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What is tick-borne encephalitis (TBE)?

TBE is a viral infectious disease which affects the central nervous system.

10 – 12 K Cases of TBE are reported each year World Health Organization [1]

TBE is transmitted to humans by the bite of an infected tick and normally occurs during outdoor activities in forested areas.

Infected ticks are commonly found in the forests and grassy areas of the Baltic States, the Russian Federation and central, northern and eastern Europe[2].

In 2018, the highest number of confirmed cases of TBE in EU/ EEA countries included Czech Republic (712), Germany (583), Lithuania (384), Switzerland (377), Sweden (359), Austria (170)[3,4].

Map source: European Centre for Disease Prevention and Control (ECDC) and Federal Office of Public Health FOPH in Switzerland

Map source: European Centre for Disease Prevention and Control (ECDC) and Federal Office of Public Health FOPH in Switzerland

What are the signs and symptoms?

The time between the exposure to the TBE virus and first signs of symptoms typically range between 7 to 14 days. In the first phase of infection, the virus can cause flu-like symptoms:

  • Fever
  • Shivers
  • Headache
  • Muscle ache

You might also feel sick or experience a circular red rash. Approximately 20-30%[5] of infected people subsequently experience a second phase which can include neurological conditions, ranging from mild meningitis to severe encephalitis. The encephalitis developed in the second phase may cause paralysis, permanent sequelae or death[2].

TBE vs. Lyme disease

Although both transmitted by tick bites, TBE is viral and Lyme disease is bacterial. That means that antibiotics will stop the spread of the Lyme bacteria but not the TBE virus. And, unlike Lyme disease, TBE is vaccine preventable.

Am I At Risk?

Not every tick bite will infect you with TBE. You’re most likely to be at risk of contracting the disease if you’re in areas where TBE-infected ticks are prevalent, particularly under these circumstances:

During April to November

Hiking and camping or other outdoor activities

Hiking or climbing to altitudes up to 2,000 metres[6]

Walking through grassy and forested areas

If you start to experience some of the signs and symptoms up to a month after returning from a forested or grassy area, you should consult a doctor.

Protecting yourself against TBE

There are lots of practical things you can do to prevent yourself from contracting TBE but the most effective protection is to get the TBE vaccine if you’re planning to spend a lot of time outdoors in an affected area.

The TBE vaccine

TBE is a vaccine-preventable disease.

  • The vaccination requires a course of 3 injections for full protection[7]
  • The first booster is often recommended to be administered within 3 years[8]
  • In most countries, subsequent booster doses are recommended every 5 years for persons younger than 60 years and every 3 years for persons 60 years of age or older[8]
  • Make sure you get the second dose at least 2 weeks before you travel[7]
  • You should be able to get the vaccine at your GP, travel centre and pharmacy

How to avoid being bitten

  • Wear long trousers, socks and closed footwear when hiking or camping or spending time outdoors in risk areas
  • Wear light-coloured clothing so you can spot and brush ticks off more easily
  • Stick to paths where possible
  • Apply insect repellent containing DEET
  • Avoid consuming unpasteurised dairy products in case the dairy animal was infected with TBE
  • Tick bites don’t always hurt so inspect your body every day to check for any ticks that may have become attached. Remove them as soon as possible

How To Remove A Tick

Make sure you pack a pair of fine-tipped tweezers or a tick removal tool and some antiseptic. Most pharmacies will stock these items, as will some vet and pet shops.

If a tick has attached itself to your skin, you can safely remove it by following these steps:

Step 1

Using the tweezers or tool, grasp the tick as close to your skin as you can.

Step 2

Slowly pull the tick upwards – take care not to crush the tick as you do.

Step 3

Once removed, dispose of the tick.

Step 4

Clean the bite with soap water and antiseptic.

This is all you need to do unless you start to feel unwell.

More Information

Learn more about TBE from:

References

  1. WHO, https://www.who.int/immunization/diseases/tick_encephalitis/en/ accessed 24/03/20
  2. WHO, https://www.who.int/health-topics/tick-borne-encephalitis#tab=tab_3 accessed 30/11/21
  3. ECDC, https://www.ecdc.europa.eu/sites/default/files/documents/TBE-annual-epidemiological-report-2018.pdf accessed 11/05/20
  4. https://www.bag.admin.ch/bag/de/home/das-bag/aktuell/medienmitteilungen.msg-id-73873.html
  5. CDC, https://www.cdc.gov/vhf/tbe/symptoms/index.html accessed 30/03/20
  6. https://www.bag.admin.ch/bag/fr/home/krankheiten/krankheiten-im-ueberblick/fsme.html
  7. https://www.who.int/ith/vaccines/tbe/en/
  8. Joachim Hombach, Alan D.T. Barrett, Herwig Kollaritsch, 59 – Tickborne Encephalitis Vaccines, Editor(s): Stanley A. Plotkin, Walter A. Orenstein, Paul A. Offit, Kathryn M. Edwards, Plotkin’s Vaccines (Seventh Edition), Elsevier, 2018, p. 1089.e5, ISBN 9780323357616, https://doi.org/10.1016/B978-0-323-35761-6.00059-6