How Other Countries Handle Tick-Borne Disease — A Comparative Look

Tick-borne disease is not a single policy problem with a single right answer. Different countries, working from the same pathogens and overlapping evidence, have built very different institutions to count cases, diagnose patients, and fund research. A 2023 international review puts the starting observation plainly:

"In accordance with bibliometric data, differences exist between different countries and regions on the information available regarding ticks and TBD, communication to the population of the associated risks, and the implementation of vector/pathogen/disease surveillance and effective control interventions. These differences are affected by investment in science and technology." — MDPI, 2023. Perception of Ticks and T...

The variation runs through surveillance, diagnostics, treatment guidelines, vaccination, and even which diseases are considered "neglected." This article walks through the major jurisdictions as their own institutions describe themselves, with the US as the reference baseline.

Europe: a centralized agency with decentralized reporting

The European Centre for Disease Prevention and Control, based in Stockholm, was "Established in 2005 and based in Stockholm, Sweden" (ECDC) as "a European Agency whose mandate is to strengthen Europe’s defences against infectious diseases through identifying, assessing and communicating current and emerging threats to human health posed by infectious diseases" (ECDC). ECDC characterizes tick-borne illness as the continent's largest vector-borne burden:

"Summary Tick-borne diseases are the most common vector-borne diseases in Europe." — ECDC, 2011, pp. 1–2. Expert Consultation on Ti...

The four diseases ECDC's own toolkit prioritizes are "Lyme borreliosis, Tick-borne encephalitis, Tick-borne relapsing fever and Crimean-Congo haemorrhagic fever" (ECDC) — a mix that looks different from the US CDC's reportable list, with TBE and CCHF in particular having no real US parallel.

But the centralized agency sits on top of deeply uneven national systems. A 2011 expert consultation at ECDC — the document that still anchors EU surveillance policy on tick-borne disease — found "About 85 000 cases of Lyme borreliosis are reported annually across Europe through various surveillance systems" (ECDC 2011), a number the consultation itself warned was "to be considered with care due to specific difficulties in diagnosis and case definition" (ECDC 2011). The surveillance landscape the consultation documented is a patchwork:

"Twenty-three of the 28 responding countries have surveillance systems for Lyme borreliosis, and of these, 17 countries have comprehensive surveillance systems. Twenty-one countries have surveillance systems which operate at a national level, and a number of other countries have surveillance systems which operate at a sub-national or regional level. Mandatory reporting operates in 16 countries and voluntary reporting is found in five countries." — ECDC, 2011, pp. 3–4. Expert Consultation on Ti...

That heterogeneity is itself the policy problem. "The heterogeneity of the applied case definition in the Member States and the absence of a centralised reporting and surveillance system at an EU level make data acquisition and comparison challenging. Moreover, not all Member States have a case definition for Lyme borreliosis." (ECDC 2011) On whether to fix this by mandating EU-level reporting, the 2011 meeting did not reach agreement: "For Lyme borreliosis, no consensus was reached on its notifiable status: the complexity of the disease, with many clinical outcomes and many possible laboratory practices in use resulting in both under and over-reporting, may imply that it is not feasible to require mandatory reporting at the EU level." (ECDC 2011)

Tick-borne encephalitis moved in a different direction. The same consultation recommended that "tick-borne encephalitis is added to the list of mandatory notifiable diseases in the EU, and that therefore a case definition should be agreed upon" (ECDC 2011). Even so, national-level surveillance for TBE remains uneven: "Surveillance systems for tick-borne encephalitis exist in 20 out of 30 participating countries in the online survey, with a surveillance case definition adopted in 10 of 20 countries. Case definitions used in particular countries differ in terms of criteria and case classification adopted." (ECDC 2011)

Rickettsioses — the family that includes Mediterranean spotted fever — are reported even more thinly:

"Surveillance systems for rickettsioses exist in 14 of the 30 participating European countries, with a surveillance case definition adopted in seven out of the 14 countries. There are considerable differences between case definitions used in particular countries. Laboratory diagnosis of suspected rickettsial infection seems to be limited to four countries (Italy, France, Portugal and Spain)." — ECDC, 2011, pp. 7–8. Expert Consultation on Ti...

The disease burden is real. The 2011 consultation estimated "The mean number of tick-borne encephalitis cases in Europe is almost 2900 per year during the 11-year period leading up to 2010." (ECDC 2011) For Lyme, the within-country peaks are concentrated in particular regions: "A 2002 study for example estimated 60 000 annual cases in Germany alone" (ECDC 2011), with "the highest reported incidences in literature were found in Slovenia (312 per 100 000 inhabitants) and Switzerland (155 per 100 000 inhabitants)" (ECDC 2011). TBE research concentration is similarly skewed: "Studies evaluating tick-borne encephalitis risk come mainly from a few high-endemic countries (72% articles from six countries: Czech Republic, Germany, Lithuania, Slovenia, Sweden and Switzerland)" (ECDC 2011).

ECDC's own framing of why this matters is candid:

"Lyme borreliosis likely presents a significant morbidity which is currently un-quantified in any meaningful way, other than in prospective studies in high-endemic areas. As a result, it presents an unknown burden and therefore an unknown and un-defined requirement for responses from the health system despite political and public awareness." — ECDC, 2011, pp. 4–5. Expert Consultation on Ti...

How European clinical practice diverges from the US

European diagnostic labs work with a different pathogen mix than US labs do, and this cascades into how disease presents and what tests should detect. A 2025 comparative review:

"The primary tick vectors for Borrelia species in Europe are I. ricinus and I. persulcatus, while in America, it is a combination of I. scapularis and I. pacificus. In Asia and Russia, the principal vector is I. persulcatus." — Elsevier, 2025. A Comprehensive Review of...

The US CDC's own reference manual treats European Lyme as a distinct clinical entity: "As in the United States, the erythema migrans (EM) rash is the most common early manifestation; later neurologic, cardiac, and rheumatologic disease may occur. In European Lyme disease, the EM rash may spread more slowly and is less commonly accompanied by systemic symptoms. Atrophic skin lesions (acrodermatitis chronica atrophicans) are a frequent late manifestation of infection with B. afzelii." (CDC 2022) CDC flags a lab-compatibility issue US providers often miss:

"LABORATORY CONFIRMATION Antibodies to Borrelia species that cause Lyme disease outside the United States may not be reliably detected by all tests used in the United States. Providers who suspect internationally-acquired Lyme disease should use diagnostic tests that have been validated for these species." — CDC, 2022, pp. 47–48. Tickborne Diseases of the...

The 2020 IDSA/AAN/ACR Lyme guideline, the US clinical standard, makes a related observation on transmission timing: "Observations from 2 European epidemiological studies in which tick engorgement levels were measured suggest that transmission of B. burgdorferi sensu lato may occur within 24 hours of attachment of I. ricinis ticks. It is unclear whether differences in the tick or Borrelia species may be responsible for the faster transmission rate." (IDSA 2020)

On treatment, the split between jurisdictions is structural. Testimony in the 2012 US House hearing on global Lyme challenges described how the UK ended up aligned with the US position:

"The former head of the Health Protection Agency laboratory served as consultant to the IDSA panel in the development of 2006 guidelines, so it is understandable that the views of IDSA have prevailed in the UK." — House, 2012. Global Challenges in Diag...

That witness then summarized the practical consequence:

"When it comes to treatment, the UK follows IDSA despite European guidelines which point out that there have been no good-quality European trials on agent, dose or treatment length, but most treatment recommendations are, in fact, based on opinion, not evidence." — House, 2012. Global Challenges in Diag...

UK case-counting is also a recurring theme in the hearing record: "In the UK we don't know the incidence, as only positive blood tests are recorded; however, an audit at a highly aware GP practice has found an incidence 20 times that of the surrounding region. Extrapolating from this, it seems perfectly possible that the recorded figure for the UK of a mere 1,300 cases may actually be 26,000." (House 2012) Central Europe, by contrast, is described as having the opposite problem — more experience with the disease but a different set of gaps: "In Central Europe, where incidence of Lyme disease is far higher, doctors have more experience, and they were telling us Lyme is a big problem, we don't have good enough tests, and we don't know how to treat." (House 2012)

Latin America: Mexico and Brazil as the RMSF front line

Where Lyme disease dominates the US and European tick-policy conversation, Rocky Mountain spotted fever dominates in parts of Latin America. A 2024 review in PLOS Neglected Tropical Diseases frames the regional shift:

"For reasons that remain unclear, RMSF reemerged during the last 25 years in multiple communities of the southwestern United States, and even more dramatically, across several towns and cities in several states of northern Mexico, where it now exists as hyperendemic disease in peri-domestic settings –." — PLOS, 2024. Rocky Mountain spotted fe...

The countries with the heaviest burden, by the review's accounting, are "Mexico, Brazil, and the US constituting the countries with the heaviest recognized burden" (PLOS 2024). The US CDC confirms the cross-border pattern:

"Similar epidemiologic characteristics and transmission dynamics have been reported in parts of Mexico. A high incidence of RMSF occurs in several northern Mexican states, including Baja California and Sonora, which border the United States." — CDC, 2016, pp. 7–8. Diagnosis and Management...

The political economy of the disease in Mexico is not subtle. "Poverty has been identified as a key determinant for most rickettsial diseases and this is particularly evident with RMSF in Mexico and other countries of Latin America where increased tick exposure, higher morbidity, and greater severity of clinical manifestations occur among economically disadvantaged groups." (PLOS 2024) The same review documents how institutional capacity maps onto outcomes:

"In several regions of Latin America, laboratory confirmation of R. rickettsii is not achieved because of (a) limited access to effective diagnostic technology; (b) difficulties to support entomological and epidemiological surveillance systems at the regional and local levels; and (c) funding obstacles that hinder the capacity to detect the pathogen in populations of ticks and hosts." — PLOS, 2024. Rocky Mountain spotted fe...

A notable policy moment came in 2015:

"An example of how important political support is to alleviate the deleterious impact of RMSF, occurred in April 2015 in México. Due to the significant increase in cases and deaths caused by the disease, the Ministry of Health issued a national declaration of epidemiological emergency, which made a call for strengthening epidemiological surveillance, medical care, and prevention of the disease. Among other benefits of this declaration, public hospitals and clinicians had access for the first time to intravenous doxycycline to care for severe cases, and some regions had financial support for dog spaying and neutering campaigns and acquisition of acaricides." — PLOS, 2024. Rocky Mountain spotted fe...

Brazil presents a different profile. "Another salient example occurs in Brazil where 1,245 cases were confirmed during the 2007 to 2015 period with the majority being reported from the state of São Paulo; moreover, the CFR increased from 19.2% to 40.2% in different states during the last decade." (PLOS 2024) The research gap compounds the clinical one: "our review of the PubMed database revealed 70% of 1,803 papers concerning RMSF published during 1916 to 2023 were studies predominantly performed in the US, while in Latin America, together with Brazil and Mexico represented 11% of all results for the disease" (PLOS 2024).

A 2023 MDPI international review frames the same pattern in regional terms: "in Brazil, like in other Latin American tropical countries, mosquito-borne diseases are at the top of the media and academic agenda in relation to all knowledge about vector-borne diseases affecting humans. In contrast, human tick-borne diseases, caused by a great variety of viruses, bacteria, and protozoa, are arguably the most prominent in the United States and Europe" (MDPI 2023).

And at the global level:

"Currently, WHO considers neither RMSF nor any other rickettsiosis as an NTD, which could perpetuate technical and structural barriers that hamper appropriate consideration of the disease." — PLOS, 2024. Rocky Mountain spotted fe...

Asia: TBE, SFTS, and a different surveillance posture

The Eurasian tick-borne encephalitis serocomplex spans Europe into Asia. A 2019 ASM review locates the clinical burden:

"TBEV causes clinical disease in more than 10,000 to 20,000 humans in Europe and Asia per year. An increased incidence of TBE has been noted in Europe, as a consequence of climate and socioeconomic changes, and the areas of endemicity for TBEV are shifting northward. This group of viruses produces a wide range of disease symptoms as well as subclinical infections depending on the subtype. The European and Siberian subtypes of TBEV generally cause biphasic fever characterized by an influenza-like prodromal phase followed by an asymptomatic period and, in one-third of cases, a second phase with aseptic meningitis, encephalitis, or meningoencephalitis. Up to 50% of patients have long-term sequelae Asymptomatic and subclinical infections constitute approximately 70 to 95% of all TBEV infections. Following an outbreak of the Far Eastern subtype of TBEV in China in 1952, approximately one-third of the patients had sequelae, and approximately one-third of the patients died." — ASM, 2019. Emerging Tick-Borne Disea...

New viruses continue to emerge from the region. "A deadly virus transmitted by Haemaphysalis longicornis*, Dabie bandavirus,* has emerged in Southeast Asian countries in recent decades, including Japan, South Korea, and China. The virus causes severe fever with thrombocytopenia syndrome (SFTS)." (Elsevier 2025) The 2019 ASM review adds: "Illness from SFTSV was first confirmed in China in 2009. It was retrospectively identified in South Korea in 2010 and 2012 and in the western regions of Japan in 2013." (ASM 2019)

A 2025 report from the China CDC's weekly publication notes that surveillance models differ across countries:

"In Europe, Italy maintains tick-borne disease surveillance as a crucial component of their human health program, emphasizing human data and expertise." — CCDC, 2025. An Alarming Public Health...

Lyme borreliosis in Asia is transmitted by a different Ixodes species than in Europe or North America. "B. afzelii and B. garinii are spread by I. ricinus in Europe and I. persulcatus in Asia, with the habitats of these two species overlapping in eastern Europe." (ASM 2019)

Australia: a dissenting clinical culture

Australia does not appear prominently in the surveillance literature in this pool, but it does appear prominently in the patient-experience data. A 2023 survey of 986 Lyme patients across 28 countries found a country-level effect:

"Results showed that country was associated with how often a doctor granted a patient’s request for a Lyme disease test, χ 2 (4, n = 673) = 16.89, p = 0.002. Australian doctors were less likely to grant the request for a test (19%) than the average doctor across the other four countries (38%)." — MDPI, 2023. Medical Gaslighting and L...

On whether doctors accepted a positive test: "The country of residence was also associated with how often a positive test result convinced doctors the patient had Lyme disease, χ 2 (4, n = 863) = 26.89, p < 0.001. Australian doctors believed a positive test result less often (6%) than the average doctor (17%). Interestingly, doctors in the US (22%) and Ireland (23%) believed Lyme disease test results slightly more often than average." (MDPI 2023) And on whether doctors accepted a classic physical finding:

"More Australian doctors (M = 6.21, SD = 11.04) told their patients they did not have Lyme disease despite the patient exhibiting the bullseye rash normally associated with Lyme disease, H(4) = 15.48, p = 0.004. Follow-up Dunn tests comparing mean rank scores for all possible country pairings showed only US doctors were statistically less likely (M = 3.24, SD = 8.37) to tell patients they did not have Lyme disease despite their bullseye rash, z = 2.93, p < 0.05." — MDPI, 2023. Medical Gaslighting and L...

Alpha-gal syndrome — the mammalian-meat allergy triggered by tick bites — has been identified in Australia as well. A 2020 review: "Following identification of AGS, patients with the same allergy in Australia, Europe, Scandinavia, Japan, and South Africa have been reported." (T&F 2020) The tick vectors differ by continent: "AGS has been studied and reported globally with variation in the involved tick species: Ixodes ricinus in Europe, Haemaphysalis longicornis in Asia, Amblyomma americanum in the United States (U.S.), and Ixodes australiensis in Australia" (MDPI 2023).

Africa and travelers

Africa's tick-borne disease profile shows up in most national surveillance systems indirectly — through travelers. The US CDC's reference manual:

"TICKBORNE DISEASES ABROAD AFRICAN TICK BITE FEVER (ATBF) AGENT: Rickettsia africae African tick bite fever (ATBF) is the most commonly diagnosed rickettsial disease among returning international travelers. ATBF is transmitted by Amblyomma hebraeum and A. variegatum ticks. Travelassociated cases of ATBF often occur in clusters with exposure during activities such as safari tours, game hunting, and bush hiking." — CDC, 2022, pp. 46–47. Tickborne Diseases of the...

"African tick bite fever, caused by Rickettsia africae and transmitted by Amblyomma ticks, is common among travelers returning from safaris or related places, and it is the second most frequent cause of fever for travelers from sub-Saharan Africa after malaria." (Elsevier 2025) On the ground, "In Africa, species like R. microplus and A. variegatum in South Africa and Nigeria primarily target livestock, causing diseases such as anaplasmosis and babesiosis" (MDPI 2025).

WHO and the global architecture

At the global level, the World Health Organization has engaged tick-borne disease through two primary mechanisms visible in this literature: reporting aggregated case counts and issuing disease codes. On the case-count side, a 2012 House hearing noted: "About 85,000 cases are reported annually in Europe as of 2006, according to the WHO, but that was recognized as a gross underestimate." (House 2012) More recently:

"The World Health Organization ICD-11 issued new Lyme disease codes ratified by 194 nation members. The ICD-11 expanded to include severe and potentially fatal complications recognized in acute Lyme disease and/or CLD." — MDPI, 2023. Medical Gaslighting and L...

On funding and investment differences, the 2023 MDPI international review observes:

"In humans, an obvious reduction of the impact of ticks and TBD could be managed by informing the population on the risks associated with ticks and TBD, involving frequent public news media and advertisements, as currently carried out in northern countries of Europe, which are measuring their impact and adaptation. Although the U.S. Department of Agriculture (USDA), the National Institutes of Health (NIH), and the European Centre for Disease Prevention and Control provide online free access to information about TBD, gaps are obvious in both the transmitted information and the ability of citizens to understand the information. The same applies to ticks feeding on pets, that have an extraordinarily high contact with humans." — MDPI, 2023. Perception of Ticks and T...

And it argues for a cross-sector frame:

"Considering the close interaction between humans, animals, and tick vectors, a multidisciplinary approach linking human, animal, and environmental health within a “One Health” framework is essential. Systematic and comprehensive surveillance studies investigating ticks and TBD in defined areas are needed. Collaborative efforts between Egypt and Europe, combining fieldwork, research capacity, and funding, could lead to a better understanding of the epidemiological landscape of ticks and TBD. This collaboration could also help establish a robust database. Furthermore, it is crucial to strictly monitor and control the influx of potentially infected animals and exotic tick species through animal trade." — MDPI, 2023. Perception of Ticks and T...

Where comparisons get hard

Comparing health systems on a disease like Lyme is especially awkward because basic economic data is hard to line up. A 2022 CDC economic-burden study:

"The few studies that provide more comprehensive cost estimates of Lyme disease were conducted in Europe under healthcare systems with financing structures different from those of the United States." — CDC, 2022, pp. 1–2. Economic Burden of Report...

And from the same study: "In a recent study in the Netherlands, Van den Wijngaard et al. used a societal perspective to estimate a total cost of $137 for patients with erythema migrans only and $6,398 (2016 US dollars) for those with disseminated Lyme borreliosis. These costs are lower than those for our societal results for confirmed localized disease ($1,307) and higher than those for our societal results for confirmed disseminated disease ($3,251)." (CDC 2022)

At the species level, the geographic sprawl is itself policy-relevant: "B. burgdorferi is a zoonotic tick-borne pathogen transmitted by the bite of an infected Ixodes tick ( and ). It is highly invasive and infects more humans in Europe, Asia, Russia, and North America than any other tick-borne bacteria." (ASM 2019) And as a 2019 Philosophical Transactions paper notes, "Lyme disease and many of the deer tick microbial guild are also global health burdens from western Europe to Japan." (RSocB 2019)

The through-line

The cross-jurisdictional picture in this literature is not one of countries slowly converging on shared answers. It is a picture of systems that have inherited different pathogen mixes, different institutional histories, different research priorities, and different funding levels — and that are working the problem at different tempos. ECDC's 2011 meeting summarized the European version of the problem this way:

"The meeting recognised that surveillance of Lyme borreliosis at the EU level would certainly be of value and that collection of comparable data throughout Europe would allow for the assessment of the disease burden, trends in the EU, and the impact of public health measures (if any). These assessments are currently not possible due to the differences in reporting systems, applied case definitions and laboratory practices." — ECDC, 2011, pp. 4–5. Expert Consultation on Ti...

And the 2023 MDPI international review, writing from outside any one national system, lands on a similar reading:

"As reported in different countries and regions, the incidence of emerging TBD will likely increase in the near future and will be recognized as studies progress in countries with fewer studies." — MDPI, 2023. Perception of Ticks and T...

Sources

    Not medical advice. See a healthcare provider for medical decisions. Medical Disclaimer