You should consider being immunised against tick-borne encephalitis (TBE) before you travel to certain countries in Europe and Asia. Check with your practice nurse at least 6-8 weeks before you travel to see if you should have this immunisation. Ideally, for complete protection, start the course of injections six months before travelling.
What is tick-borne encephalitis (TBE)?
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.
Who should be immunised against tick-borne encephalitis (TBE)?
Your doctor or practice nurse can advise if you should have this immunisation for your travel destination. Maps and information on the travel health advice websites listed below will also show you if you need immunisation.
Generally, the risk to the average traveller to affected countries is small. Immunisation 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 vaccine schedule
The usual schedule is to have three injections 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 slightly less protection than the other schedule.
The dose for children over the age of 1 but younger than 16 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, immunisation should be completed at least a month before travel. It is considered to be effective against all strains of the disease.
Who should not receive the tick-borne encephalitis (TBE) vaccine?
- 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 is because the vaccine contains small amounts of egg protein. Allergy to egg is rare and it does not mean an upset stomach when you eat eggs, or disliking eggs.)
- The vaccine is not licensed for children under the age of 1 year.
- This vaccine is safe if you are pregnant or breast-feeding.
Are there any possible side-effects from the vaccine?
- 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.
You should also try to prevent tick bites and infection
Immunisation 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.
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.
Further reading and references
Tick-borne encephalitis: the green book, chapter 31; Public Health England (April 2013)
Tickborne encephalitis (TBE); Public Health England
Bogovic P, Strle F; Tick-borne encephalitis: A review of epidemiology, clinical characteristics, and management. World J Clin Cases. 2015 May 163(5):430-41. doi: 10.12998/wjcc.v3.i5.430.
Amicizia D, Domnich A, Panatto D, et al; Epidemiology of tick-borne encephalitis (TBE) in Europe and its prevention by available vaccines. Hum Vaccin Immunother. 2013 May9(5):1163-71. doi: 10.4161/hv.23802. Epub 2013 Feb 1.
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