Tick-borne encephalitis vaccine

Check with your practice nurse at least 6-8 weeks before you travel to see if you should have this vaccination. Ideally, for complete protection, start the course of injections six months before travelling.

What is tick-borne encephalitis?

Tick-borne encephalitis (TBE) is caused by a virus. It is usually spread by bites from ticks which are infected with the virus. Unpasteurised milk from infected animals, especially goats, is a less common source of the infection.

Affected people often develop a flu-like illness that lasts about a week. This may progress to inflammation of the brain (encephalitis) or inflammation of the tissues around the brain (meningitis). These are serious conditions which can cause headache, high temperature (fever), sickness (vomiting), agitation and confusion. In severe cases they can lead to a coma or even, less commonly, death.

People who recover from the illness may have long-term problems as a result. These include weakness of arms or legs, or problems with co-ordination or walking.

There are three different types of TBE virus:

• European TBE virus.

• Far Eastern TBE virus.

• Siberian TBE virus.

European TBE occurs mainly in western and central European countries and is particularly common in forest and mountainous regions. Far Eastern TBE occurs in eastern Russia and some countries in East Asia, particularly in forested regions of China and Japan. Siberian TBE occurs in Siberia and some parts of Russia.

Generally, the risk to the average traveller to affected countries is small. Vaccination is recommended for people who intend to walk, camp or work in heavily forested regions of affected countries between April and October when the ticks are most active.

In particular, if you stay in areas where there is heavy undergrowth. It is also recommended for people who handle material that may be infected by the virus (for example, laboratory workers).

There is currently no risk from TBE in the UK. There have been a few cases of it in the UK but those people contracted it abroad. The virus does not pass between people.

The usual schedule is to have three injections (doses) of vaccine. The second vaccine is given 1-3 months after the first and the third is given 5-12 months after the second. You should have booster doses every three years if you continue to be at risk of infection. If immunity is required more quickly, a second dose can be given two weeks after the first dose, which gives around 90% of the protection compared to the longer schedule.

The dose for children over the age of 1 year but younger than 16 years is half the adult dose. There is a special vaccine preparation for children. In the UK, the adult vaccine is called TicoVac® and the children's vaccine is called TicoVac Junior®.

The vaccine stimulates your body to make antibodies against the virus. These antibodies are proteins which protect you from this illness should you come into contact with this virus.

Ideally, vaccination should be completed at least a month before travel. It is considered to be effective against all strains of the disease.

• If you are ill with a high temperature (fever) you should postpone the injection until you are better.

• You should not have a booster if you have had a severe reaction to this vaccine in the past.

• You should not have this vaccine if you have a severe allergy to egg. This means an allergy where you have anaphylaxis - eg, your throat swells up and you have difficulty breathing. This is because the vaccine contains a small amount of egg protein. If you have a mild allergy to eggs (such as developing a rash), or you just dislike eggs or they upset your stomach, you can still have the vaccine.

• The vaccine is not licensed for children under the age of 1 year.

• There is no evidence of harm if the vaccine is given to women who are pregnant or breastfeeding.

• Mild pain and redness occur at the site of injection in some people.

• Some people develop a high temperature (fever), particularly after the first dose. This is most common within twelve hours of having the vaccine. This usually settles within 24-48 hours.

• Severe reactions are extremely rare.

Vaccination is extremely effective. However, if you are travelling to affected areas, whether you have been immunised or not, it is also important to:

• Cover arms, legs and ankles.

• Use insect repellent on exposed skin, socks and outer clothing.

• Not drink unpasteurised milk, especially goat's milk.

Tick removal

Ticks should be removed as soon as possible with tweezers as close to the skin attachment as possible. They should be removed by steady pulling without jerking or twisting. Other ways of removing ticks are with tick removal tools, or with loops of cotton or floss. Do not pull a tick out with your fingers as you may break it off and only pull out some of it.