You should consider being immunised against tick-borne encephalitis (TBE) before you travel to certain countries in Europe and Asia. Check with your practice nurse at least 6-8 weeks before you travel to see if you should have this immunisation.
What is tick-borne encephalitis?
Tick-borne encephalitis (TBE) is caused by a virus. It is usually spread by bites from ticks which are infected with the virus. Unpasteurised milk from infected animals, especially goats, is a less common source of the infection. Affected people often develop a flu-like illness that lasts about a week. This may progress to encephalitis (brain inflammation) or meningitis (inflammation of tissues around the brain) which can cause headache, fever, confusion, agitation, and vomiting, and can lead to a coma or even, less commonly, death.
There are three different types of TBE virus: Western European TBE virus, Far Eastern TBE virus and Siberian TBE virus. Western European TBE occurs mainly in western and central European countries and is particularly common in forest and mountainous regions. Far Eastern TBE occurs in eastern Russia and some countries in East Asia, particularly in forested regions of China and Japan. Siberian TBE occurs in Siberia.
Who should be immunised against tick-borne encephalitis?
Your doctor or practice nurse can advise if you should have this immunisation for your travel destination.
Generally, the risk to the average traveller to affected countries is small. Immunisation is recommended for people who intend to walk, camp or work in heavily forested regions of affected countries between April and October when the ticks are most active. In particular, if you stay in areas where there is heavy undergrowth. It is also recommended for people who handle material that may be infected by the virus (for example, laboratory workers).
The vaccine schedule
The usual schedule is to have three injections of vaccine. The second vaccine is given 1-3 months after the first and the third is given 5-12 months after the second. You should have booster doses every three years if you continue to be at risk of infection. If immunity is required more quickly, then a second dose can be given two weeks after the first dose, which gives slightly less protection than the other schedule.
The vaccine stimulates your body to make antibodies against the virus. These antibodies protect you from this illness should you become infected with this virus.
Ideally, immunisation should be completed at least a month before travel. It is considered to be effective against all strains of the disease.
Who should not receive the tick-borne encephalitis vaccine?
- If you are ill with a fever you should postpone the injection until you are better.
- You should not have a booster if you have had a severe reaction to this vaccine in the past.
- You should not have this vaccine if you have a severe allergy to egg. (This is because the vaccine contains small amounts of egg protein. Allergy to egg is rare and it does not mean an upset stomach when you eat eggs, or disliking eggs.)
- The vaccine is not licensed for children under the age of 3 years. However, it is used routinely in Austria from 18 months of age. This vaccine may be recommended to children younger than 3 years old if they are going to be at high risk.
- This vaccine is safe to give if you are pregnant or breast-feeding.
Are there any possible side-effects from the vaccine?
- Mild pain and redness occur at the site of injection in some people.
- Some people develop a fever, particularly after the first dose. This is most common within twelve hours of having the vaccine. This usually settles within 24-48 hours.
- Severe reactions are extremely rare.
You should also try to prevent tick bites and infection
Immunisation is around 99% effective. So, if you are travelling to affected areas, whether you have been immunised or not, it is also important to:
- Cover arms, legs and ankles.
- Use insect repellent on exposed skin, socks and outer clothing.
- Not drink unpasteurised milk, especially goat's milk.
Ticks should be removed as soon as possible with tweezers (or fingers covered by tissue paper if no tweezers are available) as close to the skin attachment as possible, by steady pulling without jerking or twisting.
Information on immunisation from the NHS
Health Advice for Travellers
Leaflet from the Department of Health.
Patient.co.uk Travel Health Page
Has a comprehensive list of links to UK websites on travel health.
Dr Tim Kenny
Dr Louise Newson
Dr Adrian Bonsall