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Clinical Presentation
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Initial Phase
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Second Phase

 

TBE is a serious disease that can lead to permanent brain damage or even death.

Up to 2 out of 100 people infected with TBE die.

TBE in Adults

  • The majority of tick-borne encephalitis virus (TBEV) infections are asymptomatic, but it remains difficult to ascertain the proportion who are asymptomatic due to underdiagnosis.
  • It is estimated that 1 in 3 of infected persons develop symptoms for TBE. 
  • The incubation period of TBE is usually 7–14 days (range: 2–28 days), with a shorter incubation period of 3–4 days reported for alimentary transmission.
  • Case-fatality rates of greater than 20% are reported, although the severity of the disease appears to be associated with the viral subtype involved:
    • ≥20% for the Far-Eastern subtype
    • 6–8% for the Siberian subtype
    • 1–2% for the European subtype
  • In ≤40% of encephalitic cases, the disease results in permanent central nervous system (CNS) sequelae, including various neuropsychiatric and cognitive complaints characteristic of postencephalitic syndrome.
  • In fatal cases, characteristic neuropathological changes include polioencephalomyelitis.

 

For the EU TBEV subtype there are two distinct phases:

The initial disease phase may last 1-8 days and may include:

 
Progression in Adults

 

The initial phase is followed by an asymptomatic interval that usually lasts for about 1 week (range: 1–21 days).

 

Second disease phase-symptoms can occur in 20-30% of patients and can include:

Brain
 
  • Meningitis typically manifests with high fever, headache, nausea and vomiting; many patients have photophobia, and some vertigo.
  • Encephalitis may be manifested by impaired consciousness ranging from somnolence to stupor and, in rare cases, coma.
  • Patients aged over ~40 years are more likely to develop the encephalitic form of the disease. Risk factors include age, comorbidities and immunosuppression.
  • In patients aged over 60 years, TBE increasingly takes a severe course, leading to paralysis and the highest case-fatality rate.

 

Immunization is the only proven and reliable way to help  prevent against TBE infection* 

*As is the case for all vaccines in general it is possible that not all vaccinated individuals will develop protective immunity against TBE.

*This number applies to the European variant.

 

  • Hansson KE et al. Clin Infect Dis. 2020;70(2):245-251. 

  • Bogovic P, Strle F. World J Clin Cases. 2015;3(5):430–441.

  • European Centre for Disease Prevention and Control (ECDC). Factsheet about tick-borne encephalitis (TBE). https://www.ecdc.europa.eu/en/tick-borne-encephalitis/facts/factsheet, (accessed June 2020).

  • World Health Organization (WHO). Wkly Epidemiol Rec 2011;86:241–256, (accessed June 2020).

  • Barrett PN et al. In: Plotkin SA, Orenstein WA, Offit PA. Vaccine (Sixth Edition), Elsevier, 2013, pp. 773–788.

  • Hombach J et al. In:. Plotkin, Walter A. Orenstein, Paul A. Offit, Kathryn M. Edwards, Plotkin's Vaccines (Seventh Edition), Elsevier, 2018, pp. 1080–1094.

  • Chrdle A., Chmelik V. and Ruzek D. Tick-borne encephalitis: what travelers should know when visiting an endemic country. Hum Vaccin Immunother. 2016; 12(10): 2694–2699.