Figure

Figure. Locations in northwestern Romania where sheep were positive for tick-borne encephalitis virus–specific antibodies, determined by using virus neutralization test (6). BH, Bihor; BN, Bistriţa-Năsăud; CJ, Cluj; MS, Mureş; SJ, Sălaj.

In September 2016, we randomly selected 519 serum aliquots from adult sheep from samples previously collected (July–August 2016) by the National Program for Surveillance, Prevention, Control and Eradication of Animal Diseases in 5 counties in northwestern Romania (Figure). The counties, number of samples, and number of sampling sites were Bihor, 119 samples, 12 locations; Bistrița-Năsăud, 100 samples, 10 locations; Cluj, 100 samples, 7 locations; Mureș, 100 samples, 11 locations; and Sălaj, 100 samples, 10 locations). We froze the aliquots at −20°C before processing. We used the IMMUNOZYM FSME (TBE) IgG All-Species kit (Progen GmbH, Heidelberg, Germany) ELISA to detect TBE virus antibodies. We retested samples exhibiting ≥25 Vienna units/mL by using virus neutralization test (VNT) as described previously (6).

We tested samples from 168 (32.37%) sheep with borderline or positive results from ELISA by using VNT, and this method identified 78 (15.02%) animals as positive for antibodies specifically neutralizing TBE virus (Technical Appendix Table). Positive results were distributed among the counties we investigated: the highest seroprevalence was identified in sheep in Bihor County (27.73%) and the lowest seroprevalence in Mureș County (2%) (Table; Figure). We found positive sheep samples in 40 (80%) of 50 examined locations.

TBE has been reported previously in Romania, but few studies confirmed the presence of the virus (7–10). However, in the past 3 decades, except for a few occasional records (11) and small-scale serologic surveys during clinical outbreaks, there have been large knowledge gaps in the studies on TBE in Romania, and the prevalence and distribution remain fairly unknown. We used sheep as sentinels for TBE virus distribution in northwestern Romania and identified the virus by VNT in 15.02% of sheep in 40 of 50 examined localities in 5 counties.

According to the latest technical report by the European Centre for Disease Control and Prevention (12), during 2008–2010, only 14 cases of TBE were reported among humans in Romania. All 14 cases originated in 5 counties in northwestern Romania; incidence was low (<0.5/100,000 inhabitants) in Bihor, Bistrița-Năsăud, Cluj, and Mureș and moderate (0.5–4.0/100,000 inhabitants) in Sălaj. In a recent survey done by collecting I. ricinus ticks from vegetation, livestock, and reptiles in central and southeastern Romania, the prevalence the TBE virus estimated by using molecular methods was <1% (13). Coipan et al. evaluated the seropositivity for TBE in 51 patients who had neurologic signs and were admitted to a hospital in Sibiu County, Romania; specific TBE antibodies were found in samples from 38 (75%) patients (14). An outbreak of rural TBE was reported in the central Romania region of Transylvania, related to consumption of infected goat milk; specific serology in 41.5% of the patients was positive for TBE virus (15). Similar seroprevalence studies in other outbreaks found lower seropositivity values (5.8%–11.6%) in human patients (15); the same study randomly evaluated 1,669 human serum samples from Transylvania and reported a 0.5% seroprevalence for TBE. Taken together, these results suggest that clinical cases of TBE in Romania are largely underreported, and many case-patients are misdiagnosed.

Our study confirms that TBE virus is endemic in northwestern Romania and should be considered a public health risk in this country. Considering the number of sheep and their almost ubiquitous presence in this country, their sentinel role in countrywide mapping of the TBE distribution should be evaluated.