Tick-borne Encephalitis

Tick-borne encephalitis (TBE) is an illness caused by a virus spread through tick bites. You can also get TBE by eating or drinking unpasteurized dairy products (such as milk and cheese) from infected goats, sheep, or cows.

Symptoms include fever, achiness, loss of appetite, headache, nausea, and vomiting. Swelling of the brain and/or spinal cord, confusion, and sensory disturbances occur in 20-30% of people with TBE. One percent of people die from this infection.

TBE is found in many parts of Europe and Asia (from eastern France to northern Japan and from northern Russia to Albania). Several thousand cases are reported each year, but there are probably many other cases that do not get reported. The highest number of cases occurs in Russia. Other countries with high risk for disease are Czech Republic, Estonia, Germany, Hungary, Latvia, Lithuania, Poland, Slovenia, Sweden, Switzerland, China, Japan, Mongolia, and South Korea.  Travelers are more likely to get TBE from April through November (mostly in early and late summer) and when traveling to forested areas where ticks are common.

There is no vaccine that prevents TBE that is available in the United States, but it is available in some other countries. Travelers anticipating high-risk activities may consider being vaccinated in Canada or Europe. High-risk activities include working or camping in forested areas or farmland, adventure travel, or living in countries where TBE is present for an extended period of time.

All travelers should take these steps to prevent TBE:

Eat only pasteurized dairy products (such as milk and cheese).

Prevent tick bites:

• Cover exposed skin by wearing long-sleeved shirts, long pants, and hats.
  • Tuck in shirts, tuck pants into socks, and wear closed shoes instead of sandals to prevent bites.
• Avoid wooded and brushy areas with high grass, brush, and leaves. Walk in the center of hiking trails.
• Use a repellent that contains 20% or more DEET for  protection that lasts up to several hours.
  • Products containing DEET include Off!, Cutter, Sawyer, and Ultrathon.
• Always follow product directions and reapply as directed.
  • If you are also using sunscreen, apply sunscreen first and insect repellent second.
  • Follow package directions when applying repellent on children. Avoid applying repellent to their hands, eyes, and mouth.
• Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents). You can buy pre-treated clothing and gear or treat them yourself.
  • Treated clothing remains protective after multiple washings. See the product information to find out how long the protection will last.
  • If treating items yourself, follow the product instructions carefully.
  • Do not use permethrin directly on skin.

Find and remove ticks from your body:

• Bathe or shower as soon as possible after coming indoors.
• Check your entire body (under your arms, in and around your ears, in your belly button, behind your knees, between your legs, around your waist, and especially in your hair). Use a hand-held or full-length mirror to view all parts of your body.
  • Be sure to remove ticks properly.
  • Parents should check their children for ticks.
• Check your pets and belongings. Ticks can be on outdoor equipment and clothes.

• Avoid Bug Bites - Information for travelers
• Insect Repellent Use and Safety

• Tick-borne Encephalitis in CDC Yellow Book, Health Information for International Travel- “Yellow Book”
• Protection against Mosquitoes, Ticks, & Other Insects & Arthropods