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Tick-borne encephalitis Content Supplied by NHS Choices
Introduction

Tick-borne encephalitis (TBE) is a viral infection spread to humans by the bite of a small spider-like parasite called a tick.

It's a rare infection that's only acquired abroad in certain European and Asian countries (see 'Risk areas' below).

Initial symptoms of TBE are similar to flu and can include:

These symptoms usually last for up to eight days, after which point most people make a full recovery.

However, some people go on to develop more serious symptoms caused by the virus spreading to the protective layer of tissue that covers the brain and spinal cord (meningitis) or the brain itself (encephalitis).

These 'second-stage' symptoms can include:

  • changes in mental state, such as confusion, drowsiness or disorientation
  • seizures (fits)
  • sensitivity to bright light (photophobia)
  • being unable to speak
  • paralysis (inability to move certain body parts)

If TBE reaches this stage, you'll usually need to be admitted to hospital. These symptoms tend to get slowly better over a few weeks, but it may take several months or years to make a full recovery and there's a risk you could experience long-term complications (see below).

Around one in every 100 cases of TBE is fatal.

Read more about the symptoms of tick-borne encephalitis.

When to seek medical help

Contact your GP if you've returned from an area of the world known to have cases of TBE (see below), and you start to experience flu-like symptoms.

You should seek medical advice as soon as possible if you've been bitten by a tick while in a risk area and you haven't been vaccinated against TBE, or if you develop a rash or fever after being bitten.

The advanced stages of TBE need emergency treatment in hospital. Call 999 (or the equivalent number where you're staying) immediately and ask for an ambulance if you have flu-like symptoms that are getting rapidly worse and affecting your mental state.

Risk areas

The TBE virus isn't present in the UK, so there's no risk of infection within the UK. However, cases of infection can occur among travellers returning from countries within Europe and Asia where TBE-infected ticks are found.

Infected ticks are mainly found in rural areas of central, northern and eastern Europe. There are also two sub-types of TBE found in eastern Russia and in some countries in East Asia, particularly forested regions of China and Japan.

Visit Travel Health Pro for a map showing the areas where infected ticks are found.

How the infection is spread

Ticks are found in forests, woods, grasslands, riverside meadows, marshes, brushwood and scrublands. They usually live in the undergrowth, where they can easily get onto people's clothes or skin.

You can become infected with TBE if you're bitten by an infected tick. The virus is present in the tick's saliva, which also contains a natural anaesthetic so you may not notice you've been bitten.

You can be bitten by an infected tick at any time of year, but tick activity is at its highest during the Spring and early Summer.

Drinking unpasteurised milk and eating unpasteurised dairy products from infected animals, particularly goats, can expose you to the TBE virus. However, this is rare.

How common is tick-borne encephalitis

Very few cases of TBE have been reported in the UK, with just nine cases diagnosed in 2013/14.

However, TBE is fairly common in areas where infected ticks are found, so it's important to take steps to reduce your risk of infection (see below).

The World Health Organization (WHO) estimates that between 10,000 and 12,000 cases of TBE are reported worldwide each year. However, the actual number of cases is thought to be much higher than this because it's likely that many cases aren't reported.

How tick-borne encephalitis is treated

If a doctor thinks you may have TBE, they'll carry out a blood test or lumbar puncture (where a sample of spinal fluid is removed) to confirm whether you're infected.

There's currently no cure for TBE, so treatment aims to help relieve symptoms until the infection passes.

If you only experience the initial symptoms of TBE, no treatment is required other than taking painkillers, such as ibuprofen or paracetamol, to help relieve your symptoms.

You'll usually be admitted to hospital if you develop second-stage symptoms. In hospital you'll receive fluids into a vein (intravenous fluids), help with breathing and nursing care.

Read more about treating viral meningitis and treating encephalitis.

Possible complications

If you develop second-stage symptoms of TBE caused by the infection spreading to the brain, there's a risk you could experience long-term (and possibly permanent) complications, such as:

  • memory problems
  • problems concentrating and a short attention span
  • behavioural changes, such as becoming more impulsive and having poor judgement

These types of long-term effects occur in more than one in 10 people who develop symptoms of TBE.

Read more about the complications of tick-borne encephalitis.

Preventing tick-borne encephalitis

The best way to prevent TBE is to be vaccinated against the infection before you travel if you're going to be working or travelling in a part of the world where there's a risk of TBE, particularly if you're planning to visit rural areas or go hiking or camping.

The vaccine, which is only available privately, provides protection against TBE in around nine out of every 10 people who receive it.

Even if you've been vaccinated, you should still take precautions to reduce your risk of being bitten by an infected tick. For example, you should:

  • wear long-sleeved tops and trousers tucked into your socks
  • apply insect repellent containing DEET to exposed skin
  • regularly check for ticks - common places to find them are around the hair line, behind the ears, on or around the elbows, the backs of the knees, the groin and the armpits

Read more about preventing tick-borne encephalitis.

Ticks in the UK

You should also be aware that tick bites can spread other illnesses, such as Lyme disease, which you can get after being bitten by a tick in the UK. Therefore, follow the advice above to avoid tick bites when you and your family are in areas of the UK where ticks are commonly found.


Symptoms of tick-borne encephalitis

Around two in every three people infected with a tick-borne encephalitis (TBE) virus don't develop any symptoms. However, if symptoms do develop, they can be very serious.

In most cases, the symptoms of TBE develop in two distinct stages.

First stage

The initial symptoms of TBE usually develop at some point between two and 28 days after being bitten by an infected tick. Symptoms can include:

These initial symptoms usually last for one to eight days, after which point most people will make a full recovery.

However, after a period of up to three weeks without any symptoms, some people will go on to develop more serious problems.

Second stage

In the second phase of the infection, the virus starts to affect your central nervous system (brain and spinal cord), which can cause:

  • meningitis - inflammation of the membranes surrounding the brain and spinal cord
  • encephalitis - inflammation of the brain

Symptoms of meningitis and encephalitis include:

  • a sudden fever
  • nausea and vomiting
  • a stiff neck
  • a headache
  • changes in mental state, such as confusion, drowsiness, or disorientation
  • seizures (fits)
  • sensitivity to bright light (photophobia)
  • an inability to speak
  • personality and behavioural changes
  • paralysis (inability to move certain body parts)

If TBE reaches this stage, you'll need to be admitted to hospital. These symptoms usually slowly get better over a few weeks, but it may take several months or years to make a full recovery and more than one in 10 people develop long-term problems.

Around one in every 100 people who develops symptoms of TBE will die as a result of the condition.

Read more about the complications of tick-borne encephalitis.

When to seek medical advice

You should contact your GP if you've returned from an area of the world with a high TBE risk and you start to experience flu-like symptoms.

Seek medical advice as soon as possible if you've been bitten by a tick in a TBE risk area and you haven't been vaccinated against TBE, or if you develop a rash or fever after being bitten.

The advanced stages of TBE need emergency hospital treatment. Call 999 (or the equivalent number where you're staying) immediately and ask for an ambulance if you have flu-like symptoms that are getting rapidly worse and are affecting your mental state.

Read more about diagnosing tick-borne encephalitis and treating tick-borne encephalitis.


Complications of tick-borne encephalitis

It's estimated that more than one in every 10 people with tick-borne encephalitis will develop long-term or permanent complications as a result of the infection.

Complications that can occur include:

  • memory problems
  • personality and behavioural changes
  • speech and language problems (aphasia)
  • epilepsy - a condition that affects the brain and causes regular seizures (fits)
  • changes in emotions, such as mood swings
  • problems with attention, concentration, planning and problem solving
  • movement problems
  • low mood
  • fatigue (extreme tiredness)

Individual care plans

If you do develop these problems, a number of different specialists may be involved in your care while you recover in hospital and when you return home. These may include:

  • a neuropsychologist - a healthcare professional who specialises in brain injury and rehabilitation
  • an occupational therapist - who can identify problem areas in a person's everyday life, such as dressing or getting to the shops, and help them devise practical solutions
  • a physiotherapist - who uses physical methods, such as massage, manipulation and exercise
  • a speech and language therapist - who uses specialist techniques to improve all aspects of communication

Before you're discharged from hospital, your health and social care needs will be fully assessed and an individual care plan drawn up to meet those needs.

Caring for someone with TBE

If you're the primary carer of someone recovering from TBE, such as their spouse or parent, you should be invited to discussions about their care plan. Your own circumstances and requirements should also be taken into account.

You should be given information about the support services available in your local community. You'll also find useful information and advice about caring for someone in the care and support section.

Caring for someone with emotional and behavioural problems can be stressful, so it's important you don't neglect your own mental and physical wellbeing. See carers' breaks and respite care for more information and advice.


Preventing tick-borne encephalitis

You can reduce your risk of developing tick-borne encephalitis (TBE) by getting vaccinated and taking precautions to avoid tick bites when in high risk areas.

TBE vaccination

Vaccination against TBE is recommended for anyone who may be at risk of TBE through their work or travels. It provides protection for more than nine out of every 10 people who have it.

The vaccination isn't available on the NHS, so you'll need to pay for it privately. The cost of the vaccination course can vary, but it's usually around 50-70 per dose.

The vaccination is given as an injection and three doses are needed for full protection. The second dose is given one to three months after the first, and the third dose is given five to 12 months after the second.

If necessary, the course can be accelerated, with the first and second doses given two weeks apart. This shorter course offers rapid short-term protection for at least nine in every 10 people who have it. If you have this accelerated schedule, you should have the third dose five to 12 months after the second as usual if you continue to be at risk.

Booster doses are recommended if you continue to be at risk. For people between 16 to 60 years of age, the first booster dose should be given three years after the third standard dose. Further booster doses should then be given every five years after the last booster dose. For people over 60, the intervals between booster doses shouldn't exceed three years.

Side effects and precautions

Any reactions to the TBE vaccination are usually mild and don't last long. You may experience temporary swelling and redness and pain at the site of the injection. You may also have a high temperature (fever) for a day or two after the first dose.

Most people can have the TBE vaccination safely, but you should tell the doctor or nurse before being vaccinated if you:

  • have a fever
  • have a condition, or are receiving treatment, that affects your immune system
  • have a condition that affects your brain or central nervous system
  • are pregnant or breastfeeding

In these circumstances you may still be able to have the vaccine, but your doctor or nurse will need to check with a travel medicine specialist before giving it to you.

You shouldn't have the vaccine if you've had an allergic reaction to eggs (as the vaccine contains egg protein) or any of the other vaccine components in the past.

Preventing tick bites

Even if you've been vaccinated against TBE, it's still important to take steps to reduce your risk of being bitten by a tick because the vaccine isn't 100% effective.

The best way to reduce your risk of getting TBE is to avoid getting bitten by a tick when you're in areas where there's a high risk of TBE infection. You should:

  • wear long-sleeved tops and long trousers tucked into your socks (you can also treat your clothes with insecticides such as permethrin)
  • wear light-coloured clothes so ticks are easier to spot and brush off
  • apply insect repellent containing DEET to exposed skin
  • regularly check your body for ticks - common places to find them are the hair line, behind the ears, around the elbows, the backs of the knees, the groin and the armpits

There's also a risk of being infected if you drink milk or eat dairy products from an infected animal, so you should avoid eating and drinking all unpasteurised milk and dairy products in countries where there's a high risk of TBE.

You should also be aware that tick bites can spread other illnesses, such as Lyme disease, which you can get after being bitten by a tick in the UK. Therefore, follow the advice above to prevent tick bites when you're in an area of the UK where ticks are commonly found.

Read about who's at risk and where ticks are found in the UK.

What to do if you find a tick

After a tick has attached itself to you, it may not start feeding for several hours. After feeding, adult ticks can be about the size of a coffee bean, but tick larvae can be tiny.

If you find a tick on your body, remove it as quickly as possible. You should:

  • use tweezers or a special tick remover and wear gloves or cover your fingers with tissue to avoid touching the tick
  • grab the tick as close to the skin as you can, and gently pull straight up until all parts are removed
  • avoid twisting or jerking the tick as you're removing it because it may cause the mouthparts to break off and remain in your skin after the tick has been removed
  • avoid squeezing the body of the tick and the contents of its stomach into the site of your bite

After removing the tick, wash your hands with soap and water and clean the tick bite with soap and water or an antiseptic, such as an iodine scrub.

Seek medical advice as soon as possible if you've been bitten by a tick in a TBE risk area and you haven't been vaccinated against TBE, or if you develop a rash or fever after being bitten.


 
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