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 Most people with Lyme disease get better after antibiotic treatment. This can take months for some people, but the symptoms should improve over time. from consuming meat from animals affected by TBE to be Negligible to Very Low with high uncertainty

The Advisory Committee on the Microbiological Safety of Food noted when assessing the above FSA risk assessment that it would be sensible to mark this subject for revisiting in the future when more data is available, potentially covering a broader geographical area and a longer time period.

The scale of harm caused by the infectious threat in terms of morbidity and mortality depends on spread, severity, availability of interventions and context. Transmission of TBEV is highly reliant on co-feeding of nymphs and larvae, and a recent study has shown some evidence of co-infestation ( 27).

The impact of infection in the UK population is considered very low. Question 3. Is this disease endemic in humans within the UK? Yes Go to question 7. (Outcome) Question 7. Do environmental conditions in the UK support the natural vectors of disease? Yes, or unknownThere is no specific treatment for TBE. Supportive treatment can significantly reduce morbidity and mortality. 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

Some human cases have been associated with consumption of unpasteurised milk or milk products from infected animals ( 13 to 15). TBEV is rarely transmitted from human to human via transplant ( 16), blood transfusion or breastfeeding ( 17). Animal studies have shown the potential for vertical transmission from an infected mother to the foetus ( 18). Infection has also been acquired accidentally in laboratories ( 19).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