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TBE Risk Area: Map, Vaccination & Protection

A TBE risk area is a region with an elevated risk of tick-borne encephalitis virus transmission. The RKI updates the list of risk areas annually based on reported cases.

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Things worth knowing about "FSME risk area"

A TBE risk area is a region with an elevated risk of tick-borne encephalitis virus transmission. The RKI updates the list of risk areas annually based on reported cases.

What Is a TBE Risk Area?

A tick-borne encephalitis (TBE) risk area is a geographic region where there is an elevated risk of infection with the TBE virus through the bite of infected ticks (primarily Ixodes ricinus). In Germany, the Robert Koch Institute (RKI) publishes and updates the list of TBE risk areas annually, based on officially reported human cases. The German abbreviation FSME stands for Frühsommer-Meningoenzephalitis (early summer meningoencephalitis).

Distribution and Location of Risk Areas

TBE risk areas are found mainly in:

Southern Germany: especially Bavaria and Baden-Württemberg, as well as parts of Hesse, Thuringia, Saxony, and Rhineland-Palatinate
Austria: large parts of the country are considered risk areas
Switzerland: certain regions, particularly in central and eastern Switzerland
Other European countries: Czech Republic, Slovenia, Hungary, the Baltic states, parts of Scandinavia, and Russia

Related TBE virus strains also occur in Asia, particularly in Siberia, China, and Japan.

How Are Risk Areas Defined?

The RKI classifies a district as a TBE risk area if at least one case of local TBE infection was reported within a five-year period. The classification is based on a statistical model that relates the number of reported cases to the local population size, ensuring a meaningful and consistent threshold.

Vaccination Recommendations for Risk Areas

The German Standing Committee on Vaccination (STIKO) recommends TBE vaccination for all individuals who live in or travel to risk areas and may be exposed to tick bites. This is especially relevant for:

People who spend time in forests, meadows, bushland, or gardens
Hikers, cyclists, hunters, and outdoor workers
Travelers to TBE-endemic regions in Europe or Asia

Symptoms and Disease Course

After a tick bite, symptoms typically appear within 7 to 14 days. TBE often follows a two-phase course:

First phase: Flu-like symptoms such as fever, headache, fatigue, and muscle aches
Second phase (in about 10% of infected individuals): Involvement of the central nervous system, including meningitis (inflammation of the meninges), encephalitis (brain inflammation), or myelitis (spinal cord inflammation)

Severe cases can lead to permanent neurological damage. There is no specific antiviral treatment; management is purely symptomatic.

Protective Measures in Risk Areas

In addition to vaccination, the following precautions help reduce the risk of tick bites:

Wearing long, light-colored clothing when spending time outdoors
Applying tick repellents to exposed skin and clothing
Thoroughly checking the body for ticks after outdoor activities
Removing ticks promptly and carefully (do not twist or crush them)

References

Robert Koch Institute (RKI): TBE risk areas in Germany (updated annually). Available at: www.rki.de
Standing Committee on Vaccination (STIKO): Recommendations for TBE vaccination. Epidemiological Bulletin, most recent edition.
Dobler G, Erber W, Bröker M, Schmitt HJ (eds.): The TBE Book. 4th edition. Global Health Press, Singapore, 2020.

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