Andrzej Suski, and Barbora Kinross. The authors would also like to thank Johanna Takkinen for her comments on the project report.

Publisher Copyright:
© 2022


  • Alimentary
  • Blood-borne
  • Meta-analysis
  • TBE
  • Unpasteurized milk
  • Vertical transmission


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