Riccardo loves walking in the mountains in spring and summer. Last July he went hiking in Carina in the Friuli Venezia Giulia region in Italy. It was a hot sunny day, so he wore short pants and a short-sleeved shirt. Riccardo took some friends with him to show them the mountains he loves. They had a very long walk amongst the woods and peaks and they rested in the grassland. Once back home, having a shower, Riccardo felt something strange beneath his hand while washing his leg. He saw a small dark freckle on his left calf that wasn’t there before. It would have been difficult to see it without feeling it with his hand. Unfortunately, that was not a piece of dirty dust but a tick that bit him during the walk.
Riccardo felt a bit foolish: “I should have worn longer pants” he thought. However, he was somewhat prepared. He took a fine-tipped tweezer a grabbed the tick firmly. It was difficult to grasp it as close as possible to the skin, but with the help of a magnifying glass, he managed to do so and pulled the tick upward to remove it. Then he finished his shower, applied some antiseptic on the wound and went to sleep. He had a bad night. He dreamt of dangerous diseases spreading up through his leg. The day after he called the doctor who said: “Mark the day on the calendar and call me back if you develop flu-like symptoms within a month. Be more cautious next time, Riccardo!”. The doctor knew this could be a dangerous bite. While the probability of developing severe diseases is low, it is always better to be cautious and monitor the symptoms.
Tick-borne encephalitis (TBE) is a common tick-borne disease, along with Lyme borreliosis. Over the last decade, TBE cases have grown consistently in Europe. According to the European Centre for Disease Control, in 2019 there were 3246 confirmed events of infection. This disease is endemic in many countries of central, north, and eastern Europe where most cases are reported. Unfortunately, Riccardo went hiking in one of the regions where this disease is endemic, i.e. constantly present. While this does not mean that all ticks in that area carry the pathogen, it is a sign of danger, so anyone engaged in outdoor activities should pay higher attention to ticks and tick bites. Tick-borne encephalitis causes flu-like symptoms such as headache, fever, pain, fatigue, and weakness but can have much worse consequences that could lead, in some cases, to death. The disease is caused by a virus, named tick-borne encephalitis virus, that passes into humans from the tick bite and replicates in the body with the risk of causing severe inflammation of the brain, called encephalitis, if not contained efficiently by the immune system. There is no specific treatment for TBE once you are infected but there is an effective vaccine that prevents infection.
Ticks and the diseases they carry can have a great impact both at the human and animal levels. Riccardo and his friends, just as everyone engaged in outdoor recreational activities, including farmers, are at risk in endemic regions. But tick-borne diseases also affect animals and these threats could have great consequences at the economic level, not just for the health system but also for the production sector. Costs derive from the direct loss in the production of meat, milk, eggs and leather that are associated with both simple tick bites and eventual subsequent diseases. Farmers spend great sums of money on therapies when animals become infected and fall ill; in the worst scenario, they could also lose their entire livestock and farm. The annual economic cost of tick-borne diseases has been estimated to be at around 70 million USD, considering only small ruminants.
This is due also to the fact that there are many diseases caused by viruses or bacteria carried by ticks. Tick-borne encephalitis virus is the most known flavivirus, but many others can be harmful to humans and animals. At present only one vaccine is available to protect humans from TBE and much research is needed to develop and find new vaccines for known, and emerging tick-borne diseases. As the current COVID-19 pandemic has shown us, scientists need to share knowledge and information as fast and as openly as possible. When this happens, preventive solutions, treatments and hopefully vaccines can be found quickly. But research is only one part of the solution. The second pillar for successful protection from tick-borne diseases is surveillance. A diffused network of trained surveillance institutes could constantly monitor the presence of known and new pathogens.
The TBFVnet project was launched to address both of these issues. It brings together research institutes across Europe to study and survey tick-borne flaviviruses. The partners are experts in different fields of infectious diseases carried by wild animals and are located in key positions within endemic regions of tick-borne diseases. The partners can study all the different aspects of tick-borne diseases such as the survey of emerging viruses, their biology, and the development of new vaccines as well as new diagnostic tools and antivirals.
International projects like TBFVnet are great examples of how cross border scientific cooperation can help society in the long term. New tools to detect flaviviruses, or effective antivirals, can have a tremendous impact on health. “With the COVID-19 pandemic, we learned too late the importance of quick diagnostics and capillary surveillance for infectious diseases – points out Alessandro Marcello, head of Molecular Virology at the ICGEB – A network of laboratories sharing tools and knowhow should be already in operation on the territory to monitor endemic and emerging diseases to instruct an efficient health response”.
The costs of prevention and research are undoubtedly high. Many scientists and much equipment, as well as transnational infrastructure, are required to face such threats. However, as the COVID-19 pandemic has shown, the cost of prevention represents just 2% of the economic damage caused by an outbreak. Riccardo was lucky, the month passed without him developing any symptoms. But he will remember the dreams he had that night and next time he will be more cautious. He will ask at tourist offices if the region he wants to explore is endemic for tick-borne diseases. Probably he will wear long pants and shirts, use repellents for his clothes, and he will check and tell his friends to check for tick bites at the end of the day. This is what he can do to prevent harmful infections while having a pleasurable, long walk in the countryside. But science can do much more. Research can produce treatments and vaccines to cure sick people and protect the weak.
This article originally appeared in the June issue of the Regional Cooperation Magazine.
