Human activities predominate in determining changing incidence of tick-borne encephalitis in Europe

Explanations for the dynamics of tick-borne disease systems usually focus on changes in the transmission potential in natural enzootic cycles. These are undoubtedly important, but recent analyses reveal that they may not be quantitatively the most significant side of the interaction between infected ticks and humans. Variation in human activities that may impact inadvertently but positively on both the enzootic cycles and the degree of human exposure to those cycles, provide more robust explanations for recent upsurges in tick-borne encephalitis in Europe. This can account for long-term increases in incidence that coincided with post-soviet political independence, for small-scales spatial variation in incidence within a country, and for short-scale fluctuations such as annual spikes in incidence. The patterns of relevant human activities, typically those related to the use of forest resources, are evidently driven and/or constrained by the cultural and socio-economic circumstances of each population, resulting in contrasting national epidemiological outcomes.