Facts about Tick-borne encephalitis (TBE)

 


Tick-borne encephalitis (TBE) is generally described as a type of viral encephalitis which is typically caused by a virus and it can be spread through ticks to humans not human to human. Ticks are small parasites which can survive by sucking blood from animals and also includes humans. The primary carriers of this virus are humans. The viral encephalitis virus is also found in small rodents and also found in larger animals like deer, sheep and goats.


People like travellers to areas where Tick-borne encephalitis occurs may be at a high risk when walking,camping or working in woodland places. In European countries, early spring through to late autumn are generally considered as high risk but seasons might vary based on location. Since 2011, six confirmed cases of Tick-borne encephalitis have been identified in the United Kingdom. Six of them had a history of travel to TBE endemic areas of Europe.


Typically, TBE occurs in two stages:

  • mild flu-like illness

  • potentially serious infection of central nervous system


Tick-borne encephalitis disease develops from serious illness to fatal in europe. And also long term neurological complications are most common.


How can you get TBE?


Humans can be infected through a tick bite from an infected tick. Typically ticks like tiny species live in places like dark forest areas, woods, grasslands, riverside meadows, marshes, brushwood and shrublands. Generally, these ticks usually live in the underground areas because then only they can easily get onto the clothes or skin of passers-by or travellers. So, for example, walkers are at the highest risk of getting the TBE disease. Another highest risk is for people who are going hiking or camping in forest areas up to a height of about 1500m.


Not all the ticks carry the TBE virus, but ticks can be present in up to 10% of ticks in some affected areas.


In some rare cases, people have been infected after you drink the untreated milk from animals like goats. Typically, there is no direct human to human transmission.


Tick-borne encephalitis (TBE) virus create huge endemic in previous years at many places of Europe such as Estonia, Slovenia, Latvia, Lithuania, Czech Republic, Austria, Sweden, Switzerland, Slovakia, Hungary, Poland, Finland, Germany, France, Croatia and Norway and other countries like Siberia, Far-Eastern Russia, northern China and Japan. In the previous years, TBE virus has been identified for the first time in countries like Netherlands and UK in the respective years of 2016 and 2019.


Causes of tick-borne encephalitis



Usually, Tick-borne encephalitis (TBE) disease is caused by a Flavivirus which affects the brain and spinal cord.


Typically, TBE disease has 3 sub-types of the virus which causes the disease:


  • European or Western TBE virus

  • Siberian TBE virus

  • Far Eastern TBE virus


Symptoms of tick-borne encephalitis


Most TBE infected people do not show any of the symptoms. But those who have symptoms, they will usually take up to 4 to 28 days to show them. Symptoms usually appear faster within 3 to 4 days, if the diseases happen through milk or milk products.


The symptoms of TBE disease often appear in two phases:


First phase is like Flu-like symptoms which includes:


  • fever

  • tiredness

  • headaches

  • muscle aches

  • loss of appetite

  • nausea

  • vomiting


These flu-like symptoms usually last about 1 to 8 days after the infection.


In the second phase, the central nervous system including the brain and spinal cord is affected.


Symptoms can include:

  • Encephalitis which means swelling of the brain

  • confusion

  • paralysis means not being able to move

  • meningitis which usually causes swelling of the membrane which around the brain and spinal cord areas

  • myelitis  which means swelling of the spinal cord


Severity of this phase of infection can increase with age.


In some of the severe cases, complications during the second phase of infection might cause long-term brain, spine or nerve damages. This complications can also cause:

  • memory loss

  • hearing loss

  • loss of coordination

  • death (in some cases)


Diagnosis


Tick-borne encephalitis (TBE) can be diagnosed through a blood test and lumbar puncture (LP) test.


  • Lumbar puncture (LP) or spinal tap - it is a procedure involving passing a needle with the help of local anaesthetic, between two of the backbones which is the base of your spine that collect the cerebrospinal fluid (CSF).

  • In the first phase of illness, viruses can be detected in the blood through blood tests.

  • In the second phase of illness, antibodies can be found in both blood and cerebrospinal fluid.

  • Brain scans like CT and MRI - It shows abnormalities which are more specific to encephalitis but it does not have any particular characteristics of Tick-borne encephalitis.

Treatment

Unluckily, there is no specific treatment for Tick-borne encephalitis. People who have a severe form of TBE disease may need supportive treatment in hospitals like intensive care units. But most people will need only symptom control to ease the symptoms.


Prevention


Travellers should follow this preventive measures:


  • You should avoid known heavily tick-infected areas like forest and woodland areas during particular seasons of spring, summer and autumn where possible to get them

  • You should practise bite avoidance methods like wearing appropriate clothing and also use effective insect repellents. 

  • Regularly check the body for ticks. Some forms of ticks are tiny such as Ixodes ticks which is difficult to see

  • You should remove ticks as soon as possible  with the help of pair of fine tipped tweezers or else you can use tick remover

  • You should avoid consuming unpasteurised dairy products because it is potential route of transmission

  • You should seek medical advice from a physician if any signs of illness may occur within 28 days of a tick bite. 


Frequently Asked Questions

Q1. What is tick-borne encephalitis?

Ans: Tick-borne encephalitis (TBE) is a disease caused by a Flavivirus.

Q2. Is tick-borne encephalitis curable?

Ans: Most patients with TBE encephalitis will recover but up to one third will suffer long-term complications of the disease.


Q3. How do you treat tick-borne encephalitis?

Ans: There is no specific treatment for tick-borne encephalitis. Clinical management is supportive. 


Q4. Who is at risk of tick-borne encephalitis?

Ans: People who spend time outdoors in or near forests are at highest risk of being bitten by a tick infected with TBE virus.


Q5. Is tick borne encephalitis vaccine necessary?

Ans: Vaccination against TBE is the most effective prevention measure.

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