Tick-Borne Encephalitis (TBE) – Symptoms & Vaccination
Tick-borne encephalitis (TBE) is a viral infection transmitted by tick bites that can affect the brain and meninges. Vaccination provides effective protection.
Things worth knowing about "Tick-Borne Encephalitis"
Tick-borne encephalitis (TBE) is a viral infection transmitted by tick bites that can affect the brain and meninges. Vaccination provides effective protection.
What is Tick-Borne Encephalitis (TBE)?
Tick-borne encephalitis (TBE) is a viral infectious disease affecting the central nervous system. It is caused by the TBE virus, a member of the Flaviviridae family, and is primarily transmitted to humans through the bite of infected ticks – most commonly the castor bean tick (Ixodes ricinus). The disease mainly occurs between April and November and is endemic in specific risk areas across Central and Eastern Europe and Asia.
Causes and Transmission
The TBE virus is transmitted very rapidly after a tick bite, as the virus is already present in the tick's salivary glands. This means that prompt tick removal provides only limited protection against infection. In rare cases, the virus can also be transmitted through consumption of unpasteurised milk from infected animals such as goats, sheep, or cows.
- Main vector: Ixodes ricinus (castor bean tick)
- Rare route: unpasteurised dairy products from infected animals
- No person-to-person transmission
Risk Areas
In Germany, numerous districts particularly in Bavaria, Baden-Württemberg, Thuringia, Saxony, Hesse, and Rhineland-Palatinate are classified as TBE risk areas by the Robert Koch Institute (RKI). The virus is also widespread in Austria, Switzerland, the Czech Republic, the Baltic states, Scandinavia, and parts of Asia (Siberian TBE virus subtype).
Symptoms
The disease typically progresses in two phases:
First Phase (flu-like)
- Fever (38–39 °C)
- Headache and fatigue
- Muscle and joint pain
- Nausea
This first phase usually lasts 2–7 days and is followed by a symptom-free interval of approximately 1–3 weeks.
Second Phase (neurological)
In approximately 10–30 % of infected individuals, a second and more severe phase involving the central nervous system occurs:
- Meningitis (inflammation of the meninges): neck stiffness, severe headache, light sensitivity
- Encephalitis (brain inflammation): impaired consciousness, coordination difficulties, seizures
- Myelitis (spinal cord inflammation): paralysis symptoms, less common
Severe cases can lead to permanent neurological damage. Deaths are rare but possible.
Diagnosis
Diagnosis of TBE is based on a combination of clinical examination, medical history (e.g., tick bite in a risk area), and laboratory testing:
- Blood test: detection of TBE-specific antibodies (IgM and IgG) using ELISA
- Cerebrospinal fluid (CSF) analysis: lumbar puncture when neurological symptoms are present
- PCR testing: direct virus detection (most useful in the early phase of infection)
Treatment
No specific antiviral therapy against the TBE virus currently exists. Treatment is therefore symptomatic:
- Rest and reduced physical activity
- Pain-relieving and fever-reducing medications (e.g., paracetamol, ibuprofen)
- In severe cases: inpatient treatment in a neurological intensive care unit
- Physiotherapy and rehabilitation for lasting neurological deficits
Prevention and Vaccination
The most effective protection against TBE is vaccination. Approved vaccines (e.g., FSME-IMMUN and Encepur) provide reliable protection after completing the full primary immunisation schedule. Health authorities recommend vaccination for all individuals living in or travelling to risk areas.
- Primary immunisation: 3 doses (0, 1–3 months, 5–12 months)
- Booster doses: every 3–5 years depending on age and vaccine used
- Additional protective measures: light-coloured, covering clothing outdoors, insect repellents, thorough body checks after time in nature, prompt removal of ticks
References
- Robert Koch Institute (RKI): Tick-Borne Encephalitis – RKI Advisory, 2023. Available at: www.rki.de
- World Health Organization (WHO): Tick-borne encephalitis (TBE). WHO Fact Sheet, 2022. Available at: www.who.int
- Süss J. Tick-borne encephalitis 2010: epidemiology, diagnosis, prophylaxis and treatment. J Infect. 2011;62(2):87–101.
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