Infection — Do I have to wait after a tick bite to get vaccinated for encephalitis? Medical Sciences Stack Exchange

Do I have to wait after a tick bite to get vaccinated for encephalitis?

I recently removed a tick I must have caught while camping. Thinking of my plans for the summer (which involve frequently changing clothes in the wilderness), I realized I’d like to get a vaccination against tick borne encephalitis.

Usually, a vaccine is not given right after potential exposure to the pathogens against which it protects. Is this so for the vaccine against tick encephalitis? How long do I have to wait after my last tick bite until it is safe to get the vaccine?

Also, how long does the vaccine «hold» without renewal? If it needs renewals, how is it best to time them (e.g. which season is optimal?)

Update In case that ticks are a vector for different diseases in different parts of the world, I expect to get bitten in the southern parts of Germany and the eastern parts of France. I am worried about the disease known in German as «FSME», which is endemic in these regions.

2 Answers 2

It’s hard to prove some information doesn’t exist, but maybe I’ll get points for effort 😉

There is a section on «Post exposure vaccination» in the (long) World Health Organization Background Document on Vaccines and Vaccination against Tick-borne Encephalitis (TBE). They mention the concern you also cite in your question, but go on to say that there is no evidence for it:

Of special concern is the theoretical possibility that post-exposure prophylaxis could result in antibody-dependent enhancement of the infection and exacerbation of the disease. Such phenomena have been reported for other flavivirus infections, but not for TBEV.

At least, vaccination after exposure will probably not fast enough to prevent an infection (vaccinating after exposure is, for example, done for rabies):

Since TBE has a relatively short incubation period, even an anamnestic response may not be fast enough to protect the individual following exposure.

Neither those studies nor the manufacturer information for FSME Immun (which might be what you would receive — warning for others: that information is in German) state a waiting period. A good guess would probably be the incubation period for TBE (median 8 days).

That part is easier. For the two vaccines usually used in Western Europe, the WHO writes

With both vaccines the manufacturers recommend a booster 3 years after completion of the primary series and subsequent boosters at intervals of 5 years (3 year intervals for individuals aged >60 years)

As for scheduling, even after those 3 or 5 years, protection is still really good (after 8 years, 90% were still protected), so there’s probably no rush and the booster can be taken when convenient.

medicalsciences.stackexchange.com

Department of Health

Powassan (POW) Virus Disease Fact Sheet

Last Reviewed: July 2017

What is Powassan virus disease?

Powassan (POW) virus disease is rare, but often serious disease caused by a virus that is spread by the bite of infected ticks. The virus is not transmitted directly from person-to-person. The virus is named after Powassan, Ontario where it was first discovered in 1958. It can cause symptoms ranging from mild flu-like symptoms to life threatening encephalitis (inflammation of the brain). In New York State, there are 1 to 2 cases of POW virus disease per year. Nationally, approximately 75 cases of POW virus disease were reported over the past 10 years (the most up-to-date national statistics can be found at https://www.cdc.gov/powassan/statistics.html). Prevention by following proper precautions to reduce exposure to ticks is the best defense against POW virus disease.

Who gets Powassan virus disease?

POW virus is transmitted by the bite of an infected tick. The chances of being bitten by a tick are greater during times of the year when ticks are most active. Most cases have occurred in the northeastern and Great Lakes regions of the United States during the late spring, early summer, and mid-fall when ticks are most active. People who work outdoors or engage in outdoor activities such as camping/hiking, gardening, time on athletic fields, or playing in grassy and wooded environments are at an increased risk of exposure.

How is Powassan virus spread?

Ticks can become infected with POW virus if they feed on small animals such as mice and other small mammals that are infected. The disease can be spread to humans when an infected tick bites a person. Unlike other tick-borne diseases, a tick can transmit POW virus while being attached to a person for as little as 15 minutes. POW virus disease cannot spread directly from one person to another.

The tick that primarily spreads POW virus to humans is the black-legged tick or deer tick (Ixodes scapularis). This is the same tick responsible for infecting people with Lyme disease. The squirrel tick (Ixodes marxi) and groundhog tick (Ixodes cookei) also have the potential to spread POW virus to people, but these ticks do not typically feed on humans.

What are the signs and symptoms of Powassan virus disease?

Many people who become infected with POW virus do not develop symptoms. However, for those who do, symptoms usually appear within 1 to 4 weeks after the bite of an infected tick occurred. Symptoms can include fever, headache, vomiting, weakness, confusion, loss of coordination, speech difficulties, and seizures. Severe infections are marked by a quicker onset and includes headache, high fever, confusion, tremors, seizures, paralysis, coma or death. POW virus can cause encephalitis (inflammation of the brain) and meningitis (inflammation of the membranes that surround the brain and spinal cord). Half of survivors have permanent neurological symptoms, such as recurrent headaches, muscle wasting and memory problems. Approximately 10% of POW virus encephalitis cases are fatal.

How is Powassan virus disease diagnosed?

Health care providers diagnose infection based on the patient’s clinical symptoms and tests of blood or spinal fluid. These tests typically detect antibodies that the immune system makes against the viral infection. If you think you or a family member may have POW virus disease, it is important to consult your healthcare provider.

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What is the treatment for Powassan virus disease?

There is no specific medicine to cure or treat POW virus disease. Health care providers will usually attempt to relieve the symptoms of the illness. Supportive care for severe illnesses may include hospitalization, respiratory support, and intravenous fluids.

What can be done to prevent Powassan virus disease?

The best prevention of POW virus disease is through tick bite prevention. Generally, ticks cannot jump or fly onto a person. They wait in vegetation and cling to animals and humans when they brush by. When in a potentially tick-infested habitat (wooded and grassy areas), take special care to prevent tick bites, such as wearing light-colored clothing (for easy tick discovery) and tucking pants into socks and shirt into pants. Check frequently during outdoor activity for ticks on clothing or skin. Brush off any ticks on clothing or skin before skin attachment occurs. (Duct tape or lint rollers can be quite useful in removing ticks from clothing). A thorough check of body surfaces for attached ticks should be done once indoors. For proper tick removal, please watch the video at Tick removal.

Insect repellents can be effective at reducing bites from ticks that can spread disease. If you decide to use a repellent, use only what and how much you need for your situation. More information on repellents can be found at Environmental Protection Agency- insect-repellents.

  • Be sure to follow label directions.
  • Try to reduce the use of repellents by dressing in long sleeves and pants tucked into socks or boots.
  • Children should only handle repellents with adult supervision. Adults should apply repellents to their own hands first and then gently spread it on the child’s exposed skin. Avoid applying directly to children’s hands. After returning indoors, wash your child’s treated skin and clothing with soap and water or give the child a bath.
  • Do not apply near eyes, nose or mouth and use sparingly around ears.
  • After returning indoors, wash treated skin with soap and water.

Domestic animals can carry ticks into areas where you live so it is important to check pets for ticks before they enter the home.

How should a tick be removed?

Grasp the mouthparts with tweezers as close as possible to the attachment (skin) site. Be careful not to squeeze, crush or puncture the body of the tick, which may contain infectious fluids. Pull firmly and steadily upward to remove the tick. After removing the tick, thoroughly disinfect the bite site and wash hands. The NYSDOH has created a video on proper tick removal (Proper Tick removal) and a printable card with steps on how to remove ticks (How to Remove a Tick Card). See or call a doctor if there are concerns about incomplete tick removal. Do not attempt to remove ticks by using petroleum jelly, lit cigarettes or other home remedies because these may increase the chance of contracting a tick-borne disease.

What is a Tick actual size?

Deer Ticks (Actual Size): Nymph, Female, Male

www.health.ny.gov

Encephalitis

Medically reviewed by Drugs.com. Last updated on Apr 17, 2020.

  • Health Guide
  • Disease Reference
  • Care Notes
  • Medication List

Overview

Encephalitis (en-sef-uh-LIE-tis) is inflammation of the brain. There are several causes, but the most common is viral infection.

Encephalitis often causes only mild flu-like signs and symptoms — such as a fever or headache — or no symptoms at all. Sometimes the flu-like symptoms are more severe. Encephalitis can also cause confused thinking, seizures, or problems with senses or movement.

Rarely, encephalitis can be life-threatening. Timely diagnosis and treatment are important because it’s difficult to predict how encephalitis will affect each individual.

Symptoms

Most people with viral encephalitis have mild flu-like symptoms, such as:

  • Headache
  • Fever
  • Aches in muscles or joints
  • Fatigue or weakness

Sometimes the signs and symptoms are more severe, and might include:

  • Confusion, agitation or hallucinations
  • Seizures
  • Loss of sensation or paralysis in certain areas of the face or body
  • Muscle weakness
  • Problems with speech or hearing
  • Loss of consciousness

In infants and young children, signs and symptoms might also include:

  • Bulging in the soft spots (fontanels) of an infant’s skull
  • Nausea and vomiting
  • Body stiffness
  • Poor feeding or not waking for a feeding
  • Irritability

When to see a doctor

Get immediate care if you are experiencing any of the more-severe symptoms associated with encephalitis. Severe headache, fever and altered consciousness require urgent care.

Infants and young children with any signs or symptoms of encephalitis should receive urgent care.

One of the major signs of encephalitis in infants is bulging of the soft spots (fontanels) of the baby’s skull. Pictured here is the anterior fontanel. Other fontanels are found on the sides and back of an infant’s head.

Causes

The exact cause of encephalitis is often unknown. But when a cause is known, the most common is a viral infection. Bacterial infections and noninfectious inflammatory conditions also can cause encephalitis.

There are two main types of encephalitis:

  • Primary encephalitis. This condition occurs when a virus or other agent directly infects the brain. The infection may be concentrated in one area or widespread. A primary infection may be a reactivation of a virus that had been inactive after a previous illness.
  • Secondary encephalitis. This condition results from a faulty immune system reaction to an infection elsewhere in the body. Instead of attacking only the cells causing the infection, the immune system also mistakenly attacks healthy cells in the brain. Also known as post-infection encephalitis, secondary encephalitis often occurs two to three weeks after the initial infection.

Common viral causes

The viruses that can cause encephalitis include:

  • Herpes simplex virus (HSV). Both HSV type 1 — associated with cold sores and fever blisters around your mouth — and HSV type 2 — associated with genital herpes — can cause encephalitis. Encephalitis caused by HSV type 1 is rare but can result in significant brain damage or death.
  • Other herpes viruses. These include the Epstein-Barr virus, which commonly causes infectious mononucleosis, and the varicella-zoster virus, which commonly causes chickenpox and shingles.
  • Enteroviruses. These viruses include the poliovirus and the coxsackievirus, which usually cause an illness with flu-like symptoms, eye inflammation and abdominal pain.
  • Mosquito-borne viruses. These viruses can cause infections such as West Nile, La Crosse, St. Louis, western equine and eastern equine encephalitis. Symptoms of an infection might appear within a few days to a couple of weeks after exposure to a mosquito-borne virus.
  • Tick-borne viruses. The Powassan virus is carried by ticks and causes encephalitis in the Midwestern United States. Symptoms usually appear about a week after a bite from an infected tick.
  • Rabies virus. Infection with the rabies virus, which is usually transmitted by a bite from an infected animal, causes a rapid progression to encephalitis once symptoms begin. Rabies is a rare cause of encephalitis in the United States.
  • Childhood infections. Common childhood infections — such as measles (rubeola), mumps and German measles (rubella) — used to be fairly common causes of secondary encephalitis. These causes are now rare in the United States due to the availability of vaccinations for these diseases.
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When a mosquito bites an infected bird, the virus enters the mosquito’s bloodstream and eventually moves into its salivary glands. When an infected mosquito bites an animal or a human (host), the virus is passed into the host’s bloodstream, where it may cause serious illness.

Risk factors

Anyone can develop encephalitis. Factors that may increase the risk include:

  • Age. Some types of encephalitis are more common or more severe in certain age groups. In general, young children and older adults are at greater risk of most types of viral encephalitis.
  • Weakened immune system. People who have HIV/AIDS, take immune-suppressing drugs or have another condition causing a weakened immune system are at increased risk of encephalitis.
  • Geographical regions. Mosquito- or tick-borne viruses are common in particular geographical regions.
  • Season of the year. Mosquito- and tick-borne diseases tend to be more common in summer in many areas of the United States.

Complications

The complications of encephalitis vary, depending on factors such as:

  • Your age
  • The cause of your infection
  • The severity of your initial illness
  • The time from disease onset to treatment

People with relatively mild illness usually recover within a few weeks with no long-term complications.

Complications of severe illness

Inflammation can injure the brain, possibly resulting in coma or death.

Other complications — varying greatly in severity — may persist for months or be permanent. These complications can include:

  • Persistent fatigue
  • Weakness or lack of muscle coordination
  • Personality changes
  • Memory problems
  • Paralysis
  • Hearing or vision defects
  • Speech impairments

Prevention

The best way to prevent viral encephalitis is to take precautions to avoid exposure to viruses that can cause the disease. Try to:

  • Practice good hygiene. Wash hands frequently and thoroughly with soap and water, particularly after using the toilet and before and after meals.
  • Don’t share utensils. Don’t share tableware and beverages.
  • Teach your children good habits. Make sure they practice good hygiene and avoid sharing utensils at home and school.
  • Get vaccinations. Keep your own and your children’s vaccinations current. Before traveling, talk to your doctor about recommended vaccinations for different destinations.

Protection against mosquitoes and ticks

To minimize your exposure to mosquitoes and ticks:

  • Dress to protect yourself. Wear long-sleeved shirts and long pants if you’re outside between dusk and dawn when mosquitoes are most active, and when you’re in a wooded area with tall grasses and shrubs where ticks are more common.
  • Apply mosquito repellent. Chemicals such as DEET can be applied to both the skin and clothes. To apply repellent to your face, spray it on your hands and then wipe it on your face. If you’re using both sunscreen and a repellent, apply sunscreen first.
  • Use insecticide. The Environmental Protection Agency recommends the use of products containing permethrin, which repels and kills ticks and mosquitoes. These products can be sprayed on clothing, tents and other outdoor gear. Permethrin shouldn’t be applied to the skin.
  • Avoid mosquitoes. Refrain from unnecessary activity in places where mosquitoes are most common. If possible, avoid being outdoors from dusk till dawn, when mosquitoes are most active. Repair broken windows and screens.
  • Get rid of water sources outside your home. Eliminate standing water in your yard, where mosquitoes can lay their eggs. Common problems include flowerpots or other gardening containers, flat roofs, old tires and clogged gutters.
  • Look for outdoor signs of viral disease. If you notice sick or dying birds or animals, report your observations to your local health department.

Protection for young children

Insect repellents aren’t recommended for use on infants younger than 2 months of age. Instead, cover an infant carrier or stroller with mosquito netting.

For older infants and children, repellents with 10 to 30 percent DEET are considered safe. Products containing both DEET and sunscreen aren’t recommended for children because reapplication — which might be necessary for the sunscreen component — will expose the child to too much DEET.

Tips for using mosquito repellent with children include:

  • Always assist children with the use of mosquito repellent.
  • Spray on clothing and exposed skin.
  • Apply the repellent when outdoors to lessen the risk of inhaling the repellent.
  • Spray repellent on your hands and then apply it to your child’s face. Take care around the eyes and ears.
  • Don’t use repellent on the hands of young children who may put their hands in their mouths.
  • Wash treated skin with soap and water when you come indoors.

Diagnosis

Your doctor will start with a thorough physical examination and medical history.

Your doctor might then recommend:

  • Brain imaging. MRI or CT images can reveal any swelling of the brain or another condition that might be causing your symptoms, such as a tumor.
  • Spinal tap (lumbar puncture). A needle inserted into your lower back removes cerebrospinal fluid (CSF), the protective fluid that surrounds the brain and spinal column. Changes in this fluid can indicate infection and inflammation in the brain. Sometimes samples of CSF can be tested to identify the virus or other infectious agent.
  • Other lab tests. Samples of blood, urine or excretions from the back of the throat can be tested for viruses or other infectious agents.
  • Electroencephalogram (EEG). Electrodes affixed to your scalp record the brain’s electrical activity. Certain abnormal patterns may indicate a diagnosis of encephalitis.
  • Brain biopsy. Rarely, a small sample of brain tissue might be removed for testing. Brain biopsy is usually done only if symptoms are worsening and treatments are having no effect.

Treatment

Treatment for mild encephalitis usually consists of:

  • Bed rest
  • Plenty of fluids
  • Anti-inflammatory drugs — such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — to relieve headaches and fever

Antiviral drugs

Encephalitis caused by certain viruses usually requires antiviral treatment.

Antiviral medications commonly used to treat encephalitis include:

  • Acyclovir (Zovirax)
  • Ganciclovir (Cytovene)
  • Foscarnet (Foscavir)

Some viruses, such as insect-borne viruses, don’t respond to these treatments. But because the specific virus may not be identified immediately or at all, doctors often recommend immediate treatment with acyclovir. Acyclovir can be effective against HSV, which can result in significant complications when not treated promptly.

Antiviral medications are generally well-tolerated. Rarely, side effects can include kidney damage.

Supportive care

People who are hospitalized with severe encephalitis might need:

  • Breathing assistance, as well as careful monitoring of breathing and heart function
  • Intravenous fluids to ensure proper hydration and levels of essential minerals
  • Anti-inflammatory drugs, such as corticosteroids, to reduce swelling and pressure within the skull
  • Anticonvulsant medications, such as phenytoin (Dilantin), to stop or prevent seizures

Follow-up therapy

If you experience complications of encephalitis, you might need additional therapy, such as:

  • Physical therapy to improve strength, flexibility, balance, motor coordination and mobility
  • Occupational therapy to develop everyday skills and to use adaptive products that help with everyday activities
  • Speech therapy to relearn muscle control and coordination to produce speech
  • Psychotherapy to learn coping strategies and new behavioral skills to improve mood disorders or address personality changes
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Preparing for an appointment

Serious illness associated with encephalitis is usually severe and relatively sudden, so seek emergency care. The emergency care team will likely include specialists in infectious diseases and in the brain and nervous system (neurologist).

Questions from your doctor

You may need to answer these questions, or answer them on behalf of your child or another person with severe illness:

  • When did the symptoms begin?
  • Have you recently started taking any new medications? If so, what is the medication?
  • Have you been bitten by a mosquito or tick during the past few weeks?
  • Have you traveled recently? Where?
  • Have you recently had a cold, flu or other illness?
  • Are you up to date on your immunizations? When was your last one?
  • Have you had any exposure to wild animals or known toxins recently?
  • Have you had unprotected sex with a new or long-term sexual partner?
  • Do you have a condition or take any medications that result in a weakened immune system?

© 1998-2019 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. Terms of use.

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Deadly Tick-Borne Encephalitis (TBE) Confirmed For First Time In UK

The fatal tick-borne encephalitis (TBE) has been documented for the first time in the United Kingdom, according to health officials. Although the virus has been found in other European regions and some parts of Asia, this is the first time it has managed to infect someone in the UK.

A parasite called Babesia venatorum is to blame, and although it is technically an animal disease, the illness causes the infection to grow in humans who have come into contact with it. It is unknown how the virus has managed to spread from other parts of Europe into the UK, but some experts say that it could be caused by migratory birds or pets travelling throughout the region from other places.

What is tick-borne encephalitis?

Tick-borne encephalitis (TBE) is a viral infection caused by the parasitic organism Babesia venatorum . This parasite lives in animals and is a part of the flavivirus family. The virus attacks the body’s central nervous system and affects the brain and spinal cord. It doesn’t always manifest into something serious, but it can lead to meningitis or meningoencephalitis, depending on how the immune system responds to it.

Because TBE is an animal disease, they are the carriers. Once a tick bites an infected animal, the animal contracts the virus and can transfer it to humans through the same method. Humans are also susceptible to catching tick-borne encephalitis from their pets or livestock once they become infected. The virus is spread through the saliva of the infected tick and into the bloodstream. The infection then grows in the cells throughout the body, replicating itself until it has spread to all areas.

Image by Qimono on Pixabay : When the virus gets into the cells, it replicates itself and spreads throughout the body.

What are the symptoms of tick-borne encephalitis?

Often, the symptoms of TBE present themselves as other illnesses. The way the virus spreads throughout the body will depend entirely on the person’s immune system. The first initial symptoms will be like that of a common flu, such as nausea, headache, mild fever, vomiting and an overall unwell feeling. These symptoms don’t always appear after the initial infection, though, and some people could have the virus without any symptoms present.

Those who are experiencing these symptoms will notice that they tend to last roughly eight days – but after the incubation period of eight to 14 days is over, the virus takes flight throughout the rest of the body, attacking the brain and other vital organs. Once the infection has reached the brain, inflammation will occur; this results in neurological symptoms such as sensitivity to light, motor function impairment, sensory problems, and brain fog with confusion. In the worst cases, seizures and death are also a risk after contracting TBE.

In animals, the neurological symptoms manifest similarly to humans, but they can be much worse. For example, dogs may experience seizures and even death, while other animals such as ruminants may experience lethargy and respiratory problems.

Who is at risk?

The risk factors for contracting TBE vary from person to person, but the most likely cause of the infection is through a tick bite. Ticks are present in highly wooded areas, so people who frequent hiking trails or spend a lot of time outdoors are at a higher risk of getting the infection through a tick bite. It has also been reported that the virus can spread from animals, especially livestock, when a person drinks unpasteurised milk from an infected animal or takes part in the slaughter of infected sheep. Although extremely rare, mothers with the infection can pass it onto their child through breastfeeding, and people who receive blood transfusions can also be at a slightly higher risk of contracting the illness.

Those who suffer the worst part of the illness are those with weakened immune systems, the elderly, and those who travel often to different parts of the world where the infection rate is higher.

Image by 12019 on Pixabay: Livestock can play a huge role in the contraction of tick-borne encephalitis in the UK.

How can you reduce your risk?

To help limit the chances of getting bit by an infected tick, it’s important to protect yourself in wooded areas where ticks are known to carry the disease. Wearing loose, light-coloured clothing along with bug spray and checking for bites immediately upon returning home will all lower the risk of catching tick-borne encephalitis in the UK.

To diagnose the illness, a doctor will perform blood tests and may have to do a more invasive test of the spinal fluid to ensure it hasn’t spread. Since there is no specialised treatment for TBE, the only way to monitor the illness is to manage symptoms and try to strengthen the immune system. The only true way of fighting the disease is allowing the body to handle it.

Lyme disease in the UK

TBE isn’t the only virus that can be contracted through a tick bite. Lyme disease is one of the main illnesses that is spread through tick bites and in the UK alone, around 8,000 people were infected with Lyme disease in 2019.

Lyme disease can be treated with antibiotics, but if left untreated can cause flu-like symptoms in the early stages, advancing slowly to more serious conditions such as numbness in the limbs, arthritis, and weakened cognitive function.

www.bca-clinic.com

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