Tick-borne encephalitis: What travelers should know when visiting an endemic country

Figures & data

Figure 1. Life stages of Ixodes ricinus ticks: larvae- size 0.8 mm (A), nymphs – size 1.2×1.5 mm (B), adult male - size 1.5×2.5 mm (C), unfed female – size 2×4 mm (D), and fully engorged female 7×11 mm (E). (photo by Jan Erhart).

Figure 2. Areas of TBEV distribution in the Eurasian region (A) with possible overlapping regions of other major flavivirues (WNV – West Nile virus, DENV – Dengue virus, JEV – Japanese encephalitis B virus). A map of TBEV distribution in Europe (B).

Table 1. Vaccination schedule.

Name	FSME-Immun^§	Encepur	TBE Moscow	EnceVir
Virus subtype	European	European	Far Eastern	Far Eastern
Manufacturer	Pfizer, Austria	Novartis Vaccines, Germany	Chumakov Institute, Moscow, Russia	Microgen, Tomsk, Russia
Year of approval	1976	1994	1982	2001
Standard regimen (3 doses)
Dose 1	Day 0	Day 0	Day 0	Day 0
Dose 2	Month 1–3	Month 1–3	Month 1–7	Month 5–7
Dose 3	Month 9–12	Month 9–12	Month 12	Month 16–18
Rapid/accelerated regimen
Dose 1	Day 0	Day 0	N/A	Day 0
Dose 2	Day 14	Day 7		Day 21–35^**
Dose 3	Month 5–12	Day 21		Day 42–70^**
Dose 4	N/A	Month 12–18		Month 5–12
Pediatric use
Age range	1–15 years	1–12 years	From 3 y of age	From 3 y of age
Pediatric formulation	FSME-Immun Junior (half of adult dose)	Encepur-Children (half of adult dose)	Same dose as adultss	N/A, recommended to half the adult dose
Ongoing protection
Booster	Every 5 years	Every 5 years	Every 3 years	Every 3 years
Booster in >60 y of age	Every 3 years	Every 3 years	Every 3 years	Every 3 years
Availability	EU, Russia, Canada	EU, Russia	Russia, Ukraine, Kazakhstan, Belarus	Russia, Ukraine, Kazakhstan, Belarus

§ Marketed as TicoVac and TicoVac Junior in the UK and Canada;

* from 6 months of age in high risk areas;

** double dose. Adapted from Kollaritsch et al. 2011.⁵

Kollaritsch H, Krasilnikov V, Holzmann H, Karganova G, Barrett A, Süss J, Pervikov Y, Bjorvatn B, Duclos P, Hombach J. Background document on vaccines and vaccination against tick-borne encephalitis (TBE) WHO Position Paper. Geneva: WHO Strategic Advisory Group of experts on immunization. Available at: http://www.who.int/immunization/sage/6_TBE_backgr_18_Mar_net_apr_2011.pdf, Last accessed June 2016

 Google Scholar