Exploring the Threat of Tickborne Encephalitis (TBE)

What is Tickborne Encephalitis?

Tickborne encephalitis is a viral infection primarily transmitted through the bite of infected ticks. These ticks carry the TBE virus and can pass it on to humans during feeding. The impact of TBE on the central nervous system underscores its significant threat to human health.

The virus can also be spread by consuming unpasteurised milk and dairy products. Although it is not spread from person to person, there have been rare reports of transmission through blood transfusions and from mother to baby during breastfeeding.

Where could I catch Tickborne Encephalitis?

Tickborne encephalitis is prevalent in Europe and Asia, where tick populations thrive in their natural habitats. Notable incidences of TBE have been reported in countries like Austria, Germany, Switzerland, and the Baltic states. It’s important to note that tick activity peaks during the warmer months making TBE a seasonal infection, with cases usually reported from April to November.

During the past 30 years, the range of Tickborne encephalitis virus transmission appears to have expanded to new geographical areas and to higher altitudes. Climate change is thought to have resulted in this shift of TBE risk areas, diagnostic/surveillance, and changes in human activities.

Ticks that carry TBE can be found in forest fringes, gardens, grasslands, woodlands, and city parks.

Is There A Risk In The UK?

In 2019, the first TBE virus detection in UK ticks was reported from Thetford Forest, East Anglia, England. In the same year, TBE was confirmed in a different geographical location in England: the Hampshire/Dorset border.

In September 2022, a TBE case was reported in England and likely acquired in Scotland in June 2022. In October of the same year, another case was reported, likely due to exposure in the North Yorkshire Moors.

The current assessment of overall TBE risk in the UK is very low for the general population.

What Are The Symptoms Of TBE?

The symptoms of TBE can range from mild to severe, with flu-like symptoms often marking the initial stage of infection.  Most infections can have no symptoms.

Individuals may experience neurological complications as the virus progresses, including encephalitis (inflammation of the brain) and meningitis (inflammation of the membranes surrounding the brain and spinal cord). These severe symptoms occur approximately 7 days after the flu-like symptoms. Severe cases of Tickborne Encephalitis can result in long-term neurological damage or, in some instances, prove fatal. TBE is rarely fatal in Europe; however, in Asia, the fatality rate is 20% of cases, with long-term neurological problems common.

What Is My Risk Whilst Travelling?

Your risk is dependent on the following factors for your trip:

• Destination
• Duration
• Season
• Activities
• Tick activity
• Vaccination status

By booking a video consultation with our Travel Health Nurse Specialist, you will receive a personalised risk assessment and any vaccine recommendations for your trip.

How To Avoid Tickborne Encephalitis

Preventing Tick bites is paramount in reducing the risk of Tickborne Encephalitis by

• Tick Repellents – use insect repellents containing DEET or Pircaridin on exposed skin. Read our blog on Avoiding Insect Bites for more information.
• Protective Clothing: Wear long-sleeved shirts, long trousers, and closed-toe shoes to minimize skin exposure to ticks. Light-coloured clothing makes it easier to spot ticks on clothes.
• Stay on Trails – stick to designated trails and avoid wandering into tall grass or dense vegetation where ticks tend to be.
• Tick Checks—Conduct tick checks after outdoor activities, paying close attention to hidden areas like the scalp, armpits, and groin. Ticks can be hard to see at first; they can be the size of a freckle or speck of dirt. After feeding, adult ticks become engorged and can be the size of a coffee bean.
• Removing ticks correctly and as soon as possible with a pair of flipped tweezers or a tick remover. Tick Removal | Ticks | CDC
• Consider Vaccination – travellers planning extended stays or frequent visits to endemic areas may opt for TBE vaccinations
• Avoid raw (unpasteurized) dairy products and milk.

The Tickborne Encephalitis Vaccine

There is a vaccine for anyone living in an endemic area. Some countries a vaccination program against TBE.

For UK travellers the vaccine is recommended for:

• Anyone living in TBE risk areas,
• Those at occupation risk in endemic areas, eg farmers, forestry workers, woodcutters, soldier
• Travellers visiting TBE-affected areas including forests, grasslands and city parks whose activities put them at increased risk, e.g. camping, hiking and mountain biking
• Lab workers who may be exposed to TBE.

The vaccine consists of 3 vaccines over the course of 5 months. For more information, book here to speak to our Nurse specialist.

In conclusion, Tickborne Encephalitis (TBE) presents a significant health risk for travellers exploring Europe and Asia. While the overall risk in the UK remains low, recent cases highlight the importance of awareness and proactive measures. Understanding the symptoms, risk areas, and preventive measures is essential for travellers to reduce their risk of TBE.

Knowledge and preparation are the keys to minimising the threat of TBE and ensuring a memorable and safe travel experience amidst nature’s beauty.

Resources:

NaTHNaC – Tick-borne encephalitis (travelhealthpro.org.uk)

Ticks | Ticks | CDC

Written by Amanda Howarth May 2024