Expert Elicitation on Exposure to Tick Bites and Tick-Borne Encephalitis Risk in Occupational and Recreational Forest Activities

<b>Background:</b> Tick-borne encephalitis (TBE) virus is transmitted to humans via tick bites and occasionally via the consumption of unpasteurized milk products. According to the literature, the most important driver of TBE emergence and increase in incidence in humans is changes in human behaviour/activities. <b>Method and principal findings:</b> To compensate for the lack of data, expert opinions were gathered to identify the risk factors for exposure to tick bites linked to twenty-eight human activities (professional or recreational) in forests and to target prevention messages at the populations most at risk. Opinions were elicited from a total of twenty-five European experts. Seven criteria were included in the analysis for each activity: frequency, seasonality, duration of exposure, distance covered, degree of contact with vegetation, speed and average level of protection against tick bites. The activities considered to be the most at risk of exposure to tick bites are, in descending order: three occupational activities (forest monitoring activities, forestry and wood industry activities and scientific and/or analytical activities), five recreational activities and one hunting activity (mushroom picking, spending the night in the forest, hunting, naturalist activities, orienteering, and berry or fruit picking). <b>Conclusions and significance:</b> Prevention messages regarding tick bites could be targeted at people who engage in activities considered in this analysis to be at highest risk of exposure to tick bites.