Areas at Risk for Tick-borne Encephalitis

Key points

  • Tick-borne encephalitis can be found in parts of the region stretching from western and northern Europe to northern and eastern Asia.
  • People who travel to these areas might be at risk for infection.
  • Tick-borne encephalitis is not found in the United States.

General distribution of tick-borne encephalitis

Country-specific risk information provided below the map

Map of Europe, Asia, and Africa with areas at risk for TBE in blue
Approximate distribution of tick-borne encephalitis as of January 20, 2024.

Country-specific risk information for tick-borne encephalitis

The information should be interpreted cautiously because tick-borne encephalitis (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.

  • Risk Information
  • Focally endemic throughout country. Highly endemic regions include Carinthia, Styria, Upper Austria, Salzburg, Tyrol, and Vorarlberg Provinces.
  • Almost all country considered endemic; no TBE virus detected in some small geographically dispersed areas.
  • Only three confirmed autochthonous cases ever reported; all occurred in 2020 and were from geographically dispersed areas.
Bosnia and Herzegovina
  • Situation unclear as very limited information available. Fewer than 10 human cases reported. TBE virus previously isolated from ticks.
  • Cases only reported sporadically, but extent of underdiagnosis unknown.
  • 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 Xinjiang Autonomous Region (Tianshan and Altai Mountains) and southwestern China in Yunnan and Tibet provinces also reported to have transmission. One U.S. traveler previously infected in Tianjin Province.
  • 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.
  • Endemic only on Bornholm, an island in Baltic Sea. Very rare sporadic cases reported from other areas including from microfoci in North Zealand.
  • 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.
  • TBE focally endemic and found particularly in some archipelago and coastal areas mostly in southern part of country. During 2019-2023, TBE incidence highest in coastal municipalities of Kustavi and Pargas, and in province of Åland. Based on local vaccination recommendations, greatest risk is for persons resident during transmission season in the Åland Islands, Pargas, Simo, Kemi, Kotka Archipelago, Suvisaaristo archipelago in Espoo, Sammonlahti district of Lappeenranta, Preiskari Island near Raahe, Kustavi, Sipoo archipelago, Karhusaari Island in Helsinki, Tohmajarvi, and parts of Lohja (Ojamo, Lylyinen/Hormajarvi, Vohloinen/Virkkala, Kirkniemi), Kirkkonummi (Luoma, Masala), Lappeenranta (Kuusimaki-Lavola), and Raseborg (Bromarv)(as of January 2024).
  • Main endemic area is Alsace in 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.
  • 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 in central Hesse, Saarland, Rhineland-Palatinate, Lower Saxony, and Saxony-Anhalt.
  • Highest incidence in western (Transdanubian) and northern parts of country with much lower or no risk in most other areas.
  • Risk primarily in pre-alpine and alpine areas in northeast including Veneto (mainly Belluno alps), Friuli-Venezia Giulia, and Trentino-South Tyrol (also referred to as Trentino-Alto Adige) regions.
  • Fewer than 10 cases diagnosed during past 30 years, all in Hokkaido prefecture (island in northern Japan). No clear evidence of transmission in other areas of Japan. Japanese health authorities do not have recommendations for vaccination of local population.
  • Main risk areas considered to be Almaty and East Kazakhstan regions, and Sandyktau district of Akmola region. Rare sporadic cases reported from some other central and northern locations.
  • Situation unclear as very limited information available. TBE virus-infected ticks and possible human case reported from Ala-Archa National Nature Park in Tian Shan mountains (Chüy Region).
  • Highly endemic and regularly among countries with highest reported incidence in Europe. Endemic areas are present throughout country, with highest incidence in Kurzeme region in west and Vidzeme and Riga regions in central Latvia.
  • TBE virus-infected ticks previously detected. Liechtenstein health authorities consider risk exists in entire country.
  • 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.
  • Situation unclear as very limited information available. TBE virus previously isolated from ticks.
  • Main risk area in Selenge and Bulgan provinces in north.
  • 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.
  • Coastal areas in southern Norway, specifically Agder and Vestfold and (og) Telemark Counties, considered endemic.
  • Greater than 70% of reported cases diagnosed in Podlaskie and Warmian-Masurian provinces in northeast. Most of remainder of country has endemic foci.
  • Only sporadic cases reported, but information limited and disease might be underdiagnosed.
  • Endemic areas widespread across southern part of 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.
  • Low number of reported cases, but diagnostic testing not routinely conducted; cases reported from various locations including rural areas in vicinity of Belgrade.
  • Foci of transmission distributed throughout country with higher risk areas in north and center, particularly Banská Bystrica, Žilina, and Trenčín regions.
  • Highly endemic and regularly among the countries with highest reported incidence in Europe. Cases reported from throughout 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.
  • Highly endemic in regions around Stockholm in 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 south. Other natural foci in southern and central parts of country.
  • Entire country, except for cantons of Geneva and Ticino, considered at-risk. Higher risk in north-eastern, central, and midwestern regions of country, with Thurgau canton considered highly endemic
  • TBE viral ribonucleic acid detected in one pool of ticks from northwestern Tunisia but local establishment of TBE virus not confirmed.
  • Majority of infections during last 15 years reported from Volyn region and Crimea. Other foci detected throughout country, including in 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.