TBE vaccination: benefits and side effects
Tick-borne encephalitis (TBE) is a feverish infection of the meninges and brain. The triggering viruses get into the blood through a tick bite and then spread in the central nervous system. TBE should not be confused with another infection caused by a tick bite, Lyme disease. In this article you will find out in which cases a TBE vaccination makes sense.
Why the TBE vaccination?
The causative agents of TBE disease are transmitted through infected tick saliva . They get into the human bloodstream and attack the central nervous system. Transmission from person to person is not possible. With a TBE vaccination, a disease can be prevented in 95 percent of cases.
TBE vaccination is not a tick protection vaccination
Important: The vaccination against TBE is often referred to as a “tick vaccination”. However, it only protects against the pathogens that cause tick-borne encephalitis and not against other diseases that can be transmitted by ticks, such as Lyme disease, which is much more widespread .
TBE infections more common in warm months
Most TBE diseases are recorded in the warm months between May and September, since ticks are only active between April and November. The name tick-borne encephalitis can also be derived from this. However, the actual incidence of incidents each year is particularly dependent on how severe the previous winter was. If the winter months were very cold, there are fewer ticks in the following year than in a mild winter and therefore fewer cases of TBE.
Outbreak in only 10 percent of cases
After infection with the TBE virus, the disease actually breaks out in only about ten percent of cases. The vast majority of those affected do not express any symptoms at all, so that an infection heals unnoticed. In the other infected people, the disease manifests itself in a third of the cases as a kind of summer flu with fever and cold symptoms.
Development of meningoencephalitis
In a small proportion of those infected, meningitis develops, usually benign, after the onset of the disease, which can lead to memory and concentration disorders and severe headaches. In the case of a severe course of the disease, this can result in the meningoencephalitis that gives it its name. In this case, the inflammation not only affects the meninges, but also the brain itself. Accompanying symptoms can be paralysis, unconsciousness or seizures, very rarely such an inflammation also leads to death. In rare cases, meningoencephalitis leads to permanent damage such as impaired concentration, chronic symptoms such as tiredness or headaches and in individual cases, primarily in older people, to permanent paralysis.
Who should get the TBE vaccination?
The TBE vaccination is not a generally recommended vaccination. Since the TBE virus only occurs in so-called natural herds, i.e. only in certain, regionally clearly delimited areas, there has so far been no reason for the Standing Vaccination Committee (STIKO) of the Robert Koch Institute to make a general recommendation. The affected areas, which in Germany are mainly in the federal states of Bavaria and Baden-Württemberg, have hardly shifted or expanded for decades, which is why infection outside of these natural sources is extremely unlikely. You can find an annually updated overview of the urban and rural districts at risk on the Robert Koch Institute website.
Within the risk areas, the TBE vaccination is particularly advisable for certain professional groups who are often outdoors, such as gardeners, farmers, foresters or forest workers. But other groups of people who often spend their free time outside, such as walkers, dog owners, cyclists, hobby gardeners or camping holidaymakers, should also consider vaccination against TBE. Children can be vaccinated from the age of one year. However, the risk of the disease and possible complications is significantly lower for them than for adults, which is why doctors often advise against vaccination.
In general, a vaccination should only be carried out after an assessment of the individual risk of infection of each individual, whereby the length of stay in a risk area should be taken into account as well as the fact where the person concerned moves and what dangers they are exposed to as a result is.
TBE vaccination in three steps
A dead vaccine is used to vaccinate against TBE disease, with two different sera being used for children and adults. The vaccine for children contains only half as many antigens as that for adults, since the immune system in children is sufficiently stimulated due to the lower number of antigens.
The immunization is divided into three partial vaccinations, which should be carried out within one year.
- The first TBE vaccination preferably takes place in winter so that there is already a high number of antibodies in the blood at the beginning of the TBE season. In principle, however, vaccination is possible at any time.
- The second vaccination dose is given one to three months after the first vaccination. Shortly thereafter, reliable vaccination protection is available.
- The immunization is completed nine to twelve months after the second vaccination by administering a third dose of vaccine intended to provide long-lasting protection.
How long does the vaccination protection of the TBE vaccination last?
With complete immunization, the vaccination protection lasts for about five years, which is why a booster is possible every three to five years. However, it is advisable to have the antibody level in the blood checked before the next vaccination in order to be able to better assess the actual vaccination protection and thus avoid unnecessary booster vaccinations.
Rapid immunization for TBE vaccination possible
If the stay in one of the designated risk areas is planned at short notice and there is no time for the conventional procedure of the TBE vaccination, there is the possibility of a quick immunization. The vaccination schedule is shortened and given two doses of vaccine within two weeks or three doses within three weeks. The exact procedure depends on which vaccine is used and should be discussed with the doctor treating you. Optimal protection is available within the framework of rapid immunization about two weeks after the last vaccination. To achieve long-term protection, a booster dose should be given one year after the last dose.
When should the TBE vaccination not be carried out?
In certain cases, at least temporarily, vaccination against TBE should be avoided:
- If the person to be vaccinated has an acute infection accompanied by fever, the vaccination should not be given until two weeks after complete recovery.
- If symptoms have occurred after a previous vaccination that go beyond the normal range of vaccination reactions, such as fainting or febrile seizures, another vaccine should be used if possible. The same applies to known allergies to an ingredient in the vaccine. This is particularly relevant for people allergic to chicken protein, as some of the TBE vaccines are grown on cell cultures from chickens.
- After a tick bite, a TBE vaccination should be avoided for two weeks in order not to distort the diagnosis of a TBE disease that may occur.
- Pregnant and lactating women should only be treated after careful consideration of the benefits against the risks of vaccination, since there are no precise data on the effects of the vaccine on the unborn child.
- Children under the age of one should not be vaccinated because their immune system is not yet fully developed and the vaccination cannot be effective.
What side effects can a TBE vaccination have?
As with most vaccinations, vaccination against TBE can also lead to slight vaccination reactions. Redness, swelling and pain at the injection site and swelling of the nearby lymph nodes are common side effects. Flu-like symptoms such as headaches and body aches or gastrointestinal problems are not uncommon. Furthermore, especially in children, fever or short-term febrile seizures can occur.
In rare cases, the TBE vaccination causes neurological side effects. These include, for example, severe headaches, nausea and dizziness, blurred vision, temporary sensory disturbances, seizures or signs of paralysis. Inflammation of the nerves or the brain has also occurred after a vaccination.
Allergic reactions, such as hives, which are caused by the accompanying substances contained in the vaccine serum, such as aluminum hydroxide or various antibiotics, sometimes occur.
Do small children really need the TBE vaccination?
It is striking that the possible side effects of the vaccination largely coincide with the symptoms of the actual TBE disease. Although the symptoms of the TBE vaccination occur only about half as often, the side effects seem to outweigh the benefits of the vaccination. Children under the age of three in particular are more likely to have side effects from vaccinations, which in view of the fact that TBE is usually uncritical in them, speaks against vaccinating small children. So far, however, there are no long-term studies in which the complication rate after vaccination and disease are compared.
A clear decision as to whether a TBE vaccination makes sense or not can only be made on a case-by-case basis. You should therefore have a detailed consultation with your doctor before each vaccination so that he can explain the opportunities and risks of the vaccination to you and, if necessary, suggest alternatives.