Tick-borne encephalitis (TBE)

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The risk of getting tick-borne encephalitis (TBE) is much lower than the risk of getting Lyme disease. Only a small number of ticks are infected with the . TBE may be mild, but it can sometimes also lead to serious complications.

TBE is a flu-like viral that can sometimes lead to meningitis. TBE infections are very rare. A total of about 485 cases of TBE (both mild and severe forms) were reported in Germany in 2017 – with most occurring in the southern German states of Bavaria and Baden-Wuerttemberg. Although TBE usually clears up without any lasting health problems within one week, symptoms may last for months. Serious complications are much more common in adults than they are in children. In most children, the course of the disease is mild and long-lasting consequences are very rare.

What are the signs of TBE?

A TBE 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 are similar to flu symptoms and include fever, headaches, vomiting and dizziness.

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

Signs of a more severe course of disease

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 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. Less than 1 out of 100 people die of severe TBE.

Where does TBE occur?

Some parts of Germany have been declared as high-risk areas. These are districts where TBE 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 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 . The German federal states with the highest occurrence of TBE are Baden-Wuerttemberg, Bavaria, Hesse, Rhineland-Palatinate and Thuringia. In the northern part of Germany there are hardly any ticks that carry the TBE . 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 .

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 is also higher in some parts of Austria, Hungary, Croatia, Sweden and Finland. The TBE 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).

When might it be a good idea to have a TBE vaccine?

The German Standing Committee on Vaccination (STIKO) 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 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 of people in certain professions, such as agriculture and forestry, is paid for by their employer.

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

What does the vaccine involve?

The vaccine consists of three injections. The first two are given about 1 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 . Children can be vaccinated against TBE too, but their risk of serious complications from TBE is much lower than that of adults anyway.

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.

Demicheli V, Debalini MG, Rivetti A. Vaccines for preventing tick-borne encephalitis. Cochrane Database Syst Rev 2009; (1): CD000977.

Deutsche Dermatologische Gesellschaft (DDG). Kutane Lyme Borreliose (S2k-Leitlinie). AWMF-Registernr.: 013-044. March 2016.

European Centre for Disease Prevention and Control (ECDC). Tick-borne encephalitis. Annual Epidemiological Report for 2016. July 2018.

Robert Koch-Institut (RKI). Empfehlungen der Ständigen Impfkommission (STIKO) beim Robert Koch-Institut – 2018/2019. August 23, 2018. (Epidemiologisches Bulletin Nr. 34).

Robert Koch-Institut (RKI). FSME: Risikogebiete in Deutschland (Stand: Januar 2019). Bewertung des örtlichen Erkrankungsrisikos. February 14, 2019. (Epidemiologisches Bulletin Nr. 7).

Robert Koch-Institut (RKI). Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten für 2017. Berlin: RKI; 2018.

Robert Koch-Institut (RKI). RKI-Ratgeber: Frühsommer-Meningoenzephalitis (FSME). August 18, 2015.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

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Updated on April 25, 2019
Next planned update: 2022

Authors/Publishers:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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