Tick-Borne Encephalitis — Traveler Summary

Tick-Borne Encephalitis

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Traveler Summary

Key Points

  • Tick-borne encephalitis (TBE), a viral infection occurring in focal areas of Europe and Asia, is acquired through the bite of an infected tick.
  • Risk exists for travelers hiking, camping, or engaging in outdoor activities in affected countries, especially during the months of April through November.
  • Symptoms include fever, headache, muscle ache, and fatigue.
  • Consequences of infection can include brain inflammation, nervous system complications, muscle paralysis, and death.
  • Prevention includes wearing long, light-colored trousers tucked into boots when hiking, as well as observing personal protective measures effective against tick bites.
  • TBE vaccine (not available in the U.S. or Canada) may be given in 2 or 3 doses depending on the vaccine. Accelerated schedules are available.
  • Vaccine side effects are most commonly injection-site reactions, fever, tiredness, and diarrhea.
  • Duration of vaccine protection is 3 to 5 years; a booster dose is recommended if at continued risk.

Introduction

TBE, a viral infection that occurs in focal areas of Europe and Asia, is transmitted via the bite of an infected tick. Travelers going to affected countries with exposure in tick-infested areas are at risk of acquiring this potentially serious infection. No curative treatment is available after infection.

Risk Areas

TBE occurs in focal areas of Europe and Asia, extending from eastern and southern England to northern Japan and from northern Russia to Albania. Although Russia has the largest number of reported cases annually, Czech Republic, Estonia, Latvia, Lithuania, Slovenia, and western Siberia have the highest frequency of infection. Many central European countries, particularly Austria, Germany, Poland, and Switzerland have significant regions of infection, and incidence seems to be increasing in the Scandinavian countries. TBE-infected ticks infesting areas of wooded suburbs and peri-urban and urban parks have been reported in China, Europe, Finland, Russia, Scandinavia, and the Baltic states.

Ticks are most active in spring and summer, and TBE commonly occurs from April through November. Exposure is restricted to forested areas with adjacent grasslands, forest glades, riverside meadows, marshlands, parks, and gardens, up to an altitude of about 1,500 m (4,900 ft), with most cases occurring in areas with an altitude of less than 750 m (2,500 ft).

Transmission

The TBE virus is mainly transmitted to humans through the bite of infected ticks that crawl onto humans in search of a blood meal. Although ticks may stay attached for several days, transmission can occur within seconds of being bitten. Rarely, the virus may also be transmitted by consuming unpasteurized milk or dairy products from infected farm animals, especially cows, goats, or sheep.

Risk Factors

Risk exists for travelers hiking, camping, or participating in other outdoor activities in rural, forested areas of TBE-risk countries or walking in peri-urban and urban parks in some northern European towns.

Symptoms

Symptoms appear about 8 days (range: 4-28 days) following exposure and include an influenza-like illness (fever, headache, muscle aches, and fatigue), which may either resolve completely in a few days or resolve temporarily and relapse as a more severe illness. TBE is more severe in persons 50 years and older.

Consequences of Infection

Consequences of infection include brain inflammation, nervous system complications, and muscle paralysis. Death occurs in about 2% to 40% of TBE cases, depending on the virus subtype.

Need for Medical Assistance

Travelers who develop symptoms of TBE, a generalized illness, or marked local reaction within 2 to 3 weeks of a known tick bite should seek medical attention. No specific treatment is available for TBE.

Prevention

Nonvaccine

When in a risk area, observe the following tick precautions:

  • Wear long, light-colored trousers tucked into boots when hiking, cover as much of the body surface as practicable when walking through brushy vegetation, and observe personal protective measures effective against tick bites.
  • Apply DEET (N,N-diethyl-meta-toluamide; ≥ 20%) directly to skin.
  • Treat outer clothing, boots, camping gear, bed netting, and screens with permethrin (or other pyrethroid).
  • Avoid camping at sites close to animal habitation, and sleep in screened tents.
  • Perform a thorough body check at least once a day and remove any ticks, preferably with a pair of fine-tipped tweezers, to reduce the risk of infection after visiting a tick-infested habitat.
  • Avoid unpasteurized dairy products, especially goat milk.

Vaccine

TBE vaccination may be recommended for travel to some countries. Travelers who cannot obtain TBE vaccine in their home country should arrange to receive the vaccine upon arrival at their destination, if possible. TBE vaccines are not available in the U.S. and Canada but are available in Europe and Australia.

For travel, TBE vaccination is recommended for:

  • All expatriates and travelers with prolonged stays in highly affected countries, due to the likelihood of occasional travel to forested risk areas or exposure in the outskirts of urban areas.
  • All travelers with either short or prolonged stays that include hiking, camping, or other outdoor activities in forested risk areas with more than minimal risk.
  • Persons who consume unpasteurized dairy products (milk and cheese) from goats, cows, or sheep.
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Side Effects

Side effects are usually mild to moderate and include injection-site reactions (pain, redness, and swelling), headache, fatigue, dizziness, nausea and vomiting, diarrhea, and muscle aches. Fever, which is common in very young children, occurs occasionally in older children and is infrequent in adults.

Persons with underlying medical conditions or who have concerns about the vaccine should speak to their health care provider before vaccine administration.

Timing

The primary series consists of either 2 or 3 doses. Depending on the vaccine used, doses are given as follows:

  • 2 doses; 1 each at 0 and 14 days or 1 each at 0 and 1-7 months.
  • 3 doses; 1 each at 0, 1 to 3 months, and 5-12 months after dose 2.

A primary booster dose is given 12 months after completion of the 2-dose primary series or 3 years after completion of the 3-dose series. Further booster doses are recommended every 3 to 5 years (depending on age and vaccine) if at continued risk.

Several accelerated schedules, which require several weeks to be effective, are also available and may be considered if arriving during the peak season.

tripprep.com

Encephalitis : Symptoms, Causes, Diagnosis & Treatment

1. What is Encephalitis?

Encephalitis is a condition when the brain in a human body experiences inflammation. Many factors could lead to this condition, however, the most common factor is a viral infection. Encephalitis also occurs when the body starts attacking the brain cell tissues. Encephalitis is not a life-threatening disease, but its side effects include fatigue, headache, and fever. Encephalitis occurs in 1 of every 1000 patients affected by measles. Among the many forms, Japanese Encephalitis, Tick-borne encephalitis, Rabies, and Primary and secondary encephalitis.

2. Symptoms of Encephalitis

Depending on the severity of the condition, Encephalitis presents itself in various forms. In the early stages, the symptoms of Encephalitis include Fever, headache, nausea, sensitivity to light, and body pains. As the condition progresses, the patient experiences drowsiness, fatigue, stiffness in the neck, joint pains, and stiffness in the limbs. Patients with advanced stages of Encephalitis show symptoms like Confusion, disorientation, loss of speech, hallucinations, hearing problems and Coma.

In infants, Encephalitis presents itself in the form of lack of appetite, spots on the skull, vomiting and nausea and not feeding or not waking up to feed.

3. Types of Encephalitis

The major types of Encephalitis are:

  1. Japanese Encephalitis
  2. Tick-borne Encephalitis
  3. Primary Encephalitis
  4. Secondary Encephalitis

Japanese Encephalitis:

Japanese Encephalitis is a non-communicable disease that is caused by Flavivirus which is transmitted from the bite of a Culex mosquito. The Culex mosquito is the vector that transfers the disease from the host to new animals it feeds on. Birds are the most common hosts for this form of encephalitis. In this, the vector, the Culex mosquito acquires the virus from one animal that it feeds on and transmits it to the next animal it feeds on. Pigs and Horses are the most affected by this.
A vast number of cases in Japanese Encephalitis is seen in India, Cambodia, Vietnam, China, Japan, Indonesia, Myanmar, and Nepal.

A person infected with Japanese Encephalitis will show no immediate symptoms. The symptoms will be seen 5-15 days after the onset of the condition. The symptoms include:

  • Daze
  • Vomiting
  • Paralysis
  • High-temperatures
  • Disorientation
  • Vomiting
  • Stiff neck (Stiffness in the neck is often considered as a symptom for meningitis, thereby leading to a wrong diagnosis)
  • Swelling in the testicles
  • Emotional disbalance and
  • Weakness among others

Tick-borne Encephalitis:

Tick-borne encephalitis is a viral infection that affects the central nervous system of a human body. This is caused by the Tick-borne encephalitis virus which is classified as a member of the Flaviviridae family. This form is majorly classified into:

  • European tick-borne encephalitis
  • Siberian tick-borne encephalitis and
  • Far-eastern tick-borne encephalitis or Russian tick-borne encephalitis

Human beings are often accidental hosts for Tick-Borne Encephalitis Virus(TBEV). TBEV often chooses large animals as its host. Humans are most affected in the months that lie between April and November. The transmission of the virus occurs when raw goat milk, cow’s milk or due to the consumption of unprocessed dairy products. Villages in India and a few urban towns in India have reported multiple cases of TBEV.

The incubation period for TBE is 8-14 days and in the initial stages, the patient exhibits symptoms including fever, vomiting, nausea, and muscle ache. 20-30% of these patients experience the second phase of the disease which affects the central nervous system and exhibit symptoms like headache, disorientation, symptoms of meningitis, abnormal motor functions. Few of the symptoms are temporary while a few leave a lasting effect based on the condition.

The European TBEV has a reported mortality rate of 1-2% while the Far-eastern TBEV has a predominantly higher rate of 25-30%.

Primary encephalitis

Primary encephalitis is when the virus directly affects brain cells. The infection is either concentrated at one spot or is widespread.

Secondary encephalitis

Secondary encephalitis is a condition when the immune system of a human body starts attacking the healthy cells of the brain instead of the infected cells. Secondary encephalitis is often seen in the last stages of the infection.

See also:  Temporal dynamics of the tick Ixodes ricinus in northern Europe: epidemiological implications, Parasites - Vectors, Full Text

www.narayanahealth.org

Tick-borne encephalitis — Treatment and prevention

Medical expert of the article

Medical treatment of tick-borne encephalitis

Etiotropic treatment of tick-borne encephalitis is prescribed to all patients with tick-borne encephalitis, regardless of previous vaccination or use of an antiancephalitic immunoglobulin for prophylactic purposes.

Depending on the form of the disease, immunoglobulin against tick-borne encephalitis is administered intramuscularly in the following doses.

  • Patients with a febrile form: daily in a single dose of 0.1 ml / kg, for 3-5 days before the regression of general infectious symptoms (improvement of general condition, disappearance of fever). The course dose for adults is at least 21 ml of the drug.
  • Patients with meningeal form: daily in a single dose of 0.1 ml / kg 2 times a day with an interval of 10-12 hours for at least 5 days until the patient’s overall condition improves. The average daily dose is 70-130 ml.
  • Patients with focal forms: daily in a single dose of 0.1 ml / kg 2-3 times a day at intervals of 8-12 h at least 5-6 days before the temperature decreases and the neurological symptoms stabilize. The average course dose for an adult is not less than 80-150 ml of immunoglobulin.
  • In extremely severe disease, a single dose of the drug can be increased to 0.15 ml / kg.

The effectiveness of use in the acute period of interferon alfa-2 preparations and inducers of endogenous interferon has not been studied enough.

Ribonuclease is administered intramuscularly at 30 mg in 4 hours for 5 days.

Nonspecific treatment of tick-borne encephalitis is aimed at combating common intoxication, edema of the brain, intracranial hypertension, bulbar disorders. Recommended dehydrating agents (loop diuretics, mannitol), 5% glucose solution, polyionic solutions; with respiratory disorders — ventilation, oxygen inhalation; to reduce acidosis — 4% solution of sodium bicarbonate. With meningoencephalitic, poliomyelitis and polyradiculoneuritic forms of the disease, glucocorticoids are prescribed. Prednisolone is used in tablets at the rate of 1.5-2 mg / kg per day in equal doses of 4-6 doses for 5-6 days, then gradually reduce the dose by 5 mg every 3 days (course of treatment 10-14 days). With bulbar disorders and disorders of consciousness, prednisolone is administered parenterally. With convulsive syndrome, anticonvulsants are prescribed: phenobarbital, primidone, benzobarbital, valproic acid, diazepam. In severe cases, antibiotic therapy is used to prevent bacterial complications. Apply protease inhibitors: aprotinin. The chronic form of tick-borne encephalitis is difficult to treat, the effectiveness of specific drugs is much lower than in the acute period. Recommend general restorative therapy, glucocorticoids in short courses (up to 2 weeks) from prednisolone at 1.5 mg / kg. Of anticonvulsants with kozhevnikovskoy epilepsy used benzobarbital, phenobarbital, primidon. It is advisable to prescribe vitamins, especially group B, with peripheral paralysis — anticholinesterase drugs (neostigmine methyl sulfate, ambenonium chloride, pyridostigmine bromide).

Additional treatment of tick-borne encephalitis

In an acute period exclude physical activity, balneotherapy, exercise therapy, massive electroprocedures. Sanatorium-and-curative treatment of tick-borne encephalitis is carried out not earlier than 3-6 months after discharge from the hospital in the sanatoriums of the climatic and general strengthening profile.

[1], [2], [3], [4], [5]

Mode and diet for tick-borne encephalitis

Strict bed rest is shown, regardless of the general condition and state of health during the entire febrile period and 7 days after the temperature normalization. A special diet is not required (common table). During the feverish period, abundant drinking is recommended: fruit drinks, juices, bicarbonate mineral waters.

m.iliveok.com

Mongolia Selective Vaccinations:
Tick-Borne Encephalitis

Risk is present in the northern part of the country, particularly in Bulgan and Selenge provinces.

Description

Tick-borne Encephalitis is a viral infection caused by one of three tick-borne encephalitis virus (TBEV) subtypes belonging to the Flaviviridae family: Central European, Siberian, and Far Eastern (formerly known as Russian Spring-Summer Encephalitis). It is transmitted to humans through the bite of infected Ixodes ticks. Due to climate change, tick populations are moving further north in latitude.

Tick-borne Encephalitis occurs in parts of Europe, Central Asia, and East Asia. Travellers involved in outdoor activities in forested areas are at risk, including campers, hikers, and hunters. Brushing against vegetation or walking in city parks known to have infected ticks can also put a person at risk. Transmission season is typically from March to November.

Symptoms

Usually symptoms appear 7 to 14 days after being bitten by an infected tick. Symptoms can last up to 8 days and include fever, headache, fatigue, muscle pain, nausea, and loss of appetite. Approximately one-third of patients develop severe symptoms after the first phase of the illness where the virus causes meningitis (attacks the thin lining that surrounds the brain and the spinal cord) and / or encephalitis (swelling of the brain). Second phase symptoms include stiff neck, fever, headache, nausea, sensitivity to light, confusion, disorientation, drowsiness, behavioural changes, seizures, and paralysis. Some patients may experience long-term complications such as memory loss, speech and language problems, mood disorders, epilepsy, fatigue, and motor skill difficulties. Treatment of the acute infection includes supportive care of symptoms.

Prevention

Travellers who hike, camp, or undertake outdoor activities in wooded regions or city parks of endemic areas should take measures to prevent tick bites.

  • Use a repellent containing 20%-30% DEET or 20% Picaridin. Re-apply according to manufacturer’s directions.
  • Wear neutral-coloured (beige, light grey) and breathable garments, including long-sleeved shirts and pants. Tuck pants into socks.
  • If available, apply a permethrin spray or solution to clothing and gear.
  • When hiking in wooded areas, stay in the middle of the trail and avoid tall grasses and shrubs.
  • Use a tarp when sitting on the ground.
  • Carefully examine your body, clothing, gear, and pets for ticks before entering a dwelling.
  • Promptly remove ticks using tweezers by grasping the tick’s head and mouth parts as much as possible and by pulling perpendicular from the skin. See How to: Tick Edition for videos on removing ticks correctly.
  • Thoroughly disinfect the bite site with soap and water or disinfectant. If travelling in an endemic area, save the tick in a zip-lock bag or container for up to 10 days (refrigerate live ticks; keep dead ticks in the freezer). Write down the date and location of your contact with the tick. Your healthcare practitioner may advise you to submit the tick for testing.
  • If you develop symptoms of a tick-borne disease, contact your healthcare practitioner immediately.
  • Apply sunscreen first followed by the repellent (preferably 20 minutes later).
  • More details on insect bite prevention.
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Tick removal: Regularly check your body for ticks and promptly remove using tweezers by grasping the tick’s head and mouth parts as much as possible and by pulling perpendicular from the skin. Thoroughly disinfect the bite site with soap and water or alcohol. If travelling in an endemic area, you may want to save the tick in a zip-lock bag or empty container to have it analyzed through your healthcare practitioner.

Vaccination

Recommended for travellers involved in recreational activities in forested areas such as camping and hiking or working in forestry occupations, as well as long-term travellers to endemic areas.

This vaccine is available in pediatric and adult formulations in countries where Tick-borne Encephalitis is endemic. Re-vaccination is recommended every 3-5 years depending on your age if you continue to be at risk. Discuss prevention options with your health care provider or contact us to find vaccine availability at your destination.

Infographics

Information last updated: April 16, 2020

www.iamat.org

Tick-Borne Encephalitis

What is Tick-Borne Encephalitis?

Tick-borne encephalitis (TBE) is an infectious disease of the brain caused by a group of related viruses that can be found in many parts of the world.

How do you get Tick-Borne Encephalitis?

Tick-borne encephalitis viruses are transmitted to humans through the bite of an infected tick that is found mostly in rural areas, meadows, scrub brush, and forests and mainly in the summer and fall seasons. It is usually acquired through outdoor activities, such as camping, hiking, fishing, bicycling in the woods, and collecting mushrooms, berries or flowers. It is occasionally acquired by consuming unpasturised milk or cheese obtained from infected goats, sheep or cows. It is usually not spread person to person.

Susceptibility and Resistance

All persons are susceptible. However, prior infection results in long lasting immunity to re-infection.

Incubation Period

The incubation period for Tick-Borne Encephalitis is 7-14 days.

What are the Symptoms?

About two-thirds of all infected people do not have symptoms. Eye redness may be the only outward sign of infection. However, when symptoms are present, they may vary depending on the type of virus. The disease often occurs in two phases. The first phase is marked by headache (sometimes severe), chills, fever, muscle aches and fatigue. The second phase is marked by nervous system involvement, i.e., brain inflammation, signs of meningitis, paralysis of the upper extremities and other neurological symptoms.

Most of these viruses cause mild symptoms lasting for about a week or less. Some of these viruses may cause a fever first and then be followed some days later by all the symptoms of brain inflammation (encephalitis).

Preventative Measures

Travellers to countries where TBE occurs should avoid tick habitats where possible. Daily tick checks and prompt removal of any attached ticks will help to reduce the risk of infection. Ticks can be removed by grasping them firmly with tweezers as close to the skin as possible and lifting gently. It has been shown that if ticks are removed within approximately 36 hours of the bite, the risk of acquiring TBE is reduced to nearly zero. However, the small size of the tick, especially in the nymph stage, may make detection difficult. Insect repellent and protective clothing (long-sleeved shirts, long pants, and a hat) will also help to protect against tick bites.

Vaccines against TBE are only available in Europe where the vaccines have been used extensively in parts of Europe and Russia for persons living in areas where high exposure might occur. Vaccination is usually not necessary for most travellers unless they plan on camping, hiking, or spending time outdoors in forested areas where TBE occurs.

Treatment

There is no specific treatment for TBE viral infections other than treating the symptoms. Milder illnesses improve on their own through rest and symptomatic treatment (such as over-the-counter pain medication for muscle and joint aches). Severe TBE illnesses may require hospitalisation and supportive treatment such as intravenous fluids and nursing care.

Vaccinations

Where Does It Commonly Occur?

The group of viruses that cause this infection include three types that are found in Russia, including Siberia, and other countries in Europe (eastern France, Czech Republic, Estonia, Germany, Hungary, Latvia, Lithuania, Poland, Slovenia, Sweden, and Switzerland). In Asia, it is found in China, Japan, Mongolia, and South Korea. It is not found in the Western Hemisphere.

www.sitata.com

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