To date, 2 probable cases of TBEV human infections have been reported in Hampshire, England. A further case, positive by PCR, is likely to have acquired infection in Scotland. from consuming meat from animals affected by TBE to be Negligible to Very Low with high uncertainty In clinical cases, TBE often presents as a biphasic disease. The initial viraemic phase lasts approximately 5 days (range 2 to 10 days), and is associated with non-specific symptoms such as: Where the evidence may be insufficient to give a definitive answer to a question, the alternative is also considered. The most likely outcome is shown in solid colour and the alternative outcome is shown in hatched colour. Summarised text version of Annexe A

Recent evidence of TBEV transmission in the Netherlands highlights that climatic and other environmental factors may have an impact on changing viral distribution to parts of western Europe. Is the disease endemic in the UK? Outcome The impact of infection in the UK population is considered very low. Question 4. Is the human population susceptible? YesThe following solution can be sprayed on clothing and exposed skin—even lawn furniture: Combine two cups of water, four tablespoons of apple cider vinegar, and two tablespoons of organic neem oil. This spray works great on pets at controlling these menacing pests.Rub into pet’s fur after spraying.Be careful to avoid eyes, burns or damaged skin. Where the evidence may be insufficient to give a definitive answer to a question, the alternative is also considered. The most likely outcome is shown in solid colour and the alternative outcome in hatching. Summarised text version of Annexe B In the UK, a licensed TBE vaccine is available and is currently recommended only for those ‘at high risk of exposure to the virus’, through travel to endemic areas or employment ( 41 to 43). The JCVI has been asked to consider whether vaccination of high-risk groups such as forestry workers is warranted at this stage, while further studies looking for evidence of human exposure and infection are undertaken. Outcome of impact assessment

The impact of infection in the UK population is considered moderate. Question 10. Is it highly infectious to humans? Yes The probability of infection in high-risk groups within the UK population is considered low. (Outcome) research into the effects of cheese production processes on the quantity of infectious virus presentHAIRS is a multi-agency cross-government horizon scanning and risk assessment group, which acts as a forum to identify and discuss infections with potential for interspecies transfer (particularly zoonotic infections). The probability of infection in the general UK population is considered very low. (Outcome) Question 9. Are humans highly susceptible? [note 2] Yes In humans, TBE is a viral infection involving the central nervous system (CNS). It is caused by TBEV, a ribonucleic acid ( RNA) virus belonging to the genus Flavivirus that was initially isolated in 1937 in Russia. TBE typically follows a biphasic course; a viraemic phase with flu-like symptoms, followed by a period of quiescence, then the second phase with CNS involvement.

The probability of infection in the UK population is considered very low. Question 6. Are effective measures in place to mitigate against these? Yes Approximately a third of patients experience the second phase, and up to 20% of those with severe disease experience neurological sequelae. According to a 10-year follow-up survey, 80% of patients with primary myelitic disease will remain with sequelae ( 44). Overall, the mortality rate is 0.5% to 2% ( 4). Would a significant number of people be affected? Outcome Consideration of whether vaccination of high-risk groups such as forestry workers is warranted at this stage, while further studies looking for evidence of human exposure or infection are undertaken.

How we tested

The third and fourth cases both tested positive for TBEV by polymerase chain reaction ( PCR) testing. Assessment of the risk of infection to the human population in the UK Probability There were 998 provisional cases of Lyme disease reported to PHE in England and Wales in 2012 – a similar number of cases as was reported in 2011. However, not all cases of Lyme disease are confirmed by laboratory testing and, as in previous years, the overall number of Lyme disease cases in England and Wales is estimated at between 2,000 and 3,000 cases a year. Incidence of Lyme disease acquired in England and Wales remains low compared to some other European countries or in North America. There is no specific treatment for TBE. Supportive treatment can significantly reduce morbidity and mortality.