Factors influencing tick-borne disease acquisition in Germany: A scoping review

Background

Tick-borne diseases (TBDs) are increasingly prevalent in Germany. The two most common TBDs, Lyme borreliosis and tick-borne encephalitis, often present with nonspecific symptoms and can lead to severe neurological complications. Currently, there is a lack of a comprehensive review synthesizing the risk factors associated with acquiring TBDs in Germany. Such knowledge could inform prevention strategies and support early protective measures.

Methods

A scoping review was conducted utilizing the MEDLINE/PubMed and Web of Science databases. Studies examining the risk of tick bites or TBD infection in Germany, published in German or English, were included. Two authors independently screened and charted the results collaboratively.

Results

A total of 32 studies were included. The review identified several factors associated with an increased risk of tick bites or TBDs: age groups 3–9 and 50–79 years; male gender; higher education levels; outdoor work; absence of a migration background; visiting forest kindergartens; spending more time outdoors; lack of protective measures; pet ownership; spring and summer seasons; high humidity combined with moderate temperatures; undisturbed vegetation; high deer density, particularly roe deer; residence in southern Germany; and rural living environments.

Conclusions

The identified risk factors are comparable to those reported in other European, Asian, and African contexts. These findings can be used to inform public health policies, improve prevention strategies, develop targeted early warning systems, and enhance clinicians’ awareness and knowledge about TBD risk factors in Germany.

Key messages

• Better knowledge of tick-borne diseases among health practitioners will improve prevention and early diagnosis, benefiting the public and especially high-risk groups in Germany.

• This review summarizes the key risk factors and outlines priorities for surveillance and research that can support the development of a national early‑warning approach.