Lynda Bramham
Specialist Nurse (Travel Health), National Travel Health Network and Centre (NaTHNaC)
Tick-borne encephalitis (TBE) is a vaccine preventable disease found in parts of northern, central and eastern Europe and Asia. Many UK travellers are unaware of this disease.
TBE is a viral infection usually transmitted by the bite of an infected Ixodes tick. Less commonly, the disease can also be transmitted by consuming infected, unpasteurised dairy products.
The number of human cases in Europe has increased by almost 400% in the last 30 years.1 In 2018, 3,212 cases were reported in EU/EEA countries.2 In Europe most cases are reported between May and November with a seasonal peak in July and August.2
Initial symptoms can include fatigue, headache and fever. About one third of those with symptoms go on to develop more severe disease with signs of central nervous system involvement, such as meningitis or encephalitis.3
Unfortunately, there is no specific treatment. In Europe, up to 10% of those with TBE experience severe neurological complications and up to 2% will die.1
How to prevent TBE
Ticks are often found on ground level vegetation, where they can easily be brushed onto a passing human. Ixodes ticks can be very small and difficult to see. Travellers can use insect repellents and clothing treated with insecticides to try and reduce bites.
In Europe, up to 10% of those with TBE experience severe neurological complications and 0.5-2% will die.
Ticks can spread several different infections so any found on the skin should be carefully removed with fine tipped tweezers or other devices for tick removal (available in camping/walking shops or online).
They should be pulled straight out with care to avoid squeezing the body of the tick. It is sensible to avoid drinking unpasteurised milk or eating other unpasteurised dairy products in TBE risk areas.
TBE vaccination is recommended for some travellers
TBE vaccination is recommended particularly for spring, summer and autumn travel in areas where the virus is known or presumed to occur.
Individuals who hike, camp, hunt or undertake fieldwork in risk areas should be offered vaccination.4 The vaccine is also recommended for those who will be going to live in risk areas, and particularly for those working in forestry, woodcutting, farming and the military.4
The vaccine available in the UK is suitable for travellers from one year of age. The standard vaccination course consists of three doses, with the first two administered one to three months apart and the third dose five to 12 months after the second vaccine. However, when rapid protection is required, the second dose can be given two weeks after the first.
The manufacturers state the protection rate is at least as high after the first two vaccinations following the rapid vaccination i.e., before completion of the third dose.5 The third vaccination would be recommended on return for those requiring on-going, longer term protection.
Travellers can check if TBE is a risk at their destination on TravelHealthPro: travelhealthpro.org.uk/countries.
[1] European Centre for Disease prevention and Control (ECDC)., Tick-borne encephalitis factsheet for health professionals, 2015 https://www.ecdc.europa.eu/en/publications-data/factsheet-tick-borne-encephalitis-healthcare-professionals | [2] ECDC, Tick-borne encephalitis, annual epidemiological report for 2018, https://www.ecdc.europa.eu/sites/default/files/documents/TBE-annual-epidemiological-report-2018.pdf | [3] World Health Organization. Tick-borne encephalitis vaccines position paper. July 2011 https://www.who.int/immunization/policy/position_papers/tick-borne-encephalitis/en/ | [4] Public Health England. Chapter 31 Tick-Borne encephalitis, April 2013, in Immunisation against infectious disease. https://www.gov.uk/government/publications/tick-borne-encephalitis-the-green-book-chapter-31 | [5] Pfizer Limited. Ticovac Summary of Product Characteristics, 6 November 2018 https://www.medicines.org.uk/emc/product/1923/smpc
