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Background: Impact of climate change on tick-borne encephalitis (TBE) prevalence in the tick-host enzootic cycle in a given region depends on how the region-specific climate change patterns influence tick population development processes and tick-borne encephalitis virus (TBEV) transmission dynamics involving both systemic and co-feeding transmission routes. Predicting the transmission risk of TBEV in the enzootic cycle with projected climate conditions is essential for planning public health interventions including vaccination programs to mitigate the TBE incidence in the inhabitants and travelers. We have previously developed and validated a mathematical model for retroactive analysis of weather fluctuation on TBE prevalence in Hungary, and we aim to show in this research that this model provides an effective tool for projecting TBEV transmission risk in the enzootic cycle.Methods: Using the established model of TBEV transmission and the climate predictions of the Vas county in western Hungary in 2021-2050 and 2071-2100, we quantify the risk of TBEV transmission using a series of summative indices - the basic reproduction number, the duration of infestation, the stage-specific tick densities, and the accumulated (tick) infections due to co-feeding transmission. We also measure the significance of co-feeding transmission by observing the cumulative number of new transmissions through the non-systemic transmission route.Results: The transmission potential and the risk in the study site are expected to increase along with the increase of the temperature in 2021-2050 and 2071-2100. This increase will be facilitated by the expected extension of the tick questing season and the increase of the numbers of susceptible ticks (larval and nymphal) and the number of infected nymphal ticks co-feeding on the same hosts, leading to compounded increase of infections through the non-systemic transmission.Conclusions: The developed mathematical model provides an effective tool for predicting TBE prevalence in the tick-host enzootic cycle, by integrating climate projection with emerging knowledge about the region-specific tick ecological and pathogen enzootic processes (through model parametrization fitting to historical data). Model projects increasing co-feeding transmission and prevalence of TBEV in a recognized TBE endemic region, so human risk of TBEV infection is likely increasing unless public health interventions are enhanced. [ABSTRACT FROM AUTHOR]

Estimating the tick-borne encephalitis (TBE) infection risk under substantial uncertainties of the vector abundance, environmental condition and human-tick interaction is important for evidence-informed public health intervention strategies. Estimating this risk is computationally challenging since the data we observe, i.e., the human incidence of TBE, is only the final outcome of the tick-host transmission and tick-human contact processes. The challenge also increases since the complex TBE virus (TBEV) transmission cycle involves the non-systemic route of transmission between co-feeding ticks. Here, we describe the hidden Markov transition process, using a novel TBEV transmission-human case reporting cascade model that couples the susceptible-infected compartmental model describing the TBEV transmission dynamics among ticks, animal hosts and humans, with the stochastic observation process of human TBE reporting given infection. By fitting human incidence data in Hungary to the transmission model, we estimate key parameters relevant to the tick-host interaction and tick-human transmission. We then use the parametrized cascade model to assess the transmission potential of TBEV in the enzootic cycle with respect to the climate change, and to evaluate the contribution of non-systemic transmission. We show that the TBEV transmission potential in the enzootic cycle has been increasing along with the increased temperature though the TBE human incidence has dropped since 1990s, emphasizing the importance of persistent public health interventions. By demonstrating that non-systemic transmission pathway is a significant factor in the transmission of TBEV in Hungary, we conclude that the risk of TBE infection will be highly underestimated if the non-systemic transmission route is neglected in the risk assessment. [ABSTRACT FROM AUTHOR]