What is the prevention and treatment for Tick-Borne Encephalitis (TBE)?

Tick-Borne Encephalitis: Prevention and Treatment

Prevention: Vaccination is Paramount

Vaccination offers the best protection against tick-borne encephalitis and should be recommended for all individuals with outdoor exposure in rural endemic areas during transmission season (April-November), as there is no effective antiviral treatment available. 1

Who Should Be Vaccinated

• Travelers with outdoor rural exposure in endemic areas during April-November transmission period should receive TBE vaccination, as endorsed by the World Health Organization 1
• Vaccination is recommended for all age groups above 1 year in highly endemic areas (≥5 cases/100,000/year) 2
• Individuals at risk in areas with lower incidence should also be vaccinated, particularly those aged 60-85 years who face higher morbidity 3
• Universal vaccination of all visitors to endemic areas is inappropriate—only those with outdoor rural exposure require immunization 1

Available Vaccines and Efficacy

• Two Western European vaccines are primarily available: Encepur (GSK) and FSME-IMMUN (Pfizer), both containing inactivated TBE virus with aluminum hydroxide adjuvant 1
• Field effectiveness protection rates of 96-99% have been demonstrated for persons vaccinated according to regular schedules 1
• All TBE vaccines produce seroconversion rates exceeding 87%, though the relationship between seroconversion and clinical protection has not been definitively established 4
• Accelerated schedules are available for travelers requesting protection shortly before departure: FSME-IMMUN given at 0 and 2 weeks achieves >90% seroconversion in those <50 years (>80% in older subjects); Encepur uses a 0,7,21-day schedule 1

Vaccine Safety Profile

• Adverse effects are commonly reported but none are serious or life-threatening 1, 4
• Modern formulations have improved tolerance compared to previous generations 1

Non-Vaccine Prevention Measures

• Personal protection measures (clothing, repellents) have limited effectiveness and should not be relied upon as primary prevention 1
• Regular tick checks after outdoor exposure are important but not always feasible 1
• Post-exposure prophylaxis after a tick bite is not recommended 2
• Avoid unpasteurized milk and milk products in endemic areas, as TBE can be transmitted through ingestion 1

Treatment: Supportive Care Only

There is no effective antiviral or immunomodulating therapy available for tick-borne encephalitis; treatment is entirely supportive and symptomatic. 2, 5

Acute Management Priorities

• Patients with potentially life-threatening meningoencephalitis or meningoencephalomyelitis should be admitted to an intensive care unit 2
• Lumbar puncture should be performed in all patients with suspected CNS infection unless contraindications exist 2
• Symptomatic treatment focuses on managing complications such as seizures, increased intracranial pressure, and respiratory compromise 2

Management of Specific Complications

• Seizures should be treated as any other symptomatic epileptic seizures using standard protocols 2
• For brain edema: deepen analgosedation; osmotherapy and corticosteroids are not routinely recommended 2
• If intracranial pressure is increased, therapeutic hypothermia or decompressive craniectomy might be considered 2

Diagnostic Confirmation

• TBE is defined by clinical signs of meningitis, meningoencephalitis, or meningoencephalomyelitis with CSF pleocytosis (>5 × 10⁶ cells/L) plus specific TBEV serum IgM and IgG antibodies, CSF IgM antibodies, or TBEV IgG seroconversion 2
• TBEV-specific PCR in blood is diagnostic during the first viremic phase but not sensitive during the second phase with CNS inflammation 2
• Brain and spinal cord imaging has low sensitivity and specificity but is useful for differential diagnosis 2

Clinical Context and Prognosis

• The case fatality rate in Europe is 0.5-2% (higher in Siberia and Far East) 1
• Approximately one-third of those with initial symptoms will develop neurological symptoms 1
• 80% of patients with primary myelitic manifestation will have permanent sequelae 1
• Post-encephalitic syndrome causing long-lasting morbidity develops in up to 50% of patients 5
• Older patients experience more serious symptoms and worse outcomes 1, 5

Critical Pitfall to Avoid

The fundamental problem with TBE prevention is that at-risk travelers, particularly from non-endemic countries, lack awareness of the risk and do not seek travel health advice when visiting industrialized European nations 1. Healthcare providers must proactively identify patients planning outdoor activities in endemic areas during transmission season and recommend vaccination well in advance of travel.