Suspected cases of tick-borne encephalitis are referred to the Health Protection Agency’s (HPA) Rare and Imported Pathogens Laboratory at Porton Down for diagnosis. Acute suspected encephalitis of

any cause is statutorily notifiable and infection with any species of Borrelia, the causative agent of Lyme disease, reportable under the Health Protection (Notification) Regulations 2010.

Testing is performed on the basis of symptoms and travel history to cover the principal differential diagnoses when combined with routine tests undertaken in National Health Service hospitals. Data from these tests are used for epidemiological monitoring by the HPA’s Health Protection Services at Colindale. Information to travellers and clinicians about tick-borne encephalitis, including vaccination, is provided by general practitioners and through the National Travel Health Network and Centre which is funded through the HPA.

The Health Protection Agency’s (HPA) Medical Entomology group has historical data on tick distribution in the United Kingdom (UK) for the last 100 years and has been running an enhanced tick surveillance programme for the UK since 2005. This monitoring work will continue and the latest findings, published in 2011, conclude that compared to historical data Ixodes ricinus ticks are expanding their geographic UK range, particularly in south-west England. Since 2010, the HPA has conducted studies of tick numbers at 10 sites across the UK as part of the Environmental Change Network; it is too early to say whether tick abundance has increased. Ticks collected in these studies are not currently routinely tested for levels of any pathogens, except within specific funded research projects.

Testing is available for a wide range of zoonotic agents through the Health Protection Agency’s (HPA) Rare and Imported Pathogens Laboratory and other laboratories. The selection of tests used depends on the history and travel details of the patient, and a panel of assays is performed to cover the principal differential diagnoses. If this includes a disease not available currently through the HPA’s Rare and Imported Pathogens Laboratory, samples are referred to another appropriate centre for analysis. Tests are available for a wide variety of tick-borne diseases including: Rickettsia (spotted fevers including Rocky Mountain spotted fever, Mediterranean Spotted Fever (Boutonneuse Fever), African Tick Typhus; Epidemic Typhus and Murine Typhus), Orientia (Scrub Typhus), Tularemia, Q-fever, Tick-borne Encephalitis (including Louping Ill), Rift Valley fever, Congo-Crimean Haemorrhagic Fever, Anaplasma and Ehrlichia, Bartonella and Babesiosis. Such tests may include those for relevant diseases with a similar presentation that are spread by other vectors, eg sandfly fever.