Tick-borne Encephalitis

What is tick-bourn encephalitis?

Tick-borne Encephalitis (TBE) is an infection caused by the Flaviviridae family of viruses. It is spread through the bite of a tick that is infected with this type of virus.1 The disease occurs in parts of Europe and Asia. 2

There is no specific treatment for TBE therefore vaccination against the disease is highly recommended.

The following is a summary about the disease. For further details speak to your local pharmacist or GP.

How is tick-borne encephalitis spread?

TBE is mainly transmitted through the bite of an infected Ixodes tick. Ticks are found on:

  • Forest fringes within adjacent grassland
  • Forest glades
  • Riverside meadows
  • Marshland
  • Forest plantations with brushwood
  • Shrubbery
  • Parks and gardens2

However, the virus can also be transmitted through drinking unpasteurised milk from infected animals.1

Which countries are at risk from tick-borne encephalitis?

Risk of TBE is higher in:

  • Central and Eastern Europe
  • Russia
  • Eastern Asia2

Country specific information for TBE can be found here.3

What are the signs and symptoms of tick-borne encephalitis?

The incubation period for TBE can be between 2-28 days. Most people who are infected with TBE virus do not develop symptoms.

Approximately 2-30% may develop symptoms. The 1st stage of the disease lasting from up to a week is characterised by non-specific flu-like illness:

  • Fever
  • Tiredness
  • Headache
  • Muscle pains
  • Nausea and vomiting1

What are the complications of tick-borne encephalitis?

The 2nd stage of TBE usually follows after 8 days with a sudden rise in temperature. It affects the central nervous system with symptoms of either:

  • Meningitis (fever, headache, nausea, vomiting, stiff neck)
  • Encephalitis (drowsiness, confusion, sensory disturbances, paralysis)
  • Meningoencephalomyelitis (muscle pains, respiratory paralysis)1

What is the treatment for tick-borne encephalitis?

There is no specific treatment for TBE.

The more severe symptoms require hospitalisation.

Symptom relief treatment includes:

  • Paracetamol or ibuprofen – to reduce fever and aches and pains
  • Hydration
  • Rest

What advice is there for travellers?

To minimise the risk of infection with TBE:

  • Avoid consumption of unpasteurised dairy products in areas of risk
  • Avoid known heavily tick-infested areas of forest and woodland during the spring, summer and autumn
  • Keep to footpaths and avoid walking in areas of long grass
  • Light coloured clothing will help see ticks
  • Clothing can be sprayed with insecticide

Further details on bite avoidance can be found here.4

Check the body for ticks regularly, especially after outdoor activities. Common areas for ticks to attach are:

  • At the hair-line
  • Behind the ears
  • Elbows
  • Backs of knees
  • Groin
  • Armpit

Remove ticks as soon as possible by using a pair of fine tipped tweezers or tick remover. Further information about removing ticks can be found here.5

Unvaccinated travellers bitten by ticks in endemic areas should seek local medical advice.6

If any signs of illness occur within 28 days of a tick bite, advice should be promptly sought from a medical practitioner.

When to consider vaccination

Vaccination is recommended for:

  • Those travelling to warm, forested parts of the endemic areas (particularly in the spring and summer, where ticks are most prevalent)
  • Individuals who hike, camp, hunt and undertake fieldwork in endemic forested areas
  • Those who will be going to reside in an area where TBE risk is high1
  • Laboratory workers who may be exposed to TBE6

Vaccination

A vaccine against TBE is available for children over 1 year and adults. The vaccine is inactivated and does not contain thiomersal. The schedule consists of 3 doses given on:

  • 1st dose: Day 0
  • 2nd dose: 1-3 months after the 1st dose
  • 3rd dose: 5-12 months after the 2nd dose

A booster dose is recommended every 3 years after the 3rd dose if the individual continues to be at risk.6

References

This information is taken from trusted third party websites, NaTHNaC (Travel Health Pro) and EMIS (Patient info) and use of all information has been licenced under the Open Government Licence http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/.

Although the materials are being used/replicated under the provisions of the Open Government Licence this in no way represents endorsement of Traveljab.co.uk by NaTHNaC, Emis, Public Health England, the NHS or the Department of Health and Social Care.

References:

  1. Patient.Info: Tick-borne Encephalitis and Tick-borne Encephalitis vaccination
  2. Travel Health Pro: Tick-borne encephalitis
  3. Travel Health Pro: Country information
  4. Travel Health Pro: Insect and tick bite avoidance
  5. CDC: Ticks
  6. The Green Book: Chapter 31: Tick-borne encephalitis

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