Tickborne Diseases Abroad

  • Crimean-Congo hemorrhagic fever is found in Eastern Europe, particularly in the former Soviet Union; in northwestern China; central Asia; southern Europe; Africa; the Middle East; and the Indian subcontinent.
  • Imported tickborne spotted fevers (rickettsial infections) have caused infection in returning travelers. In the U.S., the most frequently diagnosed rickettsial infection associated with international travel is caused by Rickettsia africae (the agent of African spotted fever).
  • Kyasanur forest disease is found in southern India and is typically associated with exposure to ticks while harvesting forest products. Additionally, a similar virus has been described in Saudi Arabia (Alkhurma hemorrhagic fever virus).
  • Lyme disease can be contracted in temperate forested regions throughout Europe and northern Asia, although it is more common in eastern and central Europe than western Europe. Lyme disease outside the United States is often caused by different genospecies of Borrelia burgdorferi sensu lato and may have somewhat different symptoms. Antibodies to Borrelia burgdorferi sensu lato species that cause infection outside the United States may not be reliably detected by all tests used for Lyme disease in the United States. Providers who suspect internationally-acquired Lyme disease should use diagnostic tests that have been validated for these species.
  • Omsk Hemorrhagic Fever (OHF) occurs in the western Siberia regions of Omsk, Novosibirsk, Kurgan, and Tyumen. It may be also be acquired by direct contact with infected muskrats.
  • Tickborne encephalitis (TBE) occurs in some forested areas in Europe and Asia, from eastern France to northern Japan and from northern Russia to Albania. TBE is caused by TBE virus, a flavivirus that is closely related to Powassan virus. TBE virus has three subtypes: European, Siberian, and Far Eastern. TBE virus is primarily transmitted to humans by infected Ixodes species ticks. It can also be acquired by ingesting unpasteurized dairy products (such as milk and cheese) from infected goats, sheep, or cows.

Note: Anaplasmosis, babesiosis, ehrlichiosis, tularemia, tickborne relapsing fever, Rocky Mountain spotted fever, and Powassan disease can also be acquired internationally.

See also: