Tick-borne encephalitis (TBE)

A TBE infection can – but doesn't always – cause symptoms. It often goes unnoticed in children, or the symptoms are only mild and temporary. The symptoms of a mild TBE infection such as fever, headaches, vomiting and dizziness are similar to the symptoms of the flu.

TBE is diagnosed by testing blood or cerebrospinal fluid for the TBE virus. Because the disease is caused by a virus, antibiotics won't help. There are no antiviral drugs for TBE, so there is no treatment to fight the TBE infection itself. Instead, treatment focuses on relieving the symptoms.

Sometimes people feel better for a while after the initial flu-like symptoms have gone away, and then the symptoms such as fever, extreme tiredness and headaches come back again a few days later. They may then also have other symptoms like paralysis or impaired consciousness and coordination. These symptoms are typically caused by an infection of the brain or meninges (the membranes lining the brain and spinal cord). Paralysis is usually temporary, but in rare cases it can become permanent. It may affect the face, arms or legs. Problems with swallowing, vision and speech are also possible.

It is very rare for the infection to spread to the spinal cord (myelitis), which can cause muscle weakness, paralysis and sensory disturbances. This is more common in older people than it is in younger people. About half of those people who are infected with TBE develop serious symptoms.

TBE is very rarely fatal. About 1 out of 100 people die of severe TBE.

Some parts of Germany have been declared as high-risk areas. These are districts where TBE infection is more common than in other areas. A district is considered to be a high-risk area if at least 1 out of 100,000 people living in that district, or in the region including all of its neighboring districts, has had a TBE infection within a five-year period. So far, up to 40 out of 100,000 people living in such high-risk areas have developed TBE within a period of five years.

In other words, the risk of getting TBE is very low, even in high-risk areas. Only about 0.1 to 5% of the ticks there have the TBE virus. The German federal states with the highest occurrence of TBE are Baden-Wuerttemberg, Bavaria, Hesse, Lower Saxony (Emsland), North Rhine Westphalia (Solingen), Rhineland-Palatinate (Birkenfeld), Saxony, Saxony Anhalt (Dessau-Roßlau) and Thuringia. In the northern part of Germany there are hardly any ticks that carry the TBE virus. You can find a map of the high-risk areas in Germany on the Robert Koch Institute website. This shows in more detail which districts are associated with a higher risk of infection.

Other European countries also have ticks that carry the virus, such as Eastern Europe – for instance, in some parts of the Czech Republic, Lithuania, Estonia and Poland. The risk of infection is also higher in some parts of Austria, Hungary, Croatia, Sweden and Finland. The TBE virus is extremely rare in Italy, France, Norway and Denmark. Countries that have no ticks with TBE or practically none include Great Britain, Greece, Spain and the Benelux states (Belgium, Netherlands and Luxembourg).

The German Standing Committee on Vaccination advises people who live in a high-risk area and spend a lot of time outdoors to get vaccinated. Statutory health insurers in Germany cover the cost of the vaccination for people who live in “TBE risk areas.” If you are planning to travel to a higher-risk area, contact your health insurance fund beforehand to find out whether they will pay for the vaccine.

The immunization of people in certain professions, such as agriculture and forestry, is paid for by their employer.

Research has shown that most people who get vaccinated develop antibodies against the TBE virus. These antibodies stop the TBE virus from spreading within the body. The TBE vaccine can only protect you from the TBE virus, but not from Lyme disease, which is a much more common consequence of tick bites.

The vaccination consists of three injections. Depending on the specific vaccine, the first two are given about 2 weeks to 3 months apart, and then the third is given 5 to 12 months after the very first injection. A booster injection every 3 to 5 years is recommended. After the second injection, a lot of people will already have temporary immunization. Children can be vaccinated against TBE too, but their risk of serious complications from TBE is much lower than that of adults anyway.

If vaccination is urgently needed, basic immunization can be carried out faster: Depending on the specific vaccine, the first and second vaccinations can be given one week apart, and the third then 14 days after the second vaccination at the earliest. You can talk with your doctor about whether getting vaccinated faster makes sense in your individual case.

The vaccine often has temporary side effects, including fever, dizziness, headache, tingling sensations (pins and needles) and nausea. In very rare cases, TBE vaccines can lead to more serious problems, such as nerve damage.