Tick-borne encephalitis vaccination coverage among outdoor workers in Sweden: a nationwide survey

Tick-borne encephalitis (TBE) is an emerging public health concern in Sweden, with a steadily increasing incidence over the past two decades. Climate change, expanding tick populations, and increased human exposure contribute to the growing burden of disease. Although TBE vaccination is highly effective, it is not included in Sweden's national immunization program, and data on vaccination coverage among high-risk occupational groups remain unknown. We conducted a nationwide cross-sectional Knowledge, Attitude, and Practice (KAP) survey in 2024 to assess TBE vaccination coverage among major outdoor occupational groups in Sweden. Adults engaged in outdoor professions, including farmers, forestry workers, hunters, researchers, and nature guides, were invited to participate. A Total of 1006 valid responses were analyzed. Overall knowledge and attitudes toward TBE vaccination were moderately high across demographic groups. However, vaccination practices lagged behind knowledge and attitudes levels and varied substantially by gender, occupation, income, and region. Women demonstrated higher KAP scores and higher vaccination uptake than men. Regional disparities were evident, with higher vaccination coverage in southern and central Sweden compared with northern counties. Although nearly 70% of respondents reported having received at least three vaccine doses, several subgroups showed substantial proportions of unvaccinated individuals. Despite good awareness of TBE vaccination, gaps in vaccine uptake persist among outdoor workers in Sweden. Targeted vaccination strategies, improved employer involvement, and policy measures to reduce financial barriers may be necessary to improve protection in these high-risk populations.