International travel and health

Tick-borne Encephalitis

Vaccine

The vaccine should be offered only to at-risk travellers.

Western European vaccines:

In western Europe, two vaccines are available in both adult and paediatric formulations. Although these vaccines are based on the European subtype, immunity is induced against all subtypes of the TBE virus. The vaccines contain a suspension of purified TBEV grown on chick embryo cells and are inactivated with formaldehyde. Both TBE vaccines provide safe and reliable protection.

Little information is available on the duration of protection following completion of the primary three-dose immunization.

Outside countries or areas at risk, TBE vaccines may not be licensed and will have to be obtained by special request.

Russian vaccines:

The two inactivated TBE vaccines manufactured in the Russian Federation are based on the Far Eastern subtype of the virus and propagated in primary chicken embryo cells. These vaccines are considered efficacious for individuals aged ≥3 years although supporting data are more limited for the Russian products.

Adverse reactions

With the western European vaccines, adverse events are commonly reported, including transient redness and pain at the site of injection in ≤45% of cases and fever ≥38 °C in ≤5–6%. However, none of these events is life-threatening or serious.

Both the Russian vaccines have been reported to be moderately reactogenic but without inducing severe adverse reactions. (However, some lots of the Russian vaccine Encevir were recently withdrawn because of frequent high fever and allergic reactions, particularly in children; this vaccine is currently not recommended for individuals 3–17 years of age.)

Type of vaccine: Killed

Number of doses: Western European vaccines: primary series, three i.m. doses, administered at intervals of 4–12 weeks between the first and second, and 9–12 months between the second and third doses.
Russian vaccines: primary series, three doses administered at intervals of 1–7 months between the first and second, and 12 months between the second and third doses.

Boosters: Western European vaccines: In healthy individuals aged <50 years booster doses are conventionally offered at intervals of 3–5 years if the risk continues, although in some endemic areas (Switzerland) intervals of ≤10 years are now used. In individuals aged 50 years and above, booster intervals of 3–5 years are recommended until more definitive information becomes available.

Accelerated schedules for travellers: depending on the choice of TBE vaccine, the manufacturer recommends either a rapid schedule based on immunization on day 0, day 14 and month 5–7, or an accelerated schedule based on immunization on day 0, day 7 and day 21. Russian vaccines: Booster doses are recommended every 3 years for those at continued risk of exposure.

Contraindications: Hypersensitivity to any vaccine component; adverse reaction to previous dose

Before departure: Second dose 2 weeks before departure

Recommended for: High-risk individuals only

Special precautions: Prevent blood-feeding ticks from becoming attached to the skin through use of appropriate clothing; remove ticks as soon as possible

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