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 that directly target the TBE virus. Instead, treatment focuses on relieving the symptoms and the effects of the disease. If the TBE is severe, it is treated in the hospital, and in the intensive care unit if necessary.

Sometimes, the initial flu-like symptoms go away at first, but then return a few days later with fever, extreme tiredness and headaches. Other symptoms may also develop, like impaired consciousness and coordination, or paralysis (affecting the face, arms or legs). Problems with swallowing, vision and speech are also possible. These symptoms are typically caused by an infection of the brain or meninges (the membranes lining the brain and spinal cord). This is usually temporary, but in rare cases it can become permanent.

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. The risk of developing long-term damage from myelitis is very high.

About half of those people who are infected with TBE develop serious symptoms. TBE is rarely fatal, though. 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 high-risk areas are mostly in the southern part of Germany. There are hardly any ticks that carry the TBE virus in the north. The German federal states with the highest occurrence of TBE are:

• Baden-Württemberg
• Bavaria
• Brandenburg
• Hesse
• Lower Saxony (Emsland, Celle)
• North Rhine Westphalia (Solingen)
• Rhineland-Palatinate (Birkenfeld)
• Saarland (Saarpfalz)
• Saxony
• Saxony Anhalt (Anhalt-Bitterfeld and Dessau-Roßlau)
• Thuringia

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.

Ticks with TBE are also found in other countries. That is the case in Eastern Europe, for example in certain regions of the Czech Republic, Lithuania, Estonia and Poland. The risk of infection is also higher in some parts of Austria, Sweden, Norway and Finland. The TBE virus is extremely rare in Italy, France, Hungary and Croatia. Countries that have no ticks with TBE or practically none include Great Britain, Denmark, Greece, Spain and the Benelux states (Belgium, Netherlands and Luxembourg).

TBE can prevented by vaccination. The German Standing Committee on Vaccination (Ständige Impfkommission, STIKO) recommends having a TBE vaccine if you spend a lot of time outdoors in a high-risk area for TBE. 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 vaccination consists of three injections. Depending on the specific vaccine, the first two are given about 2 weeks to 3 months apart. The third follows 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 The third is then given 14 days after the second vaccination at the earliest. You can talk with your doctor about whether getting vaccinated faster makes sense.

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.