Vaccination against early summer meningoencephalitis (TBE) is recommended, except in the cantons of Geneva and Ticino, for all residents of Switzerland who are exposed to ticks for work or leisure. Vaccination is the only option for effective and safe protection against this potentially fatal viral disease.
Vaccines against tick-borne meningoencephalitis contain killed viruses. The effect is supported by an aluminum salt. Vaccination is the most reliable protection against TBE, but is not effective as prophylaxis against Lyme disease. Ticks that are carriers of the TBE virus stay in so-called natural foci. These occur mainly in northeastern Switzerland, but also in other regions of Switzerland. In the electronic vaccination card at www.meineimpfungen.ch, risk regions are automatically determined by postal code [1]. They can also be displayed on a map [2].
Effective protection guaranteed
According to the Swiss vaccination schedule, vaccination is recommended for adults and children aged six years and older who reside in one of the risk areas (all cantons except Geneva and Ticino), especially if they are frequently active outdoors (Fig. 1) [3]. Three vaccine doses are required for complete basic immunization (0, 2-4 weeks, 6-12 months) [2]. Temporary protection is achieved after only two doses of vaccination; for complete vaccine protection, which ensures vaccine protection for at least ten years with a probability ≥95%, a third vaccination is given. The two vaccines most commonly used in Switzerland at present are TBE-Immun® and Encepur®. [3,5,6]. Vaccination is possible at any time of year, but is ideally done in winter (ticks are less active). The costs are covered by mandatory health insurance or reimbursed by the employer in the case of occupational exposure. Booster vaccinations are recommended at ten-year intervals. Vaccination is possible in children 1 year of age and older, but generally not necessary in those younger than 6 years of age because severe disease is rare in this age group [2]. However, it should be examined individually.
When infected with the TBE virus, flu-like symptoms develop within 2 to 28 days after the bite of an infected tick, which are harmless in most affected individuals, but in 5% to 15%, meningitis can develop after a further 4 to 6 days, which can also spread to the brain (meningoencephalitis). The accompanying neurological symptoms as well as general signs of illness (e.g., fatigue, sleep disturbances) regress in most cases. In severe cases, however, residual damage may remain and in about 1% of patients the disease is fatal. These are mostly elderly patients.
Increase in prevalence numbers
From 2016 to 2018, there was a marked increase in reported cases of TBE due to tick bite in Switzerland [3]. Possible causes are climate-related on the one hand and behavioral factors on the other. The Zurich University of Applied Sciences (ZHAW) has developed a free smartphone app with information about ticks, including details on distribution and protective measures [4]. Wearing long pants, closed shoes and using tick sprays can reduce the risk of a tick bite. After spending time outdoors, you should check your body for ticks and, if bitten, remove the tick immediately and disinfect the corresponding area. However, TBE viruses can also be transmitted if the tick is removed quickly. Vaccination is the only option for effective and safe protection. Ticks can transmit various pathogens and diseases caused by them. Along with early summer meningoencephalitis (TBE), Lyme borreliosis is one of the two most important tick-borne diseases.
Literature:
- The Swiss Electronic Vaccination Card, www.meineimpfungen.ch
- Infovac: The information platform for vaccination issues, www.infovac.ch/de/impfunge/nach-krankheiten-geordnet/zeckenencephalitis-fsme
- Federal Office of Public Health (FOPH): Early summer meningoencephalitis (FSME). Bulletin 6/19; 12-14.
- ZHAW: Tick prevention with the smartphone, www.zhaw.ch/de/lsfm/dienstleistung/institut-fuer-umwelt-und-natuerliche-ressourcen/zecken/app-zecke/
- Swiss Drug Compendium: FSME-Immun®, https://compendium.ch
- Swiss Drug Compendium: Encepur®, https://compendium.ch
HAUSARZT PRAXIS 2020; 15(3): 26
