Hein Sprong

Hein Sprong
  • PhD
  • Project Manager at National Institute for Public Health and the Environment

About

433
Publications
101,789
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18,142
Citations
Introduction
Research coordinator & scientist at Centre for Infectious Disease Control (CIb), RIVM, The Netherlands. Interested in molecular aspects of ecology, biology, epidemiology and diagnostics of infectious diseases. Strong focus on ticks, and tick-borne diseases and on One Health
Current institution
National Institute for Public Health and the Environment
Current position
  • Project Manager
Additional affiliations
January 2012 - present
Wageningen University & Research
Position
  • Researcher
July 2007 - present
National Institute for Public Health and the Environment
Position
  • Project Manager
July 1998 - May 2001
Academisch Medisch Centrum Universiteit van Amsterdam
Position
  • PhD Student

Publications

Publications (433)
Article
Serological assays are important tools for detecting the presence of antibodies that are indicative of past and ongoing infections. For wildlife, species-specific conjugates, which are used as detection antibodies in primary binding assays, are not available for most species. In these cases, conjugates for closely related species or immunoglobulin-...
Article
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Crimean-Congo hemorrhagic fever is a broadly distributed tick-borne disease and is caused by the arthropod-borne Crimean-Congo hemorrhagic fever virus (CCHFV). Hyalomma ticks have been associated with the circulation of the virus in natural foci and in laboratory experiments. One of the main species, Hyalomma rufipes, is originally distributed in A...
Article
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Background Tick-borne encephalitis (TBE) can be a severe neurological disease. Identifying ecological factors that may facilitate tick-borne encephalitis virus (TBEV) circulation in the Netherlands could improve awareness and detection. Aim We aimed to identify ecological factors affecting TBEV circulation in the Netherlands and to determine if th...
Article
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The largest land use change in Europe is woodland expansion, through planting and natural regeneration. Unforeseen consequences of this could include changes in environmental hazards, such as exposure to parasites and pathogens. Tick‐borne Lyme disease is the most prevalent tick‐borne disease in the northern hemisphere and is often associated with...
Preprint
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Background Mosquito-borne arboviruses, including Usutu virus (USUV) and West Nile virus (WNV), are emerging threats in Europe, with changes in climate, land use, and increased travel and trade influencing their dynamics. Understanding the emergence and establishment of these viruses in new regions is critical for informing targeted mitigation of dr...
Preprint
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Members of the Rickettsiella genus (Legionellales) are emerging as widespread bacteria associated with insects, arachnids, and crustaceans. While some Rickettsiella strains are highly virulent entomopathogens, others are maternally inherited endosymbionts that manipulate arthropod phenotypes, including the induction of defensive symbiosis and cytop...
Article
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Muridae such as rats and mice are important hosts of (zoonotic) pathogens in urbanized environments. Controlling their population size is an important component of public health policies to reduce human disease risk. Recent studies suggest that rodent populations may increase due to urban greening, but this could also be counteracted by domestic ca...
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The taxa Ixodes ricinus and Ixodes inopinatus are sympatric in Tunisia. The genetics underlying their morphological differences are unresolved. In this study, ticks collected in Jouza-Amdoun, Tunisia, were morphologically identified and sequenced using Oxford Nanopore Technologies. Three complete genome assemblies of I. inopinatus and three of I. r...
Poster
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Won the poster prize. Tick-borne risks have typically been associated with forested areas, but a substantial fraction of tick bites results from activities in private gardens. However, limited information is available on factors that drive variation among gardens. In 2021 and 2022 we conducted a citizen science project “Teek a Break”, aiming to c...
Article
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Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic disease associated with its principal tick vector, Hyalomma spp. with increasing fatal incidence worldwide. Accordingly, CCHF is a World Health Organization-prioritized disease with the absence of effective preventive interventions and approved vaccines or effective treatments. This perspective r...
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An infection with the tick-borne Rickettsia helvetica has been associated with a broad spectrum of clinical manifestations in humans, but patients are only seldomly reported. Understanding its disease etiology necessitates well-stablished infection models, improving to recognize and diagnose patients with R. helvetica infection and facilitating the...
Article
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Background Ticks carry a variety of microorganisms, some of which are pathogenic to humans. The human risk of tick-borne diseases depends on, among others, the prevalence of pathogens in ticks biting humans. To follow-up on this prevalence over time, a Belgian study from 2017 was repeated in 2021. Methods During the tick season 2021, citizens were...
Article
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Tick-borne disease incidence is predicted to increase over the next decade, so it is important to understand drivers of tick density and pathogen prevalence. Although deer are common reproduction hosts for Ixodes ricinus ticks, other reproduction hosts, such as livestock, can maintain tick populations as well. Here, we investigated tick density and...
Article
Severe babesiosis with 9.8% parasitemia was diagnosed in a patient in the Netherlands who had previously undergone splenectomy. We confirmed Babesia venatorum using PCR and sequencing. B. venatorum was also the most prevalent species in Ixodes ricinus ticks collected around the patient's home. Our findings warrant awareness for severe babesiosis in...
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A crucial factor to predict the persistence and spread of infections in natural systems is the capacity of reservoir hosts to maintain the infection and transmit it to others. This is known to greatly vary within and between species and through time, although the latter part of the variation is often less well understood in the wild. Borrelia garin...
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The incidence of diseases caused by pathogens transmitted by the tick Ixodes ricinus vary over time and space through incompletely understood mechanisms. An important determinant of the disease risk is the density of infected ticks, which is the infection prevalence times the density of questing ticks. We therefore investigated the spatial and temp...
Article
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Usutu virus (USUV) is an emerging flavivirus that is maintained in an enzootic cycle with mosquitoes as vectors and birds as amplifying hosts. In Europe, the virus has caused mass mortality of wild birds, mainly among Common Blackbird (Turdus merula) populations. While mosquitoes are the primary vectors for USUV, Common Blackbirds and other avian s...
Article
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Species composition and densities of wild ungulate communities in Europe have changed over the last decades. As ungulates play an important role in the life-cycle of the tick species Ixodes ricinus, these changes could affect both the life-cycle of I. ricinus and the transmission of tick-borne pathogens like Borrelia burgdorferi (s.l.) and Anaplasm...
Article
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Borrelia miyamotoi is an emerging Ixodes tick-borne human pathogen in the Northern hemisphere. The aim of the current study was to compare whole genome sequences of B. miyamotoi isolates from different continents. Using a combination of Illumina and PacBio platforms and a novel genome assembly and plasmid typing pipeline, we reveal that the 21 sequ...
Article
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Background: Urban areas are unique ecosystems with stark differences in species abundance and composition compared with natural ecosystems. These differences can affect pathogen transmission dynamics, thereby altering zoonotic pathogen prevalence and diversity. In this study, we screened small mammals from natural and urban areas in the Netherlands...
Article
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Background To be better prepared for emerging wildlife-borne zoonoses, we need to strengthen wildlife disease surveillance. Aim The aim of this study was to create a topical overview of zoonotic pathogens in wildlife species to identify knowledge gaps and opportunities for improvement of wildlife disease surveillance. Methods We created a databas...
Article
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The tick Ixodes ricinus parasitizes a wide range of vertebrates. These hosts vary in the relative contribution to the feeding of the different tick life stages, and their interplay is pivotal in the transmission dynamics of tick-borne pathogens. We aimed to know if there is a phylogenetic signal in the feeding and propagation hosts of I. ricinus, i...
Article
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Ticks are involved in the transmission a plethora of pathogens. To effectively control ticks and mitigate the risks associated with tick-borne diseases, it is important to implement tick control measures. These may include the use of acaricides as well as the development and implementation of an alternative, environmentally friendly tick management...
Article
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Vector-borne diseases (VBDs) are considered as (re-)emerging, but information on the transmission cycles and wildlife reservoirs is often incomplete, particularly with regard to urban areas. The present study investigated blood samples from European hedgehogs (Erinaceus europaeus) presented at wildlife rehabilitation centres in the region of Hanove...
Preprint
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Background Ixodes ricinus ticks act as vectors for numerous pathogens that present substantial health threats. Additionally, they harbor vertically transmitted symbionts, some of which have been linked to diseases. The difficulty of isolating and cultivating these symbionts has has hampered our understanding of their biological role, their potentia...
Article
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Background Hippoboscid flies are bloodsucking arthropods that can transmit pathogenic microorganisms and are therefore potential vectors for pathogens such as Bartonella spp. These Gram‐negative bacteria can cause mild‐to‐severe clinical signs in humans and animals; therefore, monitoring Bartonella spp. prevalence in louse fly populations appears t...
Article
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Tick-borne encephalitis virus (TBEV) is an emerging pathogen in the Netherlands. Multiple divergent viral strains are circulating and the focal distribution of TBEV remains poorly understood. This may, however, be explained by differences in the susceptibility of tick populations for specific viruses and viral strains, and by viral strains having h...
Preprint
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Ticks are obligate blood-feeding parasites associated with a huge diversity of diseases globally. The hard tick Ixodes ricinus is the key vector of Lyme borreliosis and tick-borne encephalitis in Western Eurasia. Ixodes ticks have large and repetitive genomes that are not yet well characterized. Here we generate two high-quality I . ricinus genome...
Article
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Urban greening has become an increasingly popular strategy to improve urban life and human health. However, there are indications that the presence and extent of urban greenness may increase the abundance of wild rats. Therefore, we investigated which environmental and socio-economic factors are associated with rat abundance, with a focus on factor...
Article
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Studies on density and pathogen prevalence of Ixodes ricinus indicate that vegetation and local host community drive much of their variation between green spaces. Contrarily, micro-geographic variation is understudied, although its understanding could reduce disease risk. We studied the density of infectious nymphal Ixodes sp. (“DIN”, proxy for dis...
Article
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The distribution of tick-borne encephalitis virus (TBEV) is expanding to Western European countries, including the Netherlands, but the contribution of different rodent species to the transmission of TBEV is poorly understood. We investigated whether two species of wild rodents native to the Netherlands, the wood mouse Apodemus sylvaticus and the y...
Article
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Background Ixodes ricinus ticks are infected with a large diversity of vertically and horizontally transmitted symbionts. While horizontally transmitted symbionts rely on a vertebrate host for their transmission, vertically transmitted symbionts rely more on the survival of their invertebrate host for transmission. We therefore hypothesized horizon...
Article
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Background Patients treated for Lyme borreliosis (LB) frequently report persistent symptoms. Little is known about risk factors and etiology. Methods In a prospective observational cohort study with a follow-up of one year, we assessed a range of microbiological, immunological, genetic, clinical, functional, epidemiological, psychosocial and cogni...
Article
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Climate change is one of the drivers of wildlife-borne disease emergence, as it can affect species abundance and fitness, host immunocompetence, and interactions with pathogens. To detect emerging wildlife-borne diseases, countries may implement general wildlife-disease surveillance systems. Such surveillance exists in the Netherlands. However, it...
Article
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Urban greening has benefits for both human and environmental health. However, urban greening might also have negative effects as the abundance of wild rats, which can host and spread a great diversity of zoonotic pathogens, increases with urban greenness. Studies on the effect of urban greening on rat-borne zoonotic pathogens are currently unavaila...
Article
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Background Arthropod vectors such as ticks, mosquitoes, sandflies and biting midges are of public and veterinary health significance because of the pathogens they can transmit. Understanding their distributions is a key means of assessing risk. VectorNet maps their distribution in the EU and surrounding areas.AimWe aim to describe the methodology u...
Article
Until 2015, tick-borne encephalitis virus (TBEV) was presumed not to be endemic in the Netherlands. Consequently, the number of diagnostic requests for detection of tick-borne encephalitis (TBE) infection had been low. Between 2006 and 2015, the laboratory of the Netherlands Centre of Infectious Disease Control (Clb), 1 of the 2 laboratories that p...
Preprint
Full-text available
Endosymbiosis, where a microbe lives and replicates within a host, is an important contributor to organismal function that has accelerated evolutionary innovations and catalysed the evolution of complex life. The evolutionary processes associated with transitions to endosymbiosis, however, are poorly understood. Here, we use comparative genomics of...
Article
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Tick-borne encephalitis (TBE) is a viral disease endemic in Eurasia. The virus is mainly transmitted to humans via ticks and occasionally via the consumption of unpasteurized milk products. The European Centre for Disease Prevention and Control reported an increase in TBE incidence over the past years in Europe as well as the emergence of the disea...
Article
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Background Tick-borne encephalitis virus (TBEV) can cause severe neurological disease in humans. Its geographical distribution is expanding in Western Europe with unresolved causes and spatial patterns, necessitating enhanced surveillance. Monitoring the virus in the environment is complicated, as it usually relies on destructive sampling of small...
Article
Full-text available
Understanding which factors determine tick‐borne disease hazard can contribute to effective disease control. In Europe, the hazard of the pathogens Borrelia burgdorferi s.l. and Anaplasma phagocytophilum is determined by local tick densities (mainly Ixodes ricinus) and the reservoir competence of the host species community. Sand lizards (Lacerta ag...
Article
Biodiversity loss and the emergence of zoonotic diseases are two major global challenges. An urgent question is how ecosystems and wildlife communities can be restored whilst minimizing the risk of zoonotic diseases carried by wildlife. Here, we evaluate how current ambitions to restore Europe's natural ecosystems may affect the hazard of diseases...
Article
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Tick-borne encephalitis virus (TBEV) may cause tick-borne encephalitis (TBE), a potential life-threatening infection of the central nervous system in humans. Phylogenetically, TBEVs can be subdivided into three main subtypes, which differ in endemic region and pathogenic potential. In 2016, TBEV was first detected in the Netherlands. One of two det...
Article
The ornate dog tick (Dermacentor reticulatus) shows a recently expanding geographic distribution. Knowledge on its intraspecific variability, population structure, rate of genetic diversity and divergence, including its evolution and geographic distribution, is crucial to understand its dispersal capacity. All such information would help to evaluat...
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Background Hepatozoon spp. are tick-borne parasites causing subclinical to clinical disease in wild and domestic animals. Aim of this study was to determine Hepatozoon prevalence and species distribution among wild mammals and ticks in Europe. Methods Samples of wild mammals and ticks, originating from Austria, Bosnia and Herzegovina, Croatia, Bel...
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Simple Summary A disease outbreak in a Swedish herd of beef cattle which may be related to a tick-borne infection initiated an in-depth study to investigate the presence of bacteria and viruses in clinically healthy and diseased cattle, as well as in wild deer and boars from the region and in ticks collected from the cattle and deer. The results in...
Article
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Background Trypanosomes are protozoan parasites of vertebrates that are of medical and veterinary concern. A variety of blood-feeding invertebrates have been identified as vectors, but the role of ticks in trypanosome transmission remains unclear. Methods In this study, we undertook extensive molecular screening for the presence and genetic divers...
Preprint
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Background: The multi-host tick Ixodes ricinus is the principal vector of zoonotic diseases in Europe. Quantifying the contribution of each host species in the tick’s pathogen transmission cycles is imperative in spatio-temporal pathogen exposure assessments, but remains challenging in the absence of techniques identifying the previous host on whic...
Article
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The European mole (Talpa europaea) has a widespread distribution throughout Europe. However, little is known about the presence of zoonotic pathogens in European moles. We therefore tested 180 moles from the middle and the south of the Netherlands by (q)PCR for the presence of multiple (tick-borne) zoonotic pathogens. Spotted fever Rickettsia was f...
Preprint
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Background Maintaining high vertebrate diversity is promoted as a potential strategy to control Lyme disease hazard via a so-called dilution effect, which occurs when increasing diversity of an ecological community reduces the transmission of a pathogen. However, empirical evidence from Europe is limited at best, while it remains unclear whether di...
Article
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Wild and domestic animals can be usefully employed as sentinels for the surveillance of diseases with an impact on public health. In the case of tick-borne encephalitis virus (TBEV), the detection of antibodies in animals can be more effective than screening ticks for detecting TBEV foci, due to the patchy distribution of the virus. In the Piedmont...
Article
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Background: The extent to which infections with Ixodes ricinus-borne pathogens (TBPs), other than Borrelia burgdorferi s. l. and tick-borne encephalitis virus (TBEV), cause disease in humans remains unclear. One of the reasons is that adequate diagnostic modalities are lacking in routine or research settings. Methods: We evaluated the analytical sp...
Article
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Wild rats can host various zoonotic pathogens. Detection of these pathogens is commonly performed using molecular techniques targeting one or a few specific pathogens. However, this specific way of surveillance could lead to (emerging) zoonotic pathogens staying unnoticed. This problem may be overcome by using broader microbiome‐profiling technique...
Article
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Tick-borne encephalitis virus (TBEV) is an emerging pathogen that was first detected in ticks and humans in the Netherlands in 2015 (ticks) and 2016 (humans). To learn more about its distribution and prevalence in the Netherlands, we conducted large-scale surveillance in ticks and rodents during August 2018-September 2020. We tested 320 wild rodent...
Article
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Background Microbial communities can affect disease risk by interfering with the transmission or maintenance of pathogens in blood-feeding arthropods. Here, we investigated whether bacterial communities vary between Ixodes ricinus nymphs which were or were not infected with horizontally transmitted human pathogens. Methods Ticks from eight forest...
Article
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Simple Summary Ixodid ticks and tick-borne diseases are expanding their geographical range, but surveillance activities vary among countries. We analysed the surveillance systems in place in the Netherlands, Spain and Italy, to identify ideal elements to monitor tick-borne diseases, by using a One Health evaluation protocol. We identified differenc...
Article
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Anaplasma phagocytophilum is a tick‐borne pathogen that has been detected in many tick and vertebrate species. It is among the most widespread tick‐borne pathogens in animals in Europe. The bacterium can be genetically divided into four ecotypes, which are linked to distinct but overlapping host species. However, knowledge about the transmission dy...
Article
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Background Various studies have evaluated the infection of Ixodes ticks and humans with the relapsing fever spirochaete Borrelia miyamotoi. However, to our knowledge, the prevalence of infection and disease has not been assessed systematically. We aimed to examine the prevalence of B miyamotoi in Ixodes ticks and humans, and the disease it can caus...
Poster
Full-text available
Wild and domestic animals can be usefully employed as sentinels for the surveillance of diseases with impact on public health. In the case of tick-borne encephalitis virus (TBEV), the detection of antibodies in animals can be more effective than screening Ixodes ricinus ticks for detecting TBEV foci, due to the patchy distribution of the virus. In...
Article
Full-text available
Background Ixodes ricinus ticks vector pathogens that cause serious health concerns. Like in other arthropods, the microbiome may affect the tick’s biology, with consequences for pathogen transmission. Here, we explored the bacterial communities of I. ricinus across its developmental stages and six geographic locations by the 16S rRNA amplicon sequ...
Preprint
Full-text available
Background: Microbial communities can affect disease risk by interfering with the transmission or maintenance of pathogens in blood-feeding arthropods. Here, we investigated whether bacterial communities vary between Ixodes ricinus nymphs, which are (un)infected with horizontally-transmitted human pathogens. Methods: Ticks from eight forest sites w...
Article
Full-text available
Ixodes ricinus ticks transmit Borrelia burgdorferi sensu lato (s.l.) as well as Borrelia miyamotoi. Larvae become infected when feeding on infected rodents, with horizontal transmission of B. burgdorferi and horizontal and vertical transmission of B. miyamotoi. We studied seasonal dynamics of infection rates of I. ricinus and their rodent hosts, an...
Article
Until 2015, tick-borne encephalitis virus (TBEV) was presumed not to be endemic in the Netherlands. Consequently, the number of diagnostic requests for detection of tick-borne encephalitis (TBE) infection has been low. Between 2006 and 2015, the laboratory of the Netherlands Centre for Infectious Disease Control (CIb), 1 of the 2 laboratories that...
Article
Full-text available
Ca. Neoehrlichia mikurensis is widely prevalent in I. ricinus across Europe and has been associated with human disease. However, diagnostic modalities are limited, and much is still unknown about its biology. Here, we present the first complete Ca. Neoehrlichia mikurensis genomes directly derived from wildlife reservoir host tissues, using both lon...
Article
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Human granulocytic anaplasmosis and tick-borne fever, affecting livestock, are diseases caused by an infection with the bacterium Anaplasma phagocytophilum. Its transmission dynamics between vertebrate hosts and ticks remain largely unknown and the potential impact on public health in the United Kingdom is unclear. This study aimed to assess the di...
Article
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Public and animal health authorities face many challenges in surveillance and control of vector-borne diseases. Those challenges are principally due to the multitude of interactions between vertebrate hosts, pathogens, and vectors in continuously changing environments. VectorNet, a joint project of the European Food Safety Authority (EFSA) and the...
Article
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Background The impact of infections with tick-borne pathogens (TBPs) other than Borrelia burgdorferi (s.l.) and tick-borne encephalitis virus (TBEV) on public health in Europe remains unclear. Our goal is to evaluate whether the presence of these TBPs in ticks can be associated with self-reported health complaints. Methods We enrolled individuals...
Article
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Background The main objective of this study was to determine the prevalence of nine vector-borne pathogens or pathogen genera in roe deer (Capreolus capreolus) in the Netherlands, and to identify which host variables predict vector-borne pathogen presence in roe deer. The host variables examined were the four host factors ‘age category’, ‘sex’, ‘nu...
Article
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Following findings in Northern America of SARS‐CoV‐2 infections in white‐tailed deer, there is concern of similar infections in European deer and their potential as reservoirs of SARS‐CoV‐2 including opportunities for the emergence of new variants. UK deer sera were collected in 2020‐21 from 6 species and a hybrid; with 1,748 tested using anti‐spik...
Article
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Background A number of tick-borne pathogens circulate in the Belgian tick population in addition to the causative agent of Lyme borreliosis. However, so far, only a few patients with tick-borne diseases other than Lyme borreliosis have been reported in Belgium. The aim of this study was to investigate the occurrence of other human tick-borne infect...
Article
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Anaplasma phagocytophilum is an important tick-borne zoonotic agent of human granulocytic anaplasmosis (HGA). In Europe, the Ixodes ticks are the main vector responsible for A. phagocytophilum transmission. A wide range of wild animals is involved in the circulation of this pathogen in the environment. Changes in populations of vertebrates living i...
Article
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Rickettsiella species are bacterial symbionts that are present in a great variety of arthropod species, including ixodid ticks. However, little is known about their genetic diversity and distribution in Ixodes ricinus, as well as their relationship with other tick-associated bacteria. In this study, we investigated the occurrence and the genetic di...
Article
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Background Lyme borreliosis and other tick-borne diseases emerge from increased interactions between humans, other animals, and infected ticks. The risk of acquiring a tick-borne infection varies across space and time, so knowledge of the occurrence and prevalence of pathogens in ticks can facilitate disease diagnosis in a specific area and the imp...
Article
European brown hare (Lepus europaeus Pallas 1778) is a broadly distributed lagomorph species in Europe, recognized as a host for Ixodes ricinus and reservoir of a wide range of pathogens with zoonotic potential. Even though Lepus europaeus represents an important game animal in Central Europe, the data available on Anaplasma phagocytophilum in this...
Preprint
Full-text available
Background: Ixodes ricinus ticks vector pathogens that cause serious health concerns. Like in other arthropods, the microbiome may affect the tick’s biology with consequences for pathogen transmission. Here, we explored the bacterial communities of I. ricinus across its developmental stages and six geographic locations by the 16S rRNA amplicon sequ...
Article
Full-text available
Background Several ungulate species are feeding and propagation hosts for the tick Ixodes ricinus as well as hosts to a wide range of zoonotic pathogens. Here, we focus on Anaplasma phagocytophilum and Borrelia burgdorferi ( s.l. ), two important pathogens for which ungulates are amplifying and dilution hosts, respectively. Ungulate management is o...
Article
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Members of the genus Bartonella are Gram-negative facultative intracellular bacteria that are transmitted by arthropod vectors. Bartonella alsatica was detected in the spleens and livers of 7 out of 56 wild rabbits (Oryctolagus cuniculus) and in the liver of 1 out of 87 domestic rabbits in the Netherlands. The molecular evidence of B. alsatica infe...
Article
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An understanding of the relationships of ticks and tick-borne pathogens can only be achieved by integrating data from multiple studies. The publication of raw material is a necessary step for wide-area meta-analyses and study design, data collection and reporting require harmonization. This is an opinion paper, not a consensus position, and is open...
Article
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Free-living animals frequently play a key role in the circulation of various zoonotic vector-borne pathogens. Bacteria of the genus Bartonella are transmitted by blood-feeding arthropods and infect a large range of mammals. Although only several species have been identified as causative agents of human disease, it has been proposed that any Bartone...
Article
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Background Tick-borne pathogens other than Borrelia burgdorferi sensu lato – the causative agent of Lyme borreliosis – are common in Ixodes ricinus ticks. How often these pathogens cause human disease is unknown. In addition, diagnostic tools to identify such diseases are lacking or reserved to research laboratories. To elucidate their prevalence a...
Article
Full-text available
Until 2015, tick-borne encephalitis virus (TBEV) was presumed not to be endemic in the Netherlands.1,2 Consequently, the number of diagnostic requests for detection of tick-borne encephalitis (TBE) infection had been low. Between 2006 and 2015, the laboratory of the Netherlands Centre of Infectious Disease Control (Clb), 1 of the 2 laboratories tha...

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