TBE: Early Summer Meningoencephalitis Caused By Ticks

Early summer meningoencephalitis (TBE) is transmitted by infected ticks. In most cases it runs smoothly, then its symptoms resemble flu. Rarely, the disease takes a severe course and can even lead to death. Below you can learn everything important about TBE and read how you can protect yourself and your children from infection.

What is TBE?

The abbreviation TBE stands for early summer meningoencephalitis. This is an inflammation of the brain, meninges and/or spinal cord. The areas can be affected individually, but also all together. TBE is caused by a viral pathogen that belongs to the flaviviruses and is related to the pathogens of yellow fever and dengue fever. In most cases, the virus is transmitted through tick bites (colloquially and incorrectly referred to as tick bites). Rarely, TBE infections occur after drinking raw milk from sheep, goats or cows. TBE cannot be transmitted from person to person, so the disease is not contagious. The older the patient, the higher the risk of a severe course of early summer meningoencephalitis. Infection with TBE can leave permanent damage and even be fatal.

First signs of TBE

Not every tick infected with TBE also transmits the pathogen to humans. Once transmission has occurred, it takes one to two – but no more than four – weeks before symptoms appear. This phase is called the incubation period. The first symptoms of TBE can be compared to those of influenza:

In nine out of ten sufferers either no symptoms occur or the symptoms last only a few days – the infection is then over after about a week. Especially in children, it usually subsides without complications.

One in ten cases takes a severe course

In ten percent of TBE patients, however, the fever rises again shortly thereafter. In these cases, the virus can cause impairment in different areas of the central nervous system. In most cases, meningitis (meningitis) or meningoencephalitis (meningitis and brain inflammation) now occur. In rare cases, the spinal cord is also affected. This is called meningoencephalomyelitis. An isolated inflammation of the spinal cord is extremely rare. Severe courses mainly affect older people.

What symptoms occur in the severe course of TBE?

Some symptoms of meningitis are more diffuse, including fever, headache, and nausea. Increased sensitivity to light and stiff neck are characteristic. The latter is typical of meningitis. The muscles of the neck are tense and painful. Therefore, the chin cannot be lowered to the chest. Meningitis caused by the TBE virus usually has strongly pronounced symptoms. In combination with brain inflammation, the symptoms become even more severe. There may be symptoms of coordination and paralysis, as well as tremors and seizures. Hearing and swallowing difficulties are also possible. If the spinal cord is also affected, the symptoms are even more severe. In this case, the muscles of the arms, legs, neck and face may be paralyzed. Respiratory paralysis, which is also possible, is life-threatening.

How is early summer meningoencephalitis diagnosed?

The first step in diagnosis is initially a medical history discussion with the physician, who asks whether there has been a tick bite and whether there is a TBE vaccination. As a rule, TBE is diagnosed with the aid of blood tests, because in addition to various inflammation parameters, specific antibodies against TBE are usually found in the blood. This can be supplemented by an examination of the spinal cord and cerebrospinal fluid, and imaging techniques can be used. Early diagnosis of TBE is beneficial, as timely treatment can help prevent long-term damage.

Treatment of TBE

There are no medications that fight the TBE viruses. This makes treatment more difficult. Therefore, unlike Lyme disease, which is also transmitted by ticks, TBE cannot be cured with medication. Therapy is merely symptomatic.In addition to medications such as anticonvulsants and painkillers, non-drug measures such as physiotherapy or speech therapy are also recommended, depending on the severity of the symptoms. In addition to other measures, the attending physician will advise patients to take strict bed rest. In severe cases, treatment in the intensive care unit may even be necessary.

How dangerous is TBE really?

Once the actual infection is over, there may be late effects in individual cases. Some subside over the course of a few weeks or months, while some are permanent. These can include headaches and fatigue, as well as neurological problems such as speech disorders, concentration problems, paralysis, and seizure disorders. The risk of death from early summer meningoencephalitis averages about one percent. When the brain, meninges, and spinal cord are affected together, the risk is sometimes much higher. Every TBE infection must be reported. The public health department must be informed of the disease no later than 24 hours after diagnosis.

How many ticks have TBE?

By no means every tick transmits the TBE virus. In addition, the risk that a tick can transmit the TBE virus is higher in certain areas than in others – these are called TBE risk areas. But even there, according to the Robert Koch Institute (RKI), it is only one to fifty ticks out of every one thousand.

TBE risk areas: Which areas are affected?

The RKI provides an up-to-date map of TBE areas. In Germany, Bavaria and Baden-Württemberg are particularly affected, as well as the south of Hesse and Thuringia, but parts of other German states are also affected. Other affected countries in Europe include Austria, Poland, Denmark, Sweden and Norway. Find out before a vacation whether your destination is one of the risk areas.

How can I protect myself from TBE?

To prevent the transmission of diseases by tick bites, it is advisable to take appropriate measures to ward off ticks, especially during the tick season in the period from March to November. You can find out how to protect yourself from tick bites here. However, the only sure protection is a TBE vaccination, colloquially also called tick vaccination. But beware: the vaccination only prevents early summer meningoencephalitis. It is not a Lyme disease vaccination! The vaccine is ineffective against this disease, which is also transmitted by tick bites. Even though only a small percentage of all ticks actually transmit TBE, the vaccination is useful. The disease can sometimes lead to death and there is no active substance against the pathogen.

TBE vaccination: when should you get vaccinated?

The STIKO (Standing Committee on Vaccination) recommends vaccination against TBE to all people who live in a risk area and are often in nature. This includes people who like to spend their free time outdoors, as well as forestry workers and members of similar professions. For residents of risk areas, the cost of TBE vaccination is covered by health insurance. Exceptions are groups of people who need the vaccination for professional reasons. Here the employer takes over the costs. Before vacationing in a risk area, you should seek advice from a travel physician. If you need a vaccination for a private trip, you may have to bear the costs yourself. However, discuss this with your health insurance company in each individual case.

How often must be vaccinated against TBE?

To achieve basic immunization, three vaccinations are necessary. The vaccination schedule depends on the vaccine used. In Germany, the vaccines used are TBE Immune and Encepur. To achieve full protection, the vaccination is repeated at intervals of several months. For adults, the schedule is as follows:

  1. The first dose is administered.
  2. One to three months later, the second dose follows.
  3. The third dose is administered five to twelve (TBE Immune) or nine to twelve (Encepur) months after the second.

If prompt vaccination protection is to be achieved, for example, because a trip to an area with TBE spread is pending at short notice, the individual doses can be administered at shorter intervals. Because they are bitten particularly often by ticks, the TBE vaccination is especially recommended for children. A special vaccine is used for them. Children can be vaccinated from the age of one.

When should you start TBE vaccination?

In principle, the first dose of TBE vaccination can be administered at any time. However, to ensure that one is already protected at the beginning of the tick season, it is advisable to administer the first shot during the winter months. Two weeks after the second dose of vaccine, most people already have provisional protection – but the long-term protective effect is only ensured by the third vaccination.

How often do you need to refresh your tick vaccination?

The first booster should be given after three years, followed by five-year intervals. People over the age of sixty, on the other hand, should continue to be vaccinated against TBE every three years. It is highly probable that one is immune to the pathogen after surviving early summer meningoencephalitis. However, it has not yet been sufficiently researched whether this immunity actually lasts for life. Therefore, these persons should also be vaccinated if they belong to the risk group. Subsequent vaccination following the bite of a tick infected with TBE is ineffective.

Possible side effects of TBE vaccination

All vaccinations can cause local reactions such as swelling, redness, or pain at the injection site. This is also true for TBE vaccination. Other vaccine reactions that may occur in the first few days after administration include diffuse symptoms such as increased temperature, fever, headache or muscle aches, gastrointestinal problems, and a general feeling of illness. In most cases, these symptoms subside on their own after a short time. In individual cases, the TBE vaccination can cause severe and permanent damage to the nervous system, especially paralysis, especially in adults. If allergic to chicken egg protein, TBE vaccination should be given only after careful consideration of the benefits and risks.