For the last 60 years, only a few cases of tick-borne encephalitis (TBE) have 
been detected in Bulgaria. Considering the remarkable increase in TBE morbidity 
in Europe over the past two decades, we conducted a study of TBE among patients 
with acute viral meningitis who were hospitalised in Bulgaria during 2009 to 
2012. A total of 86 patients with viral meningitis of unknown aetiology during 
this period were tested. Acute TBE was confirmed in three of these patients. The 
last TBE case was detected in October 2012; the other two were diagnosed in 
2009. To the best of our knowledge, these three patients are the first confirmed 
TBE cases reported in Bulgaria. The risk of TBE is underestimated in Bulgaria 
due to the low awareness of medical doctors.