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Tick-borne encephalitis (TBE)








Geographic Distribution						Print
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										General distribution of tick-borne encephalitis (TBE) virus: Country-specific risk information provided below the map
Map of Europe, Asia, and Africa**Country-specific risk information (as of November 12, 2023)**
*The information should be interpreted cautiously because TBE virus transmission can be highly variable within risk areas and from year to year. Additional information is available on websites or publications from national authorities in some TBE-endemic countries.*
Country
Risk informationCountry-specific risk information
Austria
Focally endemic throughout country. Highly endemic regions include Carinthia, Styria, Upper Austria, Salzburg, Tyrol, and Vorarlberg Provinces.Belarus
Almost all of the country considered endemic; no TBE virus detected in some small geographically dispersed areas.Belgium
Only three confirmed autochthonous cases ever reported; all occurred in 2020 and were from geographically dispersed areas.Bosnia and Herzegovina
Situation is unclear as very limited information is available. Fewer than 10 human cases reported. TBE virus previously isolated from ticks.Bulgaria
Cases only reported sporadically, but extent of underdiagnosis is unknown.China
About 90% of cases reported from northeastern China, with highest endemicity in Inner Mongolia Autonomous Region (Daxing’an Mountains), Heilongjiang Province (Xiaoxing’an Mountains), and Jilin Province (Changbai Mountains). Northwestern China in the Xinjiang Autonomous Region (Tianshan and Altai Mountains) and southwestern China in Yunnan and Tibet provinces also reported to have transmission. One U.S. traveler also previously infected in Tianjin Province.Croatia
Highest risk reported in northeastern and northwestern regions, with lower risk in central mountainous region and only sporadic cases reported from Adriatic coastal region. Most cases reported from Koprivnica-Krizevci, Medimurje, and Bjelovar-Bilogora counties.Czech Republic (Czechia)
Highly endemic and regularly among countries with highest reported incidence in Europe. Foci of transmission occur throughout country, with greatest risk reported from Southern Bohemian Region.Denmark
Endemic only on Bornholm, an island in the Baltic Sea. Very rare sporadic cases reported from other areas including from microfoci in North Zealand.Estonia
Highly endemic and regularly among countries with highest reported incidence in Europe. Endemic areas found throughout the country, with highest incidence in western part of country.Finland
TBE focally endemic and found particularly in some archipelago and coastal areas mostly in the southern part of the country. During 2016-2020, TBE incidence highest in the coastal municipalities of Pargas and Simo, in the Åland Islands, and in Kustavi; during this same period no TBE cases diagnosed in > 80% of Finnish municipalities. Based on local vaccination recommendations, the greatest risk is for persons resident during the transmission season in the Åland Islands, Pargas, Simo, southern parts of Kemi, the Kotka Archipelago, the Sammonlahti district of Lappeenranta, on the island of Preiskari close to Raahe, the Lohjanjärvi archipelago area, Kustavi, Luoma area in Kirkkonummi, and in part of the Sipoo archipelago (as of March 2021).France
Main endemic area is Alsace in the northeast and Auvergne-Rhône-Alpes region. In small number of additional locations mostly sporadic cases occur. French health authorities do not have recommendations for vaccination of the local population.Germany
Highest risk in southern part of Germany, with 80% to 90% cases reported from Baden-Wurttemberg and Bavaria. Other key risk areas include southern Hesse, southeastern Thuringia, southeastern Brandenburg, and Saxony. Additional localized areas of risk are in central Hesse, Saarland, Rhineland-Palatinate, Lower Saxony, and Saxony-Anhalt.Hungary
Highest incidence in the western (Transdanubian) and northern parts of country with much lower or no risk in most other areas.Italy
Risk primarily in the pre-alpine and alpine areas in the northeast including Veneto (mainly Belluno alps), Friuli-Venezia Giulia, and Trentino-South Tyrol also referred to as Trentino-Alto Adige (Bolanzo and Trento provinces) regions.Japan
Fewer than 10 TBE cases diagnosed during past 30 years, all in Hokkaido prefecture (island in northern Japan). No clear evidence of transmission in any other areas of Japan. Japanese health authorities do not have recommendations for vaccination of the local population.Kazakhstan
Main risk areas considered to be Almaty and East Kazakhstan regions, and the Sandyktau district of Akmola region. Rare sporadic cases reported from some other central and northern locations.Kyrgyzstan
Situation is unclear as very limited information is available. TBE virus-infected ticks and possible human case reported from Ala-Archa National Nature Park in Tian Shan mountains (Chüy Region).Latvia
Highly endemic and regularly among countries with highest reported incidence in Europe. Endemic areas are present throughout the country, with highest incidence in Kurzeme region in west and Vidzeme and Riga regions in central Latvia.Liechtenstein
TBE virus-infected ticks previously detected. Liechtenstein health authorities consider risk exists in entire country.Lithuania
Highly endemic and regularly among countries with highest reported incidence in Europe. Endemic areas present throughout country, with highest incidence in recent years in Utena County.Moldova
Situation is unclear as very limited information is available. TBE virus previously isolated from ticks.Mongolia
Main risk area in Selenge and Bulgan provinces in the north.Netherlands
First human cases identified in 2016, with sporadic cases from several different locations diagnosed since. Dutch health authorities do not have vaccination recommendations for local population.Norway
Coastal areas in southern Norway, specifically Agder and Vestfold and (og) Telemark Counties, considered endemic.Poland
Greater than 70% of reported cases diagnosed in Podlaskie and Warmian-Masurian provinces in northeast. Most of remainder of country has endemic foci.Romania
Only sporadic cases reported, but information limited and disease might be underdiagnosed.Russia
Endemic areas widespread across southern part of the non-tropical forest belt and variable incidence in different locations. As of 2019, 48 regions considered endemic. High transmission reported from southern parts of Western and Eastern Siberia and Southern Urals.Serbia
Low number of reported cases, but diagnostic testing not routinely conducted; cases reported from various locations including rural areas in the vicinity of Belgrade.Slovakia
Foci of transmission distributed throughout the country with higher risk areas in north and center, particularly Banská Bystrica, Žilina, and Trenčín regions.Slovenia
Highly endemic and regularly among countries with highest reported incidence in Europe. Cases reported from throughout the country with highest incidence in north and central regions.South Korea
No human cases reported; TBE virus detection in ticks and rodents only. South Korean health authorities do not have recommendations for vaccination of the local population.Sweden
Highly endemic in regions around Stockholm in the eastern part of south-central Sweden (Stockholm Archipelago, Malaren Lake, Uppsala and Sodermanland counties), with other main risk areas around lakes (i.e., Vanern, Vattern) in the south. There are other natural foci in southern and central parts of country.Switzerland
Entire country, except for cantons of Geneva and Ticino, considered at-risk. Higher risk in north-eastern, central, and midwestern regions of the country, with Thurgau canton considered highly endemic.Tunisia
TBE viral ribonucleic acid detected in one pool of ticks from northwestern Tunisia but local establishment of TBE virus not confirmed.Ukraine
Majority of infections during last 15 years reported from the Volyn region and Crimea. Other TBE foci detected throughout the country, including in the Rivne, Zhytomyr, Kyiv, Chernihiv and Carpathian regions.United Kingdom
Focally endemic in small number of areas. Three cases of probable or confirmed human disease reported from England since 2019 and one confirmed case likely acquired in Scotland reported in 2022. Infected ticks identified in Thetford Forest, Hampshire/Dorset border, New Forest, and New Yorkshire Moors. United Kingdom health authorities do not have recommendations for vaccination of the local population.
							
					
							Last Reviewed:  November 13, 2023						Source: 	Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD)
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