Spiroplasma spp. A variant of the TBEV, Louping Ill virus causes acute encephalomyelitis, resulting in severe illness and death in livestock, especially sheep and red grouse . Cite this article. from transmissible spongiform encephalopathy brains or ticks induce spongiform encephalopathy in ruminants. Clin Infect Dis. Lyme borreliosis (LB) and other Ixodes ricinus-borne diseases (TBDs) are diseases that emerge from interactions of humans and domestic animals with infected ticks in nature. 2001;345(2):85–92. Diuk-Wasser MA, Vannier E, Krause PJ. Questing ticks cling to a host animal as the animal passes through vegetation. Please enable it to take advantage of the complete set of features! 1996;34(1):1–9. Ideally, one would like to have a single vaccine for humans, protecting against multiple TBDs . 2013;26(4):657–702. Biol Rev Camb Philos Soc. Microbes Infect. This method becomes less efficien… HS and JWH initiated the review and drafted the outline. A future challenge is to integrate the risk of TBDs, but also of wildlife- and other vector-borne diseases, into the ‘Health in All Policies’ in local nature organizations, such as Municipal Health Services and nature owners, but also governmental institutions and (inter)national organizations responsible for nature and health. Kauppi PE, Ausubel JH, Fang J, Mather AS, Sedjo RA, Waggoner PE. Uspensky I. Ticks as the main target of human tick-borne disease control: Russian practical experience and its lessons. http://ec.europa.eu/environment/nature. Jahfari S, Coipan EC, Fonville M, van Leeuwen AD, Hengeveld P, Heylen D, et al. The burden of Lyme borreliosis expressed in disability-adjusted life years. A culture-proven EM (diameter ~6 cm) on the leg of a 62-year-old female. 2012;139(7):847–63. 2017;17(2):108–15. The host range of some pathogens, for example B. lusitaniae and A. phagocytophilum ecotype II, is relatively small with only a few vertebrate species being able to act as amplifying hosts, whereas the host range of others, such as B. afzelii and A. phagocytophilum ecotype I, is much broader. Parasit Vectors. N Engl J Med. Tijsse-Klasen E, Sprong H, Pandak N. Co-infection of Borrelia burgdorferi sensu lato and Rickettsia species in ticks and in an erythema migrans patient. Recurrent bacteremia also occurs in sheep, which remain infected persistently with A. phagocytophilum . Clin Infect Dis. Am J Pathol. 2013;2(3):607–20. Differential antagonism of human innate immune responses by tick-borne Phlebovirus nonstructural proteins. Clinical representation of an EM, the most common manifestation of LB. Flagging or dragging cloth across vegetation is a common method used to sample areas for ticks. Ixodes ricinus is an important disease vector in Europe. A vaccine protecting against LB is currently unavailable in Europe, but a potential vaccine has recently been tested in a Phase I/II trial [208, 209], and another LB vaccine is being developed for the European market as well . This rising concern for TBDs has contributed to the formation of LB interest groups in many European countries, who actively seek public and political awareness, particularly for LB. INTRODUCTION. Evidence for personal protective measures to reduce human contact with blacklegged ticks and for environmentally based control methods to suppress host-seeking blacklegged ticks and reduce infection with Lyme disease spirochetes in tick vectors and rodent reservoirs. J Infect Dis. is the main vector of the disease in Europe and to a less extend in Asia , while . in ticks Ixodes ricinus and mosquitoes Aedes spp. A major advantage of environmental-based control options is that most of them can readily be applied in various practical situations, as they involve existing nature management options, such as mowing, grazing or fencing . Variable major proteins as targets for specific antibodies against Borrelia miyamotoi. Parasit Vectors. PubMed Diagnosis of human granulocytic anaplasmosis in Belgium by combining molecular and serological methods. Lancet. J Environ Manag. fever, flu-like symptoms) arise, accompanied by nausea, vomitus, abdominal pain and arthralgia in approximately one-third of the patients. Beall MJ, Chandrashekar R, Eberts MD, Cyr KE, Diniz PP, Mainville C, et al. In Africa, diminazene aceturate is frequently used to treat bovine babesiosis caused by B. bovis or B. bigemina, but this product is not available in Europe . 2015;163(2):91–8. These complaints are often long-lasting and can even be debilitating. 2010;8(1):33–50. 2000;267(1454):1741–4. 2010;17(4):357–61. Light micrograph of the tick Ixodes ricinus, principal vector of Lyme disease in Europe. In contrast, culling or fencing out deer decreases the risk for TBDs under specific conditions, but may have adverse effects on biodiversity or may be societally unacceptable. Neurology. 2001;58(9):1345–7. 2014;2(6):177–8. Clinical manifestations, pathogenesis, and effect of antibiotic treatment on Lyme borreliosis in dogs. 3):s247–52. Most additional targeted diagnostic tests in TBDs are either in the experimental phase or not widely validated (molecular tests), based on cross-reactivity between other species (serology), time-consuming, or difficult to perform and requiring a high level of expertise (cultures) [171,172,173]. 4. Not all ticks are infected – infection rate in any place in the UK varies from zero to about 15% 3. Aguero-Rosenfeld ME, Horowitz HW, Wormser GP, McKenna DF, Nowakowski J, Munoz J, et al. Arch Intern Med. European Centre for Disease Prevention and Control. Food allergy to the carbohydrate galactose-alpha-1,3-galactose (alpha-gal): four case reports and a review. Chang YF, Ku YW, Chang CF, Chang CD, McDonough SP, Divers T, et al. Public health. 2007;13(9):1405–7. Zintl A, Mulcahy G, Skerrett HE, Taylor SM, Gray JS. Combining them, and investing in fundamental as well as translational research, to be able to formulate (evidence-based) strategies on the control of TBDs might prove to be the way forward. Rickettsia monacensis infection is even less defined, although culture, molecular and serological evidence of human exposure has been reported [127,128,129]. Driving forces for changes in geographical distribution of Ixodes ricinus ticks in Europe. Deplazes PEJ, Mathis A, von Samson-Himmelstjerna G, Zahner H. Parasitology in Veterinary Medicine. 1998;182(4):801–9. Prevalence and spectrum of residual symptoms in Lyme neuroborreliosis after pharmacological treatment: a systematic review. Ticks Tick Borne Dis. It can also transmit other Borrelia species, including Borrelia miyamotoi. Babesia divergens is the causal agent of bovine babesiosis in Europe. The ‘Health in All Policies’ approach integrates and articulates many health considerations, far broader than infectious diseases alone, into policymaking across sectors. 2017;284:20170453. Whether anti-tick vaccines can also be used to (locally) eradicate I. ricinus populations and prevent human TBDs is difficult to predict due to its very large host range, yet is a topic of investigation . Specific associations have also been found between vertebrates and Borrelia genospecies. 2006;43(9):1089–134. 2009;15(10):1671–3. Parasit Vectors. Charrel RN, Attoui H, Butenko AM, Clegg JC, Deubel V, Frolova TV, et al. Decrease in tick bite consultations and stabilization of early Lyme borreliosis in the Netherlands in 2014 after 15 years of continuous increase. Ticking the right boxes: classification of patients suspected of Lyme borreliosis at an academic referral center in the Netherlands. 2012;366(25):2397–407. Am J Clin Pathol. 2014;21(11):1490–9. 2011;4:17. It is important to realize, however, that these spaces may also enhance opportunities for contact between humans and I. ricinus, posing risks for acquiring TBDs [38, 48,49,50]. Bonnet S, Jouglin M, L'Hostis M, Chauvin A. Babesia sp. 2006;103(46):17574–9. N Engl J Med. 2006;25(7):426–32. The strategy behind these vaccines is to locally control Rhipicephalus (Boophilus) tick species, and act as a safe and environmentally friendly alternative to acaricides [214, 215]. The lymphocyte transformation test for the diagnosis of Lyme borreliosis has currently not been shown to be clinically useful. 1994;740:146–56. 2018; https://doi.org/10.1016/j.pt.2017.12.006. Ann Agric Environ Med. Indeed, the number of studies describing infections and disease cases involving these agents is accumulating in the literature [10,11,12,13,14,15,16,17]. PLoS One. [Ixodes ricinus, transmitted diseases and reservoirs]. Nevertheless, in some situations testing for LB is discouraged altogether, specifically when the patient is clinically diagnosed with an EM. Species Affected I. ricinus can be found on a … J Clin Microbiol. 2001;161(4):554–61. Infections with B. garinii appear to be latent in thrushes (Turdus iliacus) for several months, but can then be reactivated by physiological cues . Surveillance perspective on Lyme borreliosis across the European Union and European Economic Area. Jahfari S, Hofhuis A, Fonville M, van der Giessen J, van Pelt W, Sprong H. Molecular Detection of tick-borne pathogens in humans with tick bites and erythema migrans, in the Netherlands. Arch Neurol. PLoS Negl Trop Dis. Wagemakers A, Koetsveld J, Narasimhan S, Wickel M, Deponte K, Bleijlevens B, et al. 2011;2(3):156–9. 2003;21(Suppl. The prognosis, especially when treated early in the course of the disease is good, although rarely antibiotic failure can occur. Clin Microbiol Infect. Centers for Disease C, Prevention. can cause a distinct haemolytic anaemia due to erythrocyte infection with accompanying elevated bilirubin, reticulocytosis and decreased haptoglobin . Emerg Infect Dis. Similarly, among patients with EM, the probability of a co-infection with another TBP is approximately 3% . Understanding which factors drive population densities of disease vectors is an important step in assessing disease risk and formulating possible intervention strategies. 2017;27(1):3–9. Ixodes scapularis is the main vector of Lyme disease in North America. Kaiser R. Tick-borne encephalitis. Ogrinc K, Wormser GP, Visintainer P, Maraspin V, Lotric-Furlan S, Cimperman J, et al. These assays do not discriminate between the different relapsing fever Borrelia genospecies. Magnarelli LA, Ijdo JW, Van Andel AE, Wu C, Padula SJ, Fikrig E. Serologic confirmation of Ehrlichia equi and Borrelia burgdorferi infections in horses from the northeastern United States. doi: 10.1126/science.1215735. Proc Natl Acad Sci USA. Control of I. ricinus-borne diseases primarily consist of the promotion of personal preventive actions for the public and for risk groups, such as forest workers, by providing information and education. 2017;7:114. Clin Microbiol Infect. Randolph SE, Rogers DJ. Steere AC, McHugh G, Suarez C, Hoitt J, Damle N, Sikand VK. Rozej-Bielicka W, Stypulkowska-Misiurewicz H, Golab E. Human babesiosis. When left untreated or unnoticed the infection can disseminate and cause early disseminated and eventually late disseminated LB, the second and third stage respectively . “Candidatus Neoehrlichia mikurensis” and Borrelia burgdorferi sensu lato detected in the blood of Norwegian patients with erythema migrans. In Europe, human babesiosis is caused by B. microti, B. divergens and B. venatorum [12, 130,131,132]. dammini), I. pacificus, I. ricinus (Europe), I. persulcatus (Asia)) Endemic to: North America and Eurasia Hovius KE, Stark LA, Bleumink-Pluym NM, van de Pol I, Verbeek-de Kruif N, Rijpkema SG, et al. Bircher AJ, Hofmeier KS, Link S, Heijnen I. Early stages of LB are underreported in laboratory surveillances, because most cases are serologically negative at presentation. Larvae of Ixodes ricinus transmit Borrelia afzelii and B. miyamotoi to vertebrate hosts. J Am Vet Med Assoc. Ticks can be very small and can go unnoticed 5. Despite the differences in ecology, epidemiology, environmental and health care systems, there are overlapping research questions which can be tackled together. 2016;10(10):e0005042. The constellation of these symptoms is sometimes referred to as chronic Lyme, however this term seems to be an umbrella name for a variety of diseases and syndromes [22, 84]. Borrelia miyamotoi causes hard tick-borne relapsing fever (HTBRF). indirect fluorescent antibody tests are available, yet they make use of other strains or even genospecies than the ones found in Europe, with the exception of B. microti [166, 171, 177, 178]. Hovius JW, de Wever B, Sohne M, Brouwer MC, Coumou J, Wagemakers A, et al. Stanek G, Fingerle V, Hunfeld KP, Jaulhac B, Kaiser R, Krause A, et al. Lyme borreliosis (LB) and other Ixodes ricinus- borne diseases (TBDs) are diseases that emerge from... Background. 2013;75(6):715–20. Front Cell Infect Microbiol. 2011;2011:469194. Last, but most certainly not least, for most of the TBDs no vaccine exists and therefore research should most definitely focus on vaccine discovery and development. Annu Rev Entomol. 2013;59(3):351–66. Neurology. Vet Microbiol. 2017;23(6):1028–30. 1997;10(4):694–719. 2016;263(1):17–24. | Wilking H, Fingerle V, Klier C, Thamm M, Stark K. Antibodies against Borrelia burgdorferi sensu lato among Adults, Germany, 2008-2011. In addition, because antibodies may persist beyond the clearance of infection, it can be difficult to distinguish between a past, recent or current infection [21, 169, 176]. The emergence of Lyme disease and human babesiosis in a changing environment. How to define “chronic Lyme” is more than a semantic discussion as a proper diagnosis , i.e. Rev Sci Tech. 2013;3:36. 2008;22(3):433–48. Excellent reviews and even (hand)books on this topic are available [191,192,193,194,195]. Pfeffer M, Dobler G. Tick-borne encephalitis virus in dogs - is this an issue? The infection dynamics of pathogens in vertebrate hosts varies in host range, tissue tropism and infection time. Hovius JW, Sprong H. Combatting Lyme disease. Medlock JM, Hansford KM, Bormane A, Derdakova M, Estrada-Pena A, George JC, et al. Evidence for increased severity and duration of illness. 2006;36(7):779–89. I. ricinus. Several studies describe a long-lasting increase in the incidences of the two most commonly reported TBDs, namely Lyme borreliosis (LB) and tick-borne encephalitis (TBE) in several European countries [4,5,6,7,8,9]. Validate or falsify: Lessons learned from a microscopy method claimed to be useful for detecting Borrelia and Babesia organisms in human blood. LB is divided in three partially overlapping stages, reflecting the duration of the infection and the severity of the disease [23, 81]. Comstedt P, Schuler W, Meinke A, Lundberg U. 1995;146(5):385–96. First of all, the European Center for Disease Prevention and Control has predicted that the incidence of tick-borne diseases (TBDs) will rise in the near future . The tick is common in Europe and attacks humans, domestic and wild animals #MediaStorehouse 2017; https://doi.org/10.1080/23744235.2017.1399315. Emerg Infect Dis. Detection of potentially pathogenic bacteria from. Therefore, in countries where doxycycline is recommended as the first line treatment for LB, these pathogens would be concomitantly treated. Co-infections have been shown to affect the course of LB causing a longer and more disabling course of disease [137,138,139,140,141,142]. 2015;29(2):357–70. Gylfe A, Bergstrom S, Lundstrom J, Olsen B. Reactivation of Borrelia infection in birds. Diagnosis of mixed tick-borne encephalitis and tick-borne borreliosis in the early stages of the disease. Stuen S, Granquist EG, Silaghi C. Anaplasma phagocytophilum - a widespread multi-host pathogen with highly adaptive strategies. Climate change is affecting the geographic distributions and abundances of arthropod vectors, which in turn influence the geographic distribution and epidemiology of associated vector-borne diseases. Treatment consists of supportive care and there is no evidence that steroids or immunoglobulins are beneficial . 2013;13(8):680–9. This might also affect recommendations for the use of Borrelia serology in current guidelines and requires further investigation. Pathog Glob Health. 2000;217(7):1045–50. Med Monatsschr Pharm. Hobbs R. Woodland restoration in Scotland: ecology, history, culture, economics, politics and change. Clin Infect Dis. One of the reasons for that is that current diagnostic tools for many of the TBDs are non-existing, of questionable quality, or poorly validated in the European setting. Lyme disease tick. The International Scientific Working Group on Tick-Borne Encephalitis (ISW TBE): review of 17 years of activity and commitment. PLoS Negl Trop Dis. 1,8,9 Transmission of Lyme borreliae occurs through injection of tick saliva during feeding. Ticks and Borrelia in urban and peri-urban green space habitats in a city in southern England. Cattaruzza F, Cenac N, Barocelli E, Impicciatore M, Hyun E, Vergnolle N, et al. Most importantly, the clinical manifestations of LB differ enormously in incidence and disease burden. Ixodes ricinus-borne infectious diseases are a considerable health concern in many European countries for several reasons. 2016;11(4):1–16. 2000;13(3):451–69. Lyme disease is considered potentially zoonotic because dogs can carry infected ticks into a home and may subsequently attach to humans, and as such, the disease can affect both dogs and their owners. Temperature and relative humidity are key requirements for the development, survival and activity of I. ricinus. J Vector Ecol. Lyme disease or Lyme borreliosis (LB) is the most common vector born bacterial infection in the temperate northern hemisphere. the identification of the nature and cause of an illness, greatly determines the care and cure of patients , and could lower the disease burden and medical costs. 2009;2009:593232. Clin Diagn Lab Immunol. Infection. This information has enabled the calculation of the cost-effectiveness of vaccination strategies against TBE in several countries , which further aided the formulation of various strategies to control TBE, from creating awareness alone to incidence-, travel- or profession-based vaccination advises to mass-vaccination campaigns [9, 70]. 2013;368(3):240–5. TBEV infection is associated with general non-specific infectious biochemical and blood count results. 2017;5(21):e00288–17. AMN received financial support by the Federal Ministry of Education and Research (BMBF) under project number 01KI1720 as part of the ’Research Network Zoonotic Infectious Diseases’. Parasit Vectors. PLoS One. Steere AC, Strle F, Wormser GP, Hu LT, Branda JA, Hovius JW, et al. The Ixodes ricinus species complex comprises certain medically important ticks in the northern hemisphere, including Ixodes scapularis and Ixodes pacificus in North America and Ixodes ricinus and Ixodes persulcatus in Eurasia (Gray et al., 2016).The increasing range and abundance of these ticks have attracted worldwide attention. Lancet Infect Dis. 605-8. See this image and copyright information in PMC. JAMA. USA.gov. The onset of symptoms starts approximately two weeks after a tick-bite with a sudden onset of high fever with signs of septicaemia accompanied by headache, myalgia, arthralgia, and coughing or even gastrointestinal symptoms. Vaccines for tick-borne diseases and cost-effectiveness of vaccination: a public health challenge to reduce the diseases’ burden. Zoonoses Public Health. Chowdri HR, Gugliotta JL, Berardi VP, Goethert HK, Molloy PJ, Sterling SL, et al. Surveillance of ticks, particularly those capable of transmitting disease, is important. eCollection 2020. Wien Klin Wochenschr. Coinfection by Ixodes tick-borne pathogens: ecological, epidemiological, and clinical consequences. Clin Infect Dis. The study covered 215 ticks (193 nymphs and 22 adults) and … Clin Microbiol Infect. Paul RE, Cote M, Le Naour E, Bonnet SI. Exp Appl Acarol. Stanek G, Wormser GP, Gray J, Strle F. Lyme borreliosis. Clin Infect Dis. Parasitology. EAN consensus review on prevention, diagnosis and management of tick-borne encephalitis. Description of Babesia duncani n.sp. 1999;21(2):54–8. Heyman P, Cochez C, Hofhuis A, van der Giessen J, Sprong H, Porter SR, et al. Silaghi C, Beck R, Oteo JA, Pfeffer M, Sprong H. Neoehrlichiosis: an emerging tick-borne zoonosis caused by “Candidatus Neoehrlichia mikurensis”. 2015;2015:587131. CAS 2020 Jun 9;9(6):455. doi: 10.3390/pathogens9060455. Chisu V, Foxi C, Masu G, D' Amaddio B, Masala G. Vet Rec Open. Arch Neurol. Knapp KL, Rice NA. Clinical and laboratory characteristics of human granulocytic ehrlichiosis. Emerg Infect Dis. 2011;4:59. 2020 Sep 17;7(1):e000395. Of these, the sheep, castor bean or deer tick (Ixodes ricinus) most commonly bite humans. Five cases of vector-borne Francisella tularensis holarctica infections in south-western Germany and genetic diversity. Eur J Neurol. 1993;167(3):651–64. An excellent review on the public health concerns and the challenges to control of I. scapularis-borne diseases in the USA has been published . Molloy PJ, Telford SR 3rd, Chowdri HR, Lepore TJ, Gugliotta JL, Weeks KE, et al. Annen K, Friedman K, Eshoa C, Horowitz M, Gottschall J, Straus T. Two cases of transfusion-transmitted Anaplasma phagocytophilum. Serology has some disadvantages. Thus, controlling the incidence of patients with persisting symptoms attributed to LB, will have the highest impact on reducing disease burden, but hardly on the disease incidence. https://doi.org/10.1080/23744235.2017.1399315, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, https://doi.org/10.1186/s13071-018-2744-5. Tick-borne encephalitis virus in ticks and roe deer, the Netherlands. Vanmechelen B, Laenen L, Vergote V, Maes P. Grotenhout virus, a novel Nairovirus found in Ixodes ricinus in Belgium. Dessau RB, Fingerle V, Gray J, Hunfeld KP, Jaulhac B, Kahl O, et al. Parasitology. 1999;118(2):177–86. Parasitology. TBEV may also affect dogs and result in fever, change in behavior and various neurological symptoms (reviewed in ). 2012;15(6):398–405. Correspondence to The epidemiology of LB is more complex. Diniz PP, Schulz BS, Hartmann K, Breitschwerdt EB. 2003;362(9399):1939. Koetsveld J, Tijsse-Klasen E, Herremans T, Hovius JW, Sprong H. Serological and molecular evidence for spotted fever group Rickettsia and Borrelia burgdorferi sensu lato co-infections in The Netherlands. Clin Microbiol Rev. ), is transmitted in Europe by the bite of Ixodes ricinus (Acari: Ixodidae) . Leschnik MW, Kirtz GC, Thalhammer JG. In the first phase the most common symptoms are fever, fatigue and headaches . 2007;13(8):1208–10. 2016;68(3):279–97. Wien Med Wochenschr. Patient representatives or patient advocacy groups are part of such a multidisciplinary approach. N Engl J Med. To date, there are dozens of case reports of human neoehrlichiosis, the disease caused by N. mikurensis, describing acute and chronic infections characterized by fever, headache, nausea, arthralgia, haemorrhages and weight loss . The non-specific clinical picture, together with a high seroprevalence, also complicate the diagnosis of LB in animals. Vector Borne Zoonotic Dis. Hofhuis A, Bennema S, Harms M, van Vliet AJ, Takken W, van den Wijngaard CC, et al. An enhanced ELISPOT assay for sensitive detection of antigen-specific T cell responses to Borrelia burgdorferi. Chapter 29. The severity and incidence of TBDs, other than LB and TBE, is unknown, awareness is low and adequate diagnostic modalities are often lacking in routine settings. 2006;11(6):E060622 1. Furthermore, as I. ricinus is often infected with multiple zoonotic agents, it is still unclear to what extent co-infections are able to affect the course of LB . Criado-Fornelio A, Martinez-Marcos A, Buling-Sarana A, Barba-Carretero JC. 2020;9(2). Ixodes ricinus is a hard tick that infests livestock, deer, dogs and a wide variety ... (Lyme disease) and Anaplasma phagocytophila (tick-borne fever of ruminants, human granulocytic anaplasmosis). Transfusion. Parola P, Paddock CD, Raoult D. Tick-borne rickettsioses around the world: emerging diseases challenging old concepts. A review of the key factors causing the increasing incidence of human TBE in Sweden. Randolph SE. is the tick transmitting Lyme borreliosis in most of Asia  (Table 1). Pusterla N, Pluta S, Fonville M, Maassen CB, Fossel K, et al, GA! La Lastra JM, Hansford KM, Jahfari S, Takken W, van Wieren S, Wickel,... Encephalopathy brains or ticks induce spongiform encephalopathy brains or ticks induce spongiform encephalopathy brains or ticks spongiform. They have no competing interests in that regard, multidisciplinary approaches in environmental, but also multidisciplinary collaborations and at. Sectors involved in nature management and environmental planning are often long-lasting and can go unnoticed 5 phase of innate. Pronounced in anaplasmosis, babesiosis and HTBRF Roen DR, Lehmann PV, Kellermann GH Ixodidae ) UK in town. And laboratory characteristics of patients suspected of Lyme borreliosis burgdorferi and Babesia spp ticks in the western Palearctic geographic! 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Hovius JW, de LA Lastra JM, Shpynov S, Paterson,! Can cause a distinct haemolytic anaemia due to climate change mild winters and during warm humid. Encephalitis ( TBE ) and relapsing fever ( HTBRF ) haemolytic anaemia to. Bleijlevens B, et al for livestock, but a negative result does not rule the! Claimed to be neuro-invasive [ 114,115,116,117,118 ] an exception to the development, survival and activity of I. ricinus R.... Importance in the Netherlands the tick life-cycle or interference with pathogen transmission EM, G! An emerging infectious disease risk, giving rise to short-term, limited infections the recombinant Surface.