Risk Factors for Tick-Borne Diseases in Germany: A Scoping Review.

Tick-borne diseases (TBDs) have proliferated in Germany. The two most prevalent TBDs, Lyme-borreliosis and tick-borne encephalitis, can present with nonspecific symptoms and lead to serious neurological complications. To date, a review synthesising the risk factors of acquiring a TBD in Germany is missing. Such a review could mitigate infection risk and support early protection. A scoping review was conducted using the databases MEDLINE/PubMed and Web of Science. Studies on the risk of acquiring TBDs through tick bites in Germany, written in German or English, were included in this review. Two authors screened the papers and charted the results collaboratively. Thirty-two studies were included in the review, which highlighted the following factors as being associated with an increased risk of tick bites or TBDs: being 3-9 or 50-79 years old; being male; having a higher education level; working outdoors; not having a migration background; visiting a forest kindergarten; spending more time outdoors; not using protective strategies; owning a pet; spring and summer; high humidity and moderate temperatures; unmodified vegetation; high roe deer density; living in southern Germany; and living rurally. This review identified similar risk factors as reviews from other European, Asian and African countries. The findings of this review can be used to improve public health policy, enhance TBD prevention measures, establish a targeted early warning system and enhance clinicians' knowledge.