Orientador: Gisele Fabrino Machado / Banca: Mary Marcondes / Banca: Rosemeri de Oliveira Vasconcelos / Resumo: A Leishmaniose visceral é uma enfermidade que possui uma grande variabilidade de manifestações clínicas, em humanos como em cães. Cães cronicamente infectados podem desenvolver desordens neurológicas, contudo, há poucos relatos que caracterizam as lesões e elucidam a patogenia da leishmaniose cerebral canina. Considerando a imunossupressão associada à leishmaniose visceral e que os patógenos oportunistas Toxoplasma gondii e Neospora caninum podem colaborar para a ocorrência de lesões no sistema nervoso central de cães naturalmente infectados por Leishmania chagasi, as populações de linfócitos B (CD79+) e T (CD3+) foram avaliadas no tecido nervoso de cães portadores de leishmaniose visceral e que possuem soropositividade para T. gondii e N. caninum. Lesões inflamatórias, caracterizadas por acúmulos de células mononucleares compostos principalmente por linfócitos T CD3+ predominaram em diversas regiões encefálicas dos cães infectados (P = 0,0012). Linfócitos B CD79+ foram detectados em pequena intensidade, não havendo diferença entre os grupos (P = 0,3604). Os resultados obtidos sugerem que a co-presença de leishmaniose visceral, toxoplasmose e neosporose é importante para o agravamento das lesões encefálicas, e que a imunossupressão gerada pela infecção por Leishmania não somente favorece a infecção por outros patógenos, mas colabora com esses, ocasionando lesões mais severas no tecido nervoso / Abstract: Visceral leishmaniasis is a disease with great variability regarding the clinical manifestations, in humans as in dogs. Chronically infected dogs may develop neurological disorders, however, there are few reports that characterise the lesions and make clear the pathogenesis of the canine cerebral leishmaniasis. Considering the immunossupression associated to visceral leishmaniasis and that the opportunist pathogens Toxoplasma gondii and Neospora caninum may collaborate to the occurrence of lesions in the central nervous system of dogs naturally infected by Leishmania chagasi, we evaluated the population of B (CD79+) and T (CD3+ ) lymphocytes in the nervous tissue of dogs with visceral leishmaniasis and with seropositivity to T. gondii and to N. caninum. Inflammatory lesions, characterised by mononuclear cellsaccumulation, composed mainly by CD3+ T lymphocytes predominated in several encephalic regions of the dogs from the infected groups (P=0.0012). CD79+ B lymphocytes were detected in very small intensity and presented no difference among groups (P=0.3604). The results presented herein suggest that the co-presence of visceral leishmaniasis, toxoplasmosis and neosporosis is important for the worsening of the encephalic lesions, and that the immunossupression caused by Leishmania infection not only propitiates the infection by other pathogens, but collaborate with them, causing more severe lesions in the brain / Mestre

Os herpesvírus bovino tipo 1 (BoHV-1) e 5 (BoHV-5) são alfaherpesvírus freqüentemente associados a meningoencefalites. Por outro lado, o vírus da raiva é o agente mais frequentemente identificado como causador de encefalites virais em bovinos no Brasil. O objetivo do presente estudo foi examinar a ocorrência de infecções por BoHV-1 e/ou BoHV-5 em amostras de tecido encefálico bovino submetidas ao diagnóstico de raiva e avaliar seu possível envolvimento nos quadros de encefalite que originaram a suspeita de raiva. Para tanto, 101 amostras desses tecidos, sendo 39 positivas para raiva e 62 negativas, recebidas pelo órgão oficial responsável pelo diagnóstico de raiva no Estado do Rio Grande do Sul (IPVDF) no período de 2009- 2010, foram submetidas a exames buscando o isolamento viral e amplificação de genomas de herpesvírus bovinos. Ao isolamento viral, todas as amostras foram negativas para vírus infeccioso após a realização de três passagens cegas em células MDBK. As mesmas foram submetidas à amplificação por “nested PCR” (nPCR) para a pesquisa de genomas de BoHV-1 e BoHV-5. Das 101 amostras totais analisadas esta técnica revelou que 25,7% (26/101) continham genomas de BoHV-1 e 21,8% (22/101) continham genomas de BoHV-5. Genomas de ambos os tipos foram identificadas em 30 (29,7%) amostras. Entre as amostras que foram também positivas para raiva em 23% (9/39) foram detectados genomas de BoHV-1 e em 15,4% (6/39) continham genomas de BoHV-5. Em 16 destas 39 amostras (41%) foram detectados genomas de BoHV-1 e BoHV-5. Em contrapartida, nas amostras negativas para o vírus rábico, 27,4% (17/62) também foram positivas para BoHV-1, 25,8% (16/62) foram positivas para BoHV-5. Detectaram-se os genomas de ambos BoHVs em 22,6% (14/62) dos animais. Estas diferenças não foram estatisticamente significativas, indicando não haver correlação entre a ocorrência de raiva e infecções por herpesvírus na amostragem realizada. Estes resultados indicam que, embora as infecções por BoHV-1 e BoHV-5 tenham apresentado elevada incidência nessas amostras, não havia vírus infeccioso nas mesmas, sugerindo infecções latentes sem envolvimento aparente nos quadros de encefalite que originaram a suspeita inicial de raiva. / Bovine herpesvirus type 1 (BoHV-1) and 5 (BoHV-5) are alphaherpesviruses associated with a number of clinical manifestations in cattle, including encephalitis. On the other hand, rabies virus is the agent most frequently identified as cause of viral encephalitis in cattle in Brazil. The aim of this study was to examine the occurrence of BoHV-1 and / or BoHV-5 in bovine brain tissue samples submitted to rabies diagnosis. The search was carried out by virus isolation and nested polymerase chain reaction (PCR) in brain tissues of cattle submitted to rabies diagnosis in the state of Rio Grande do Sul in the period 2009-2010. One hundred and one brain samples from cattle with signs of neurological disease, of which 39 were positive and 62 negative for rabies, were used in this study. At virus isolation, all samples were negative for the presence of infectious herpesviruses after three successive passages in MDBK cells. Of the 101 total samples analyzed, this test revealed that 25.7% (26/101) of cattle were infected with BoHV-1 and 21.8% (22/101) were infected with BoHV-5. Genomes of both types were detected in 29.7% (30/101) samples. With the 39 samples positive for rabies virus, BoHV-1 genome was detected in 23% (9/39) and 15.4% (6/39) were positive for BoHV-5 as well as in 41% (16/39) of these samples, which were positive for both BoHVs. On the other hand, the negative samples for rabies virus, 27.4% (17/62) also were positive for BoHV-1, as well and 25.8% (16/62) were positive for BoHV-5. Genomes of both BoHVs were detected in 22.6% (14/62) of the specimens. These differences were not statistically significant indicating no correlation between the occurrence of rabies and herpesvirus infections in the animals. These results do not imply that the herpesviruses detected, even showing a high incidence, were the causative agents of meningoencephalitis in the samples tested, once it was not possible to isolate virus in its infectious form, however it suggests a latent infection in the animals involved with neurological signs of meningoencephalitis whose primary suspicion was rabies.

Submitted by (edna.saturno@ufrpe.br) on 2016-11-04T16:22:18Z No. of bitstreams: 1 Sergio Alves do Nascimento.pdf: 768542 bytes, checksum: b909fa47d18e5a1f4cc1dfdb90c42f7d (MD5) / Made available in DSpace on 2016-11-04T16:22:18Z (GMT). No. of bitstreams: 1 Sergio Alves do Nascimento.pdf: 768542 bytes, checksum: b909fa47d18e5a1f4cc1dfdb90c42f7d (MD5) Previous issue date: 2012-02-28 / Cells which grow in vitro culture is divided into three categories: primary, secondary or crop finite line and continuous line, that can be grown indefinitely. These tumors derived from transformed cells or artificially or naturally. This work describes a cell line of fetal goat cornea (CorFC) and its growth in media supplemented with low FBS aimed at producing virus antigens caprine arthritis-encephalitis for antibodies by agar gel immunodiffusion. The cell line has CorFC fibroblastic appearance and has been cultivated for more than two years, more than 40 passages without noticeable change in the morphology or the rate of cell multiplication. Of the 163 serum samples tested by micro-AGID with antigen (Ag) commercial (Biovetech, Brazil), 29 (17.79%) were positive, of these, 28 were also positive for micro-AGID-MEM with Ag and Ag -DMEM/12 Ag and 29 with RPMI-1640. We observed excellent agreement adjusted kappa (k) between the micro-AGID tests employing the commercial Ag, Ag-MEM and Ag-DMEM/F12 (k = 0.98) between the antigen and perfect commercial and Ag-RPMI 1640 (k = 1,00). Due to their growth characteristics of cells CorFC have behaved as a continuous lineage, which can only be definitively confirmed with continued passages. The studied cell culture media (MEM, DMEM/F12 and RPMI 1640) showed to be adequate to nourish the cell lineage CorFC. However, considering jointly the medium RPMI 1640 was the most recommended for cultivation, in supplementation of 2% FBS for scheduling and 0.1% to manutenção.As CorFC cell line grown in MEM, and DMEM/F12 RPMI 1640 proved to be highly permissive to CAEV replication of the virus in medium with low FBS, with production of higher quality antigens, reducing input costs and simplify the processes of purification of proteins, especially when the RPMI 1640 is used. / As células que crescem em cultivo in vitro estão divididas em três classes: primárias, de linhagem finita ou cultivos secundários e de linhagem contínua, que podem ser multiplicadas indefinidamente. Estas derivam de tumores ou células transformadas artificial ou naturalmente. Neste trabalho é descrita uma linhagem de células de córnea de feto caprino (CorFC) e seu cultivo em meios suplementados com baixo teor de SFB visando à produção de antígenos do vírus da artrite-encefalite caprina para pesquisa de anticorpos pela imunodifusão em gel de Agar. A linhagem celular CorFC apresenta aparência fibroblástica e vem sendo cultivada há mais de 2 anos, por mais de 40 passagens, sem alteração perceptível na morfologia ou na taxa de multiplicação celular. Das 163 amostras de soros testados pela micro-IDGA, com antígeno (Ag) comercial (Biovetech, Brasil), 29 (17,79%) apresentaram resultado positivo; dessas, 28 também foram positivas à micro-IDGA com Ag-MEM e Ag-DMEM/12 e 29 com o Ag-RPMI 1640. Foi observada ótima concordância ajustada de kappa (k) entre os testes de micro-IDGA empregando-se o Ag comercial, Ag-MEM e Ag-DMEM/F12 (k = 0,98) e perfeita entre o antígeno comercial e Ag-RPMI 1640 (k = 1,00). Devido às suas características de crescimento as células CorFC têm se comportado como de linhagem contínua, o que só poderá ser definitivamente comprovado com a continuação das passagens. Os meios de cultivo celular estudados (MEM, DMEM/F12 e RPMI 1640) demonstraram-se adequados para nutrir as células de linhagem CorFC. Entretanto, considerando em conjunto, o meio RPMI 1640 seria o mais recomendado para seu cultivo, nas suplementações de 2% de SFB para escalonamento e de 0,1% para manutenção.As células da linhagem CorFC cultivadas em MEM, DMEM/F12 e RPMI 1640 mostraram-se altamente permissíveis à replicação do vírus CAEV em meio com baixo teor de SFB, com produção de antígenos de melhor qualidade, redução de custos com insumos e simplificação no processos de purificação de proteínas, sobretudo quando o meio RPMI 1640 é usado.

INTRODUÇÃO: A encefalite de Rasmussen (ER) é uma doença rara e esporádica, apresentando-se como uma síndrome com disfunção cerebral multifocal e convulsões focais refratárias ao tratamento medicamentoso, por vezes se manifestando com epilepsia parcial contínua. O início das crises focais predomina na infância e afeta crianças previamente hígidas, com curso progressivo. Na maioria das vezes envolve apenas um hemisfério cerebral, que se torna atrófico. O diagnóstico é feito através da análise do eletroencefalograma, características clínicas, achados de ressonância magnética (RM) e/ou achados histopatológicos. A RM encefálica é particularmente útil no estudo destes doentes, fornecendo dados que podem contribuir para o diagnóstico, ajudar na seleção do local para biópsia, assim como no acompanhamento da evolução progressiva da doença. MATERIAIS E MÉTODOS: Foram coletados os dados demográficos, avaliações neuropsicológicas, dados cirúrgicos e achados de imagem de todos os pacientes diagnosticados com ER no HCFMRP, de 1997-2016. RESULTADOS: Foram incluídos 35 pacientes com média de idade de 5,8 anos. Setenta por cento destes apresentaram-se com epilepsia parcial contínua e 29 tiveram também a confirmação histopatológica. Não houve nenhum caso de acometimento bilateral confirmado nesta amostra. Os achados de imagem mais comuns foram alteração de sinal, atrofia focal ou hemisférica e dilatação ventricular, em graus variados. Trinta e três pacientes foram submetidos ao tratamento cirúrgico. CONCLUSÕES: A definição da conduta e tratamento dos pacientes com ER deve ser discutida por equipe multidisciplinar, levando em consideração os achados clínicos, EEG e de exames de imagem, com objetivo de controlar as crises a fim de minimizar os déficits cognitivos, motores e de linguagem destes pacientes. / INTRODUCTION: Rasmussen encephalitis (RE) is a rare and sporadic disease, presenting as a multifocal brain dysfunction and focal seizures, refractory to drug treatment, sometimes manifesting with continuous partial epilepsy. The onset of seizures predominates in childhood, and affects previously healthy children with progressive course. Most often involves one cerebral hemisphere, which becomes atrophic. Diagnosis is made through EEG analysis, clinical, magnetic resonance imaging (MRI) findings and/or histopathological findings. Brain MRI is particularly useful, and provides data that can contribute to the diagnosis, help in site selection for biopsy, as well as in monitoring the progressive course of the disease. MATERIALS AND METHODS: We collected demographic data, neuropsychological evaluations, surgical and imaging findings of all patients diagnosed with RE in HCFMRP, from 1997-2016. RESULTS: It included 35 patients with a mean age of 5.8 years. Seventy percent of these presented with continuous partial epilepsy and 29 also had histopathologic confirmation. There were no cases of confirmed bilateral involvement in this sample. The most common imaging findings were signal change , focal or hemispheric atrophy and ventricular dilatation , in varying degrees. Thirtythree patients underwent surgical treatment. CONCLUSIONS: The definition of management and treatment of patients with ER should be discussed by a multidisciplinary team, taking into account the clinical, EEG and imaging findings, in order to control seizures and minimize cognitive, motor and language deficits of these patients.

Les encéphalites à anticorps (Ac) anti-récepteur NMDA (NMDAR) sont des pathologies auto-immunes nouvellement décrites ciblant un récepteur majeur du système nerveux central, le NMDAR. Les synapses glutamatergiques assurent la majeure partie de la transmission excitatrice du cerveau et les récepteurs ionotropiques au glutamate de type NMDA ont un rôle clé dans la plasticité synaptique, c'est-à-dire les modifications de la force de transmission synaptique constituant le corrélat cellulaire des processus d'apprentissage et de mémoire. Les études in vitro et in vivo de l'effet des Ac anti-NMDAR tendent à montrer une altération de la dynamique des NDMAR et une internalisation. Les Ac auraient un effet pathogénique pouvant expliquer des symptômes. Au cours de ma thèse, j'ai souhaité approfondir la compréhension de cette pathologie sur le plan clinique et mécanistique. Pour cela j'ai étudié les caractéristiques cliniques et histologiques des patients présentant une tumeur maligne associée, me permettant d'établir des recommandations de prise en charge au vu du taux de mortalité plus élevé chez ces patients et d'une fréquence plus importante de tératomes ovariens immatures que dans la population générale. En parallèle j'ai étudié l'effet des Ac anti-NMDAR sur la transmission et la plasticité synaptique dans un modèle murin d'administration chronique des anticorps. Ces études menées en électrophysiologie sur tranches aigües m'ont permis de mettre en évidence un effet des anticorps du LCR sur la plasticité synaptique significatif mais d'amplitude moindre que les études in vitro l'avaient suggéré. Nous avons également montré l'importance de la durée d'exposition aux anticorps / Anti-NMDAR autoimmune encephalitis is a newly described pathology, characterized by the presence of IgG antibodies (Abs) directed against NMDA receptor (NMDAR). Glutamatergic synapses are the main component of excitatory transmission in the adult brain and the ionotropic glutamate receptor NMDAR has a key role in synaptic plasticity. Synaptic plasticity is defined by the synapses property to modify their transmission strength and seems to be the cellular correlate of learning and memory. In vitro and in vivo studies on anti-NMDAR Abs effects showed an altered dynamic at the membrane followed by an internalization of NMDAR. Thus, Abs seem to have a pathogenic effect, able to explain clinical symptoms. During my thesis, I wanted to deepen the understanding of this pathology on the clinical and mechanistic level. To this end, I studied the clinical and histological features of patients with an associated tumor. Results obtained allow me to establish management recommendations considering the high mortality rate in these patients and a higher frequency of immature ovarian teratomas than in the general population. Simultaneously, I studied the effect of anti-NMDAR Abs on synaptic transmission and plasticity in a murine model allowing chronic Abs infusion. These results obtained by electrophysiology on acute slices allowed me to demonstrate an effect of CSF Abs on synaptic plasticity but of less amplitude that the in vitro studies had suggested. Results also highlighted the importance of the duration to antibodies exposure

Le danio zébré est un modèle bien établi pour étudier la biologie du développement des vertébrés. Ses larves transparentes sont favorables à des approches de microscopie non invasive, qui permettent de réaliser des observations à l’échelle d’un individu entier à des niveaux de résolution cellulaire et subcellulaire. Ces atouts font du danio zébré un excellent modèle pour étudier les infections virales in vivo. Au cours de mon projet, j’ai etudié l’entrée et la colonisation du système nerveux central (SNC) par le virus Sindbis (SINV) dans le modèle danio zébré. Mon projet présentait plusieurs axes: 1) développer un modèle d’infection du virus Sindbis chez le danio zébré, 2) caractériser l’invasion du SNC par le virus par des techniques d’imagerie à haute résolution, 3) définir la voie d’entrée du virus dans le SNC, 4) évaluer la dynamique de la réponse immunitaire innée par l’étude de la réponse interféron. Le suivi de la propagation du virus a été rendu possible par l’utilisation d’un ARN viral recombinant exprimant la protéine fluorescente verte ‘GFP’. L’utilisation de cette construction m’a permis de caractériser la progression de SINV chez le danio zébré et d’identifier les organes/tissus cibles que sont le vitellus, le foie, le cœur et enfin, le cerveau. Les données rassemblées jusqu'à présent m’ont aussi permis d’identifier le mécanisme par lequel SINV se propage vers le cerveau: le virus se propage par un transport axonal du system nerveux périphérique vers le SNC. Dans le cadre de la réponse immunitaire au niveau cellulaire, j’ai pu observer le rôle joué par les leucocytes, en particulier les neutrophiles, comme cellules productrices d'interféron. / The zebrafish (Danio rerio) is an important model organism, particularly for studies of development and more recently host pathogen interactions. As opposed to other vertebrate model organisms, its optical clarity and ease of genetic manipulations allow to visualize highly dynamic cellular processes in vivo at the whole organism scale. These assets make the zebrafish a perfect model for the study of viral infections in vivo, such as those caused by neurotropic viruses. The aim of this project has been to gain insights in some of the interactions that determine encephalitis, by characterizing the neurotropic Sindbis virus (SINV). This Thesis project has consisted therefore in: 1) the development of a SINV infection model in zebrafish larvae, 2) the characterization of SINV neuroinvasion upon its inoculation in the bloodstream, thanks to the use of high resolution microscopy, 3) the study of SINV mechanism of entry in the CNS, 4) the characterization of the innate immune response, both at the whole organism and organ specific level. Thanks to the use of a SINV recombinant strain, engineered to express the green fluorescent protein “GFP” in infected cells upon viral replication, we have been able to follow the onset and the progression of the infection. We have suggested infection of peripheral neurons and subsequent axonal transport to the CNS as SINV entry mechanism. At the cellular level, we have identified neutrophils as the main IFN producing cells.

No description available.

The influence of forest canopy disturbance (FCD) on La Crosse virus (LACV), leading cause of US pediatric arboviral encephalitis, is critical to understand in landscapes where forests are periodically harvested. Southwestern Virginia is part of an emerging focus of this interior forest bunyavirus. I investigated how the temperate forest mosquito community, LACV vectors, and the LACV amplifying vertebrate host (chipmunks) were impacted by logging. This research was conducted across an experimental FCD gradient (from least to most disturbed: contiguous control, fragmented control, clearcut, and high-leave shelterwood (SW)). Using gravid traps, I found that the mosquito community was resilient to logging with no significant difference in diversity or community composition across treatments. Mean number of female mosquitoes caught per trap-night declined with disturbance. FCD significantly affected the abundance of vector species in different ways. The primary LACV vector, Aedes triseriatus, and the recent invasive Ae. japonicus declined with logging. Other vectors (Ae. albopictus, Ae. canadensis, and Ae. vexans) thrived with logging. Culex pipiens/restuans was affected by disturbance but had no treatment preference. A mark-recapture study revealed that chipmunk abundance and LACV seroprevalence were greatest on the SW. In sync with Ae. triseriatus abundance but in contrast to the chipmunk results, mosquito LACV detection was significantly greater on unlogged sites. Surprisingly, LACV was detected in Ae. japonicus and Cx. pipiens/restuans. In a follow-up study, I isolated LACV from field-collected Ae. japonicus. Although LACV was previously isolated from Cx. pipiens, the vector competence was unknown. Therefore, I examined the vector competence of Cx. pipiens and Cx. restuans. Although poor vectors, I did detect LACV in the saliva of both species. An additional experiment found that nutritionally-stressed Cx. restuans were better vectors than those in the control group, indicating that environmental stressors (e.g., FCD) may alter the ability of accessory vectors to spread LACV. The influence of FCD on LACV is complex. Because logging decreases Ae. triseriatus abundance, human LACV risk is likely lowered by decreased transovarial vertical transmission. However, high chipmunk seroprevalence on disturbed sites suggest horizontal transmission with accessory vectors plays a larger role in LACV risk on recently logged sites. / Ph. D.

The present thesis examines questions related to the temporal origin of the Flavivirus genus and the ecology of tick-borne pathogens. In the first study, we date the origin and divergence time of the Flavivirus genus. It has been argued that the first flaviviruses originated after the last glacial maximum. This has been contradicted by recent analyses estimating that the tick-borne flaviviruses emerged at least before 16,000 years ago. It has also been argued that the Powassan virus was introduced into North America at the time between the opening and splitting of the Beringian land bridge. Supported by tip date and biogeographical calibration, our results suggest that this genus originated circa 120,000 (156,100–322,700) years ago if the Tamana bat virus is included in the genus, or circa 85,000 (63,700–109,600) years ago excluding the Tamana bat virus. In the second study we estimate the prevalence of tick-borne encephalitis virus (TBEV) in host-seeking Ixodes ricinus from 29 localities in Sweden and compare our data with those of neighbouring countries. Nymphs and adult ticks were screened for TBEV using a real-time PCR assay. The mean TBEV prevalence for all tick stages combined was 0.26% for Sweden and 0.28% for all Scandinavian countries, excluding Iceland. The low prevalence of TBEV in nature may partly be explained by the fact that TBEV occurs in spatially small foci and that the inclusion of ticks from non-infected foci will reduce the prevalence estimate. In the third and fourth study, we conducted the first large-scale investigations to estimate the prevalence and geographical distribution of Anaplasma spp. and Rickettsia spp. in host-seeking larvae, nymphs and adults of I. ricinus ticks in Sweden. Ticks were collected from several localities in central and southern Sweden and were subsequently screened for the presence of Anaplasma spp. and Rickettsia spp. using a real-time PCR assay. For all active tick stages combined, the mean prevalence of Anaplasma spp. and Rickettsia spp. in I. ricinus in Sweden was estimated to 1.1% and 4.8%, respectively. It was also shown that A. phagocytophilum and R. helvetica are the main Anaplasma and Rickettsia species occurring in Sweden.

In Western Europe the incidence of tick-borne encephalitis (TBE) has increased over the last 30 years, coupled with changes in distribution. Modifications in the TBE enzootic cycle, through a combination of changes in temperature, vertebrate abundance and habitat suitability may have increased the risk of TBE in recent years. In Switzerland, analysis using satellite-derived climate data demonstrated that the environment of areas with TBE since the 1980s and areas that recently became endemic for TBE have become more similar between 2001 and 2009. This was coupled with an increase in April, May and June temperature, which could have affected the tick population and/or human exposure to ticks. Deer and boar abundance also changed in some cantons. In Germany, spatio-temporal modelling demonstrated the importance of temperature, vertebrate abundance and unemployment in the incidence and distribution of TBE between 2001 and 2009. Changes in TBE reporting, April, May and June temperature, vertebrate abundance and pesticide use may have contributed to increases in TBE in 1992 and 2001. Human exposure patterns, however, appear to be as important as the enzootic cycle in shaping the incidence of TBE, not only in determining the overall trend but also in interacting with the weekly, seasonal and yearly patterns of tick hazard to give the observed incidence. In Switzerland, in weeks with warm, sunny weather, human exposure to ticks is promoted and short-term increases in tick bites are seen. Human outdoor activity also shifts the seasonal pattern of tick bites, when compared with tick questing. There was no apparent increase in time spent in outdoor activities between the 1990s and 2000s in Italy, Germany and Austria, but survey data demonstrated that walking and hiking were already popular activities across Europe by the 1990s. The popularity of mushroom and berry foraging as a source of income in Latvia, Lithuania and Poland, coupled with the expense of vaccination, provide an inverse link between economic wellbeing and TBE risk. Correspondingly, in 2009, the economic recession was associated with an increase with TBE in these three countries.