title: Economic downturn results in tick-borne disease upsurge.
abstract: BACKGROUND
  The emergence of zoonoses is due both to changes in human activities and to changes in their natural wildlife cycles. One of the most significant vector-borne zoonoses in Europe, tick-borne encephalitis (TBE), doubled in incidence in 1993, largely as a consequence of the socio-economic transition from communism to capitalism and associated environmental changes.
  
  
  METHODS
  To test the effect of the current economic recession, unemployment in 2009 and various socio-economic indices were compared to weather indices (derived from principal component analyses) as predictors for the change in TBE case numbers in 2009 relative to 2004-08, for 14 European countries.
  
  
  RESULTS
  Greatest increases in TBE incidence occurred in Latvia, Lithuania and Poland (91, 79 and 45%, respectively). The weather was rejected as an explanatory variable. Indicators of high background levels of poverty, e.g. percent of household expenditure on food, were significant predictors. The increase in unemployment in 2009 relative to 2008 together with 'in-work risk of poverty' is the only case in which a multivariate model has a second significant term.
  
  
  CONCLUSIONS
  Background socio-economic conditions determine susceptibility to risk of TBE, while increased unemployment triggered a sudden increase in risk. Mechanisms behind this result may include reduced resistance to infection through stress; reduced uptake of costly vaccination; and more exposure of people to infected ticks in their forest habitat as they make greater use of wild forest foods, especially in those countries, Lithuania and Poland, with major marketing opportunities in such products. Recognition of these risk factors could allow more effective protection through education and a vaccination programme targeted at the economically most vulnerable.
authors.affiliation: Department of Zoology, University of Oxford, Oxford, UK.
authors.forename: Elinor R
authors.initials: ER
authors.lastname: Godfrey
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Randolph
mesh_terms: D000818:Animals; D004467:Economics / Q000639:trends; D005060:Europe / Q000453:epidemiology; D006801:Humans; D015233:Models, Statistical; D012307:Risk Factors; D012959:Socioeconomic Factors; D017282:Tick-Borne Diseases / Q000453:epidemiology*; D014478:Unemployment / Q000706:statistics & numerical data; D014887:Weather