Encephalitis, Tickborne

Description

Tickborne encephalitis (TBE), also known as spring-summer encephalitis, is a viral infection of the central nervous system transmitted by bites of certain vector ticks. Human infections follow bites of infected Ixodes ricinus ticks, usually in people who visit or work in forests, fields, or pastures. Infection also can be acquired by consuming unpasteurized dairy products from infected cows, goats, or sheep.
Occurrence

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The disease occurs in Scandinavia, western and central Europe, and countries that made up the former Soviet Union. Risk of acquiring the disease is greatest from April through August, when Ixodes ricinus, the principal tick vector, is most active. TBE is common in Austria, Estonia, Latvia, the Czech Republic, Slovakia, Germany, Hungary, Poland, Switzerland, Russia, Ukraine, Belarus, and northern Yugoslavia. It occurs at a lower frequency in Bulgaria; Romania; Denmark; France; the Aland archipelago and neighboring Finnish coastline; and along the coastline of southern Sweden, from Uppsala to Karlshamn. Serologic evidence for TBE infection, as well as sporadic cases, has been reported from Albania, Greece, Italy, Norway, and Turkey. A closely related disease, Russian spring-summer encephalitis, transmitted by Ix. persulcatus ticks, occurs in China, Korea, Japan, and eastern areas of Russia. The severity of disease, incidence of sequelae, and case-fatality rates are higher in the Far East and eastern regions of Russia than in western and central Europe.

Risk to Travelers

The risk to travelers who do not visit forested areas or consume unpasteurized dairy products is low. Travelers with extensive unprotected outdoor, evening, and nighttime exposure in rural areas, such as might be experienced while bicycling, camping, or engaging in certain occupational activities, might be at high risk even if their trip is brief.

Preventive Measures

Vaccine

Although effective vaccines can be obtained in Europe from Baxter (Vienna, Austria, and Behring, Germany) available data do not support recommending its use by those traveling less than 3 weeks. Anyone traveling longer than 3 weeks should be advised to obtain the vaccine if he or she plans to be in infected areas during the warm weather months when ticks are active.

Other

Travelers should be advised to avoid tick-infested areas and to protect themselves from tick bites by dressing appropriately and using repellents. Repellents containing N,N-diethylmetatoluamide (DEET) can be applied directly on the skin. Compounds containing permethrin have an acaricidal and repellent effect and should be used on clothing and camping gear. (See Insect Protection.) Consumption of unpasteurized dairy products should be avoided.

Credits: National Center for Infectious Diseases