TBE viruses are usually transmitted through tick bites. They can cause inflammation of the brain, meninges or spinal cord. TBE stands for "early summer meningoencephalitis". TBE is usually easier in children than in older adolescents and adults. But the disease can also be severe in children.
TBE occurs mainly in Bavaria, Baden-Wurttemberg, southern Hesse, southeastern Thuringia and Saxony. There are also other TBE risk areas in Germany. In 2022, six risk areas have been added – including, for the first time, three counties in Brandenburg and the urban district of Solingen in NRW. In recent years, the number of reported TBE cases in Germany has been between 200 and 712 annually. In 2020, 712 TBE cases were reported, the highest number of cases since data collection began in 2001.
Good to know
The Standing Committee on Vaccination (STIKO) recommends vaccination against TBE as the safest protection against the disease for all persons staying or residing in TBE risk areas where they may be bitten by ticks.
Children can be vaccinated against TBE from their first birthday onwards. Please speak with your pediatrician or. your pediatrician about vaccination.
TBE: Transmission and course of the disease
TBE viruses are transmitted to humans primarily through the bite of ticks. Very rarely, an infection through the consumption of raw milk from goats, sheep or cows has been reported. There is no direct contagion from person to person.
TBE risk areas in Germany. Basis: TBE cases 2002 to 2021 reported to the Robert Koch Institute. Status: January 2022
TBE risk areas in Germany
In Germany, TBE occurs mainly in Bavaria and Baden-Wurttemberg, but also in southern Hesse, southeastern Thuringia and Saxony. Individual risk areas can be found in the districts of Marburg-Biedenkopf (in central Hesse), Saar-Pfalz-Kreis (in Saarland), Birkenfeld (in Rhineland-Palatinate) and Emsland (in Lower Saxony). In 2022, two counties in Saxony (Stadtkreis Chemnitz and LK Gorlitz) and, for the first time, three counties in Brandenburg (LK Oberspreewald-Lausitz, LK Oder-Spree and LK Spree-Neibe) and the city of Solingen in North Rhine-Westphalia were designated as new risk areas. Thus, 175 counties are currently designated as TBE risk areas. Every spring, the Robert Koch Institute (RKI) publishes an up-to-date map of TBE risk areas in Germany.
Outside the risk areas, only isolated TBE infections are observed in Germany.
The main transmission period of TBE is between April and November, in mild weather also in winter. Disease-carrying ticks occur in Central Europe up to altitudes of 2.000 m ago.
Further TBE risk areas
TBE also occurs in many other European countries. Risk areas are in Albania, Bosnia, Bulgaria, Denmark, Estonia, Finland, Greece, Italy, Croatia, Latvia, Lithuania, Norway, Austria, Poland, Romania, Russia, Sweden, Switzerland, Serbia, Slovakia, Slovenia, Czech Republic, Turkey, Ukraine, Hungary and Belarus. TBE cases occur sporadically in other countries. Close relatives of the local TBE viruses are spread from North-Eastern Europe via Siberia and China to Japan. They cause a TBE-like clinical picture, the RSSE (Russian Spring-Summer-Encephalitis).
Reported TBE cases in Germany 2005 to 2021
Source: Robert Koch Institute, SurvStat, https://survstat.rki.en/, data status: 25.03.2022*
The STIKO (Standing Committee on Vaccination) recommends vaccination against TBE to all people who are in TBE risk areas and could be bitten by ticks there.
Additional protection against tick bites
– In addition to vaccination, general measures against tick bites should be taken. This includes wearing closed clothing (long pants and sleeves, stockings, sturdy shoes, pants legs tucked into stockings) in nature, because ticks often sit in the grass, bushes or undergrowth. Contrary to popular belief, they do not fall from trees onto people or animals. Tick repellents, applied to uncovered skin and clothing, also offer a certain degree of protection, but this only lasts a few hours.
Course of the disease
TBE is usually less severe in children than in adults and older adolescents. About one to two weeks after the tick bite, flu-like symptoms with fever, headache, vomiting or dizziness initially occur for a few days, which disappear after a few days. In most cases, the disease is then over.
In a second peak of the disease, signs of meningitis with high fever, severe headache, neck stiffness and vomiting may occur. However, the brain itself and the spinal cord are attacked less frequently in children than in adults.
In most cases, the disease heals without permanent damage, even after a severe course. About a quarter of children who contract the disease can develop a severe illness that causes long-term damage to the brain and nerves in about two out of every 100 children who contract the disease.
In adolescence and adults, the risk of a severe course of the disease increases. There is no causal treatment against TBE. Only the signs of the disease, such as. B. the fever, are treated.
Reported TBE cases in 2021, broken down by age group
Source: Robert Koch Institute, SurvStat, https://survstat.rki.en/, data status: 25.03.2022
Although TBE is less common in young children and is milder than in adolescents and adults, in some cases the virus can cause severe illness, sometimes with long-lasting damage. The safest protection against TBE is the vaccination. Children aged at least 12 months can be vaccinated against. In children under three years of age, a fever reaction can occur in up to 15 percent of cases due to the vaccination. Therefore, at this age should be discussed with the doctor. The actual risk of infection for the child must be discussed with the doctor in each individual case.
The STIKO recommends vaccination for all persons who stay or live in TBE areas and could be bitten by ticks. This applies to everyone who spends time in nature such as walkers, campers, joggers or children who often play outdoors. City parks and gardens are also habitats for ticks.
For endangered population groups within Germany the health insurances usually take over the costs of the vaccination. Exceptions are – depending on the health insurance – travel vaccinations before trips abroad.
Establishment of the vaccination protection (basic immunization)
Three vaccinations are required to build up the vaccination protection. According to the usual vaccination schedule, the second vaccination dose is administered one to three months after the first vaccination. A third vaccination is then given after another 5 to 12 or 9 to 12 months, depending on the vaccine used.
In order to be protected at the beginning of the tick season in spring for the current year, it is advisable to start the vaccination series in the winter months. Only 14 days after the second vaccination, most vaccinated children are already protected, which is sufficient for the current season. For a longer lasting protective effect, the third vaccination is then required.
If the risk of infection persists, the first booster vaccination should be given after 3 years. Further boosters are then recommended for children every 5 years.
If particularly rapid protection is required, z. B. For trips planned at short notice in TBE risk areas, a vaccination can be carried out according to the so-called rapid schedule. The vaccination schedule depends on the vaccine used. Two to three vaccinations are necessary. Vaccination protection for one to one and a half years can thus be achieved as early as 3 to 5 weeks after the first vaccination. Depending on the vaccine used, an early booster vaccination may be required. Please ask your pediatrician or. your pediatrician for the most appropriate vaccination schedule.
By the way, the vaccines available in Germany also protect against the close relatives of the local TBE virus strains that occur in eastern Europe and Asia. However, the TBE vaccination does not provide protection against Lyme disease, which is also transmitted by ticks.
Tip: After each tick bite, the tetanus vaccination protection should also be checked!
Possible side effects of vaccination
The most common symptoms are pain, redness or swelling at the site of the bite. These symptoms also occur with other vaccinations and show that the body is coming to terms with the vaccine. Within the first four days after vaccination, general symptoms such as increased temperature and fever, headache, muscle and joint pain, malaise or gastrointestinal complaints may occur. Children under 3 years of age develop fever reactions after TBE vaccination in up to 15 percent of cases. Therefore, at this age, the doctor should check the risk of infection together with the parents. As a rule, the reactions to the vaccination described above subside quickly and without consequences. They occur mainly with the first vaccination, less frequently with the subsequent vaccinations.
Severe side effects such as allergic reactions are very rare. In individual cases (especially in adults) diseases of the nervous system, z. B. described paralysis, which can also last longer.
In the case of a proven severe allergy to chicken egg white, the pediatrician should be consulted. the pediatrician weigh the benefits and risks of vaccination against each other.
TBE: Frequently asked questions and answers (FAQs)
How to remove a tick?
Ticks should be pulled straight out as quickly as possible with tweezers or a special tick removal instrument. Care should be taken not to squeeze the body of the tick, otherwise pathogens from the tick can be pressed into the bite site. After pulling out the tick, the site should be carefully disinfected.
Under no circumstances should the tick be dripped with glue or nail polish, as this can further promote the transmission of pathogens to humans.
If signs of illness occur shortly after a tick bite, such as fever, headache, aching limbs or a ring-shaped redness in the area of the bite, a doctor should always be consulted. a doctor should be consulted.
At what age can children be vaccinated against TBE??
Since children like to play in nature, they are at greater risk of being bitten by a tick. However, TBE is usually less severe in children than in adolescents and adults. Children can be vaccinated from their first birthday. In children under three, vaccination can cause a febrile reaction in up to 15 percent of cases. Therefore, at this age should be consulted with the physician or. The actual risk of infection for the child must be discussed with the doctor.
In order to protect children from other tick-borne diseases such as Lyme disease, the body and clothing should be carefully checked for ticks after spending time in nature and these should be removed as quickly as possible.
Can you still protect yourself after a tick bite by a vaccination?
Subsequent vaccination after a tick bite is not recommended, as it is very unlikely to prevent infection with the TBE viruses.
The vaccination protection against TBE should be checked by a blood test?
Only for persons with an impaired immune system it is recommended to check the vaccination protection one to two months after the second partial vaccination. (If vaccinated according to the rapid schedule, the blood test is done after the third partial vaccination.) If the antibody concentration proves to be insufficient, an additional vaccination should be given.
Can all ticks in TBE risk areas transmit the virus?
Even in risk areas, not all ticks are infected with the TBE virus. Depending on the region, about every thousandth to every twentieth tick can transmit the disease. After being bitten by an infected tick, up to nearly one-third of people bitten experience symptoms of illness. These can be serious, especially in adults. Leave permanent damage, especially in the elderly. About one in a hundred people who contract the disease die from the infection. Once the disease has broken out, only the symptoms can be treated; there is no medication that is specifically effective against the TBE viruses.