© Vasilyev Alexandr / Shutterstock.com
TBE viruses are usually transmitted through tick bites. They can cause inflammation of the brain, meninges or spinal cord. TBE stands for "early summer meningoencephalitis". TBE is usually easier in children than in older adolescents and adults. But the disease can also be severe in children.
TBE occurs mainly in Bavaria, Baden-Wurttemberg, and the southern parts of Hesse, Thuringia, and Saxony. In addition, there are further TBE risk areas in Germany. In recent years, the number of reported TBE cases in Germany has ranged between 200 and 704 annually. In 2020, 704 TBE cases were reported, the highest number of cases since data collection began in 2001.
Good to know
The Standing Committee on Vaccination (STIKO) recommends vaccination against TBE as the safest protection against the disease for all persons who live in TBE risk areas or who live there and can be bitten by ticks.
Children can be vaccinated against TBE from their first birthday onwards. Please speak with your pediatrician or. Your pediatrician about vaccination.
TBE: transmission and course of the disease
Transfer
TBE viruses are transmitted to humans primarily through the bite of ticks. Very rarely, infection is also reported through consumption of raw milk from goats, sheep, or cows. There is no direct infection from person to person.
TBE risk areas in Germany
In Germany, TBE occurs mainly in Bavaria and Baden-Wurttemberg, but also in southern Hesse, southeastern Thuringia and Saxony. Individual risk areas are found in the counties of Marburg-Biedenkopf (in central Hesse), Saar-Pfalz-Kreis (in Saarland), Birkenfeld (in Rhineland-Palatinate), and Emsland (in Lower Saxony). In 2021, the districts of Dillingen a were added as new risk areas. d. Danube, Weimarer Land, Fulda, Central Saxony and the urban district of Dessau-Roblau identified. Thus, 169 counties are currently designated as TBE risk areas. The Robert Koch Institute (RKI) publishes an up-to-date map of TBE risk areas in Germany every spring.
Outside the risk areas, only isolated TBE infections are observed in Germany.
The main transmission period of TBE is between April and November, in mild weather also in winter. Disease-carrying ticks occur in Central Europe up to altitudes of 2.000 m before.
Other TBE risk areas
TBE also occurs in numerous other European countries. Risk areas are located in Albania, Bosnia, Bulgaria, Denmark, Estonia, Finland, Greece, Italy, Croatia, Latvia, Lithuania, Norway, Austria, Poland, Romania, Russia, Sweden, Switzerland, Serbia, Slovakia, Slovenia, the Czech Republic, Turkey, Ukraine, Hungary and Belarus. TBE disease occurs sporadically in other countries. Close relatives of the local TBE viruses are spread from North-Eastern Europe via Siberia and China to Japan. They cause an illness similar to TBE, RSSE (Russian Spring-Summer-Encephalitis).
Reported TBE cases in Germany 2005 to 2021
Source: Robert Koch Institute, SurvStat, https://survstat.rki.en/, data status: 03.03.2021*
| 2005 | 432 |
| 2006 | 546 |
| 2007 | 239 |
| 2008 | 289 |
| 2009 | 313 |
| 2010 | 260 |
| 2011 | 424 |
| 2012 | 195 |
| 2013 | 420 |
| 2014 | 263 |
| 2015 | 221 |
| 2016 | 353 |
| 2017 | 486 |
| 2018 | 583 |
| 2019 | 444 |
| 2020 | 706 |
| *2021 | 3 |
The STIKO (Standing Committee on Vaccination) recommends vaccination against TBE to all people who are in TBE risk areas and could be bitten by ticks there.
Additional protection against tick bites
- In addition to vaccination, general measures should be taken against tick bites. This includes wearing closed clothing (long pants and sleeves, stockings, sturdy shoes, pants legs tucked into stockings) in nature, because ticks often sit in the grass, bushes or undergrowth.
Contrary to popular belief, they do not drop from trees onto people or animals.
Tick repellents, applied to uncovered skin and clothing, also provide some protection, but it only lasts a few hours.
Disease progression
TBE usually runs more easily in children than in adults and older adolescents. About one to two weeks after the tick bite, flu-like symptoms with fever, headache, vomiting or dizziness appear for a few days at first, which disappear again after a few days. In most cases, the illness is then over.
In a second peak of the disease, signs of meningitis with high fever, severe headache, neck stiffness and vomiting may occur. But the brain itself and the spinal cord are attacked less often in children than in adults.
In most cases, the disease heals without permanent damage. About a quarter of children with the disease can develop a severe condition that causes long-term brain and nerve damage in about two out of every 100 children with the disease.
In adolescence and adults, the risk of severe disease progression increases. There is no causal treatment against TBE. Only the signs of the disease, such as z. B. the fever, should be treated.
Reported TBE cases in 2020, broken down by age group
Source: Robert Koch Institute, SurvStat, https://survstat.rki.en/, data status: 03.03.2021
| 0 – 4 | 13 |
| 5 – 9 | 28 |
| 10 – 14 | 28 |
| 15 – 19 | 22 |
| 20 – 24 | 20 |
| 25 – 29 | 35 |
| 30 – 39 | 69 |
| 40 – 49 | 83 |
| 50 – 59 | 179 |
| 60 – 69 | 126 |
| 70+ | 76 |
TBE: Vaccination
Even though TBE occurs less frequently in young children and is less severe than in adolescents and adults, in some cases the virus can lead to severe illness, sometimes with long-lasting damage.
The safest protection against TBE is provided by vaccination. Children at the age of at least 12 months can be vaccinated. In children under three, vaccination can cause a fever reaction in up to 15 percent of cases. Therefore, at this age with the doctor or. The actual risk of infection for the child must be discussed with the doctor in each individual case.
The STIKO recommends vaccination to all people who are in TBE areas or live there and could be bitten by ticks. This applies to all those who spend a lot of time outdoors, such as walkers, campers, joggers or children who often play outdoors. City parks and gardens are also habitats for ticks.
Children can be vaccinated against TBE from their first birthday onwards. Please speak with your pediatrician or. Your pediatrician about vaccination.
For endangered population groups within Germany, health insurances usually cover the costs of vaccination. Exceptions are – depending on the health insurance – travel vaccinations before trips abroad.
Build-up of vaccination protection (basic immunization)
Three vaccinations are necessary to build up the vaccination protection. According to the usual vaccination schedule, the second vaccination dose is administered one to three months after the first vaccination. A third vaccination is then given, depending on the vaccine used, after another 5 to 12 or. 9 to 12 months.
In order to be protected for the current year already at the beginning of the tick season from April, it makes sense to start with the vaccination series in the winter months. As early as 14 days after the second vaccination, 90 percent of those vaccinated have protection that is initially sufficient for the current season. For a longer lasting protective effect, the third vaccination is then required.
Booster vaccinations
If the risk of infection persists, an initial booster vaccination is recommended 3 years after complete basic immunization, with subsequent boosters required every 5 years thereafter.
Quick scheme
If particularly rapid protection is required, z. B. for trips planned at short notice in TBE risk areas, vaccination can be carried out according to the so-called rapid schedule. Here the vaccination scheme depends on the vaccine used. Two to three vaccinations are necessary. Vaccination protection for one to one and a half years can be achieved 3 to 5 weeks after the first vaccination. Depending on the vaccine used, an early booster vaccination may be necessary. Please ask your pediatrician or. consult your pediatrician for the most appropriate vaccination schedule.
By the way, the vaccines available in Germany also protect against the close relatives of the local TBE virus strains, which occur in eastern Europe and in Asia. However, the TBE vaccination does not provide protection against Lyme disease, which is also transmitted by ticks.
Tip: After each tick bite, the tetanus vaccination should also be checked!
Possible side effects of vaccination
The most common symptoms are pain, redness or swelling at the site of the bite. These symptoms also occur with other vaccinations and indicate that the body is coming to terms with the vaccine.
Within the first four days after vaccination, general symptoms such as increased temperature and fever, headache, muscle and joint pain, malaise or gastrointestinal complaints may occur.
Children under 3 years of age develop fever reactions after TBE vaccination in up to 15 percent of cases. Therefore, at this age, the doctor should check the risk of infection together with the parents.
As a rule, the described reactions to the vaccination subside quickly and without consequences. They occur mainly during the first vaccination, less frequently during the subsequent vaccinations.
Severe side effects such as allergic reactions are very rare. In individual cases (especially in adults), diseases of the nervous system, e.g., inflammation of the brain, have been reported. B. described paralysis, which can also last longer.
Important note
In the case of a proven severe allergy to chicken egg white, you should discuss the vaccination with your pediatrician. the pediatrician should weigh the benefits and risks of the vaccination against each other.
TBE: Frequently asked questions and answers (FAQs)
How to remove a tick?
Ticks should be pulled straight out as quickly as possible with tweezers or a special tick removal instrument. Care should be taken to avoid squeezing the body of the tick as much as possible, otherwise pathogens from the tick can be forced into the bite site. After pulling out the tick, the site should be carefully disinfected.
Under no circumstances should the tick be dabbed with glue or nail varnish, as this can further promote the transmission of pathogens to humans.
If signs of illness such as fever, headache and pain in the limbs or a ring-shaped reddening in the area of the bite occur shortly after a tick bite, a doctor should always be consulted. a doctor should be consulted.
At what age can children be vaccinated against TBE??
Since children like to play in nature, they are at greater risk of being bitten by a tick. However, TBE is usually milder in children than in adolescents and adults. Children can be vaccinated from their first birthday onwards. Children under three years of age may develop a fever reaction from the vaccination in up to 15 percent of cases. Therefore, at this age should be discussed with the doctor or. discuss with the doctor how high the actual risk of infection is for the child.
In order to protect children from other tick-borne diseases such as Lyme disease, the body and clothing should be carefully checked for ticks after spending time in nature and these should be removed as soon as possible.
Can you still be protected by a vaccination after a tick bite??
Subsequent vaccination after a tick bite is not recommended, as it is very unlikely to prevent infection with the TBE viruses.
the vaccination protection against TBE should be checked by a blood test?
Only for people with impaired immune defenses, it is recommended to check the vaccination protection one to two months after the second partial vaccination. (If you have been vaccinated according to the rapid schedule, the blood test is carried out after the third partial vaccination).) If the antibody concentration proves to be insufficient, an additional vaccination should be given.
Can all ticks in TBE risk areas transmit the virus?
Even in risk areas not all ticks are infested with the TBE virus. Depending on the region, about one in a thousand to one in twenty ticks can transmit the disease. After being bitten by an infected tick, up to one third of the people bitten experience symptoms of illness. These can be severe, especially in adults, and can leave lasting damage, especially in older people. About one in a hundred people who are bitten die from the infection. Once the disease has broken out, only the symptoms can be treated, there is no medication that is specifically effective against the TBE viruses.
Link tips
Information from the Robert Koch Institute on current TBE risk areas in Germany.