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Adverse event reporting can be found at the bottom of the page
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Prescribing Information for TicoVac® (Tick-Borne Encephalitis Vaccine (whole Virus Inactivated)) can be found here. Information about adverse event reporting can be found at the bottom of the page.
Tick-borne encephalitis (TBE) is an infection of the central nervous system that affects the brain, spinal cord and membranes around them and can be more severe in some individuals.1
TBE virus belongs to a closely related group of viruses called flaviviruses. These include yellow fever, dengue and Japanese encephalitis. There are mainly 3 genetic strains of the TBE virus: European/Western, Siberian and Far Eastern.1
People can develop TBE if they have been bitten by a tick that is infected with the TBE virus.1
Between 10,000 to 12,000 clinical cases of TBE are reported each year globally.2
TicoVac® and TicoVac Junior® (tick-borne encephalitis vaccine suspension for injection in a prefilled syringe) are vaccines indicated for the active (prophylactic) immunization against tick-borne encephalitis (TBE) of persons of 16 years of age and older and children aged between 1 and 15 years.12,13
Both are to be given on the basis of official recommendations regarding the need for, and timing of, vaccination against TBE.
How is it spread?
Who is at risk?
Symptoms of TBE
How is TBE spread?
Transmission of TBE to humans usually takes place during a tick bite through the saliva of an infected tick, although unpasteurised dairy products from infected animals can also pose a risk.1
Ticks are the main vectors and reservoir hosts of the TBE virus. Ticks can get infected with TBE through co-feeding, feeding on a viremic host or occasionally transovarially from infected females to eggs.1
Not all ticks spread TBE. But in highly endemic† areas up to 40% of ticks carry the virus, although prevalence varies considerably by region3, see ‘who is at risk?’ tab above.
† Endemic areas are where an infection in a population is constantly maintained at a controllable level.
Who is at risk?
Location
TBE has been reported in over 35 countries. TBE infected ticks can be found across parts of Europe, including some parts of the UK, North Africa and Asia.3,4
Reports of TBE are generally at altitudes lower than 1500 metres. However, ticks have been noted at higher altitudes, thought to be as a result of climate change.5
Time of year
Ticks are typically active when temperatures are above 6º Celsius, usually from March to November. However, the tick season can vary each year depending on the climate.1
Activity
Ticks live outside and near the ground but can be found both within or outside cities, in parks, gardens and forests.5
Outdoor activities can put you at risk of coming into contact with ticks; for example, if you take part in activities in grassy areas where ticks are commonly found.5
Symptoms of TBE
For most people infected with the TBE virus, there are no symptoms but if there are, they usually appear up to 2 weeks after being bitten and follow 2 phases:6
1st Phase: Flu-like symptoms for 2-7 days followed by an asymptomatic period for 2-10 days.
High fever, headache, tiredness, nausea, muscle spasms
2nd Phase: Involving the neurological system with symptoms of meningitis and/or encephalitis
High fever, headache, fatigue, nausea, vomiting and vertigo
Most people infected recover fully, but 35 to 58% of people with TBE develop post-encephalitic syndrome (PES), which causes serious long-term complications including paralysis.6
TBE has a mortality rate of 0.5-2% - this means that up to 1 in every 50 people who develop symptoms of TBE will die from the infection.7
You can find out how to spot & remove ticks on the NHS website
Diagnosing TBE
Diagnosis of TBE is based on the following elements:
Exposure- if the individual has been exposed to risk factors related to TBE transmission such as their outdoor activities, travel and vaccination history.3,8
Laboratory testing- detection of anti-TBEV antibodies using either ELISA* or neutralization test is the only definitive diagnosis technique.8
*ELISA: enzyme linked immunosorbant assay
Is there treatment for TBE?
There is no specific treatment for TBE, and unlike Lyme disease (which is also transmitted by ticks) it cannot be treated with antibiotics.6,9
Therefore, TBE can only be treated symptomatically through:9
• Monitoring of vital functions, if necessary in an ICU
• Maintaning the water and electrolyte balance
• Ensuring sufficient caloric intake
• Administration of analgesics and antipyretics
• If necessary, administration of anticonvulsive agents
• Using physiotherapy for paralysed limbs to prevent muscle atrophy
• Rehabilitation
What can help to prevent TBE?
There are steps to help to prevent TBE both before and during travels to countries where there is a risk of TBE, see the countries below where there is risk of TBE:3,10
Before travel
Vaccination before travel is a proven way to help prevent TBE infection.11
World Health Organisation (WHO)- “Immunization offers the most effective protection.” 2
You should recommend vaccination against TBE to anyone who may be at risk of TBE through their work or are travelling to the above TBE risk areas and participating in activities which increase the risk of virus exposure such as walking, hiking, cycling and camping.3,11
Click here for more information on TBE vaccination in the UK.
When travelling
There are additional steps that help to protect individuals from TBE infection and avoid tick bites:4
Learn how to remove ticks here
References:
1. Lindquist L et al. Tick-borne encephalitis. The Lancet. 2008;371(9627):1861-71
2. World Health Organisation. Tick-borne encephalitis. Available at: https://www.who.int/health-topics/tick-borne-encephalitis#tab=tab_1. Accessed June 2022
3. Dobler G, et al. The TBE Book. Global Health Press Pte Ltd; 5th edition (2022)
4. NHS. Tick-borne encephalitis. Available at: https://www.nhs.uk/conditions/tick-borne-encephalitis/#:~:text=Tick%2Dborne%20encephalitis%20(TBE)%20is%20an%20infection%20spread%20by,some%20parts%20of%20the%20UK. Accessed June 2022
5. Travel Health Pro. Tick-Borne Encephalitis Factsheet. Available at: https://travelhealthpro.org.uk/factsheet/22/tick-borne-encephalitis Accessed June 2022
6. Kaiser R. Tick-borne encephalitis. Infect Dis Clin North Am. 2008;22(3):561-75
7. European Centre for Disease Prevention and Control. Factsheet about tick-borne encephalitis (TBE). Available at: https://www.ecdc.europa.eu/en/tick-borne-encephalitis/facts/factsheet Accessed June 2022
8. Kollaritsch H, et al. (2012) Vaccines and vaccination against tick-borne encephalitis. Expert Review of Vaccines. 11:9, 1103-1119. DOI: 10.1586/erv.12.86
9. Holzmann H, Diagnosis of tick-borne encephalitis. Vaccine 2003; 21 Suppl 1:S36-40
10. Travel Health Pro. Country Information. NaTHNaC. Available at: https://travelhealthpro.org.uk/countries. Accessed June 2022
11. World Health Organisation Regional Office for Europe, European Centre for Disease Control and Prevention. Factsheet about Tick-borne encephalitis in Europe. Available at: https://www.euro.who.int/__data/assets/pdf_file/0010/246169/Fact-sheet-Tick-borne-encephalitis-Eng.pdf Accessed June 2022
12. TicoVac® Summary of Product Characteristics. Accessed June 2022
13. TicoVac Junior® Summary of Product Characteristics. Accessed June 2022
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